Early Palliative Care and Its Impact on End-of-Life Care for Cancer Patients in Brazil

Background: Integrating palliative care into standard oncology care has been recommended for cancer patients. Early palliative care is associated with less aggressive treatment at the end of life. Objective: To describe cancer patients receiving palliative care in Brazil, determining the time from entry into palliative care to death, and investigating whether late referral to palliative care is associated with aggressive end-of-life treatment. Design: This was a cross-sectional study of cancer patients receiving palliative care in Brazil. Setting/Subjects: Subjects were 2985 cancer patients 18 years of age who received at least two palliative care visits at the SAo Paulo State Cancer Institute, in the city of SAo Paulo, Brazil, and died between 2010 and 2013. Measurements: We evaluated the time from the first palliative care consult to death, stratifying cases by the timing of entry into palliative care (3 or <3 months before death). The associations between early palliative care and indicators of aggressive treatment were assessed by Pearson's chi-square test and Fisher's exact test. Results: The overall median time between entry into palliative care and death was 34 days (mean, 72 days) and was significantly shorter in 2013 than in 2010 (p<0.001). The number of emergency department visits was significantly lower among the patients who entered palliative care earlier (p<0.001). Conclusions: Among cancer patients in Brazil, late referral to palliative care is common. Patients who enter palliative care earlier appear to receive less aggressive end-of-life treatment.