Trends in specialized palliative care referrals at an oncology center from 2007 to 2019

Lucka Boltezar,Barbara Jezersek Novakovic,Maja Ebert Moltara

doi:10.1186/s12904-021-00828-w

Lucka Boltezar, Barbara Jezersek Novakovic + Show 1 more

Open Access

https://doi.org/10.1186/s12904-021-00828-w

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Abstract

BackgroundEarly referral to palliative care, at least 3 months before death, should be a standard of care in oncological practice. Real life data in this setting are invaluable since they provide a picture of everyday practice and serve as the basis for future improvements.MethodsWe conducted a retrospective cohort assessment of all patients referred to our specialized palliative care (SPC) services at the Institute of Oncology, Ljubljana, Slovenia. Our analysis includes patient referrals between 2007 and 2019.ResultsDuring the above-specified time period of 13 years, 3234 patients were referred for SPC services at our institution. The median age at SPC referral was 67 years. The majority of patients (63%) were assessed only once, while 31% of patients were seen on more than one occasion. Median time from SPC referral to death was 25 days for the whole group. 1693 patients (52.7%) were referred to SPC in the last 30 days before death, 785 (25.8%) patients between 31 and 90 days and 652 (21.4%) patients more than 3 months before death. Neither age nor sex correlated with the duration of referral time. However, there was a strong correlation between the year of referral to palliative care and the duration of palliative care service (ρ = 0.19, p < 0.001). The median referral to death interval for lymphoma patients and breast cancer patients were 15 and 18 days, respectively, and the median referral to death interval for colorectal cancer and lung tumor patients were 34 and 26 days before death, respectively.ConclusionThroughout the existence of our SPC services we have observed a positive trend in the number of referrals, a lengthening of time between referral and death, as well as an increase in the proportion of patients with an early referral to SPC (more than 3 months before death). Neither age nor sex correlated with the length of referral time.

Highlights

Referral to palliative care, at least 3 months before death, should be a standard of care in oncological practice
Patient characteristics The cohort consisted of 3234 patients who were engaged in our Specialized palliative care (SPC) services between 2007 and 2019
In a similar study performed in Leeds, UK, analysing 3900 cancer patients, among patients with non-cancer diagnoses, patients over 75 had limited access to palliative care compared to younger patients [9]

Summary

Introduction

Referral to palliative care, at least 3 months before death, should be a standard of care in oncological practice. Integration of palliative care into standard oncological treatment of advanced cancer has been gaining in importance over the past few decades [1, 2]. Temel et al were the first to emphasize early integration of palliative care into standard oncological care, leading to a better quality of life and better survival of patients with metastatic disease [3]. Specialized palliative care (SPC) services at our institute have evolved gradually: first with the establishment of the Department of Acute Palliative Care (APCD) in 2007 and later with the introduction of an outpatient clinic and inpatient consultations in 2013. Our Department comprises seven in-patient beds, while mobile palliative care services are planned for the future. The palliative service at IOL only deals with cancer patients

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