Outcomes of early palliative care referrals for patients with advanced lung cancer.
Bibliographic record
Abstract
9625 Background: Despite previous studies showing benefits of early referral to palliative care in improving quality cancer care, late referral and under-utilization are major concerns. The aim of this study was to determine the impact of early palliative medicine specialist referral (EPC) on quality cancer care outcomes in advanced lung cancer pts at a comprehensive cancer center. Methods: In this prospective non-randomized controlled study, pts with advanced non-small cell lung cancer with oncologist estimated survival of ≤ 6 months were referred to EPC, N=51. A control group of similar characteristics were recruited from pts with regular follow-up at the thoracic oncology clinic [standard oncology care,UC], N=52. Descriptive statistics and Wilcoxon rank sum tests were used to describe change in FACT-lung, Edmonton Symptom Assessment Scale(ESAS)-symptom distress scores and Hospital Anxiety and Depression Scale(HADS) at follow-up visit. Results: The median age was 61yrs; 52% were female. There was no difference in age, gender, race (p>0.1) at baseline between the two groups, but the EPC pts had a higher symptom burden (EPC 30.5 vs. UC 11.0 p=.001). At follow-up EPC pts had significant improvement in symptoms scores. EPC pts also were more likely to have improved QOL and EOL discussions (Table). Conclusions: EPC was associated with improved symptom distress scores and improved health utilization outcomes, although baseline symptom distress scores were worse in EPC at time of referral. Change in the symptom scores at follow-up and quality-care outcomes in UC and EPC. UC EPC p Median change IQR Median change IQR ESAS symptom distress 5.0 (-2.0,16) -2.5 (-9.7, 6.7) .02 HADS depression 1.0 (0,5.0) -1.0 (-2.0, 3.0) .04 FACIT lung cancer subscale -3.0 (-5.0,1.0) 3.0 (-2.0,5.0) .002 FACT_L TOI -9.0 (-16.0,-1.3) -5.0 (-6.75,10.7) .006 HADS depression (caregiver) .5 (-1.0, 2.2) -1.0 (-4.0,1.0) .025 Quality Metrics ICU sdmissions 4/51 3/52 .68 Median ICU LOS 11 5.0 .21 ICU deaths 1/51 0/52 .38 Any chemotherapy within 14 days of death 3/51 (6%) 1/51 (1%) .3 Hospice referrals 5/51 (10%) 14/52 (27%) .02 Completion of advance directives 2/51 (4%) 9/52 (17%) .03 Discussion of advance care planning 2/51(4%) 34/51 (67%) .001
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".