Referral Delays to Specialized Palliative Care among Oncology Inpatients in a Portuguese Cancer Centre
DOI:
https://doi.org/10.20344/amp.24418Keywords:
Neoplasms, Palliative Care, Portugal, Referral and Consultation, Waiting ListsAbstract
Access to specialized palliative care is a key component of quality cancer care, yet delays remain common in Portugal and institution-level data on referral pathways are scarce. We performed a retrospective observational study including all oncology inpatients referred to specialized palliative care units at a Portuguese comprehensive cancer center between January 2022 and June 2024, and we analysed referral outcomes and waiting times from referral to admission or death. Of 3177 hospitalized oncology patients, 208 (6.5%) were referred to palliative care, and nearly two-thirds (63.0%) died before admission. The median waiting time from referral to admission was 29.5 days (IQR 20.0 – 41.0), while patients who were not admitted died a median of 34.0 days (IQR 20.0 – 54.0) after referral. Among admitted patients, median length of stay in palliative care units was 21.5 days (IQR 10.0 – 40.5). These findings show that most hospitalized oncology patients referred to specialized palliative care do not reach admission in time, reflecting substantial delays in access despite referral. Improving referral pathways and strengthening system capacity are essential to ensure timely palliative care for patients with advanced cancer in Portugal.
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Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209-49. DOI: https://doi.org/10.3322/caac.21660
Direção-Geral da Saúde. Portugal – Doenças Oncológicas em Números – 2021. Lisboa: DGS; 2021.
Hui D, Hannon BL, Zimmermann C, Bruera E. Improving patient and caregiver outcomes in oncology: team-based, timely, and targeted palliative care. CA Cancer J Clin. 2018;68:356-76. DOI: https://doi.org/10.3322/caac.21490
Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733-42. DOI: https://doi.org/10.1056/NEJMoa1000678
World Health Organization. Palliative care. Geneva: WHO; 2020 [cited 2024 May 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/palliative-care.
Kaasa S, Loge JH, Aapro M, Albreht T, Anderson R, Bruera E, et al. Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol. 2018;19:e588-653. DOI: https://doi.org/10.1016/S1470-2045(18)30415-7
Jordan RI, Allsop MJ, ElMokhallalati Y, Jackson CE, Martin A, Currow DC, et al. Duration of palliative care before death in international routine practice: a systematic review and meta-analysis. BMC Med. 2020;18:368. DOI: https://doi.org/10.1186/s12916-020-01829-x
Entidade Reguladora da Saúde. Informação de monitorização: avaliação do acesso a cuidados paliativos em Portugal Continental. Lisboa: ERS; 2024. [cited 2024 Aug 20]. Available from: https://www.ers.pt/media/ee2ge4yv/im_rncp_08-22024.pdf.
Silva MD, Gomes B, Antunes B, Ferreira PL, Sarmento VP, Pinto C. Portuguese national programme for palliative care: Overview and challenges ahead. Int J Palliat Nurs. 2022;28:184-91.
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