Association between the timing of palliative care consultation and end-of-life outcomes in patients with cancer

PURPOSE: While growing evidence supports the benefits of early palliative care (PC) referral for patients with cancer, the optimal timing of referral remains unclear. This study aimed to examine the association between the timing of PC consultation and end-of-life (EOL) outcomes in patients with cancer. METHODS: This retrospective cohort study included patients with cancer who were referred for PC consultation at a tertiary hospital in the Republic of Korea between January 2018 and December 2022 and had died by June 2023. Clinical data were linked to the National Health Insurance Service database. Referral timing was categorized as late (≤ 30 days), intermediate (31-90 days), or early (> 90 days) before death. Primary outcomes included completion of advance statements, hospice use, aggressive care during the last month of life, and total medical costs near the EOL. RESULTS: Among 6,151 patients, 43.3% received late referrals, and 23.8% received early referrals. Earlier referrals were more common among older patients and those with longer disease duration, Medicaid coverage, or lung and non-gastrointestinal solid tumors. Compared with late referrals, early referrals were associated with a higher likelihood of completing advance statements (adjusted odds ratio [aOR] 1.98; 95% confidence interval [CI] 1.73-2.27), greater hospice use (aOR 1.30; 95% CI 1.12-1.51), lower rates of aggressive care, and reduced medical costs near EOL. CONCLUSION: Early PC consultation offers an important opportunity to enhance advance care planning, promote hospice use, and reduce unnecessary healthcare utilization at EOL, supporting earlier integration of PC into routine oncology practice.