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Early versus delayed palliative/supportive care in advanced cancer: an observational study
  1. Elena Bandieri1,
  2. Federico Banchelli2,
  3. Fabrizio Artioli1,
  4. Claudia Mucciarini1,
  5. Giorgia Razzini1,
  6. Massimiliano Cruciani1,
  7. Leonardo Potenza3,
  8. Roberto D'Amico2,
  9. Fabio Efficace4,
  10. Eduardo Bruera5 and
  11. Mario Luppi3
  1. 1 Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
  2. 2 Statistic Unit, Department of Medical and Surgical Sciences, UNIMORE, Modena, Italy
  3. 3 Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
  4. 4 Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
  5. 5 Palliative Care & Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Professor Mario Luppi, Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena 41124, Italy; mario.luppi{at}


Objective The positive impact of early palliative care interventions in advanced cancer patients has so far been largely evaluated in randomised controlled trials. This study aimed at providing information on the value of early palliative/supportive care, integrated with standard oncologic care, in a real-life setting.

Methods This was a retrospective observational study of 292 advanced cancer patients consecutively admitted at Carpi Hospital in Modena, Italy, between 2014 and 2017. For the purpose of this analysis, patients were classified into two groups (early and delayed palliative/supportive care patients), and analysed for different clinical indicators. Early and delayed palliative/supportive care were classified according to the time elapsed from advanced cancer diagnosis until palliative/supportive care start.

Results A total of 200 patients (68%), with at least three visits, were included in the analyses. The frequency of chemotherapy use in the last 60 days of life was 3.4% and 24.6% in the early and delayed groups, respectively (adjusted OR=0.1; 95% CI 0.0 to 0.4; p=0.002). The estimated survival probability at 1 year was 74.5% (95% CI 65.0% to 85.4%) and 45.5% (95% CI 37.6% to 55.0%), in the early and delayed groups, respectively. Performance status, pain and all the Edmonton Symptom Assessment Scale items, assessed at baseline and at 1 to 12 weeks after the intervention, showed significant improvement over time. However, no between-group differences were found with regard to symptom outcomes.

Conclusions An earlier palliative/supportive care intervention was associated with reduced aggressiveness of therapy, in patients receiving community oncology care. Symptom burden was improved by early palliative/supportive care, independently of the timing of patient referral.

  • cancer pain
  • chemotherapy
  • early palliative care
  • early supportive care

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  • Contributors EBa and ML have full access to all of the data used in the study and take the responsibility for the integrity of the data and the accuracy of the data analysis. EBa, FB, RD and ML have contributed to the acquisition, analysis and interpretation of data. EBa, FB, FA, CM, GR, MC, LP, RD, FE, EBr and ML have commented on manuscript draft, final version and approved the submitted manuscript. FB and RD performed statistical analysis.

  • Funding Programma di Ricerca Regione Emilia Romagna-Università, Ricerca per il Governo Clinico, 2010–2012 (3b211-19 to ML).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Modena and Reggio Emilia Ethical Committee, Modena, Italy (No. 833/2018).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.