title: Assessment of the integration between oncology and palliative care in advanced stage cancer patients.
abstract: Chemotherapy is indicated for patients with metastatic malignancy in order to improve quality of life and in some cases to increase survival. However, the greatest difficulty regarding the choice of treatment is to evaluate the clinical benefit and intrinsic toxicity of each procedure. The best strategy is the integration between oncology and palliative care, which is still mostly insufficient. The main objective of this study was to assess time to palliative care referral for cancer patients with advanced local or metastatic disease and to investigate the impact of covariates on this relationship.
  
  
  
  A retrospective, cross-sectional, observational pilot study was conducted on 286 patients divided into two groups, one consisting of metastatic patients and the other of non-metastatic patients at diagnosis. Karnofsky Performance Scale (KPS), setting, and survival time were evaluated.
  
  
  
  One hundred eighteen patients (41.25%) were metastatic and 168 (58.74%) had locally advanced malignant disease. The median time of metastatic patient referral to the group of palliative care (GPC) was 5.3 months, with 39.8% referred earlier and 60.2% referred late (≥3 months). 60.2% of metastatic patients were referred to the GPC with a KPS <70% and 56% of non-metastatic patients were referred earlier and 44% after 3 months. There was improved survival only in metastatic patients referred to the GPC with a KPS ≥70% (p = 0.02).
  
  
  
  Many oncology patients were referred late to the GPC. A higher KPS was a risk factor for late referral because only severe patients were referred earlier. Metastatic patients referred with a KPS ≥70% had a longer survival.
authors.affiliation: Division of Clinical Oncology, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Dos-Anjos
authors.affiliation: Division of Clinical Oncology, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Priscila B M
authors.initials: PBM
authors.lastname: Candido
authors.affiliation: Division of Clinical Oncology, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Victor D L
authors.initials: VDL
authors.lastname: Rosa
authors.affiliation: Group of Palliative Care, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Rua Mariano Casadio, 275, Jardim Canadá, Ribeirão Preto, SP, 14024-360, Brazil.
authors.forename: Rodrigo E
authors.initials: RE
authors.lastname: Costa
authors.affiliation: Group of Palliative Care, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Rua Mariano Casadio, 275, Jardim Canadá, Ribeirão Preto, SP, 14024-360, Brazil.
authors.forename: Fernanda R C B
authors.initials: FRCB
authors.lastname: Neves
authors.affiliation: Group of Palliative Care, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Rua Mariano Casadio, 275, Jardim Canadá, Ribeirão Preto, SP, 14024-360, Brazil.
authors.forename: André F
authors.initials: AF
authors.lastname: Junqueira-Santos
authors.affiliation: Occupational Therapy Course, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Marysia M R P
authors.initials: MMRP
authors.lastname: De-Carlo
authors.affiliation: Division of Clinical Oncology, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Fernanda M
authors.initials: FM
authors.lastname: Peria
authors.affiliation: Group of Palliative Care, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Rua Mariano Casadio, 275, Jardim Canadá, Ribeirão Preto, SP, 14024-360, Brazil. nereida@fmrp.usp.br.
authors.forename: Nereida K C
authors.initials: NKC
authors.lastname: Lima
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods*; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D010865:Pilot Projects; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: Metastatic disease; Oncology; Palliative care; Survival