Predictors of early referral of advanced cancer patients to an outpatient palliative care specialty clinic in a tertiary cancer hospital.

Abstract

136 Background: Integration of palliative care (PC) with oncologic care has been advocated. In recent years our group has observed increased referral of cancer patient in earlier stages of illness. Our study objective was to compare clinical characteristics of advanced cancer (aCA) patients referred by their oncologists within 2 months of aCA diagnosis (early referral, ER) versus those referred more than 2 months later (late referral, LR). Methods: We collected data on baseline characteristics, symptoms, and the timing of PC referral on consecutive cancer patients seen in first consultation at the outpatient PC specialty clinic in fiscal year 2013. Results: Of the 1225 cancer patients referred for PC consultation, 968 (79%) patients had aCA, of which 38% (n = 372) were seen as ER, and 62% (n = 596) as LR. As compared to the LR group, patients in the ER group had significantly higher severity of pain, SOB, anxiety and drowsiness. In the ER group, a significantly higher proportion of patients had aCA status at initial presentation to their oncologist as compared to the LR group (83% versus 60%; p < 0.0001). Of all the referring primary services, Thoracic Medicine was the only service where a majority of aCA patients were in the ER group (161 versus 122 patients; p < 0.05). In regression analysis, the odds of patients being referred early was higher if they belonged to the Thoracic Medicine service, had aCA at initial presentation to their oncologist, and had higher severity of fatigue and drowsiness. Overall, the median survival of aCA patients, calculated from date of PC consultation, was 5.9 months, and did not differ between ER and LR groups (6.1 and 5.8 months; log-rank 0.832). Conclusions: Our study demonstrates that oncologist’s decision to refer patients early to PC clinic depends on the type of primary service, having advanced stage disease at initial presentation, presence of symptoms of fatigue and drowsiness, and prognostication of decreased survival. The median survival time of 6 months from PC consultation is encouraging and suggests earlier PC referral of cancer patients as compared to earlier reports.