Timing and patterns of referral to palliative care for patients with metastatic non-small cell lung cancer (NSCLC) in South Western Sydney Local Health District (SWSLHD). — ASN Events
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Timing and patterns of referral to palliative care for patients with metastatic non-small cell lung cancer (NSCLC) in South Western Sydney Local Health District (SWSLHD). (#151)

Howard Chan 1 , Peey-Sei Kok 1 , Clement Chao 2 , Joseph Descallar 3 4 , Victoria Bray 5 , Annette Tognela 1 2 , Po Yee Yip 1 2 , Note: H.Chan and P.S. Kok are first co-authors
  1. Macarthur Cancer Therapy Centre , Campbelltown Hospital, Sydney, New South Wales, Australia
  2. University of Western Sydney, Sydney, New South Wales, Australia
  3. South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales , Australia
  4. Ingham Institute, Sydney, New South Wales, Australia
  5. Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, New South Wales, Australia

Background: In 2010, Temel et al demonstrated early referral to palliative care (PC) improved quality of life and overall survival (OS) in patients with newly diagnosed metastatic NSCLC. 

Aim:  To examine the timing and patterns of referral to the PC service for patients with metastatic NSCLC to assess its impact on survival and other clinical indicators.

Methods: We retrospectively reviewed medical records for patients with newly diagnosed metastatic NSCLC treated in the Liverpool and/or Macarthur Cancer Therapy Centres.  Patients were identified using an institutional electronic database.  Patients were analysed pre- (1/1/2008-31/12/2009) and post-Temel ( 1/1/2011-31/12/2012), respectively, to identify any changes in referral patterns.  Due to Temel’s publication, patients diagnosed in 2010 were excluded.  Early referral to PC was defined as within 8 weeks of diagnosis. Cox regression was used to analyse OS between early and late groups.

Results: 266 patients were included: 134 from 2008-2009 and 132 from 2011-2012. The median age at diagnosis was 66 (range 31-91) with 65% male, 84% ex- or current smokers and 78% were English speaking.   249 (94%) were referred to PC; 159 (64%) were referred early and 90 (36%) late.  In the early group, 46% were ECOG PS 0-1 at diagnosis, compared to 85% in the late group.  Hospitalisations were similar between the early and late groups with mean number of admissions being  2.8, and the mean length of stay (total number of days in hospital from diagnosis to death) was 30.2 days. 

Of the 244 patients analysed for survival, median OS for the early and late groups were 3.1 months vs. 9.8 months, respectively (HR 0.42; 95%CI 0.32-0.56; p<0.0001). There was no change in referral patterns pre- or post-Temel.  

Conclusion: This suggests timing of PC referrals is tailored according to patient factors and physician discretion in our SWSLHD. However, our results showed early referral to PC did not improve OS in this cohort and Temel’s publication has not changed our practice. 

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