GOC Program Improved Outcomes for Cancer Patients During COVID-19 Pandemic

A goals-of-care (GOC) program implemented in response to the COVID-19 pandemic improved hospital and ICU outcomes for patients with cancer, according to researchers. 

MD Anderson Cancer Center in Houston implemented the “myGOC” program in March 2020. The program was associated with significant reductions in patients’ length of stay in the ICU, ICU mortality, and in-hospital mortality.  

David Hui, MD, from MD Anderson, presented these results at the 2022 ASCO Annual Meeting. 

Dr Hui explained that the goals of the myGOC program were to optimize the use of ICU and hospital beds, maximize goal-concordant care, and minimize the use of inappropriate interventions at the end of life. 

The program involved risk stratification, oncologist-initiated GOC discussions, real-time monitoring with immediate feedback, education about palliative care, involvement of a rapid-response team, longitudinal monitoring of program metrics, and support from institutional leadership.

The researchers assessed the effects of the myGOC program by analyzing patients from before the program was implemented (May-December 2019) and after (May-December 2020). 

The pre-program period included 6977 patients, 727 of whom were admitted to the ICU. The group had a total of 13,312 hospitalizations, and 2802 patients had repeated admissions. 

The post-program period included 5964 patients, 638 of whom were admitted to the ICU. There were 10,796 hospitalizations and 2264 patients with repeated admissions.

The researchers found that, from the pre- to post-program period, there was a significant reduction in:

• ICU mortality (28.2% vs 21.9%; P =.0001)
• Length of ICU stay (mean, 6.8 days vs 5.4 days; P <.0001). 
• In-hospital mortality (7% vs 6.1%; P =.004). 

These associations remained significant when the researchers excluded patients with documented cases of COVID-19 in 2020. 

On the other hand, there was no significant difference between the time periods for ICU admission rates, hospital length of stay, or duration of overall survival from the time of ICU admission. 

In the post-program period, a greater proportion of hospitalized patients had an in-hospital do not resuscitate (DNR) order (19.6% vs 14.7%; P <.0001), and DNRs were documented earlier (mean, 5.2 days vs 8.2 days; P <.0001). 

In addition, patients were more likely to have advanced care planning (ACP) documentation during their index hospitalization in the post-program period (48.9% vs 11.1%; P <.0001), and ACP documentation was done earlier (mean, 2.1 days vs 6.3 days; P <.0001).

“These changes are consistent with our planned program goals,” Dr Hui said. “We feel that these findings could potentially inform how system-wide implementation of a goals-of-care intervention could potentially have a positive impact on patient and hospital outcomes.” 

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Hui D, Nortje N, George MC, et al. Impact of an interdisciplinary goals of care program on hospital outcomes at a comprehensive cancer center during the COVID-19 pandemic: A propensity score analysis. Presented at ASCO 2022; June 3-7, 2022. Abstract 6502.