title: Palliative care referral and associated outcomes among patients with cancer in the last 2 weeks of life.
abstract: BACKGROUND
  Palliative care (PC) improves the quality of life of patients with advanced cancer. Our aim was to describe PC referral among patients with advanced cancer, and associated outcomes in an academic medical centre.
  
  
  METHODS
  We reviewed the medical records of 536 inpatients with cancer who had died in 2010. Our retrospective study compared patients who accessed PC services with those who did not. Statistical analysis was conducted using non-parametric tests due to non-normal distribution. We also conducted a multivariate analysis using a logistic regression model including age, gender, type of cancer and metastatic status.
  
  
  RESULTS
  Out of 536 patients, 239 (45%) had PC referral. The most common cancer types were respiratory (22%) and gastrointestinal (19%). Patients with breast cancer (OR 23.76; CI 6.12 to 92.18) and gynaecological cancer (OR 7.64; CI 2.61 to 22.35) had greater PC access than patients with respiratory or haematological cancer. Patients referred to PC had significantly less chemotherapy in the last 2 weeks of life than non-referred patients, with 22 patients (9%) vs 59 (19%; p<0.001). PC-referred patients had significantly fewer admissions to intensive care units in the last month of life than non-referred patients, with 14 (6%) vs 58 (20%; p<0.001).
  
  
  CONCLUSIONS
  There was a large variation in access to PC according to the type of cancer. There is a need to improve collaboration between the PC service and the respiratory, cancer and haematology specialists. Further research will be required to determine the modality and the impact of this collaboration.
authors.affiliation: Département de Soins Palliatifs, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Ledoux
authors.affiliation: Département de Soins Palliatifs, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Wadih
authors.initials: W
authors.lastname: Rhondali
authors.affiliation: Département de Soins Palliatifs, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Lafumas
authors.affiliation: Département d'Information Médicale, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Berthiller
authors.affiliation: Pôle Information Médicale Evaluation Recherche (IMER), Hospices Civils de Lyon, Lyon, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Teissere
authors.affiliation: Département d'Information Médicale, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Piegay
authors.affiliation: Pôle Information Médicale Evaluation Recherche (IMER), Hospices Civils de Lyon, Lyon, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Couray-Targe
authors.affiliation: Pôle Information Médicale Evaluation Recherche (IMER), Hospices Civils de Lyon, Lyon, France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Schott
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.affiliation: Département de Soins Palliatifs, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Marilène
authors.initials: M
authors.lastname: Filbet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D064946:Hospice and Palliative Care Nursing / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing*; D010166:Palliative Care / Q000379:methods* / Q000523:psychology*; D063868:Patient Outcome Assessment; D011788:Quality of Life / Q000523:psychology*; D012017:Referral and Consultation; D012189:Retrospective Studies
keywords: Cancer; Death; Hospice care; Supportive care; Symptoms and symptom management