Background

The early integration of palliative care into the assistance of oncological patients who can no longer be treated curatively due to the progression of their disease, is a topic where randomized individual studies in the relevant literature show clear evidence of advantages in terms of quality of life and symptom control in this group of patients. Organisational and communicative challenges of palliative care could be solved better, if we offered palliative care to these patients earlier.

Aim

The “round table” is a new care concept for the palliative patients which the authors developed in their department based on intervention models and guide lines for the early integration of palliative care. It was introduced in 2022 and tested over 6 months. After a positive evaluation of the participants of the “round table” asked as “experts” in a Delphi Study, the project was continued on a monthly cadence.

Methods

The participants of the “round table” are the members of the palliative care team and doctors, nurses and the psycho-oncologist from the oncology DH. Other participants such as social worker or breast nurses can join, if required (figure 1).

Patients are presented according to 3 defined criteria (primary metastatic cancer, switch from curative to palliative, progression of a known palliative situation). There is also the option of presenting a palliative patient for whom a need is identified.

Every participant of the “round table” can present one or more patients if they respect one of the above mentioned criteria.

Results

In four years, almost 200 patients were discussed, with an average of 6 patients per month. Since we are a gynaecological department, breast cancer patients are the majority, followed by ovarian cancer. The other gynaecological cancers represent only a small amount of our patients.

Since we are a gynaecological department, breast cancer patients are the majority, followed by ovarian cancer. The other gynaecological cancer represent only a small amount of our patients.

As shown in table 2, most patients were discussed because of a progression of their disease. The “need” criterium was used much more in the first year, especially for social issues such as concomitant dementia or social isolation.

Approximately 2/3 of the patients received regular palliative assistance, for a smaller amount of patients, we decided not to intervene at the moment (stand by group), because especially in breast cancer patients there are some who are doing extremely well despite of their multiple metastasis. One might notice a trend over this 3 years in recognizing better the patients belonging to this group. A small number of patients refused palliative care when proposed early, most of them accepted palliative assistance in their last weeks of life.

As shown in table 4, the period of assistance before death varied widely (27 months maximum and one month minimum), even if the median time of assistance was about 9 months. We considered only the two first years 2022 and 2023, since most of the patients we began assisting in 2024 are still alive.

Discussion

The success of the “round table” can be expressed not only in numbers, but also in a change of the relationship between patients and palliative care team.

The introduction of the ‘round table’ has not only facilitated the work of the palliative team, which is now informed about new palliative patients at an early stage, but has also raised the awareness of the team of the oncologic day hospital about this issue.

The first palliative interview has also changed, as in most cases the palliative care team is no longer faced with patients at the end of their life, whose most urgent need is often symptom control and who see the palliative team representative as the embodiment of approaching death. Now the most important theme in the discussions is the creation of a care network and the patient's quality of life. The transition to ‘end-of-life’ care, which is necessary at a later stage, usually succeeds without problems because a relationship of trust has already been established.

Since February 2025, a round table has been introduced also for medical oncology patients of our hospital.