title: Timing of palliative care referral and symptom burden in phase 1 cancer patients: a retrospective cohort study.
abstract: BACKGROUND
  Phase 1 trials offer patients with advanced cancer the opportunity to pursue life-prolonging cancer treatments. In the current study, the timing of referral and symptom burden between patients referred to palliative care by phase 1 oncologists and those referred by non-phase 1 oncologists were compared.
  
  
  METHODS
  All 57 patients with advanced solid tumors who were referred by phase 1 oncologists to the palliative care outpatient clinic at The University of Texas M. D. Anderson Cancer Center (MDACC) between 2007 and 2008 were included. The comparison cohort was comprised of 114 non-phase 1 patients who were stratified by age, sex, and cancer diagnosis in a 1:2 ratio. Information regarding patient characteristics, Edmonton Symptom Assessment Scale (ESAS), timing of referral, and survival was retrieved.
  
  
  RESULTS
  Both cohorts had the following matched characteristics: average age of 57 years, with 44% of the patients being female and 47% having gastrointestinal cancers. At the time of palliative care consultation, patients referred by phase 1 oncologists were more likely than patients referred by non-phase 1 oncologists to have a better performance status (Eastern Cooperative Oncology Group 0-1: 61% vs 36% [P = .003). The ESAS was not significantly different with the exception of better well-being in the phase 1 cohort (mean, 4.5 vs 5.5; P = .03). No difference was found for the duration between registration at MDACC and palliative care consultation (13 months vs 11 months; P = .41) and overall survival from the time of palliative care consultation (5 months vs 4 months; P = .69).
  
  
  CONCLUSIONS
  Outpatients referred to palliative care by phase 1 oncologists were found to have a better performance status but similar symptom burden compared with patients referred by non-phase 1 oncologists. Patients with phase 1 involvement did not appear to have delayed palliative care referral compared with non-phase 1 patients. The results of the current study support the development of a simultaneous care model.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.forename: Henrique
authors.initials: H
authors.lastname: Parsons
authors.forename: Linh
authors.initials: L
authors.lastname: Nguyen
authors.forename: Shana L
authors.initials: SL
authors.lastname: Palla
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennurajalingam
authors.forename: Razelle
authors.initials: R
authors.lastname: Kurzrock
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D017321:Clinical Trials, Phase I as Topic; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D010146:Pain / Q000453:epidemiology; D010166:Palliative Care; D011787:Quality of Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors