title: Early palliative intervention for patients with advanced cancer.
abstract: BACKGROUND
  Early palliative intervention in advanced cancer patients with metastatic non-small-cell-lung cancer has been shown to improve survival time. Possibly, palliative intervention at the time of outpatient care further improves patient survival time.
  
  
  OBJECTIVE
  We performed a comparative study of late and early referrals of patients with advanced cancer to clarify the appropriate time for palliative intervention and the improvement in survival time.
  
  
  METHODS
  Two hundred and one cancer patients, all since deceased, who were treated in our department over a period of 4 years were divided into two groups: patients who experienced outpatient services for <7 days (late referral group, 64 patients) and those who experienced outpatient services for ≥7 days (early referral group, 137 patients). Survival time, duration of chemotherapy and post-progression survival were retrospectively analyzed through examination of medical records.
  
  
  RESULTS
  Survival time of the early referral group was longer than that of the late referral group in all the cases (19.0 vs. 6.5 months, P < 0.001). Survival time in advanced non-small-cell lung cancer was 3.5 and 14.0 months (P = 0.010) and 16.5 and 20.9 months (P = 0.039) in advanced colorectal cancer, respectively. There was no significant difference in gastric cancer (P = 0.310). Post-progression survival in each group was 0.7 and 2.7 months (P = 0.018) in non-small-cell lung cancer.
  
  
  CONCLUSIONS
  The results of this study suggested that early outpatient referral and palliative intervention leads to improvement of the outcome in patients with advanced non-small-cell lung cancer and colorectal cancer. A prospective comparative study is warranted.
authors.affiliation: Department of Palliative Care, Sakai Hospital, Kinki University Faculty of Medicine, Japan. mtsuka@sakai.med.kindai.ac.jp
authors.forename: Masatomo
authors.initials: M
authors.lastname: Otsuka
authors.forename: Atsuko
authors.initials: A
authors.lastname: Koyama
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Minoru
authors.initials: M
authors.lastname: Niki
authors.forename: Chihiro
authors.initials: C
authors.lastname: Makimura
authors.forename: Ryo
authors.initials: R
authors.lastname: Sakamoto
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Sakai
authors.forename: Masahiro
authors.initials: M
authors.lastname: Fukuoka
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000628:therapy; D018450:Disease Progression; D061345:Early Medical Intervention / Q000379:methods / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D010045:Outpatients; D010166:Palliative Care / Q000379:methods*; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000628:therapy; D013997:Time Factors
keywords: early palliative intervention; non-small-cell lung cancer; outpatient palliative care; post-progression survival; survival time