Palliative Medicine Point of Care UltraSound in Cancer Patients in a Specialist Palliative Medicine Outpatient Department: A Retrospective Analysis of Diagnostic and Procedural Impact

INTRODUCTION

MATERIALS AND METHODS

This retrospective study was conducted among patients attending the specialist PM OPD between September 2024 and December 2024. Institutional Ethics Committee approval (OIEC/4694/2025/00002, dated 01 April 2025) was obtained before the commencement of the study. In this retrospective study, all PM-POCUS examinations were conducted by one consultant (Raghu S Thota [RST]), providing consistent imaging. Medical records of adult cancer patients (aged 18 years and above) who underwent PM-POCUS during their specialist PM OPD visit within the study period were reviewed. Patients were excluded if documentation of PM-POCUS findings was incomplete.

Data were extracted retrospectively from electronic medical records and included demographic variables (age, sex), cancer type and stage, current oncological treatments and clinical details such as the indication for PM-POCUS (e.g., evaluation for pleural effusion, ascites or vascular assessment). Pre-POCUS clinical impressions and initial management plans were recorded. Additional data collected comprised ultrasound findings, diagnostic outcomes, any changes in clinical diagnosis or management (such as the decision to perform paracentesis or adjust medications) and subsequent symptom improvement or deterioration.

The primary outcome was the proportion of cases in which PM-POCUS was utilised and resulted in a change in clinical management. Secondary outcomes included the spectrum of PM-POCUS indications and patient-reported symptom relief or outcomes following POCUS-guided interventions. Descriptive statistics were employed to summarise demographic characteristics, cancer types and PM-POCUS indications. Trend analysis was performed to evaluate patterns of PM-POCUS utilisation throughout the 4-month study period.

RESULTS

A total of 90 PM-POCUS [Table 1] was performed in 76 patients with an average age of 48 years, with 64% female gender. Gastrointestinal, breast and gynaecology [Table 2] is the largest group of patients who underwent PM-POCUS. The most common indication was abdominal distention and dyspnoea [Table 3]. Out of 90 uses, we had 91 diagnostics, of which 58 patients were diagnosed with ascites, 16 patients with pleural effusion and 2 patients were diagnosed with DVT [Table 4]. No diagnosis was made 9 times, which were true negatives. PM-POCUS assessments also yielded diagnoses of pain syndromes (4) and pericardial effusion (2) in descending order. PM-POCUS altered clinical management in 33% (30 examinations led to interventions) of diagnoses [Table 5], primarily through procedural interventions such as paracentesis (21) and thoracocentesis (5). Although 58 patients had been diagnosed with ascites and 16 had pleural effusion, 21 and 5 patients underwent the procedures, respectively, as the remaining patients were stable to undergo any procedural interventions [Table 6]. An average of 2 L of fluid was drained during all paracentesis procedures, ranging from 1.2 to 5 L. There was no drainage in two paracentesis procedures after dressing, which resulted in re-adjustments on the table, and one patient had perioral numbness.

DISCUSSION

Our retrospective study is the first of its kind to measure the utilisation and integration of POCUS in a comprehensive specialist palliative care OPD. The integration of POCUS into specialist palliative care outpatient practice, as reflected in our study, underscores its transformative role in the timely diagnosis and management of complex symptoms in patients with advanced cancer. Our findings, based on 90 PM-POCUS applications in 76 patients, highlight both the clinical utility and the growing necessity of this modality in the comprehensive care plan of PM.

A retrospective chart review of palliative care patients in whom POCUS was employed suggests that it is a valuable and adaptable tool in specialist palliative care settings. It supports clinicians in both diagnostic decision-making and procedural guidance. Most notably, POCUS was frequently used for the assessment and management of ascites and pleural effusions in patients with advanced cancer.^[6] In one of the first few reports in the literature concerning POCUS use in palliative care, Gishen and Trotman described the use of POCUS in an inpatient unit.^[7] The authors reported drainage of ascites as the most common use of POCUS, in addition to other indications. To date, there have been only a few small studies that demonstrated the use of POCUS in outpatient palliative care settings.^[8-12] A retrospective chart review described the use of POCUS for patients with ascites in non-hospital settings, including hospices, residential care facilities and patient homes.^[8] The most common underlying malignancy was ovarian cancer, followed by gastrointestinal, lung, breast, genitourinary cancers and cancers of unknown primary origin. Our cohort comprised predominantly female patients (64%), with a mean age of 48 years. The majority had underlying malignancies of gastrointestinal, breast or gynaecological origin. This distribution aligns with previous studies reporting a high prevalence of POCUS use among patients with advanced gastrointestinal and breast cancers, which are frequently associated with complications such as malignant ascites and pleural effusions. The relatively young mean age may reflect the demographic characteristics of the local patient population or referral patterns to specialist palliative care services.

Abdominal distention and dyspnoea emerged as the most common indications for PM-POCUS, consistent with the symptom burden observed in advanced cancer patients. Furthermore, there are many studies that underscore the broad diagnostic applications of POCUS, with the evaluation of peritoneal and pleural fluids representing the most frequently reported indication.^[7,13,14] Specifically, POCUS has long been recognised as a valuable tool to help clinicians differentiate between fluid accumulations contributing to a patient’s symptoms and other underlying abnormalities. Of the 90 POCUS assessments, ascites was diagnosed in 58 cases and pleural effusion in 16, while DVT was identified in 2 patients. These findings mirror the literature, which identifies malignant ascites, pleural effusions and DVT as primary targets for POCUS in palliative care settings.^[2,5,15]

The diagnostic yield of PM-POCUS in our study was high, with only nine instances where no definitive diagnosis was made. This supports the growing body of evidence that POCUS, when performed by trained palliative care clinicians, can provide rapid, accurate bedside evaluation for a range of pathologies, thereby reducing reliance on radiology services and minimising patient transfers.^[2,6,16]

A notable proportion of patients (30 patients, 33%) required procedural interventions following PM-POCUS assessment, including paracentesis, pleural tapping and pain blocks. The average volume of fluid drained during paracentesis was 2 L, with a range from 1.2 L to 5 L—figures comparable to those reported in other specialist palliative care cohorts.^[5,6] The ability to perform these interventions promptly at the point of care is critical; it not only alleviates distressing symptoms such as pain and breathlessness but also potentially reduces the need for hospital admissions and emergency department visits.^[2,5,6]

The low rate of procedural complications, limited to two unsuccessful paracenteses and one case of perioral numbness, further attests to the safety and feasibility of PMPOCUS-guided interventions in the outpatient setting. This is consistent with reports from other centres, where POCUS guidance has been associated with fewer adverse events and improved procedural accuracy compared to traditional landmark-based techniques.^[5,16]

The application of POCUS in palliative care extends beyond diagnosis and intervention; it embodies a patient-centred approach that emphasises rapid symptom relief, reduced procedural burden and enhanced quality of life.^[2] The literature increasingly recognises POCUS as a valuable tool for triaging patients, guiding clinical decision-making and facilitating home- or hospice-based care.^[2,16] Handheld and portable ultrasound devices have made it feasible to deliver these benefits even in resource-limited or community settings.^[2,16,17]

Our findings reinforce the argument that POCUS should be considered an essential skill for palliative care physicians. Its integration into routine practice can expedite diagnosis, tailor interventions to individual patient needs, and potentially reduce healthcare costs by minimising unnecessary investigations and hospitalisations.^[2,18]

Despite its clear benefits, the widespread adoption of POCUS in palliative care faces several barriers. These include the need for structured training programs, ongoing competency assessment, and the development of standardised protocols for image acquisition and interpretation.^[2,18] Our study, which relied on a single experienced operator, highlights the importance of dedicated training to ensure diagnostic accuracy and procedural safety.

Recent literature advocates for the inclusion of POCUS training within PM curricula, emphasising hands-on workshops, simulation-based learning and mentorship by experienced practitioners.^[2,18] Such initiatives are crucial for overcoming initial apprehensions and ensuring that palliative care teams can fully leverage the potential of this technology. Our results are congruent with those from international studies. For example, a Canadian retrospective review found that POCUS was most frequently used for the diagnosis and management of ascites and pleural effusions in cancer patients, with a high rate of successful bedside interventions and minimal complications.^[6] Similarly, reports from resource-limited settings have demonstrated the value of POCUS in reducing unnecessary hospital transfers and facilitating safe, effective care in the community.^[16,17]

The proportion of patients requiring intervention in our study (33%) is comparable to or slightly lower than that reported in other series, possibly reflecting differences in patient selection, clinical protocols or operator experience.^[2,6] The diagnostic spectrum in our cohort–encompassing ascites, pleural and pericardial effusions, DVT and pain syndromes– further illustrates the versatility of PM-POCUS in addressing the multifaceted needs of palliative care patients.^[2,15]

CONCLUSION

Our study adds to the growing body of evidence supporting the integration of PM-POCUS into specialist palliative care practice. The high diagnostic yield, procedural safety and positive impact on symptom management observed in our cohort underscore the value of this modality in addressing the complex needs of patients with advanced cancer. As palliative care continues to evolve, the adoption of POCUS– supported by structured training and ongoing research– holds significant promise for improving patient outcomes and advancing the field.