Predictors of palliative care (PC) referral for advanced cancer patients.

Abstract

e19613 Background: We previously examined factors associated with delayed PC referral. Little is known about the actual proportion of patients referred to PC. We determined the proportion of patients who had a PC consultation at our cancer center and the predictors of referral. Methods: All adult patients in the Houston area who died of advanced cancer between 9/1/2009 and 2/28/2010 while under the care of our institution were included. We collected baseline demographics and data on PC referral. Multivariate logistic regression was used to examine factors associated with PC referral. Results: 386/912 (42%) decedents had a PC referral, and 179 (46%) were seen initially as outpatients. In multivariate analysis, PC referral was associated with younger age (odds ratio (OR) 0.98 per year; 95% confidence interval (CI) 0.97-0.99; P<0.001), married status (OR 1.5; 1.1-2.0; P=0.005), and gynecologic cancer (OR 1.9, 1.1-3.5, P=0.02 relative to lung). Among patients with a PC referral, outpatient consultation was more likely among patients with head and neck cancer (OR=5.5, 1.7-17.6, P=0.004 relative to lung). In contrast, hematologic malignancy was associated with decreased PC referral (OR=0.59, 0.36-0.97, P=0.04), fewer outpatient PC consultations (OR=0.3, 0.1-0.7, P=0.01) and less time from referral to death (Table). Conclusions: Younger, married patients and those with gynecologic cancer were more like to be referred to palliative care. Head and neck cancer patients were more often seen as PC outpatients. Patients with hematologic malignancies had fewer PC referrals and often late in the disease trajectory compared to patients with solid tumors. [Table: see text]