Abstract
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.