Letters to the Editor Integration of Oncology and Palliative Care, a Forgotten Indicator: Shared Decision-Making Hui et al. [1] have published a review article addressing the integration of oncology and palliative care (PC). As described by the authors, integration is a heterogeneously defined concept, but since PC improves quality of life, quality of end-of- life care, satisfaction, costs of care, and survival, parameters to identify and improve integration are needed. This review identified 38 indicators related to structure and processes of clinical programs, education, research, and administration that could help define and measure integration. But we believe that the authors have missed one important indicator. In a case series study of metastatic cancer patients previously treated with chemotherapy, we studied the quality of end-of-life care [2] based on indicators such as location of death, number of emergency room visits in last month of life, and chemotherapy administration in last 14 days of life [3, 4]. In our study, PC team intervention, even when early, had no impact on indicators. Only patients’ case discussions at the dedicated weekly onco-palliative meetings independently decreased the odds of receiving chemotherapy in the last 14 days of life (odds ratio: 0.5; 95% confidence interval: 0.2–0.9) and of dying in an acute care setting (odds ratio: 0.3; 95% confidence interval: 0.1–0.5). In our opinion, this indicator is only partially captured by two indicators described in the review: communication, cooperation, and coordination between PC and oncology services (indicator 13); and involvement of PC in multidisci- plinary tumor boards/patient care rounds (indicator 14). We propose that shared decision-making in patient care between oncologists and the PC team should be considered an indicator of integration of oncology and palliative care. OLIVIER HUILLARD Department of Medical Oncology, H ˆ opital Cochin, Assistance Publique Hˆ opitaux de Paris, Universit ´ e Paris Descartes, Paris, France ISABELLE COLOMBET VINCENT MONTHEIL FABIENNE WEILER Department of Palliative Medicine, H ˆ opital Cochin, Assistance Publique Hˆ opitaux de Paris, Universit ´ e Paris Descartes, Paris, France PASCALINE BOUDOU-ROUQUETTE JENNIFER ARRONDEAU CAMILLE TLEMSANI ANATOLE CESSOT JULIE GIROUX JEROME ALEXANDRE FRANÇOIS GOLDWASSER Department of Medical Oncology, H ˆ opital Cochin, Assistance Publique Hˆ opitaux de Paris, Universit ´ e Paris Descartes, Paris, France PASCALE VINANT Department of Palliative Medicine, H ˆ opital Cochin, Assistance Publique Hˆ opitaux de Paris, Universit ´ e Paris Descartes, Paris, France Disclosures Olivier Huillard: Sanofi, Astellas, MSD, Bayer (ET); François Goldwasser: Fresenius Kabi, Roche, Bayer, Boeringher (C/A), Roche, Bayer, Baxter (RF). The other authors indicated no financial relationships. (C/A) Consulting/advisory relationship; (RF) Research funding; (E) Employment; (ET) Expert testimony; (H) Honoraria received; (OI) Ownership interests; (IP) Intellectual property rights/ inventor/patent holder; (SAB) Scientific advisory board REFERENCES 1. Hui D, Kim YJ, Park JC et al. Integration of oncology and palliative care: A systematic review. The Oncologist 2015;20:77–83. 2. Colombet I, Montheil V, Durand JP et al. Effect of integrated palliative care on the quality of end-of-life care: Retrospective analysis of 521 cancer patients. BMJ Support Palliat Care 2012;2:239–247. 3. Earle CC, Park ER, Lai B et al. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol 2003;21: 1133–1138. 4. Earle CC, Neville BA, Landrum MB et al. Evaluating claims-based indicators of the intensity of end-of-life cancer care. Int J Qual Health Care 2005;17:505–509. http://dx.doi.org/10.1634/theoncologist.2015-0131 The Oncologist 2015;20:e26 www.TheOncologist.com ©AlphaMed Press 2015 by guest on July 19, 2018 http://theoncologist.alphamedpress.org/ Downloaded from