Application of locally developed referral criteria for palliative care in metastatic hormone receptor–positive breast cancer patients: A non-randomized controlled trial.

Abstract

e24080 Background: Persons with advanced cancer are often referred to palliative care in the late stages of their disease. This trial aimed to evaluate the impact of palliative care consultation based on locally developed referral criteria, compared to usual care among patients with metastatic hormone-positive breast cancer. Methods: This nonrandomized controlled trial used a nonequivalent pre–post control-group design. A total of 107 women with stage IV hormone-positive, HER2-negative breast cancer were included at the Outpatient Breast Cancer Department of University Hospital Centre Zagreb, Croatia. The intervention consisted of consultation with a hospital supportive and palliative care team guided by locally developed referral criteria, while the control group received usual care. Symptom burden was assessed using the Edmonton Symptom Assessment System–revised (ESAS-r). Quality of life using was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative (EORTC QLQ-C15-PAL). Assessments were conducted at three time points in both the intervention and control groups. Results: At baseline, the intervention group (N = 52) reported higher symptom burden (Mann–Whitney U = 1097; p = 0.04) and lower quality of life (Mann–Whitney U = 884; p < 0.001) compared with controls (N = 55). Similar differences were observed at 3 months. At 6 months, no significant differences were found between the intervention and control groups in symptom burden (Mann–Whitney U = 1271; p = 0.23) or quality of life (Mann–Whitney U = 1174; p = 0.11). Within-group analyses showed no significant change in symptom burden over six months in either group. Quality of life declined in the intervention group between baseline and 6 months (Wilcoxon signed-rank test = −1.960; p = 0.050), while no significant change was observed in the control group. Conclusions: This study indicates that patients referred to palliative care based on locally developed criteria had significantly higher symptom burden and lower quality of life at baseline, reflecting greater clinical complexity. Over six months, symptom burden remained stable in both groups, and between-group differences were no longer observed. These findings suggest that referral criteria successfully identified patients with greater needs and that early palliative care integration was associated with symptom stability over time, despite poorer baseline status. Clinical trial information: https://osf.io/vp5jr/overview .