Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient’s profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011–2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level > 35 g/l. The median [1st-3rd quartile] IP was 0.39 [0.16–0.72], ranging between 0.53 [0.20–0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07–0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units. The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.

中文翻译：

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首次转诊至综合性姑息治疗计划：其时机的回顾性分析

建议在晚期癌症的早期阶段转诊姑息治疗（PC）。这项研究的目的是在综合性姑息治疗计划（IOPC）中描述患者在首次提及该计划时的概况，转诊的时间以及其对临终护理路径的影响。IOPC结合了每周一次的针对顽固性癌症患者的抗癌会议（OPM）和/或PC团队的临床评估。肿瘤科医生可以咨询OPM的多学科委员会，需要讨论其目标和护理结构的患者。我们分析了2011–2013年首次在OPM转诊的所有患者。我们将早熟指数（IP）定义为从初次转诊到死亡与诊断为无法治愈到死亡的时间之间的比率，范围从0（初次转诊）到1（早期转诊）。在416例患者中，有57％出现肺癌，尿路上皮癌或肉瘤。初次转诊至IOPC时，有76％接受抗肿瘤治疗，门诊患者为63％，工作状态≤2的为56％，血清白蛋白水平> 35 g / l。中位[第1至第3四分位] IP为0.39 [0.16-0.72]，范围从0.53 [0.20-0.79]（最早转诊，即接近诊断为可治愈的肺癌）到0.16 [0.07-0.56]（最新转诊） ，即相对于转移性疾病而言，对于前列腺癌而言接近死亡。在367名死者中，有42名（13％）在死前14天内接受了抗肿瘤治疗，在PC部门中有157名（43％）死亡。IOPC是一个有效的组织，可以使PC尽早集成，并在使用寿命即将结束时降低护理的积极性。