Journal Article Annotations
2025, 3rd Quarter

Palliative Medicine

Annotations by R. Garrett Key, MD
September, 2025

Early Specialist Palliative Care in Patients with Metastatic Cancer: A Population-Based Cohort Study.

PUBLICATION #1 — Palliative Medicine

Early Specialist Palliative Care in Patients with Metastatic Cancer: A Population-Based Cohort Study.

Ling Guo, Thomas W LeBlanc, Cardinale B Smith, R Sean Morrison, May Hua.

Abstract: J Pain Symptom Manage. 2025 Aug;70(2):140-148.e2. doi: 10.1016/j.jpainsymman.2025.04.005. Epub 2025 Apr 17.

Context:
Although early integration of specialist palliative care (PC) is recommended for patients with advanced cancer, how frequently these guidelines are followed is unknown.

Objective:
To examine use of early PC in real-world settings.

Methods:
Retrospective cohort study of patients with a first diagnosis of metastatic cancer who received care in U.S. hospitals with PC programs that participated in the National Palliative Care Registry in 2018-2019. The primary outcome was the proportion of early specialist PC initiation (within eight weeks of a first metastatic cancer diagnosis) overall and after stratification by cancer type. Patient, hospital and PC program characteristics were compared between patients who received early PC, late PC, and no PC.

Results:
Of 171,224 patients, 14.1% received PC during the study period. Only 8.0% of patients received early PC. Proportions of early PC were highest for patients with lung cancer, and lowest for patients with breast cancer (12.0% vs. 4.3%). Patients who received early PC had more comorbidities, diagnoses for symptoms or psychiatric conditions, and complications of cancer, and were more likely to have had a serious hospitalization in the prior 12 months. Hospital and program characteristics were not substantially different between patients who did and did not receive early specialist PC.

Conclusion:
A low proportion of patients with metastatic cancer received early specialist PC, demonstrating a significant gap in guideline-concordant delivery of specialist PC. Patients who received early PC were substantially different from those who did not, suggesting that its use is targeted to patients with specific characteristics.

Keywords:
Delivery of health care; Hospices; Neoplasms; Palliative care; Retrospective studies; Symptom burden; Terminal care.

Annotation

The finding:
Despite the well-established benefits to quality of life, symptoms burden, aggressive end-of-life care, and survival time, many patients with metastatic cancer do not receive early palliative care intervention.

Strength and weaknesses:
The strengths of this paper include a robust dataset of over 170,000 patients from many clinical settings, clear findings that can be easily interpreted and explained to both other providers and lay people, and secondary analysis that describes the subset of patients who do get more frequent early palliative referral. A weakness is that the dataset relies on participation in National Palliative Care Registry which may exclude some settings. The provision of Palliative Care (PC) is also based to some degree on association of a provider NPI number with PC certification which may miss services provided by non-PC certified specialists who are still providing effective PC.

Relevance:
C-L Psychiatrists can play a role in helping to advocate for early referral to PC for patients with metastatic cancer and we also can play a role in helping to educate patient about PC and reduce barriers to referral (e.g. conflation of all palliative medicine with hospice).