Timing of Specialist Palliative Care Consultation at a Comprehensive Cancer Center: A 7-Year Longitudinal Study

PURPOSE – Despite evidence supporting the benefits of early referral to palliative care (PC), many patients with advanced cancer continue to experience delayed referral or no referral at all. This study evaluated trends in outpatient PC consultation over 7 years at a comprehensive cancer center and identified predictors of timely referral to PC.METHODS – We randomly selected 700 patients seen at our outpatient supportive care center (100 per year, 2017-2023). Demographics, cancer diagnosis, symptom burden, date of outpatient PC consultation, and survival status were retrieved from their electronic medical records. The primary outcome was overall survival (OS), defined as time from outpatient PC consultation to death or last follow-up. Timely referral to PC was defined as occurring ≥6 months before death or last follow-up from outpatient PC consultation. Univariable and multivariable logistic regression models identified predictors associated with timely referral.RESULTS – Among 700 patients (median age 62 years, 54% female, 92% with advanced cancer), the median OS increased from 9.3 months in 2017 to 31.7 months in 2021 (P = .0001). The median follow-up for living individuals at the data cutoff was 19.1 months. The median number of PC visits increased from 3 to 7 between 2017 and 2023. Four hundred forty-nine (72%) patients received timely referral. In multivariable analysis, timely referral was independently associated with male sex (odds ratio [OR], 1.85; P = .014), head and neck cancer (OR, 4.64; P < .001), hematologic malignancies (OR, 3.31; P = .013), lower pain (OR, 0.9; P = .008), lower anorexia (OR, 0.88; P = .001), year of consultation (OR, 1.12; P = .038), and better performance status (OR, 0.70; P = .006).CONCLUSION – This study reveals a gradual and consistent shift toward earlier PC referral at a comprehensive cancer center, demonstrating that timely referral to PC with a follow-up of 30+ months is possible.