Access to Palliative Care Among Patients Treated at a Comprehensive Cancer Center

Background. Palliative care (PC) is a critical component of comprehensive cancer care. Previous studies on PC access have mostly examined the timing of PC referral. The proportion of patients who actually receive PC is unclear. We determined the proportion of cancer patients who received PC at our comprehensive cancer center and the predictors of PC referral. Methods. We reviewed the charts of consecutive patients with advanced cancer from the Houston region seen at MD Anderson Cancer Center who died between September 2009 and February 2010. We compared patients who received PC services with those who did not receive PC services before death. Results. In total, 366 of 816 (45%) decedents had a PC consultation. The median interval between PC consultation and death was 1.4 months (interquartile range, 0.5–4.2 months) and the median number of medical team encounters before PC was 20 (interquartile range, 6–45). On multivariate analysis, older age, being married, and specific cancer types (gynecologic, lung, and head and neck) were significantly associated with a PC referral. Patients with hematologic malignancies had significantly fewer PC referrals (33%), the longest interval between an advanced cancer diagnosis and PC consultation (median, 16 months), the shortest interval between PC consultation and death (median, 0.4 months), and one of the largest numbers of medical team encounters (median, 38) before PC. Conclusions. We found that a majority of cancer patients at our cancer center did not access PC before they died. PC referral occurs late in the disease process with many missed opportunities for referral. 摘要 背景. 姑息治疗（PC）是癌症综合管理的关键组成部分。先前关于PC途径的研究多侧重于分析PC转诊时机。实际接受PC的患者比例仍不清楚。本研究旨在明确在我们综合癌症中心接受PC的癌症患者比例以及PC转诊的预测因子。 方法. 我们回顾了休斯顿地区MD Anderson癌症中心死于2009年9月˜ 2010年2月的晚期癌症患者连续队列分布图表。我们在死亡之前接受过PC服务的患者与未接受过PC服务的患者之间进行了比较。 结果. 总体上，816例死亡患者中有366例（45%）曾做过PC咨询。PC咨询与死亡之间的中位间隔时间为1.4个月（四分位数间距范围，0.5 ˜4.2个月），PC之前到医生处就诊的中位次数为20次（四分位数间距范围，6˜45次）。多变量分析显示，年龄较大、已婚、特定癌症类型（妇科、肺部以及头颈部癌症）与PC转诊显著相关。血液系统肿瘤患者PC转诊比例显著降低（33%），晚期癌症确诊至PC咨询的间隔时间最长（中位值，16个月）、PC咨询与死亡之间的间隔时间最短（中位值，0.4个月）、PC之前到医生处就诊次数也属最多之列（中位值，38个月）。 结论. 本研究发现，我们分析的癌症中心癌症患者中大多数在死亡之前未获得PC途径。在疾病进展过程中PC转诊发生很晚，丧失了很多转诊时机。 The proportion of cancer patients who received palliative care at a comprehensive cancer center and the predictors of palliative care referral were determined. The majority of cancer patients did not access palliative care before they died.