The current treatment approach for patients in palliative care (PC) requires a health model based on shared and individualised care, according to the degree of complexity encountered. The aims of this study were to describe the levels of complexity that may be present, to determine their most prevalent elements and to identify factors that may be related to palliative complexity in advanced-stage cancer patients. An observational retrospective study was performed of patients attended to at the Cudeca Hospice. Socio-demographic and clinical data were compiled, together with information on the patients’ functional and performance status (according to the Palliative Performance Scale (PPS)). The level of complexity was determined by the Diagnostic Instrument of Complexity in Palliative Care (IDC-Pal©) and classified as highly complex, complex or non-complex. The impact of the independent variables on PC complexity was assessed by multinomial logistic regression analysis. Of the 501 patients studied, 44.8% presented a situation classed as highly complex and another 44% were considered complex. The highly complex items most frequently observed were the absence or insufficiency of family support and/or caregivers (24.3%) and the presence of difficult-to-control symptoms (17.3%). The complex item most frequently observed was an abrupt change in the level of functional autonomy (47.6%). The main factor related to the presence of high vs. non-complexity was that of performance status (odds ratio (OR) = 10.68, 95% confidence interval (CI) = 2.81–40.52, for PPS values < 40%). However, age was inversely related to high complexity. This study confirms the high level of complexity present in patients referred to a PC centre. Determining the factors related to this complexity could help physicians identify situations calling for timely referral for specialised PC, such as a low PPS score.

Background: Early palliative care (EPC) in patients with advanced cancer is associated with better quality of life and fewer cancer-related symptoms during the dying process and improved overall survival (OS). Patients with small cell lung cancer (SCLC) have a biologically aggressive disease, so early inclusion may be relevant to modify clinical practice guidelines. Methods:We performed a retrospective cohort study of patients with SCLC diagnosed between 2009 and 2019. The primary outcome of the study was to correlate the EPC with quality indicators (QIs) at the end of life. EPC was considered if they were referred within 12 weeks after diagnosis. Quality indicators (QIs) for end-of-life cancer care that we used were defined as a six-point scale: home or hospice death, received opioids <7 days before death, not an intensive care unit admission, not a prolonged inpatient hospital admission (>14 days), not >1 emergency room visits, all in the last month of life, and no chemotherapy within 2 weeks before death. Overall survival (OS) was also assessed.Results: Of 101 SCLC, 69.3% were male and 31.7% were female. The median age was 65 years (SD 9,013). A EPC was performed in 24.5% of the sample. There were no differences in clinical characteristics between both groups except for stage at diagnosis, extended disease, 92% in EPC vs 68.4% in non-EPC, p¼0.038, and type of chemotherapy, carboplatin, 84% in EPC vs 57.9% in non-EI, p:0.034. The primary outcome EPC was associated with lower score in QIs at end of life (1.20 vs 1.87, p¼0.018). These differences remained when adjusting for stage in the multivariate model. Patients with EPC used more morphine at the end of life (76% vs 50%, p¼0.041) and had fewer visits to the emergency department (28% vs 55.3%, p:0.033). However, no differences were observed between prolonged admissions, chemotherapy received in the last 14 days before death and place of death. OS was 5.16 months (95% CI, 3.41-6.90) in EPC vs 9.01 months (95% CI, 7.25-10.77) in non-EPC, p¼0.007.Conclusions: EPC is related to less therapeutic aggressiveness at the end of life. Higher rate of extended disease could be related to worse prognosis and survival. SCLC should be referred to EPC to maximize the full benefits.Legal entity responsible for the study: The authors.