Timing of telepalliative care and end-of-life outcomes in advanced cancer: A multicenter retrospective cohort study.

Abstract

1518 Background: Telemedicine has become an integral component of palliative care delivery; however, its impact on end-of-life outcomes in oncology remains insufficiently explored, particularly in low- and middle-income countries (LMICs). Place of death is a key quality indicator in palliative oncology and reflects goal-concordant care. This study evaluated whether the timing of palliative care teleconsultations was associated with a higher likelihood of home death among patients with advanced cancer receiving care in a Brazilian multicenter setting. Methods: We conducted a multicenter retrospective cohort study in Brazil including adults with advanced cancer who received interdisciplinary palliative care and died due to disease progression between January 1, 2024, and December 31, 2025. Exposure to telepalliative care was defined according to the timing of teleconsultations relative to death (any teleconsultation, ≤7 days, ≤30 days, or exclusively in-person care). The primary outcome was place of death (home vs other). Secondary outcomes included intensive care unit (ICU) admission and receipt of disease-modifying therapy in the last 30 days of life. Given the sample size, associations were evaluated using univariate logistic regression. Results: Among 116 patients (median age 65 years; 55% female), 63 (54.3%) received telepalliative care. Exposure to telepalliative care overall, irrespective of timing, was not associated with home death. In contrast, telepalliative care delivered closer to death was significantly associated with a higher likelihood of home death, particularly when performed within the last 7 days of life (OR 5.93; 95% CI 1.75–20.15; p = 0.004) and within the last 30 days (OR 3.08; 95% CI 1.04–9.10; p = 0.042). Telepalliative care was also associated with lower odds of ICU admission in the last 30 days of life (OR 0.34; 95% CI 0.16–0.73; p = 0.006) and reduced odds of receiving disease-modifying therapy in the final month of life (OR 0.35; 95% CI 0.15–0.79; p = 0.012). Conclusions: In this Brazilian multicenter retrospective cohort, the timing of telepalliative care, rather than teleconsultation exposure alone, was a key determinant of end-of-life outcomes. Telepalliative care delivered closer to death was associated with a higher likelihood of home death and reduced use of high-intensity end-of-life care. These findings highlight the importance of timely integration of telepalliative care to maintain continuity of interdisciplinary care and support goal-concordant end-of-life care, particularly in resource-constrained and geographically diverse settings.