Assessment of the integration between oncology and palliative care in advanced stage cancer patients

Abstract

Purpose: Chemotherapy is indicated for patients with metastatic malignancy in order to improve quality of life and in some cases to increase survival. However, the greatest difficulty regarding the choice of treatment is to evaluate the clinical benefit and intrinsic toxicity of each procedure. The best strategy is the integration between oncology and palliative care, which is still mostly insufficient. The main objective of this study was to assess time to palliative care referral for cancer patients with advanced local or metastatic disease and to investigate the impact of covariates on this relationship.

Methods: A retrospective, cross-sectional, observational pilot study was conducted on 286 patients divided into two groups, one consisting of metastatic patients and the other of non-metastatic patients at diagnosis. Karnofsky Performance Scale (KPS), setting, and survival time were evaluated.

Results: One hundred eighteen patients (41.25%) were metastatic and 168 (58.74%) had locally advanced malignant disease. The median time of metastatic patient referral to the group of palliative care (GPC) was 5.3 months, with 39.8% referred earlier and 60.2% referred late (≥3 months). 60.2% of metastatic patients were referred to the GPC with a KPS <70% and 56% of non-metastatic patients were referred earlier and 44% after 3 months. There was improved survival only in metastatic patients referred to the GPC with a KPS ≥70% (p = 0.02).

Conclusions: Many oncology patients were referred late to the GPC. A higher KPS was a risk factor for late referral because only severe patients were referred earlier. Metastatic patients referred with a KPS ≥70% had a longer survival.

Keywords: Metastatic disease; Oncology; Palliative care; Survival.