Terminal cancer patients and timing of referral to palliative care: A Multicenter prospective cohort study

Massimo Costantini, Franco Toscani, Michele Gallucci, Cinzia Brunelli, Guido Miccinesi, Marcello Tamburini, Eugenio Paci, Paola Di Giulio, Carlo Peruselli, Irene Higginson, Julia Addington-Hall

Research output: Contribution to journalArticlepeer-review


This study describes the characteristics of a representative sample of terminally ill cancer patients at admission to Italian palliative care programs, the rate and reasons for discontinuation of care, and survival after enrollment. All Italian palliative care units (PCUs) specifically committed to palliative care were asked to consecutively register all new patients (n = 3901) between January and June, 1995. Fifty-eight of the 62 PCUs contacted by the Steering Committee completed the study. A random sample of 589 evaluable patients was prospectively selected from the 2667 eligible patients. Patients were mostly referred by a general practitioner (31.2%) or a specialist (42.1%). Most patients (84.7%) were followed until death. Seventy-seven discontinued care because of hospital admission (6.6%), change of residence (3.9%), refusal (1.7%), or improvement (0.8%). Median survival was 37.9 days; 14.3% of the patients died within 7 days, and 15.3% lived longer than 180 days. A statistically significant association between survival and gender, cancer type, setting of the first visit, and type of unit was observed. In Italy, as in other countries with different health systems, referral of cancer patients to palliative care tends to occur late in the course of the disease. This study suggests that the process of enrollment and the duration of patients' survival in palliative care, when studied in large unselected populations, can provide important information relevant to the care of terminally ill patients.

Original languageEnglish
Pages (from-to)243-252
Number of pages10
JournalJournal of Pain and Symptom Management
Issue number4
Publication statusPublished - Oct 1999


  • Cancer
  • Palliative care
  • Survival

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • Neurology
  • Nursing(all)


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