title: Access to palliative care among patients treated at a comprehensive cancer center.
abstract: BACKGROUND
  Palliative care (PC) is a critical component of comprehensive cancer care. Previous studies on PC access have mostly examined the timing of PC referral. The proportion of patients who actually receive PC is unclear. We determined the proportion of cancer patients who received PC at our comprehensive cancer center and the predictors of PC referral.
  
  
  METHODS
  We reviewed the charts of consecutive patients with advanced cancer from the Houston region seen at MD Anderson Cancer Center who died between September 2009 and February 2010. We compared patients who received PC services with those who did not receive PC services before death.
  
  
  RESULTS
  In total, 366 of 816 (45%) decedents had a PC consultation. The median interval between PC consultation and death was 1.4 months (interquartile range, 0.5-4.2 months) and the median number of medical team encounters before PC was 20 (interquartile range, 6-45). On multivariate analysis, older age, being married, and specific cancer types (gynecologic, lung, and head and neck) were significantly associated with a PC referral. Patients with hematologic malignancies had significantly fewer PC referrals (33%), the longest interval between an advanced cancer diagnosis and PC consultation (median, 16 months), the shortest interval between PC consultation and death (median, 0.4 months), and one of the largest numbers of medical team encounters (median, 38) before PC.
  
  
  CONCLUSIONS
  We found that a majority of cancer patients at our cancer center did not access PC before they died. PC referral occurs late in the disease process with many missed opportunities for referral.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Boulevard, Houston, Texas 77030, USA. dhui@mdanderson.org
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.forename: Sun-Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Jung Hye
authors.initials: JH
authors.lastname: Kwon
authors.forename: Kimberson Cochien
authors.initials: KC
authors.lastname: Tanco
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.forename: Jung Hun
authors.initials: JH
authors.lastname: Kang
authors.forename: Wadih
authors.initials: W
authors.lastname: Rhondali
authors.forename: Gary
authors.initials: G
authors.lastname: Chisholm
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003191:Comprehensive Health Care; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D010166:Palliative Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D055815:Young Adult