Timing of palliative care referral and symptom burden in phase I cancer patients: A retrospective cohort study.
Authors: H. A. Parsons, D. Hui, L. Nguyen, S. L. Palla, J. Liu, S. Yennurajalingam, R. Kurzrock, E. Bruera
Journal: Journal of Clinical Oncology (2010)

9062 Background: Phase I (P1) trials offer advanced cancer patients the opportunity to pursue further life-prolonging cancer treatments. In this study, we compared the timing of referral and symptom burden between patients referred to PC by P1 oncologists and those referred by non-Phase I oncologists (NP1). Methods: All 57 patients with advanced solid tumors referred by P1 to our PC outpatient clinic in 2007/2008 were included. The comparison cohort consisted of 114 NP1 patients stratified by age, sex and cancer diagnosis in a 1:2 ratio. We retrieved information regarding patient characteristics, Edmonton Symptom Assessment Scale (ESAS), timing of referral and survival. We compared baseline characteristics with Fisher's exact and median tests, ESAS with t-tests, and time events with log rank tests. Results: Both cohorts had the following matched characteristics: average age 57, female 44% and gastrointestinal cancers 47%. At the time of PC consultation, P1 patients were more likely than NP1 patients to have a diagnosis of metastatic cancer (97% v. 83%, p=0.046), more prior courses of systemic therapy (median 3 v. 2, p<0.001), better performance status (ECOG 0-1, 61% v. 36%, p=0.003), and to be not delirious (100% v. 90%, p=0.03). ESAS did not differ between P1 and NP1, except for better well being in P1 patients (mean 4.5 v. 5.5, p=0.03). P1 patients had longer overall survival from diagnosis of advanced cancer (median 1093d v. 704d, p=0.01), and longer duration between diagnosis of advanced cancer and PC consult (843d v. 350d, p<0.001). Importantly, no difference was found for the duration between M.D. Anderson registration and PC consult (409d v. 340d, p=0.41), and overall survival from time of PC consult (137d v. 116d, p=0.45). The duration between first oncologist contact and PC referral was longer for P1 compared to NP1 (589d v. 248d, p=0.019), while the duration between referring team's initial contact and PC referral was shorter for the P1 cohort (31d v. 268d, p<0.001). Conclusions: P1 outpatients referred to PC had a better performance status but similar symptom burden as NP1 patients. P1 involvement did not delay PC referral compared to NP1. This supports the development of a successful simultaneous care model. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration AstraZeneca, Centocor, Johnson & Johnson, Maxygen, Merck Amgen, AstraZeneca, Center for Biomedical Continuing Education (CBCE), Genentech, Enzon, IDSC, ImClone Systems, Johnson & Johnson, Maxygen, Merck, Pharmion, Roche Abraxis, Amgen, AmpliMed, Antigenics, AstraZeneca, Bayer, BMS, Callisto, Centocor, Concordia, Curagen, Eisai, Eli Lilly, Enzon, Exelixis, Genentech, GlaxoSmithKline, Globomax, Hoffman- La Roche, Kinex, Merck, Metastatix, MGI Pharmaceuticals, Myriad, Novartis, Pfizer, Pharmacyclics, Pharmion, Phoenix Biotech, Reata, Taiho, Vioquest, Ziopharm