Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Can we move beyond disease-based referral triggers and use patient-reported needs to guide earlier palliative care integration?  (144435)

Melanie Rabbets 1 , Mona Faris 2 , Simone Cheung 3 , Clare Zachulski 3 , Catherine Mason 3 , Adnan Nagrial 3 , Purnima Sundaresan 3 , Sally Greenaway 3 , Mark Wong 3 , Pei Ding 3 , Caitlin Mulcahy 3 , Susmita Reddy Karri 3 , Likitha Sudini 3 , Kim Hobbs 3 , Haryana Dhillon 2 , Rhiannon Mellor 3 , Rosemary Habib 3
  1. BlacktownHospital, WESTMEAD, NSW, Australia
  2. Sydney University, Sydney, NSW, Australia
  3. Western Sydney Local Health District, Westmead, NSW, Australia

Background: Early integration of specialist palliative care improves outcomes for people with cancer, but optimal approaches to identify those benefitting from early referral remain uncertain. We evaluated whether baseline symptom burden and supportive care needs were associated with specialist palliative care referral in a prospective oncology cohort.

 

Methods: Patients with advanced cancer in a tertiary centre in Western Sydney, completed Edmonton Symptom Assessment System (ESAS) and Supportive Care Needs Survey Short Form (SCNS-ST9). Associations between symptom burden, supportive care needs, and palliative care referral were examined using correlation analyses, linear and multivariable logistic regression adjusting for age, ECOG performance status, primary site, metastatic burden, and ESAS total score.

 

Results: Fifty-eight patients with diverse advanced cancers were included. Participants had median age 67 years (IQR 28–85), median of one metastatic site (IQR 0–6). Median ESAS total score at initial assessment was 17 (IQR 8–41), demonstrating substantial symptom burden early. Among patients with SCNS-ST9 data (n=16), median item score was 1.8 (IQR 1.1–3.6). Total ESAS score was associated with greater supportive care needs (p=0.03) and poorer ECOG performance status (p=0.005), but not metastatic burden (p=0.843) or primary site (p=0.182).

 

A total of 46% participants were referred to specialist palliative care. Median time from diagnosis to palliative care referral was 5.9 months (range 0.3–19.6). Those referred had greater pain, lethargy, appetite disturbance, metastatic burden, and poorer ECOG status (p<0.05). On multivariable logistic regression, higher baseline ESAS total score remained independently associated with specialist palliative care referral (OR 1.069 per point increase, 95% CI 1.005–1.137, p=0.03).

  

Conclusion: Symptom burden was the strongest predictor of specialist palliative care referral, supporting routine symptom assessment as a tool to identify patients with unmet supportive care needs. These findings challenge disease-focused referrals and highlight role of routine patient-reported symptom assessment to facilitate needs-based palliative care.

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