Referred not deferred.

Generating solid data is only the first step to impacting clinical practice. An arguably more important step is widespread adoption of a proven intervention. Here is what you might call phase 4 data assessing the real world impact of recently-generated high level evidence of myriad benefits with early referrals to outpatient palliative care, defined here as >12 months prior to death, for patients with advanced cancer. Two cohorts of patients receiving cancer care at Princess Margaret in Toronto were retrospectively defined as pre-evidence (n=337 in 2006) and post-evidence (n=417 in 2015). Fortunately, late referrals, defined as <6 months from death, decreased from 69% to 45% while early referrals increased from 13% to 31%. Impressively, this translated to a doubling of median time from referral to death from 3.5 to 7 months. TBL: Randomized evidence has resulted in cancer patients having access to palliative care for twice as long. | Hausner, Oncologist 2020