title: Characteristics of patients with advanced lung cancer referred to a rapid-access supportive care clinic.
abstract: There is a limited number of pragmatic studies to evaluate the criteria for referral to outpatient palliative care. The aim of our study was to compare the characteristics, symptoms, and survival of patients with advanced non-small-cell lung cancer (NSCLC) referred (RF) versus not referred (NRF) to a novel embedded same-day rapid-access supportive care clinic (RASCC) and to compare the subgroups among referred patients.
  
  
  
  We reviewed the medical records of all patients who received treatment at the thoracic oncology clinic for advanced non-small-cell lung cancer between August 1, 2012, and June 30, 2013, who were referred to the RASCC and those who were not referred. An oncology-estimated prognosis of ≤6 months and/or severe symptom distress was employed as criteria for referral to the RASCC.
  
  
  
  Of 410 eligible patients, 155 (37.8%) were referred to the RASCC. RF patients had significantly higher patient-reported scores for pain, fatigue, lack of appetite, and symptom distress, as well as worse performance status and shorter survival than NRF patients. Among the RF patients, those who were referred early (≤3 months) had significantly worse symptom distress and shorter overall survival than patients who were referred later on. The patients treated by thoracic oncologists who referred a smaller proportion of their patients to the RASCC had significantly worse anxiety, well-being, spiritual pain, and symptom distress than patients treated by those who referred a larger proportion of their patients to the RASCC.
  
  
  
  We found that patients who were referred to the RASCC had higher reported symptom distress and worse survival ratings. Further studies are needed to evaluate the optimal criteria for timely integration of palliative care and oncology care.
authors.affiliation: Department of Palliative,Rehabilitation, and Integrative Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennurajalingam
authors.affiliation: Department of Palliative,Rehabilitation, and Integrative Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Zhanni
authors.initials: Z
authors.lastname: Lu
authors.affiliation: Department of Palliative,Rehabilitation, and Integrative Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Williams
authors.affiliation: Department of Biostatistics,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Diane D
authors.initials: DD
authors.lastname: Liu
authors.affiliation: Department of Palliative,Rehabilitation, and Integrative Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Joseph Anthony
authors.initials: JA
authors.lastname: Arthur
authors.affiliation: Department of Palliative,Rehabilitation, and Integrative Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001066:Appetite; D002289:Carcinoma, Non-Small-Cell Lung / Q000628:therapy*; D057286:Electronic Health Records; D005221:Fatigue / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D010166:Palliative Care / Q000379:methods*; D012017:Referral and Consultation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013577:Syndrome; D013781:Texas; D013997:Time Factors
keywords: Advanced non-small-cell lung cancer; Palliative care; Patient characteristics; Patient-reported symptom burden; Supportive care