Supportive Care in Cancer

, Volume 26, Issue 6, pp 1933–1941 | Cite as

Factors associated with palliative care referral among patients with advanced cancers: a retrospective analysis of a large Brazilian cohort

  • Talita Caroline de Oliveira Valentino
  • Bianca Sakamoto Ribeiro Paiva
  • Marco Antonio de Oliveira
  • David Hui
  • Carlos Eduardo PaivaEmail author
Original Article



The purpose of the study is to estimate the proportion of patients who had access to palliative care (PC) and to identify the timing and factors associated with this access.


A retrospective longitudinal study that included patients who died of advanced cancer between the years of 2010 and 2014 was conducted. The proportion of patients who received PC consultations was compared during those years. Sociodemographic and clinical factors, the timing between first PC consultation and death (early, ≥ 3 months; late, < 3 months), and first PC consultation were assessed.


Of the 1284 studied patients, 988 (76.9%) were referred to PC and 839 (65.3%) had a PC consultation. The proportion of patients who received late PC consultation increased between the years 2010 and 2014 (44.2 vs. 60.4%, p = 0.001). Multivariate analysis revealed that younger age (odds ratio (OR) = 0.98, p = 0.016) and gynecologic cancer (OR = 2.17, p = 0.011) were associated with a PC consultation. Upper gastrointestinal tract (GIT) cancer (OR = 2.42, p = 0.001) and hematologic malignancies (OR = 0.37, p = 0.001) were associated with late PC consultations. The median time interval between the first PC consultation and death was 2.66 months: timing differed significantly among cancer subtypes (p = 0.002).


Most patients received PC consultation before death, and the number of patients with late consultation increased throughout the study. Patients with late referrals could have received PC earlier. The current findings suggest the need to standardize the referral criteria to optimize access to PC.


Palliative care Advanced cancer Referral and consultation Health services Quality of health care 



This project was supported by Barretos Cancer Hospital internal research funds (PAIP).

Author contributions

Conceived and designed the experiments: CEP, BSRP, and TCOV. Performed the experiments: TCOV, BSRP, and CEP. Analyzed the data: MAO and CEP. Wrote the paper: TCOV, BSRP, and CEP.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

520_2017_4031_MOESM1_ESM.doc (33 kb)
Supplementary Table 1 (DOC 33 kb)
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Supplementary Table 2 (DOC 40 kb)
520_2017_4031_MOESM3_ESM.jpg (78 kb)
Supplementary Fig 1 (JPEG 78 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Talita Caroline de Oliveira Valentino
    • 1
    • 2
  • Bianca Sakamoto Ribeiro Paiva
    • 1
    • 2
  • Marco Antonio de Oliveira
    • 2
  • David Hui
    • 3
  • Carlos Eduardo Paiva
    • 1
    • 2
    • 4
    • 5
    Email author
  1. 1.Oncology Post-Graduate Program (Stricto Sensu)Barretos Cancer HospitalBarretosBrazil
  2. 2.Research Group on Palliative Care and Health-Related Quality of Life (GPQual)Barretos Cancer HospitalBarretosBrazil
  3. 3.Department of Palliative, Rehabilitation, and Integrative MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Clinical Oncology—Breast and Gynecology DivisionBarretos Cancer HospitalBarretosBrazil
  5. 5.Institute of Education and Research—Post-GraduationBarretosBrazil

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