Missed opportunities: delayed in-hospital palliative care consultations in patients with non-metastatic cancers.

BACKGROUND: Cancer is a leading cause of death, often accompanied by significant symptom burden. Palliative care (PC) improves quality of life, clarifies treatment goals, and prevents unnecessary interventions at the end of life. While metastatic disease is considered incurable and routinely leads to PC involvement, the need for PC in patients with non-metastatic cancer is often less clear. This study investigated whether metastatic status affects timing of in-hospital PC consultation and hospitalization length in patients with advanced cancer. METHODS: We retrospectively analyzed hospitalized patients with cancer who received PC consultations between 2016-2022. Outcomes included time from admission to PC consultation, length of hospitalization, in-hospital mortality, and overall survival, analyzed using Kaplan-Meier estimates and Cox regression models. RESULTS: Among 741 inpatients with cancer, 52.1% had metastatic disease. Patients with non-metastatic cancer received PC involvement later after admission than those with metastatic cancer (median: 9 [95% CI: 7-11] days vs. 7 [95% CI: 6-8] days; p = 0.004), and were less likely transferred to the in-hospital PC unit (24.6% vs. 18.0%, p = 0.03). Early PC (within 72 h) was numerically less frequent in non-metastatic disease (16.9% vs. 22.5%; p = 0.055), and associated with shorter hospital stays (HR: 0.966 [0.961-0.971]; p < 0.001), independent of prevalent metastases (HR: 1.14 [0.99-1.33]; p = 0.08). CONCLUSIONS: Inpatients with non-metastatic cancer experienced later PC consultation after admission, while overall rates of early PC consultation remained low. Early PC after admission was associated with shorter hospital stays regardless of metastatic status, highlighting the need for early PC during hospitalization across all cancer stages.