Palliative care outpatients in a German comprehensive cancer center—identifying indicators for early and late referral

BMC Palliative Care

Research Article

M. Teufel¹  M. Fink¹  J. Hense²  M. Schuler³  M. Tewes⁴  S. Müller⁴  M. R. Salvador Comino⁴ 

[1] Clinic of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147, Essen, Germany;Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, 45147, Essen, Germany;Department of Medical Oncology, West German Cancer Center Essen, University Hospital Essen, 45147, Essen, Germany;German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147, Essen, Germany;Department of Palliative Medicine, West German Cancer Center Essen, University Hospital Essen, 45147, Essen, Germany;

关键词: Outpatient;    Palliative Care;    Advanced Cancer;    Timing of Referral;    Symptom Burden;   

DOI  :  10.1186/s12904-022-01114-z

 received in 2022-05-27, accepted in 2022-11-25,  发布年份 2022

来源: Springer

【 摘 要 】

PurposeDespite that early integration of palliative care is recommended in advanced cancer patients, referrals to outpatient specialised palliative care (SPC) frequently occur late. Well-defined referral criteria are still missing. We analysed indicators associated with early (ER) and late referral (LR) to SPC of an high volume outpatient unit of a comprehensive cancer center.MethodsCharacteristics, laboratory parameters and symptom burden of 281 patients at first SPC referral were analysed. Timing of referral was categorized as early, intermediate and late (> 12, 3–12 and < 3 months before death). Ordinal logistic regression analysis was used to identify factors related to referral timing. Kruskal–Wallis test was used to determine symptom severity and laboratory parameter in each referral category.ResultsLRs (50.7%) had worse scores of weakness, loss of appetite, drowsiness, assistance of daily living (all p < 0.001) and organisation of care (p < 0.01) in contrast to ERs. The mean symptom sum score was significantly higher in LRs than ERs (13.03 vs. 16.08; p < 0.01). Parameters indicative of poor prognosis, such as elevated LDH, CRP and neutrophil-to-lymphocyte ratio (NLR) (p < 0.01) as well as the presence of ascites (p < 0.05), were significantly higher (all p < 0.001) in LRs. In univariable analyses, psychological distress (p < 0.05) and female gender (p < 0.05) were independently associated with an ER.ConclusionA symptom sum score and parameters of poor prognosis like NLR or LDH might be useful to integrate into palliative care screening tools.

【 授权许可】

CC BY   
© The Author(s) 2022