• Masatomo Otsuka, Atsuko Koyama, Hiromichi Matsuoka, Minoru Niki, Chihiro Makimura, Ryo Sakamoto, Kiyohiro Sakai, and Masahiro Fukuoka.
• Department of Palliative Care, Sakai Hospital, Kinki University Faculty of Medicine, Japan. mtsuka@sakai.med.kindai.ac.jp
• Jpn. J. Clin. Oncol. 2013 Aug 1;43(8):788-94.

BackgroundEarly palliative intervention in advanced cancer patients with metastatic non-small-cell-lung cancer has been shown to improve survival time. Possibly, palliative intervention at the time of outpatient care further improves patient survival time.ObjectiveWe performed a comparative study of late and early referrals of patients with advanced cancer to clarify the appropriate time for palliative intervention and the improvement in survival time.MethodsTwo hundred and one cancer patients, all since deceased, who were treated in our department over a period of 4 years were divided into two groups: patients who experienced outpatient services for <7 days (late referral group, 64 patients) and those who experienced outpatient services for ≥7 days (early referral group, 137 patients). Survival time, duration of chemotherapy and post-progression survival were retrospectively analyzed through examination of medical records.ResultsSurvival time of the early referral group was longer than that of the late referral group in all the cases (19.0 vs. 6.5 months, P < 0.001). Survival time in advanced non-small-cell lung cancer was 3.5 and 14.0 months (P = 0.010) and 16.5 and 20.9 months (P = 0.039) in advanced colorectal cancer, respectively. There was no significant difference in gastric cancer (P = 0.310). Post-progression survival in each group was 0.7 and 2.7 months (P = 0.018) in non-small-cell lung cancer.ConclusionsThe results of this study suggested that early outpatient referral and palliative intervention leads to improvement of the outcome in patients with advanced non-small-cell lung cancer and colorectal cancer. A prospective comparative study is warranted.

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