Referral criteria for timely palliative care in metastatic cancer: a real-life cross-sectional study

Consensual criteria for timely palliative care referral for patients with advanced cancer were defined through an international Delphi process. However, it is unclear how often patients meet criteria and how often they meet palliative care teams accordingly. This prospective multicenter cross sectional study involved outpatients and inpatients with metastatic cancer from oncology departments in 8 hospitals. We assessed the prevalence of referral criteria and recent palliative care consultations (in the past 3 months) among outpatients and inpatients with metastatic cancer. Secondary objectives were to compare referral criteria between these settings and identify factors associated with recent palliative care consultation. 355 patients with metastatic cancer were included (average age 65.7 years; 52.4% female), with 265 (74.6%) outpatients and 90 (25.4%) inpatients. The most commonly met criteria were estimated prognosis < 1 year ( N = 235, 66.2%), need for assistance with decision-making or care planning ( N = 214, 60.3%), and severe physical symptoms ( N = 148, 41.7%). Overall, 334 patients (94.1%) met at least one criterion; 71% met at least two criteria, and 47% met at least three criteria. One hundred thirty-three (37.5%) patients had a palliative care consultation in the past 3 months. Significant differences were observed between inpatients and outpatients. Inpatients met referral criteria more frequently than outpatients (98.9% vs. 92.5%, p = 0.048) and had a higher rate of recent palliative care consultation (52.2% vs. 32.5%, p = 0.001). In multivariable analysis, inpatient care setting and a performance status of 2 were independently associated with recent palliative care consultation, whereas none of the 11 consensus criteria was. Screening for referral criteria revealed that a substantial majority of patients had supportive care needs warranting palliative care referral, particularly in the inpatient setting. Only a minority of these patients had a recent palliative care consultation, suggesting opportunities to streamline the referral process. This trial was registered in ClinicalTrial.gov PRS with the ID NCT05339945 on April 21, 2022.