Performance status, quality of life, and survival in patients with advanced cancer referred to palliative care: A pilot study.

Abstract

77 Background: Patients with advanced cancer often need specialized palliative care (PC) for aggressive symptom management as their cancer progresses. The purpose of this study is to evaluate the feasibility of following patients with advanced cancer referred to PC for symptom management. The aims are to: 1) describe survival status at 12-wks post PC referral, and 2) compare time to PC referral, performance status, and quality-of-life (QOL) at baseline across survival status groups. Methods: Patients (N=20) with advanced cancer newly referred to PC were recruited. Date of cancer diagnosis, date of referral to PC, and survival status were abstracted from the medical record. The number of weeks was calculated from the date of cancer diagnosis to the date of PC referral. Palliative Performance Status (PPS) scale was used to measure performance status. Higher % scores indicate better performance status. SF-36 was used to measure QOL. Higher scores indicate higher perceived QOL. Results: At 12-weeks post PC referral, 6 patients were alive, 8 patients were lost to follow-up, and 6 patients had died. Missed appointments with PC or cessation of cancer treatments were primary reasons patients were lost to follow-up. Patients alive at 12-wks had the best PPS scores at baseline (mean=58%) and the shortest length of time between cancer diagnosis and PC referral (mean=81.5 wks). Patients lost to follow-up had the worst PPS scores at baseline (mean=44%) and the longest time to PC referral (mean=745 wks). No differences were found on the SF-36 subscale scores. Conclusions: Performance status was a strong predictor of survival status at 12-wks post PC referral. Patients with the longest time between diagnosis and PC referral were most likely to be lost to follow-up. All patients with advanced cancer reported significant declines in QOL. Further research is needed to understand how time to PC referral is associated with missed appointments or decisions to stop cancer treatments. Prospective research from the time of diagnosis with advanced cancer through the end-of-life is needed to better understand how PC can help maintain performance status and QOL for as long as possible.