BACKGROUND: Palliative care is evolving from end-of-life care to care provided earlier in the disease trajectory. We compared clinical characteristics between patients referred late in the course of their disease (late referrals, LRs) with patients referred earlier (early referrals, ERs). METHOD: Six hundred and ninety-five patients referred to the Supportive Care Center (SCC) with follow-up within 30 days were enrolled. One hundred ERs (expected survival ≥ 2 years or receiving treatment for curative intent, 14.4%) were compared with a random sample of 100/595 consecutive LRs (all others). RESULTS: ERs were younger (54.4 versus 59.5, p=0.009), more likely to have head and neck cancer (67% versus 6%, p<0.0001), alcoholism (15% versus 4%, p=0.014), and shorter disease duration until first palliative care consultation (3.8 months versus 16.2 months, p<0.0001). They were also more likely to be referred by radiation oncologists (49% versus 3%, p<0.0001), be referred for treatment-related side effects (70% versus 9%, p<0.0001), and receive more anticancer treatment (74% versus 48%, p=0.0002). Head and neck cancer and reason for referral were independent predictors for ERs (p<0.0001) in multivariate analysis. Baseline Edmonton Symptom Assessment System (ESAS) symptoms were similar between ERs and LRs. Both groups exhibited improved ESAS scores at follow-up; LRs experienced greater improvement in the symptom distress score (-5.5 versus -3, p=0.007). The median total number of medical visits was higher in ERs (p<0.001); however, the median number of visits per month was higher in LRs (p<0.001). CONCLUSIONS: ERs had different patient characteristics than LRs, and although ERs experience distress similar to that of LRs, their needs and outcomes differ.
BACKGROUND: Palliative care is evolving from end-of-life care to care provided earlier in the disease trajectory. We compared clinical characteristics between patients referred late in the course of their disease (late referrals, LRs) with patients referred earlier (early referrals, ERs). METHOD: Six hundred and ninety-five patients referred to the Supportive Care Center (SCC) with follow-up within 30 days were enrolled. One hundred ERs (expected survival ≥ 2 years or receiving treatment for curative intent, 14.4%) were compared with a random sample of 100/595 consecutive LRs (all others). RESULTS: ERs were younger (54.4 versus 59.5, p=0.009), more likely to have head and neck cancer (67% versus 6%, p<0.0001), alcoholism (15% versus 4%, p=0.014), and shorter disease duration until first palliative care consultation (3.8 months versus 16.2 months, p<0.0001). They were also more likely to be referred by radiation oncologists (49% versus 3%, p<0.0001), be referred for treatment-related side effects (70% versus 9%, p<0.0001), and receive more anticancer treatment (74% versus 48%, p=0.0002). Head and neck cancer and reason for referral were independent predictors for ERs (p<0.0001) in multivariate analysis. Baseline Edmonton Symptom Assessment System (ESAS) symptoms were similar between ERs and LRs. Both groups exhibited improved ESAS scores at follow-up; LRs experienced greater improvement in the symptom distress score (-5.5 versus -3, p=0.007). The median total number of medical visits was higher in ERs (p<0.001); however, the median number of visits per month was higher in LRs (p<0.001). CONCLUSIONS: ERs had different patient characteristics than LRs, and although ERs experience distress similar to that of LRs, their needs and outcomes differ.
Authors: Thomas J Smith; Sarah Temin; Erin R Alesi; Amy P Abernethy; Tracy A Balboni; Ethan M Basch; Betty R Ferrell; Matt Loscalzo; Diane E Meier; Judith A Paice; Jeffrey M Peppercorn; Mark Somerfield; Ellen Stovall; Jamie H Von Roenn Journal: J Clin Oncol Date: 2012-02-06 Impact factor: 44.544
Authors: Joan D Penrod; Melissa M Garrido; Karen McKendrick; Peter May; Melissa D Aldridge; Diane E Meier; Katherine A Ornstein; R Sean Morrison Journal: J Palliat Med Date: 2017-06-19 Impact factor: 2.947
Authors: Teresa Hagan Thomas; Vicki A Jackson; Heather Carlson; Simone Rinaldi; Angela Sousa; Andrea Hansen; Mihir Kamdar; Juliet Jacobsen; Elyse R Park; William F Pirl; Jennifer S Temel; Joseph A Greer Journal: J Palliat Med Date: 2018-10-25 Impact factor: 2.947
Authors: Naveen Salins; Lipika Patra; M R Usha Rani; S O Lohitashva; Raghavendra Rao; Raghavendra Ramanjulu; Nandini Vallath Journal: Indian J Palliat Care Date: 2016 Jul-Sep
Authors: Gabriel Lopez; Wenli Liu; Jennifer McQuade; Richard T Lee; Amy R Spelman; Bryan Fellman; Yisheng Li; Eduardo Bruera; Lorenzo Cohen Journal: J Cancer Date: 2017-06-03 Impact factor: 4.207
Authors: Julia L Agne; Erin M Bertino; Madison Grogan; Jason Benedict; Sarah Janse; Michelle Naughton; Christine Eastep; Michael Callahan; Carolyn J Presley Journal: Palliat Med Rep Date: 2021-05-17