Advanced stage of disease and systemic inflammation as factors associated with referral of patients with colorectal cancer to a palliative care unit

Abstract

To identify factors associated with referral to an exclusive palliative care unit (PCU) in patients with colorectal cancer (CRC). Methods: Retrospective cohort study with patients having CRC of both sexes treated at a hospital unit, aged 20 years. Data were extracted from the medical records of pretreatment patients between January 2008 and August 2014. The outcome was referral to the PCU within 5 years. Logistic regression analyses were performed to assess whether sociodemographic, clinical, nutritional, and biochemistry data were associated to referral, generating odds ratios (OR), and 95% confidence intervals (CI). Results: Four hundred fifteen patients were evaluated. The Patient-Generated Subjective Global Assessment demonstrated a prevalence of malnutrition of 57.3%. One hundred one (24.3%) patients were referred to the PCU after 16.3 months (interquartile range: 7.2-33.5). These patients were more likely to be at an advanced stage of the disease and have malnutrition and exacerbated systemic inflammation. Tumor stage III and IV (OR: 2.05; 95% CI: 1.12-3.76) and neutrophil-to lymphocyte ratio (NLR) 3 (OR: 1.89; 95% CI: 1.12-3.17) were predictors of an increased chance of referral to the PCU. Conclusion: Advanced disease stage and NLR were associated with referral of patients with CCR to a PCU.