1598P - Differences in referral patterns to the palliative care team among specialized physicians in patients with terminal cancer

Background

The importance of Hospice & Palliative care for patients with terminal cancer is well established. Although hospice use is increasing, the use of hospice services is still suboptimal. Previous studies reported that surgeons tend to underuse palliative care (PC) consultation. This study aimed to investigate potential variations in referral patterns to the PC team and differences in end-of-life care among specialized physicians in patients with terminal cancer.

Methods

A single-institution retrospective observational study of consecutive PC consultations within a National Cancer Institute-designated cancer center in 2020-2021 was conducted. We categorized specialized physicians into medical oncologists (MO) and non-medical oncologists (NMO), which include hematologists, gastroenterologists, surgical and radiation oncologists.

Results

We analyzed 1710 patients, 1130 were referred from MO and 580 from NMO. Patients in the NMO group had lower levels of prognostic awareness (PA) regarding their terminal cancer status compared to those in MO. 44.7 % of patients in the MO group and 16.2 % of patients in the NMO group had accurate PA (p<0.01). The median survival from a day of PC consultation was 40.7 days for all, 47.3 days for the MO group, and 28 days for NMO group (p = 0.00). The survival time after planning Advance Directives was 100 days for all, significantly longer in the MO group (131.2 vs. 54.9 days, p=0.00). The median time from notification of discontinuation of active cancer treatment to PC consultation was 40 days. The interval to PC consultation was significantly longer in patients referred from the NMO group (92.6 days in the NMO group vs. 13.5 days in the MO group, p=0.00). The rate of discharge to specialized inpatient hospice facilities or home hospice was higher in the MO group. However, the discharge rate to acute-stage hospital, ICU was higher in the NMO group.

Conclusions

There was significant variation in referral patterns to the PC team according to a division of physicians. NMO patients had a lower level of prognostic awareness (PA) compared to MO patients. Late referrals to the PC team were observed in the NMO group. This suggests a need for increased education and training in palliative care for the NMO.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.