Differences Between Oncological and Non-oncological Patients Referred to an In-Hospital Palliative Care Support Team: A Retrospective Cohort Study in Northern Portugal.
Although specialist palliative care has traditionally focused on patients with advanced cancer, the growing burden of chronic non-oncological diseases has highlighted the need for equitable access to palliative care services. Nevertheless, non-oncological patients continue to experience delayed referral and underutilization of specialist palliative care. This study aimed to compare the characteristics, referral patterns, and clinical outcomes of oncological and non-oncological patients referred to an in-hospital palliative care support team (PCST).
We conducted a retrospective observational study including all adult patients referred to an in-hospital PCST during 2024. Patients were classified as oncological or non-oncological according to their primary diagnosis. Oncological patients were defined as those with active malignant neoplasm or advanced cancer-related disease documented as the underlying condition prompting referral to the palliative care team. Demographic characteristics, referral timing, time from referral to specialist assessment, in-hospital mortality, and transfer to a specialized palliative care unit were compared between groups. Continuous variables were analyzed using the Mann-Whitney U test, while categorical variables were compared using the chi-square or Fisher's exact test.
A total of 204 patients were referred to the PCST during the study period. After excluding 8 patients (3.9%) with missing information regarding the underlying diagnosis, 196 patients were included in the comparative analysis, comprising 106 oncological patients (54.1%) and 90 non-oncological patients (45.9%). Non-oncological patients were significantly older than oncological patients (mean age 84.1 vs. 76.1 years, p < 0.001). In-hospital mortality was significantly higher among non-oncological patients (44/90 (48.9%) vs. 21/106 (19.8%), p < 0.001), whereas transfer to a specialized palliative care unit was more frequent among oncological patients (45/106 (42.5%) vs. 15/90 (16.7%), p < 0.001).
Non-oncological patients referred to the in-hospital PCST were older, experienced worse hospital outcomes, and had lower access to specialized palliative care units than oncological patients. The comparable response time following referral suggests that disparities arise primarily in patient identification and referral rather than in the delivery of specialist palliative care. Although non-oncological patients had a longer median interval between hospital admission and referral, this difference did not reach statistical significance, and therefore delayed referral cannot be considered a definitive explanation for the observed disparities. These findings suggest that differences between the two groups may reflect differences in disease trajectory, clinical complexity, and patterns of recognition of palliative care needs.
We conducted a retrospective observational study including all adult patients referred to an in-hospital PCST during 2024. Patients were classified as oncological or non-oncological according to their primary diagnosis. Oncological patients were defined as those with active malignant neoplasm or advanced cancer-related disease documented as the underlying condition prompting referral to the palliative care team. Demographic characteristics, referral timing, time from referral to specialist assessment, in-hospital mortality, and transfer to a specialized palliative care unit were compared between groups. Continuous variables were analyzed using the Mann-Whitney U test, while categorical variables were compared using the chi-square or Fisher's exact test.
A total of 204 patients were referred to the PCST during the study period. After excluding 8 patients (3.9%) with missing information regarding the underlying diagnosis, 196 patients were included in the comparative analysis, comprising 106 oncological patients (54.1%) and 90 non-oncological patients (45.9%). Non-oncological patients were significantly older than oncological patients (mean age 84.1 vs. 76.1 years, p < 0.001). In-hospital mortality was significantly higher among non-oncological patients (44/90 (48.9%) vs. 21/106 (19.8%), p < 0.001), whereas transfer to a specialized palliative care unit was more frequent among oncological patients (45/106 (42.5%) vs. 15/90 (16.7%), p < 0.001).
Non-oncological patients referred to the in-hospital PCST were older, experienced worse hospital outcomes, and had lower access to specialized palliative care units than oncological patients. The comparable response time following referral suggests that disparities arise primarily in patient identification and referral rather than in the delivery of specialist palliative care. Although non-oncological patients had a longer median interval between hospital admission and referral, this difference did not reach statistical significance, and therefore delayed referral cannot be considered a definitive explanation for the observed disparities. These findings suggest that differences between the two groups may reflect differences in disease trajectory, clinical complexity, and patterns of recognition of palliative care needs.
Authors
Sousa Sousa, Reis Reis, Bragada Bragada, Gonçalves Gonçalves, Rocha Rocha, Rocha Rocha
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