From Inpatient Care to Palliative Care: Socio-demographic Characterization and Waiting Times of Referred Oncology Patients

Abstract Introduction: Timely access to specialized palliative care significantly improves quality of life and symptom control for oncology patients. This study aimed to characterize socio-demographic profiles, evaluate waiting times for referral and admission, and identify barriers to efficient integration of patients referred from the inpatient oncology unit to specialized palliative care units. Methods: We conducted a retrospective observational study including all oncology patients admitted to the Medical Oncology inpatient unit at Instituto Português de Oncologia de Lisboa Francisco Gentil from January 2022 to June 2024 who were referred to palliative care units. Data collected included socio-demographic variables, primary tumour types, waiting times from palliative care unit referral to admission or death, length of stay post-admission to a palliative care unit, and involvement of the local hospital palliative care team. Statistical analyses included descriptive statistics, Kaplan-Meier survival analysis, and comparative subgroup analyses. Results: Of 3177 hospitalised oncology patients, 208 (6.5%) were referred to specialized palliative care. Referrals were predominantly females (64.9%) and the median age was 70 years (IQR: 62–77.8). The most common diagnosis were head and neck (21.6%), breast (17.8%), digestive (17.3%), and gynecological (16.3%) cancers. Only 37% of referred patients were admitted to palliative care units, while 63% died before admission. Median waiting time was 29.5 days (IQR: 20.3–40.8) for those admitted and 34 days (IQR: 20–54) for those who died without being admitted. Median length of stay post-admission to a palliative care unit until death was 21.5 days (IQR: 9.8–40.3). No statistically significant differences were observed in waiting times based on age or sex. However, referral-to-outcome intervals varied significantly by tumour type, with shorter delays for patients with skin cancer and longer delays for those with gynecological cancers and sarcomas (p < 0.05). Discussion: Significant delays in accessing specialized palliative care persist, influenced by structural barriers, patient and family decision-making, geographical factors, and limited availability. The interruption of a transitional support protocol, which previously facilitated coordination between hospital discharge and formal admission to palliative care units, contributed to increased waiting times. Such inefficiencies carry substantial clinical and socioeconomic consequences, emphasizing the urgency of addressing these barriers through improved policy, structured protocols, and early intervention strategies. Conclusion: Efficient integration of oncology patients into palliative care units remains challenging. Enhancing referral processes, renewing intermediate care agreements, and promoting patient and family education are crucial to mitigate delays and optimize patient outcomes.