Early Specialist Palliative Care in Patients with Metastatic Cancer: A Population-Based Cohort Study

Context

Although early integration of specialist palliative care (PC) is recommended for patients with advanced cancer, how frequently these guidelines are followed is unknown.

Objective

To examine use of early PC in real-world settings.

Methods

Retrospective cohort study of patients with a first diagnosis of metastatic cancer who received care in U.S. hospitals with PC programs that participated in the National Palliative Care Registry in 2018–2019. The primary outcome was the proportion of early specialist PC initiation (within eight weeks of a first metastatic cancer diagnosis) overall and after stratification by cancer type. Patient, hospital and PC program characteristics were compared between patients who received early PC, late PC, and no PC.

Results

Of 171,224 patients, 14.1% received PC during the study period. Only 8.0% of patients received early PC. Proportions of early PC were highest for patients with lung cancer, and lowest for patients with breast cancer (12.0% vs. 4.3%). Patients who received early PC had more comorbidities, diagnoses for symptoms or psychiatric conditions, and complications of cancer, and were more likely to have had a serious hospitalization in the prior 12 months. Hospital and program characteristics were not substantially different between patients who did and did not receive early specialist PC.

Conclusion

A low proportion of patients with metastatic cancer received early specialist PC, demonstrating a significant gap in guideline-concordant delivery of specialist PC. Patients who received early PC were substantially different from those who did not, suggesting that its use is targeted to patients with specific characteristics.