Artikel: Use and timing of referral to specialized palliative care services for people with cancer: A mortality follow-back study among treating physicians in Belgium

Referral to specialized palliative care services (SPCS) occurs often late in the illness trajectory

but may differ across cancer types. We examined differences between cancer types in

the use and timing of referral to specialized palliative care services (SPCS) and in the reasons

for non-referral.

Methods

We conducted a population-based mortality follow-back survey among physicians who certified

a representative sample of deaths in Flanders, Belgium. We focused only on sampled

death cases of cancer (n = 2392). The questionnaire asked about the use of the existing

types of SPCS and the timing of referral to these services.

Results

Response rate was 58% (1394/2392). Patients who died from breast, respiratory, head and

neck, genitourinary or gastrointestinal cancer had higher chances of using SPCS compared

to hematologic cancer patients. The most prevalent reason for non-referral was that regular

care sufficiently addressed palliative and supportive care needs (51%). This differed significantly

between cancer types ranging from 77,8% for breast cancer and 42.1% for hematologic

cancer. A second prevalent reason for not using SPCS was that it was not meaningful

(enough) (23.9%), particularly for hematologic malignancies (35,1%) and only in 5.3% for

breast cancer.

Conclusion

Differences in referral across different types of cancer were found. Referral is more often

delayed or not initiated for patients with hematologic cancer, possibly due to differences in

illness trajectory. An influencing reason is that physicians perceive palliative care as not

meaningful or not meaningful enough for these patients which may be linked to the uncertainty

in the disease trajectory of hematologic malignancies