title: Palliative care needs of patients with cancer living in the community.
abstract: OBJECTIVE
  With improved effectiveness of early detection and treatment, many patients with cancer are now living with advanced disease and associated symptoms. As cancer becomes a chronic illness, adequate attention to patients' symptoms and psychosocial needs in the community setting requires positioning of palliative care alongside cancer care. This article describes the current palliative care needs of a population of community-dwelling patients with advanced cancer who are not yet ready for transition to hospice.
  
  
  METHODS
  This secondary analysis used quality-monitoring data collected in three community-based palliative care organizations. Analyses focused on people with cancer-related diagnoses who were receiving palliative care during 2008 to 2011.
  
  
  RESULTS
  The analytic data set included 4,980 people, 10% of whom had cancer. Median age was 71 years. Forty-eight percent had been hospitalized at least once in the 6 months before palliative care referral. Forty-nine percent had a Palliative Performance Score (PPS) of 40% to 60%; 40% had PPS ≤ 30%. Although 81% had an estimated prognosis of ≤ 6 months, 58% were expected to live weeks to months. Thirty-three percent had no identified healthcare surrogate; 59% had no do-not-resuscitate order despite declining functional status and limited prognosis. Ninety-five percent reported ≥ 1 symptom, and 67% reported ≥ 3 symptoms; a substantial proportion did not receive treatment for symptoms.
  
  
  CONCLUSIONS
  Patients referred to community-based palliative care experience multiple often-severe symptoms that have been insufficiently addressed. They tend to have declining performance status. Earlier palliative care intervention could improve outcomes but will require delivery models that better coordinate inpatient/outpatient oncology and community-based palliative care.
authors.affiliation: Division of Medical Oncology, Department of Medicine; Duke Cancer Care Research Program, Duke Cancer Institute, Duke University Medical Center; Sanford Institute of Public Policy, Duke University, Durham; Four Seasons, Flat Rock; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
authors.forename: Janet
authors.initials: J
authors.lastname: Bull
authors.forename: Dio
authors.initials: D
authors.lastname: Kavalieratos
authors.forename: Donald H
authors.initials: DH
authors.lastname: Taylor
authors.forename: William
authors.initials: W
authors.lastname: Downey
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy