Early supportive and palliative care referral at a comprehensive cancer center: A seven year study.

Abstract

12088 Background: Despite ASCO supporting the benefits of early supportive/palliative care (SPC) integration, many patients with advanced cancer were referred < 6 months before death or not at all. Our comprehensive cancer center has an active SPC program to promote early access. This study evaluated how the timing of SPC referral changed over the past seven years and identified predictors of early SPC referral. Methods: This study included a random sample of 100 patients seen for consultation at the SPC clinic per year from 2017 to 2023. Data included demographics, cancer type, disease stage, symptom burden, performance status, date of SPC referral, and date of death or last follow-up. The primary outcome was overall survival (OS) from SPC consultation. Timing of referral and number of visits were examined using time-to-event analysis. Early SPC referral was defined as occurring ≥ 6 months before death among decedents. Univariable and multivariable logistic regression models were used to identify predictors of early SPC referral. Results: Among 700 patients (median age 62, 54% female, 92% with advanced cancer), OS from SPC referral increased significantly over the years (Median OS: 9.3 months in 2017, 31.7 months in 2021, and not reached in 2023) (Table). The median follow-up for alive individuals was 19.1 months. The median number of follow-up SPC visits increased from 3 in 2017 to 7 in 2023 (P < 0.001). Early SPC referral occurred in 72% (n = 449) of decedents. In multivariable analysis, male sex (OR: 1.85, P = 0.014), head and neck cancer (OR: 4.64, P < 0.001), hematologic malignancies (OR: 3.31, P = 0.013), less pain (OR: 0.9, P = 0.008) and less anorexia (OR: 0.88, P = 0.001) were associated with early SPC referral. Conclusions: Patients at our center were referred to SPC earlier and earlier over the past 7 years, achieving a median OS of 32 months. This trend highlights that early SPC is not only possible but potentially self-reinforcing, facilitating timely, longitudinal care along the cancer journey, particularly as patients are living longer with advanced cancer. Outpatient supportive/palliative care referral between 2017 and 2023. Year 2017 2018 2019 2020 2021 2022 2023 P-Value Number of SPC Consults* 1,844 1,766 1,863 1,804 2,055 2,221 2,178 0.011 All Patients Median OS, Months 9.3(6.9 – 14.2) 9.1(6.4 – 19.5) 18.9(10.7 – 30.7) 31.8(14 – NR) 31.7(13.3 – NR) NR NR 0.0001 6-months OS % 63 61 70 75 75 83 79 Advanced Cancer Only Median OS, Months 9.3(6.9 – 14.2) 7.1(5.7 – 18.9) 15.9(9.5 – 25.8) 24.2(13.4 – NR) 25.8(12.7 – NR) 24.7(16.4 – NR) NR 0.0014 6-month OS % 63 59 68 73 73 79 78 Total SPC Visits, Median 3(3 – 4) 4 (3– 5) 3 (2– 4) 5 (3 – 7) 4 (4 – 9) 7(5 – 15 7 (6 – NR) < 0.001 Abbreviations: SPC, Supportive/Palliative Care; NR, not reached; OS, overall survival. * 100 patients were randomly selected per year for analysis. Ranges in parentheses represent 95% CI (confidence interval).