Symptom distress and patterns of palliative-care referral among oncology outpatients.

185 Background: The early implementation of palliative care services is recognized as an important aspect of oncologic care. However, rates of referral to palliative care services among oncology patients are still low, and the decision to refer is frequently at the discretion of the treating oncologist or by patient request. We sought to better identify the patterns of referral to outpatient palliative care, as well as patient symptom burden in an effort to target early and high-yield palliative care interventions.

METHODS: We conducted a cross-sectional survey among outpatients presenting to a Hematology/Oncology practice at a tertiary care hospital. Patients presenting to the clinic were asked to complete an Edmonton Symptom Assessment Scale (ESAS) survey at time of registration. Chart review was completed to identify basic demographic information, timing and extent of cancer diagnosis, basic medical and psychiatric comorbidities, and existing referral to palliative care services.

RESULTS: Between November 15, 2014 and December 24, 2014, a total of 146 complete surveys were collected from oncology outpatients. The most common malignancies were hematologic (40.4%), lung (24.6%), breast (8.2%), gastrointestinal (6.8%) and genitourinary (6.8%); 30.1% had metastatic disease at the time of the visit. A total of 13 patients (8.9%) were receiving outpatient palliative care services. As compared to patients not receiving palliative care services, those who were reported higher overall symptom distress scores (26.3 vs. 12.7, p = 0.013) and pain scores (3.5 vs. 1.6, p = 0.03). Patients receiving palliative care services also had fewer years since diagnosis (2.8 years vs. 4.5 years, p = 0.028), and a non-significant trend toward higher rates of metastatic disease (72.7% vs. 47.3%, p = 0.059).

CONCLUSIONS: Overall, low rates of referrals to palliative care were found among oncology outpatients. In addition, this study suggests oncology patients are referred to palliative care at later stages of disease, when they are already experiencing significant symptom burden. Future research will determine which patients will benefit from earlier referrals to palliative care before symptoms become more advanced.