Deepa Wadhwa1, Gordana Popovic2, Ashley Pope2, Nadia Swami2, Lisa W Le3, Camilla Zimmermann2,4,5. 1. 1 BC Cancer-Center for the Southern Interior , Kelowna, British Colombia, Canada . 2. 2 Department of Supportive Care, Princess Margaret Cancer Center, University Health Network , Toronto, Ontario, Canada . 3. 3 Department of Biostatistics, Princess Margaret Cancer Center, University Health Network , Toronto, Ontario, Canada . 4. 4 Division of Medical Oncology, Department of Medicine, University of Toronto , Toronto, Ontario, Canada . 5. 5 Princess Margaret Cancer Research Institute, University Health Network , Toronto, Ontario, Canada .
Abstract
BACKGROUND: Although timely palliative care is recommended for patients with advanced cancer, referrals to palliative care services are often late. OBJECTIVES: To identify factors associated with early referral to an oncology palliative care clinic and to describe symptom severity according to timing of referral. DESIGN: We conducted a retrospective review of 337 patients with advanced cancer referred to outpatient palliative care at a comprehensive cancer center. We gathered data related to patient demographics, diagnosis, and referral. Timing of referral was categorized as early (>12 months before death), intermediate (6-12 months before death), or late (<6 months before death). Ordinal logistic regression was used to determine factors related to referral timing, and the Kruskal-Wallis test to determine symptom severity in each referral timing category. RESULTS: Of the 337 patients, 232 (69%) referrals were late, 60 (18%) intermediate, and 45 (13%) early. On multivariable analysis, earlier referral was associated with earlier primary cancer diagnosis (p = 0.004), and referral for pain and symptom management (p = 0.001). Patients who were referred late had worse overall Edmonton Symptom Assessment System distress scores, as well as worse tiredness, nausea, drowsiness, appetite, and wellbeing (all p ≤ 0.001). Severity of pain, shortness of breath, anxiety, and depression did not differ based on time of referral. CONCLUSIONS: A longer disease course and referral for symptom management were associated with earlier referral, whereas overall symptom burden was higher for late referrals. Further research is required on combining symptom screening with timely referral to improve symptom management in advanced cancer.
BACKGROUND: Although timely palliative care is recommended for patients with advanced cancer, referrals to palliative care services are often late. OBJECTIVES: To identify factors associated with early referral to an oncology palliative care clinic and to describe symptom severity according to timing of referral. DESIGN: We conducted a retrospective review of 337 patients with advanced cancer referred to outpatient palliative care at a comprehensive cancer center. We gathered data related to patient demographics, diagnosis, and referral. Timing of referral was categorized as early (>12 months before death), intermediate (6-12 months before death), or late (<6 months before death). Ordinal logistic regression was used to determine factors related to referral timing, and the Kruskal-Wallis test to determine symptom severity in each referral timing category. RESULTS: Of the 337 patients, 232 (69%) referrals were late, 60 (18%) intermediate, and 45 (13%) early. On multivariable analysis, earlier referral was associated with earlier primary cancer diagnosis (p = 0.004), and referral for pain and symptom management (p = 0.001). Patients who were referred late had worse overall Edmonton Symptom Assessment System distress scores, as well as worse tiredness, nausea, drowsiness, appetite, and wellbeing (all p ≤ 0.001). Severity of pain, shortness of breath, anxiety, and depression did not differ based on time of referral. CONCLUSIONS: A longer disease course and referral for symptom management were associated with earlier referral, whereas overall symptom burden was higher for late referrals. Further research is required on combining symptom screening with timely referral to improve symptom management in advanced cancer.
Authors: Ziad Bakouny; Tarek Assi; Elie El Rassy; Karen Daccache; Clarisse Kattan; Aline Tohme; Marie Claire Mouhawej; Joseph Kattan Journal: Support Care Cancer Date: 2018-11-07 Impact factor: 3.603
Authors: David Hausner; Colombe Tricou; Jean Mathews; Deepa Wadhwa; Ashley Pope; Nadia Swami; Breffni Hannon; Gary Rodin; Monika K Krzyzanowska; Lisa W Le; Camilla Zimmermann Journal: Oncologist Date: 2021-01-02
Authors: Roberta I Jordan; Matthew J Allsop; Yousuf ElMokhallalati; Catriona E Jackson; Helen L Edwards; Emma J Chapman; Luc Deliens; Michael I Bennett Journal: BMC Med Date: 2020-11-26 Impact factor: 8.775
Authors: Kah Poh Loh; Christopher L Seplaki; Chandrika Sanapala; Reza Yousefi-Nooraie; Jennifer L Lund; Ronald M Epstein; Paul R Duberstein; Marie Flannery; Eva Culakova; Huiwen Xu; Colin McHugh; Heidi D Klepin; Po-Ju Lin; Erin Watson; Valerie Aarne Grossman; Jane Jijun Liu; Jodi Geer; Mark A O'Rourke; Karen Mustian; Supriya G Mohile Journal: JAMA Netw Open Date: 2022-02-01
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