Xiaoli Gu, Menglei Cheng, MinghuiLiu, Zhe Zhang, Wenwu Cheng

Department of Integrated Therapy, Fudan University Shanghai Cancer Center

Objective:The routine integration of earlyinvolvement of palliative care in advanced cancer management is not yet a partof standard practice in many countries, including Mainland China. Whetherpatients in China suffering from advanced cancer were referred to palliativecare services in a timely manner remained unclear. We sought to investigate thetiming of palliative care referral of Chinese cancer patients and itspredicator factors, then evaluate the potential barriers within Chinese culturefor early palliative care integration. Method: A total of 759 patientswho were referred to the PCU from January 2007 to December 2013 were includedin the final analysis. Patients who were still alive at the time of data collectionor who were missing data for the study variables were excluded. The PCUmaintains meticulous computerized records of all enrolled patients, includingdemographic and clinical data. The overall survival (OS) was calculated as thetime of cancer diagnosis to death. The survival since initiation of palliativecare services (POS) was calculated as the time of admission to the PCU tilldeath. The POS was determined by the Kaplan-Meier method, and univariateanalysis was conducted to identify possible factors for survival. Multivariateanalysis using the Cox proportional hazard model and a forward regressionprocedure was conducted to define independent prognostic factors. Result: Among759 patients for analysis, the mean age was 62.89 (range 61.95-63.82) yearsold. 369 patients (48.6%) were male, 559 (73.6%) were Shanghainese (indigenous)and 200(26.4%) were not Shanghainese (non-indigenous). Lung (17.9%), stomach(12.0%), colorectal (11.7%), and breast cancer (8.3%) were the most commondiagnoses. Among those 759 patients, 406 patients died in the PCU. Among them,21 patients died during within 24 hours of enrollment. 121 (15.94%) patientsdied within 1 week following initiation of palliative care services. The medianPOS was 21 days (95% CI: 19.79-22.21). The median OS for these patients was13.7 months (95%CI: 12.49-14.91). Patients who were indigenous (P=0.002),younger than 65 (P=0.033) and referred from other departments of FUSCC (P=0.04)survived longer after receiving palliative care, indicating relatively earlyreferral to PCU. Other characteristics such gender and primary cancer type hadno relationship with the POS. The multivariate analysis showed that whether ornot the patient was indigenous (P=0.002) and younger than 65 (P=0.031)were independent factors for POS. Patients in different years yieldeddifferent POS. The POS of patients in more recent years was longer although thedifferences were not significant (P=0.157). There was no difference inthe OS of patients of different years. Conclusion: The findings revealedthat Chinese cancer patients were referred relatively late to palliative careservice in their disease course. To overcome the barriers of early integrationof palliative care in a patient's treatment plan accurate information about palliativecare must be provided for both oncologists and patients via systematiceducational programs.

Key Words: early palliativeintegration  timing of referral