Towards a better integration of palliative care in oncology? A multicentric cross-sectional study

Background Palliative care was slow to be offered to patients with metastasic cancer. For 15 years, international recommendations and government programs have supported the early integration of palliative care into oncology care but the impact on clinical practice has not been evaluated. We assessed the frequency and timing of palliative care referral, and the sociodemographic and clinical factors associated with this referral. Methods We conducted an observational, multicentric, cross-sectional study concerning inpatients and outpatients with metastatic cancer. The study assessed palliative care team involvement, quality of life (EORTC-QLQC30), supportive care needs (SCNS-SF34), social vulnerability (EPICES) and one-year survival. Results 355 patients with solid incurable metastatic cancer were included. 37.5% of them had met a palliative care team, within a median time of 6.7 months after the diagnosis of first metastasis, and 4.7 months before death. Patients referred to palliative care teams were found to have higher levels of social vulnerability (49.6%, p = 0.011); poorer performance status (p < 0.0001); greater prevalence of symptoms and worse physical, emotional, cognitive, and social functionning scores (p < 0.05). They also had more psychological, physical and daily living and information needs (p < 0.05). In multivariate analysis, only social vulnerability was associated with referral to palliative care teams. One-year survival did not differ between patients with and without palliative care team involvement at the point of inclusion. Conclusion Early acess to palliative care is improving, especially for the patients with greater supportive care needs. Further studies are needed to identify the best criteria for palliative care team integration for metastatic cancer patients. Trial registration : This trial was registered in ClinicalTrial.gov PRS under the ID APHP210724.