Towards a better integration of palliative care in oncology? A multicentric cross-sectional study

Towards a better integration of palliative care in oncology? 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A multicentric cross-sectional study Marine Sahut, Carole Bouleuc, Pascale Vinant, Ingrid Joffin, Bruno Vincent, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7021025/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Palliative care was slow to be offered to patients with metastasic cancer. For 15 years, international recommendations and government programs have supported the early integration of palliative care into oncology care but the impact on clinical practice has not been evaluated. We assessed the frequency and timing of palliative care referral, and the sociodemographic and clinical factors associated with this referral. Methods We conducted an observational, multicentric, cross-sectional study concerning inpatients and outpatients with metastatic cancer. The study assessed palliative care team involvement, quality of life (EORTC-QLQC30), supportive care needs (SCNS-SF34), social vulnerability (EPICES) and one-year survival. Results 355 patients with solid incurable metastatic cancer were included. 37.5% of them had met a palliative care team, within a median time of 6.7 months after the diagnosis of first metastasis, and 4.7 months before death. Patients referred to palliative care teams were found to have higher levels of social vulnerability (49.6%, p = 0.011); poorer performance status (p < 0.0001); greater prevalence of symptoms and worse physical, emotional, cognitive, and social functionning scores (p < 0.05). They also had more psychological, physical and daily living and information needs (p < 0.05). In multivariate analysis, only social vulnerability was associated with referral to palliative care teams. One-year survival did not differ between patients with and without palliative care team involvement at the point of inclusion. Conclusion Early acess to palliative care is improving, especially for the patients with greater supportive care needs. Further studies are needed to identify the best criteria for palliative care team integration for metastatic cancer patients. Trial registration : This trial was registered in ClinicalTrial.gov PRS under the ID APHP210724. Palliative care Neoplasms Public health Needs assessment Observational study BACKGROUND Cancer is a leading cause of death worldwide. Early palliative care improves the quality of life of patients with metastatic cancer and their caregivers, and is recommended from the diagnosis of metastatic cancer, integrated into oncologic care. It has been showed that palliative care is often slow to be offered.[ 1 ] Successive reports on the development of palliative care show the discrepancy between the needs and wishes of the population and the resources available.[ 2 ] The successive studies carried out in France showed a very partial and late palliative care referral for patients with cancer. In 2010, a retrospective study on deceased patients with advanced cancer showed that only 53% had met a palliative care team, with a median time of 41 days before death.[ 3 ] A few years later in 2014, a prospective study found a median time of 31 days between the first palliative care consultation and death for cancer patients.[ 4 ] In 2020, a retrospective study on patients who died from metastatic breast cancer showed that 65% had met a palliative care team at a median time of 39 days before death.[ 5 ] In most Southern European countries and in particular in France, the adoption of palliative care has been slower than in the United Kingdom and Northern America.[ 6 ] However, for the past 20 years, international scientific recommandations and successive French government programs have been implemented to address the managemement of symptoms caused by cancer and develop the early integration of palliative care in oncologic care.[ 7 , 8 ] Their impact have not been evaluated yet. We conducted an observational, multicentric, cross-sectional study in 2022 in France involving inpatients and outpatients with incurable metastatic cancer. We sought to obtain up-to-date data on the frequency and timing of palliative care involvement, as well as the factors associated with referral to palliative care teams in France. We aim to determine whether early palliative care practices are progressing in hospital oncology departments in France. METHODS Trial design and study population We conducted an observational, cross-sectional, multicentric study in eight hospitals in the Île-de-France region (Paris and its suburbs). The survival of patients was assessed one year later. The investigators were members of the palliative care team and included patients followed by the oncologists of their hospital. If the hospital had multiple oncology departments, the investigators selected one department for the inclusion of patients in the study. The patients were included from oncology consultations, oncology day hospitals, and oncology hospitalization departments. The study was conducted from June 2022 to May 2023. In each study center, patients were included during a period of three months, on days dedicated to the study in each sector. On those days, patients were systematically included in order of arrival, until saturation of the investigators’ possibilities. All patients over 18 years old with solid metastatic cancer treated in the investigating center were eligible. The exclusion criteria were the lack of affiliation to a social security system, visual/hearing impairment or aphasia, no understanding of French, inability to give informed non-opposition as judged by the investigators, or a diagnosis of testicular cancer or ovarian choriocarcinoma (curable cancers). Clinical Data and Patients related outcome measures Sociodemographic data were collected using a self or interviewer-administered questionnaire: age, marital status, level of education, and EPICES score (a social vulnerability evaluation score validated in French).[ 9 ] Characteristics of the disease were extracted from patients’ medical records regarding primary tumor, date of diagnosis and of first metastasis, cancer treatments and performance status. The clinical data were explored using patient-reported outcome tools: the French versions of the European Organisation for Research and Treatment of Cancer- QLQC30 questionnaire (EORTC-QLQC30) [ 10 , 11 ] and the Supportive Care Need Survey short form (SNCS-SF34).[ 12 ] The EORTC QLQC30 assesses quality of life and consists of five multi-item functional scales (physical; role functioning or the ability to work and engage in leisure activities; emotional; cognitive; and social and family life), a global health status/quality of life scale, and nine symptom scales. The SCNS SF34 measures patients’ own perception of their need for help in dealing with cancer across five domains: psychological, health system and information (information on cancer, organization of care and healthcare environment), physical and daily living (physical symptoms and daily activities), patient care and support (choice of hospital and cancer specialist, support from the hospital staff), and sexuality needs. The existence of at least one palliative care consultation in the past three months and, if so, the date of the first evaluation by the palliative care team were sought in the medical records, as well as any recent unscheduled care (emergency department visits or hospitalization related to a cancer complication in the past three months). Finally, one-year survival data were obtained by consulting the national death registry. Statistics Descriptive variables were labelled by their number and percentage for categorical variables, and by their mean and standard deviation for continuous variables. The number of missing data was specified for each variable, and the percentages were calculated based on the available data. The responses to the EORTC QLQ-C30 and SCNS-SF34 were converted into 0–100 scales according to the scoring manuals, and mean scores were calculated.[ 13 ] Patients referred to a palliative care team were compared with those not referred in terms of socio-demographic and clinical characteristics as well as heath needs, using a Chi2 or Fisher test for categorical parameters and a Student’s or Wilcoxon test for continuous parameters. The factors associated with palliative care team involvement were assessed using multivariate analysis with a logistic regression model. The model included all variables with a p-value < 0.1 in the univariate analysis, except for "palliative care only" as a recent treatment of cancer (only 6 patients) and the type of cancer (not representative). Multiple imputations combined with a stepwise model based on the Wald statistic were applied. The number of imputed datasets was set to 50. For each imputed dataset, palliative care team involvement was analyzed, and a set of variables was retained. The final model included all variables selected in at least 50% of cases. Survival differences between the two groups (with and without palliative care team involvement) were analyzed using Kaplan-Meier's plots and log-rank tests. Compliance with Ethical Standards This trial was registered on ClinicalTrial.gov PRS under the ID APHP210724. None of the investigators had conflicts of interest to disclose. The study was conducted in accordance with the World Medical Association Declaration of Helsinki. In compliance with French law governing non-interventional studies, each patient and caregiver received oral and written information, and their non-opposition was documented by the investigator. This study was approved by the French National Commission for Data Protection and Freedom on February 25, 2022 (Northwest 1 People Protection Committee, SI: 21.03698.000038). RESULTS Study population characteristics The inclusion criteria were met by 696 patients; however, 279 were not included due to saturation of the investigators' inclusion possibilities, and 56 refused to participate. The study sample included 361 patients; however, data concerning palliative care involvement were missing for six of these patients, leaving 355 patients available for the initial evaluation. Subsequently, one patient with no palliative care involvement withdrew consent during the follow-up period, reducing the sample size for the survival analysis to 354 patients. More than a quarter of patients included in the study (25.9%) were recruited from hospitalization settings, 47.9% from day-hospital, and 26.8% from consultation, indicating that 74.7% of patients were recruited from ambulatory settings. The mean age of the study population was 66 years, ) 52.4% were women. A majority of patients lived with a spouse or partner (64.8%), while 24.7% lived alone. Social vulnerability was observed in 40.3% of patients. They presented with cancer of various origins. Performance status < 2 applied to 67.9% of patients. Furthermore, 88.2% of patients received systemic treatment within the last 30 days, with 59% undergoing their first or second line of treatment (table 1). Table 1- Sociodemographic characteristics of patients and characteristics of the cancer with and without palliative care involvement Total No palliative care Palliative care p-value Place of inclusion N 355 222 133 0.001 Consultation (%) 95 (26.8) 70 (31.5) 25 (18.8) Day hospital (%) 170 (47.9) 109 (49.1) 61 (45.9) Hospitalization department (%) 90 (25.4) 43 (19.4) 47 (35.3) Age mean(std) 65.7(12.6) 66.6(12.1) 64.3(13.3) 0.167* med[IQ] 67.0[58.0;75.0] 68.0[59.0;75.0] 66.0[54.0;74.0] min-max 24.0-93.0 27.0-93.0 24.0-88.0 Sex Men (%) 169 (47.6) 110 (49.5) 59 (44.4) 0.402 Women (%) 186 (52.4) 112 (50.5) 74 (55.6) Matrimonial status Married or PACS (%) 197 (58.8) 128 (62.4) 69 (53.1) 0.268 Divorced or separated (%) 57 (17.0) 30 (14.6) 27 (20.8) Widower (%) 27 (8.1) 14 (6.8) 13 (10.0) Never married (%) 54 (16.1) 33 (16.1) 21 (16.2) Missing 20 17 3 Living conditions Live with a spouse or partner (%) 215 (64.8) 138 (67.6) 77 (60.2) 0.378 Live with another person (%) 35 (10.5) 20 (9.8) 15 (11.7) Live alone (%) 82 (24.7) 46 (22.5) 36 (28.1) Missing 23 18 5 Level of study Level 1-2-3 (%) 45 (13.9) 29 (14.9) 16 (12.4) 0.149 Level 4 (%) 121 (37.3) 63 (32.3) 58 (45.0) Level 5-6 (%) 81 (25.0) 53 (27.2) 28 (21.7) Level 7-8 (%) 77 (23.8) 50 (25.6) 27 (20.9) Missing 31 27 4 EPICES (social vulnerability) Social vulnerability (%) 122 (40.3) 63 (34.2) 59 (49.6) 0.011 No social vulnerability (%) 181 (59.7) 121 (65.8) 60 (50.4) Missing 52 38 14 Performance status 0 (%) 89 (27.7) 68 (34.2) 21 (17.2) <0.0001 1 (%) 129 (40.2) 83 (41.7) 46 (37.7) 2 (%) 80 (24.9) 38 (19.1) 42 (34.4) 3 (%) 20 (6.2) 8 (4.0) 12 (9.8) 4 (%) 3 (0.9) 2 (1.0) 1 (0.8) Missing 34 23 11 Type of cancer Gynecological (%) 26 (7.3) 23 (10.4) 3 (2.3) <0.0001 Liver and biliary tracts (%) 3 (0.8) 3 (1.4) 0 (0.0) ENT (%) 7 (2.0) 5 (2.3) 2 (1.5) Pancreas (%) 44 (12.4) 30 (13.5) 14 (10.5) Skin (%) 42 (11.8) 21 (9.5) 21 (15.8) Lung (%) 65 (18.3) 49 (22.1) 16 (12.0) Prostate (%) 19 (5.4) 15 (6.8) 4 (3.0) Kidney (%) 7 (2.0) 4 (1.8) 3 (2.3) Breast (%) 38 (10.7) 23 (10.4) 15 (11.3) Digestive tract (%) 64 (18.0) 25 (11.3) 39 (29.3) Other (%) 40 (11.3) 24 (10.8) 16 (12.0) Time between diagnosis and the 1st metastasis (months) mean(std) 14.6(34.8) 14.2(30.6) 15.3(41.1) 0.492 med[IQ] 0.6[0.0;14.1] 0.5[0.0;13.0] 0.6[0.0;16.1] min-max 0.0-345.4 0.0-170.7 0.0-345.4 Missing 101 62 39 Treatment received in the past Surgery (%) 197 (55.5) 122 (55.0) 75 (56.4) 0.878 Radiotherapy (%) 158 (44.5) 99 (44.6) 59 (44.4) >0.99 Systemic treatments (%) 344 (96.9) 214 (96.4) 130 (97.7) 0.547 Simple monitoring (%) 6 (1.7) 4 (1.8) 2 (1.5) >0.99 Palliative care only (%) 1 (0.3) 1 (0.5) 0 (0.0) >0.99 Treatment received in the last 30 days Surgery (%) 4 (1.1) 3 (1.4) 1 (0.8) >0.99 Radiotherapy (%) 21 (5.9) 12 (5.4) 9 (6.8) 0.769 Systemic treatments (%) 313 (88.2) 193 (86.9) 120 (90.2) 0.448 Simple monitoring (%) 32 (9.0) 24 (10.8) 8 (6.0) 0.182 Palliative care only (%) 6 (1.7) 1 (0.5) 5 (3.8) 0.029 Number of previous treatment lines 0 ou 1 Line (%) 203 (59.0) 131 (61.2) 72 (55.4) 2 Lines (%) 66 (19.2) 39 (18.2) 27 (20.8) 3 Lines (%) 36 (10.5) 24 (11.2) 12 (9.2) More of 4 lines (%) 39 (11.3) 20 (9.3) 19 (14.6) Missing 11 8 3 Type of systemic treatment (in the last 30 days) Chemotherapy (%) 199 (63.6) 115 (59.6) 84 (70.0) 0.082 Immunotherapy (%) 120 (38.3) 79 (40.9) 41 (34.2) 0.281 Targeted therapy (%) 27 (8.6) 13 (6.7) 14 (11.7) 0.192 Hormonotherapy (%) 21 (6.7) 17 (8.8) 4 (3.3) 0.099 Frequency, place and timing of palliative care team involvment 37.5% of patient had met a palliative care team within the past 3 months, at home and/or in a hospital. Of the 27 patients who had met a home-based palliative care team in the past 3 months, 17 also met a hospital-based team. The median time between the first metastasis diagnosis and the first palliative care consultation was 6.7 months (IQ 4.4 ;35.9) (table 2). Table 2- Frequency, place and timing of palliative care involvment Total Consultation with a palliative care team in the last 3 months (hospital-based and/or at home) Yes (%) 133 (37.5) Consultation with an hospital-based palliative care team in the last 3 months Yes (%) 123 (34.6) Consultation with a home-based palliative care team in the last 3 months Yes (%) 27 (7.8) Missing 11 Time between diagnosis and 1st evaluation by a palliative care team (months) mean(std) 31.6(52.3) med[IQ] 16.6[4.4;35.9] min-max 0.0-346.1 Missing 269 Time between the 1st metastasis and the 1st evaluation by a palliative care team (months) mean(std) 16.2(36.2) med[IQ] 6.7[1.4;20.5] min-max -55.1-261.9 Missing 265 Time between the 1st evaluation by a palliative care team and death (months) N 33 Mean (std) 7.8(7.6) Med [IQ] 4.7[3.6;8.2] Min-max 1.2-33.0 Factors associated with palliative care team involvement Univariate analysis revealed significant associations between palliative care team involvement and sociodemographic factors: the place of inclusion (hospitalization department or day-hospitalization versus consultation), social vulnerability, and type of cancer (p<0.05). Cancer treatment dit not differ between patients who met the palliative care team and the others (table 1). Patients who met a palliative care team exhibited poorer performance status (p<0.0001, table 1) and more severe conditions and symptoms for all items of EORTC-QLQC30 (p<0.05) except for dyspnea and insomnia (table 3). The SCNS-SF34 demonstrated that patients followed by a palliative care team had more psychological needs (p=0.012), health system and information needs (p=0.015) and physical and daily living needs (p=0.001) (table 4). Patient receiving integrated palliative care exhibited a higher frequency of recent hospitalization due to their cancer (52.4% versus 29.6%, p<0.0001), yet the frequency of recent emergency department visits (p=0.332) and hospitalization in intensive care unit (11 patients in both groups, p=0.378) remained comparable (table 5). In the multivariate analysis, social vulnerability was independently associated with palliative care, with an odds ratio (OR) of 1.70 ( CI 1.04-2.77, p=0.035) . Table 3- Results of the EORCT QLQ-C30 with and without palliative care team involvment Total No palliative care Palliative care p-value Physical functioning mean(std) 69(27.8) 72.8(26.6) 63(28.8) 0.001 med[IQ] 75.0[53.3;93.3] 80.0[60.0;93.3] 66.7[41.2;86.7] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 24 19 5 Role functioning mean(std) 68(34.7) 73.3(32.9) 59.4(35.9) <0.0001 med[IQ] 83.3[50.0;100.0] 83.3[66.7;100.0] 66.7[33.3;100.0] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 24 18 6 Emotional functioning mean(std) 71.5(25.7) 74.3(24.8) 67.2(26.5) 0.007 med[IQ] 75.0[58.3;91.7] 83.3[60.4;91.7] 75.0[50.0;83.3] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 25 20 5 Cognitive functioning mean(std) 80.2(22.6) 82.4(22.8) 76.6(21.8) 0.002 med[IQ] 83.3[66.7;100.0] 83.3[66.7;100.0] 83.3[66.7;100.0] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 24 19 5 Social functioning mean(std) 64.1(32.6) 68.6(31.4) 56.9(33.3) 0.001 med[IQ] 66.7[33.3;100.0] 83.3[50.0;100.0] 50.0[33.3; 83.3] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 24 19 5 Fatigue mean(std) 49.1(28.8) 44.3(28.4) 56.8(28) <0.0001 med[IQ] 44.4[33.3;66.7] 33.3[22.2;66.7] 55.6[33.3;77.8] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 23 18 5 Nausea and vomiting mean(std) 13.7(23.1) 11.1(21.3) 18(25.2) 0.002 med[IQ] 0.0[0.0;16.7] 0.0[0.0;16.7] 8.3[0.0;33.3] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 24 19 5 Pain mean(std) 32.2(31.1) 25.8(29.1) 42.3(31.5) <0.0001 med[IQ] 33.3[0.0;50.0] 16.7[ 0.0;50.0] 33.3[16.7;66.7] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 24 19 5 Dyspnea mean(std) 28(30.5) 27.7(29.9) 28.6(31.5) 0.904 med[IQ] 33.3[0.0;33.3] 33.3[0.0;33.3] 33.3[0.0;33.3] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 27 22 5 Insomnia mean(std) 35.9(35) 34.8(34.4) 37.5(36) 0.555 med[IQ] 33.3[0.0;66.7] 33.3[0.0;66.7] 33.3[0.0;66.7] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 25 20 5 Appetite loss mean(std) 33.5(37.5) 27.3(34.8) 43.2(39.5) <0.0001 med[IQ] 33.3[0.0;66.7] 0.0[0.0;33.3] 33.3[0.0;66.7] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 28 23 5 Constipation mean(std) 23.2(33.5) 19.2(30.5) 29.7(36.9) 0.009 med[IQ] 0.0[0.0;33.3] 0.0[0.0;33.3] 0.0[0.0;66.7] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 25 19 6 Diarrhoea mean(std) 18.6(29.5) 15.4(27) 23.7(32.4) 0.018 med[IQ] 0.0[0.0;33.3] 0.0[0.0;33.3] 0.0[0.0;33.3] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 24 19 5 Financial difficulties mean(std) 11.5(25.3) 9.1(22.3) 15.3(29.1) 0.032 med[IQ] 0.0[0.0;0.0] 0.0[0.0; 0.0] 0.0[0.0;33.3] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 27 20 7 Global health status/QoL mean(std) 56.4(24.2) 61.5(23.3) 48.4(23.3) <0.0001 med[IQ] 58.3[41.7;75.0] 66.7[50.0;83.3] 50.0[33.3;66.7] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 26 20 6 EORTC-QLQ-C30 mean(std) 70.8(18.9) 74.4(17.9) 65.2(19.1) <0.0001 med[IQ] 73.5[58.9;85.5] 78.1[63.4;88.2] 66.5[49.5;81.7] min-max 18.3-100.0 18.3-100.0 25.1- 98.3 Missing 36 29 7 Table 4- Results of the SCNS-SF34 with and without palliative care team involvement Total No palliative care Palliative care p-value Psychological needs mean(std) 38(27) 35.1(26.8) 42.5(26.7) 0.012 med[IQ] 35.0[15.0;58.8] 30.6[12.5;52.5] 40.0[20.0;64.7] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 28 21 7 Health system and information needs mean(std) 32(20.8) 29.5(19.1) 36(22.7) 0.015 med[IQ] 27.3[20.5;40.9] 25.0[18.2;38.6] 29.5[23.3;52.3] min-max 0.0-100.0 0.0- 97.7 0.0-100.0 Missing 34 27 7 Physical and daily living needs mean(std) 33.7(25.9) 30.6(26) 38.9(25.2) 0.001 med[IQ] 25.0[15.0;50.0] 25.0[10.0;45.0] 35.0[20.0;60.0] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 29 20 9 Patient care and support needs mean(std) 26.5(19) 24.9(18) 29(20.2) 0.071 med[IQ] 25.0[15.0;30.0] 25.0[15.0;30.0] 25.0[20.0;35.0] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 33 27 6 Sexuality needs mean(std) 24.3(29.8) 22.9(28.8) 26.6(31.4) 0.382 med[IQ] 8.3[0.0;41.7] 8.3[0.0;41.7] 16.7[0.0;50.0] min-max 0.0-100.0 0.0-100.0 0.0-100.0 Missing 45 31 14 Table 5- Unscheduled care during the past 90 days with and without palliative care team involvement Unscheduled care Total No palliative care Palliative care p-value Cancer-related emergency department consultation in the last 90 days Yes (%) 87 (26.8) 49 (24.6) 38 (30.2) 0.332 Missing 30 23 7 Cancer-complication related hospitalization in the last 90 days Yes (%) 125 (38.5) 59 (29.6) 66 (52.4) <0.0001 Missing 30 23 7 Cancer complication related hospitalization in intensive care unit in the last 90 days Yes (%) 22 (6.8) 11 (5.6) 11 (8.7) 0.378 Missing 31 24 7 One year survival 82 patients were deceased one year after their inclusion: 37 (27.8%) from the group of patients who had already met a palliative care team before inclusion, and 45 (20.4%) from the other group. The survival between the two groups dit not differ significantly (p=0.083, figure 1, supplementary material). Among the deceased patients in the palliative care group, the date of first contact with the palliative care team was available for 33 individuals, and the median time between the first evaluation by a palliative care team and death was 4.7 months (table 1). DISCUSSION One third of the patients in our study met a palliative care team, with a median of 6.7 months from first metastasis diagnosis, and 4.7 months before death. Although generally in good condition, patients who met a palliative care team had poorer performance status, reported more symptoms and supportive care needs, and were more frequently hospitalized for cancer complications in univariate analysis. Social vulnerability remained associated with the intervention of a palliative care team in multivariate anlaysis. Among patients with metastatic cancer who had met a palliative care team, a large proportion of them were undergoing systemic treatment, and almost 70% had a good performance status (<2), meaning it is now possible in France to get out of the curative versus palliative care dichotomy. Considering the new oncologic treatments offering reduced toxicities and prolonged survival, the growing incidence of cancer and the scarcity of palliative care resources, the current medical literature and professional recommendations have shifted from a systematic time-based palliative care referral towards need-based interventions targeting the right patients at the right time.[14–17]. In our study, patients referred to palliative care teams had more symptoms and supportive care needs. Their disease had more functional and social impact on their daily life, whereas the number of previous lines of systemic treatment did not differ between the two groups. Thus, patients referred to palliative care seem to have been selected on need-based criteria. Nevertheless, no systematic strategy for screening supportive care needs or referring patients is currently recommended in France, nor is it implemented in the centers participating in the study. Therefore, it is impossible to determine if the patients’ needs were correctly detected or if the patients were referred only based on the appreciation or habit of the oncologist, leading to potential inconsistencies or delayed referral. Given the significant supportive care needs of this population of patients,[18] a need-based approach should be associated with a systematic screening of symptoms and healthcare needs to guarantee equal and appropriate access to palliative care.[16] Other types of studies have already assessed the implementation of palliative care teams for advanced cancer patients. Most of them are retrospective series of deceased patients [3,5,19] or retrospective cohorts [20,21]. French studies showed that 40 to 65% of deceased patients met a palliative care team before death, with a median time between the first palliative care consultation and death of 24 days to 2.3 months, depending on the centers and the type of cancer. In a prospective study conducted in 2014 in the Ile de France region, the median time between the first consultation with a palliative care team and death was 31 days for cancer patients. [4]. In an Italian study of 229 deceased patients with metastatic lung cancer, 43% met a palliative care team at a median time of 20 days before death.[22] In Ireland, a retrospective series of 102 deceased patients found 92% of palliative care referrals occuring 64 days before death.[23] In 2016, Hui et al. evaluated the « ESMO Designated Centers of Integrated Oncology and Palliative Care » (ESMO-DCs), 70% of patients with advanced cancer had a palliative care consultation before death at a median time of 90 days for outpatients and 21 days for inpatients. Early referral to palliative care (>6 months before death) occurred only in 24 (20%) of ESMO-DCs.[24] Other institutions are able to provide earlier palliative care as reported in a retrospective study on 200 patients reffered to the Supportive Care Outpatient Clinic at the University of Texas MD Anderson Cancer Center, with a median survival of 14 months following first attendance at the palliative care outpatient unit.[25] The cross-sectional design of our study allows us to consider the population of patients with metastatic cancer as a whole, from the diagnosis of incurability to death. Survival didn’t differ significantly between the two groups, and only 27.8% of patients who met a palliative care team died in the year following the inclusion. Thus, our study enables us to individualize patients who benefit from early palliative care referral more effectively than series focusing solely on deceased patients. This explains the low frequency of recent palliative care team consultations in our population compared to retrospective studies, and the longer interval between the first palliative care consultation and death. Our results also emphasize patients’ needs regarding information about the healthcare system and cancer care. Although patients with advanced cancer want to be involved in discussions regarding their care and the prognosis of their disease,[26] few of them have these discussions with their oncologist.[27] In previous studies, younger age, being more educated, believing they have less time to live, having strong faith, and poor ability to perform daily activities were associated with more information needs.[18,26] We found that patients who met a palliative care team expressed more information needs in univariate analysis, but this result was not confirmed in multivariate analysis. This suggests that information needs may stem from the poorer clinical conditions of patients referred to palliative care teams. However, we cannot exclude that the need for information of more symptomatic or distressed patients may motivate oncologists to refer them to palliative care teams. It is important to determine what type of information is needed for each patient. The « Health system and information » section of the SCNS-SF34 includes questions that assess various requests for information such as oral or written information on the practical course of care and results of medical tests, explanations of the benefits and side effects of treatments, information on what can help them get better, need to find individual or group support, and finally to have the choice to follow or not an exam or a treatment. These varied information needs do not call for the same response: some are addressed to oncology teams or coordinating nurses, others could be a first step towards advanced care planning. The capacity and willingness of patients to engage in advanced care planning and to cope with the implications of their prognosis present complex challenges. This may be where palliative care teams could be most helpful. A tool like the Autonomy Preference Index could be particularly useful to understand what kind of prognostic information is desired and acceptable for each patient.[28] Our study raises several public health questions. We found that socially vulnerable patients, as identified by the EPICES score, were more often referred to palliative care teams. Studies in the United States reported reduced access to palliative care for socially deprived patients, due to cultural differences and financial barriers.[29] France provides universal social security coverage, ensuring free access to palliative care. Janah et al. found no impact of social deprivation on palliative care access in the French national health system database.[30] On the contrary, Frasca et al. reported lower referral to hospital palliative care teams for socially deprived patients in the Gironde regionparticularly those living in rural areas.[21] Our study took place in the urban area of Paris and its suburbs, which offer more palliative care access than other regions.[20,31] These divergent results raise questions about inequalities in acess to early palliative care across France. [31] Furthermore, we found that patients with metastatic cancer who met a palliative care team usually did so at the hospital. If a majority of cancer patients prefer to die in their own homes,[32] little is known about patients’ preferences regarding the place of early palliative care. Some authors report the feasibility and the challenges of home-based early palliative care for patients with cancer in other health systems. [33–35] In our study, only a few met a home palliative care team. One possible explanation could be the good general conditions of the included patients, who may not have wanted or needed home-care interventions. But we cannot exclude that this is the result of a lack of resources for home palliative care teams in these areas. Finally, patients referred to palliative care teams had more frequent recent hospitalization for cancer complication, with no increase in emergency room visits. Palliative care teams could improve care pathways by anticipating and coordinating care, thereby reducing unplanned hospitalizations. By detecting needs and anticipating potential complications, palliative care teams can improve the patient care trajectory from primary care to hospital settings and avoid unexpected or unnecessary care.[16]Thus, early palliative care in cancer could lead to healthcare cost savings.[36] More research is needed to determine the respective roles and coordination of hospital and home-based palliative care teams in the French health system, and the most efficient and cost-effective models of organization. Our study has several limitations. First, the distribution of cancers in our study is not representative of that in the general French population, with an overrepresentation of lung and colorectal cancers. The type of cancer could influence the palliative care referral since it has been shown that colorectal, prostate and breast cancer have less referral, unlike lung cancer, regardless of the cancer prognosis.[21] This suggests that the professional habits of oncologists may influence palliative care referrals. Secondly, the oncology departments in which the study was conducted were chosen by the palliative care team, and may have had more established palliative care integration practices than other departments. In addition, our study was conducted in the Île-de France region, which has better palliative care acess than many other regions in the country.[31] Thus,our study may have overestimated the overall level of palliative care integration in France. Third, we chose to estimate the median time between first referral to palliative care and death using the 1-year survival of patients who had already met a palliative care team by the day of inclusion. The study cannot determine if deceased patients in the other group had been seen by a palliative care team between inclusion and death, or whether the median duration of follow-up before death would have been longer had the cohort been followed for a longer period. Finally, we cannot determine from these results whether the palliative care referral needs of our study population were comprehensively addressed, nor whether the actual palliative care interventions were effective in improving patient outcomes. Despite these limitations, this study is one of the first cross-sectionnal study assessing palliative care referral. The study is particularly relevant due to its multicenter design, the inclusion of both outpatients and inpatients, and the study of the association between supportive care needs and palliative care referral for patients with metastatic cancer. CONCLUSION The integration of palliative care into oncologic care for patients with metastatic cancer is progressing in France, with earlier hospital-based referrals, targeting the more frail and symptomatic patients, and allowing better healthcare pathways between home and hospital. Ongoing efforts should be made to achieve earlier palliative care referral (>6 months before death). Research is ongoing to identify the need of metatastic cancer patients for referral to palliative care, and the modalities for an efficient and sustainable model of early palliative care involvement in oncologic care within the French health system. Declarations Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. This study was approved by a French ethics committee (Northwest 1 People Protection Committee). Non opposition was obtained from all individual participants included in the study, in accordance with the French law on non-interventional studies. Consent for publication: Not applicable. Availability of data and materials : Data are available upon reasonable request. The procedures carried out with the French data privacy authority (CNIL, Commission nationale de l'informatique et des libertés) and the European regulation (GDPR) do not provide for the transmission of the database, nor the information and consent documents signed by the patients. Consultation by the editorial board or interested researchers of individual participant data that underlie the results reported in the article after deidentification may nevertheless be considered, subject to prior determination of the terms and conditions of such consultation and in respect for compliance with the applicable regulations. For all inquiries, please contact the following : [email protected] Competing interests : The authors declare that they have no competing interests Funding: The sponsor was Assistance Publique – Hôpitaux de Paris (Délégation à la Recherche Clinique et à l’Innovation). The study was funded by the Fondation de France and the Ile-de-France regional health agency. Authors’ contribution: MSI, PV, CB, IJ, BV, MJ and MS contributed to the study conception and design. Material preparation and data collection were performed by MSI, PV, CB, IJ, BV, LS, AC, FB. Analysis were performed by MJ and MG. The first draft of the manuscript was written by MSI and MS and all authors commented on previous versions of the manuscript. LY provided English proofreading. All authors read and approved the final manuscript. Aknowledgments : We thank the Fondation de France and the Ile-de-France regional health agency for financing this study, the staff of the Clinical Research Unit AP-HP Paris Saclay Ouest involved in the project, and the Assistance Publique – Hôpitaux de Paris (Délégation à la Recherche Clinique et à l’Innovation) which was the promoter. References Jordan RI, Allsop MJ, ElMokhallalati Y, Jackson CE, Edwards HL, Chapman EJ, et al. Duration of palliative care before death in international routine practice: a systematic review and meta-analysis. BMC Med. 2020;18:368. https://doi.org/10.1186/s12916-020-01829-x . Aubry R. Etat des Lieux du Développement des soins palliatifs en France en 2010. Rapport à Mr le Président de la République et Mr le Premier Ministre. n.d.:66. Colombet I, Bouleuc C, Piolot A, Vilfaillot A, Jaulmes H, Voisin-Saltiel S, et al. Multicentre analysis of intensity of care at the end-of-life in patients with advanced cancer, combining health administrative data with hospital records: variations in practice call for routine quality evaluation. BMC Palliat Care. 2019;18:35. https://doi.org/10.1186/s12904-019-0419-4 . Vinant P, Joffin I, Serresse L, Grabar S, Jaulmes H, Daoud M, et al. Integration and activity of hospital-based palliative care consultation teams: the INSIGHT multicentric cohort study. BMC Palliat Care. 2017;16:36. https://doi.org/10.1186/s12904-017-0209-9 . Lucchi E, Berger F, Milder M, Commer J-M, Morin S, Capodano G, et al. Palliative Care Interventions and End-of-Life Care for Patients with Metastatic Breast Cancer: A Multicentre Analysis. Oncologist. 2024;29:e708–15. https://doi.org/10.1093/oncolo/oyae023 . Les soins palliatifs | Cour des comptes. 2023. https://www.ccomptes.fr/fr/publications/les-soins-palliatifs (accessed November 7, 2024). plan-fin. -de-vie-2022.pdf n.d. Les Plans cancer - Stratégie. de lutte contre les cancers en France n.d. https://www.e-cancer.fr/Institut-national-du-cancer/Strategie-de-lutte-contre-les-cancers-en-France/Les-Plans-cancer (accessed November 7, 2024). Sass C, Dupré C, Giordanella JP, Girard F, Guenot C, Labbe É et al. Le score Epices : un score individuel de précarité. Construction du score et mesure des relations avec des données de santé, dans une population de 197 389 personnes n.d. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76. https://doi.org/10.1093/jnci/85.5.365 . Kaasa S, Bjordal K, Aaronson N, Moum T, Wist E, Hagen S, et al. The EORTC core quality of life questionnaire (QLQ-C30): validity and reliability when analysed with patients treated with palliative radiotherapy. Eur J Cancer Oxf Engl 1990. 1995;31A:2260–3. https://doi.org/10.1016/0959-8049(95)00296-0 . Brédart A, Kop J-L, Griesser A-C, Zaman K, Panes-Ruedin B, Jeanneret W, et al. Validation of the 34-item Supportive Care Needs Survey and 8-item breast module French versions (SCNS-SF34-Fr and SCNS-BR8-Fr) in breast cancer patients. Eur J Cancer Care (Engl). 2012;21:450–9. https://doi.org/10.1111/j.1365-2354.2012.01356.x . Fayers P, Aaronson N, Bjordal K, Sullivan M. EORTC Study Group on Quality of Life. EORTC QLQ-C30 Scoring Manual 1995. Temel JS, Jackson VA, El-Jawahri A, Rinaldi SP, Petrillo LA, Kumar P, et al. Stepped Palliative Care for Patients With Advanced Lung Cancer: A Randomized Clinical Trial. JAMA. 2024;332:471. https://doi.org/10.1001/jama.2024.10398 . Hui D, Mori M, Watanabe SM, Caraceni A, Strasser F, Saarto T, et al. Referral criteria for outpatient specialty palliative cancer care: an international consensus. Lancet Oncol. 2016;17:e552–9. https://doi.org/10.1016/S1470-2045(16)30577-0 . Hui D, Hannon BL, Zimmermann C, Bruera E. Improving patient and caregiver outcomes in oncology: Team-based, timely, and targeted palliative care. CA Cancer J Clin. 2018;68:356–76. https://doi.org/10.3322/caac.21490 . Sanders JJ, Temin S, Ghoshal A, Alesi ER, Ali ZV, Chauhan C, et al. Palliative Care for Patients With Cancer: ASCO Guideline Update. J Clin Oncol. 2024;42:2336–57. https://doi.org/10.1200/JCO.24.00542 . Wang T, Molassiotis A, Chung BPM, Tan J-Y. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care. 2018;17:96. https://doi.org/10.1186/s12904-018-0346-9 . Martin A, Carton M, Thery L, Burnod A, Daniel C, Du Rusquec P, et al. Palliative care integration and end-of-life care intensity for patients with NSCLC. Lung Cancer Amst Neth. 2024;192:107800. https://doi.org/10.1016/j.lungcan.2024.107800 . Janah A, Gauthier R, Morin L, Bousquet L, Le Bihan-Benjamin PJ, Tuppin C. P, Access to palliative care for cancer patients between diagnosis and death: a national cohort study. Clin Epidemiol 2019;Volume 11:443–55. https://doi.org/10.2147/CLEP.S198499 Frasca M, Orazio S, Amadeo B, Sabathe C, Berteaud E, Galvin A, et al. Palliative care referral in cancer patients with regard to initial cancer prognosis: a population-based study. Public Health. 2021;195:24–31. https://doi.org/10.1016/j.puhe.2021.03.020 . Caraceni A, Lo Dico S, Zecca E, Brunelli C, Bracchi P, Mariani L, et al. Outpatient palliative care and thoracic medical oncology: Referral criteria and clinical care pathways. Lung Cancer Amst Neth. 2020;139:13–7. https://doi.org/10.1016/j.lungcan.2019.10.003 . O’Sullivan HM, Conroy M, Power DG, Bambury RM, O’Mahony D, Collins DC et al. Immune Checkpoint Inhibitors and Palliative Care at the End of Life: An Irish Multicentre Retrospective Study. J Palliat Care 2022:8258597221078391. https://doi.org/10.1177/08258597221078391 Hui D, Cherny N, Latino N, Strasser F. Characteristics and level of integration of ESMO Designated Centres of integrated oncology and palliative care. Ann Oncol 2016;27. https://doi.org/10.1093/annonc/mdw384.02 Hui D, Anderson L, Tang M, Park M, Liu D, Bruera E. Examination of referral criteria for outpatient palliative care among patients with advanced cancer. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2020;28:295–301. https://doi.org/10.1007/s00520-019-04811-3 . Parker SM, Clayton JM, Hancock K, Walder S, Butow PN, Carrick S, et al. A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information. J Pain Symptom Manage. 2007;34:81–93. https://doi.org/10.1016/j.jpainsymman.2006.09.035 . Wright AA. Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment. JAMA. 2008;300:1665. https://doi.org/10.1001/jama.300.14.1665 . Colombet I, Rigal L, Urtizberea M, Vinant P, Rouquette A. Validity of the French version of the Autonomy Preference Index and its adaptation for patients with advanced cancer. PLoS ONE. 2020;15:e0227802. https://doi.org/10.1371/journal.pone.0227802 . Craigs CL, West RM, Hurlow A, Bennett MI, Ziegler LE. Access to hospital and community palliative care for patients with advanced cancer: A longitudinal population analysis. PLoS ONE. 2018;13:e0200071. https://doi.org/10.1371/journal.pone.0200071 . Janah A, Le Bihan-Benjamin C, Mancini J, Bouhnik A-D, Bousquet P-J, Bendiane M-K. Access to inpatient palliative care among cancer patients in France: an analysis based on the national cancer cohort. BMC Health Serv Res. 2020;20:798. https://doi.org/10.1186/s12913-020-05667-8 . Cousin F, Gonçalves T, Dauchy S, Marsico G. Atlas des soins palliatifs et de la fin de vie en France Troisième édition – 2023 n.d. Higginson IJ, Sen-Gupta GJ. Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med. 2000;3:287–300. https://doi.org/10.1089/jpm.2000.3.287 . Dhollander N, Smets T, De Vleminck A, Van Belle S, Deliens L, Pardon K. Phase 0–1 early palliative home care cancer treatment intervention study. BMJ Support Palliat Care. 2022;12:e103–11. https://doi.org/10.1136/bmjspcare-2018-001716 . Bojesson A, Brun E, Eberhard J, Segerlantz M. Quality of life for patients with advanced gastrointestinal cancer randomised to early specialised home-based palliative care: the ALLAN trial. Br J Cancer. 2024;131:729–36. https://doi.org/10.1038/s41416-024-02764-x . Dhollander N, De Vleminck A, Deliens L, Van Belle S, Pardon K. Barriers to the early integration of palliative home care into the disease trajectory of advanced cancer patients: A focus group study with palliative home care teams. Eur J Cancer Care (Engl). 2019;28:e13024. https://doi.org/10.1111/ecc.13024 . Zemplényi AT, Csikós Á, Fadgyas-Freyler P, Csanádi M, Kaló Z, Pozsgai É, et al. Early palliative care associated with lower costs for adults with advanced cancer: evidence from Hungary. Eur J Cancer Care (Engl). 2021;30. https://doi.org/10.1111/ecc.13473 . Additional Declarations No competing interests reported. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Madalina","middleName":"","lastName":"Jacota","suffix":""},{"id":493108252,"identity":"f15ad213-68c7-4849-9be1-d98f380c08b8","order_by":11,"name":"Malamine Gassama","email":"","orcid":"","institution":"AP-HP, Ambroise Paré Hospital","correspondingAuthor":false,"prefix":"","firstName":"Malamine","middleName":"","lastName":"Gassama","suffix":""},{"id":493108253,"identity":"a53314b7-544b-46f2-b74a-a40ca192351f","order_by":12,"name":"Matthieu Stampa","email":"","orcid":"","institution":"Centre gérontologique départemental 13","correspondingAuthor":false,"prefix":"","firstName":"Matthieu","middleName":"","lastName":"Stampa","suffix":""}],"badges":[],"createdAt":"2025-07-01 13:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7021025/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7021025/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88031742,"identity":"93af2059-127e-4c01-85e5-bac93e88c9a4","added_by":"auto","created_at":"2025-07-31 15:38:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1433282,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7021025/v1/14aa479d-1aa1-44f4-af4d-2c6e92d15a83.pdf"},{"id":88030893,"identity":"e4266418-0d6c-48d3-a36d-c9679decb878","added_by":"auto","created_at":"2025-07-31 15:30:48","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":42849,"visible":true,"origin":"","legend":"","description":"","filename":"SUPPLEMENTARYMATERIAL20250502.docx","url":"https://assets-eu.researchsquare.com/files/rs-7021025/v1/a336b3cdcf83875b8064aaa6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Towards a better integration of palliative care in oncology? A multicentric cross-sectional study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eCancer is a leading cause of death worldwide. Early palliative care improves the quality of life of patients with metastatic cancer and their caregivers, and is recommended from the diagnosis of metastatic cancer, integrated into oncologic care. It has been showed that palliative care is often slow to be offered.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Successive reports on the development of palliative care show the discrepancy between the needs and wishes of the population and the resources available.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] The successive studies carried out in France showed a very partial and late palliative care referral for patients with cancer. In 2010, a retrospective study on deceased patients with advanced cancer showed that only 53% had met a palliative care team, with a median time of 41 days before death.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] A few years later in 2014, a prospective study found a median time of 31 days between the first palliative care consultation and death for cancer patients.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] In 2020, a retrospective study on patients who died from metastatic breast cancer showed that 65% had met a palliative care team at a median time of 39 days before death.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] In most Southern European countries and in particular in France, the adoption of palliative care has been slower than in the United Kingdom and Northern America.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] However, for the past 20 years, international scientific recommandations and successive French government programs have been implemented to address the managemement of symptoms caused by cancer and develop the early integration of palliative care in oncologic care.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Their impact have not been evaluated yet. We conducted an observational, multicentric, cross-sectional study in 2022 in France involving inpatients and outpatients with incurable metastatic cancer. We sought to obtain up-to-date data on the frequency and timing of palliative care involvement, as well as the factors associated with referral to palliative care teams in France. We aim to determine whether early palliative care practices are progressing in hospital oncology departments in France.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cb\u003eTrial design and study population\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe conducted an observational, cross-sectional, multicentric study in eight hospitals in the \u0026Icirc;le-de-France region (Paris and its suburbs). The survival of patients was assessed one year later.\u003c/p\u003e\u003cp\u003eThe investigators were members of the palliative care team and included patients followed by the oncologists of their hospital. If the hospital had multiple oncology departments, the investigators selected one department for the inclusion of patients in the study. The patients were included from oncology consultations, oncology day hospitals, and oncology hospitalization departments. The study was conducted from June 2022 to May 2023. In each study center, patients were included during a period of three months, on days dedicated to the study in each sector. On those days, patients were systematically included in order of arrival, until saturation of the investigators\u0026rsquo; possibilities. All patients over 18 years old with solid metastatic cancer treated in the investigating center were eligible. The exclusion criteria were the lack of affiliation to a social security system, visual/hearing impairment or aphasia, no understanding of French, inability to give informed non-opposition as judged by the investigators, or a diagnosis of testicular cancer or ovarian choriocarcinoma (curable cancers).\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical Data and Patients related outcome measures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSociodemographic data were collected using a self or interviewer-administered questionnaire: age, marital status, level of education, and EPICES score (a social vulnerability evaluation score validated in French).[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Characteristics of the disease were extracted from patients\u0026rsquo; medical records regarding primary tumor, date of diagnosis and of first metastasis, cancer treatments and performance status.\u003c/p\u003e\u003cp\u003eThe clinical data were explored using patient-reported outcome tools: the French versions of the European Organisation for Research and Treatment of Cancer- QLQC30 questionnaire (EORTC-QLQC30) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and the Supportive Care Need Survey short form (SNCS-SF34).[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] The EORTC QLQC30 assesses quality of life and consists of five multi-item functional scales (physical; role functioning or the ability to work and engage in leisure activities; emotional; cognitive; and social and family life), a global health status/quality of life scale, and nine symptom scales. The SCNS SF34 measures patients\u0026rsquo; own perception of their need for help in dealing with cancer across five domains: psychological, health system and information (information on cancer, organization of care and healthcare environment), physical and daily living (physical symptoms and daily activities), patient care and support (choice of hospital and cancer specialist, support from the hospital staff), and sexuality needs.\u003c/p\u003e\u003cp\u003eThe existence of at least one palliative care consultation in the past three months and, if so, the date of the first evaluation by the palliative care team were sought in the medical records, as well as any recent unscheduled care (emergency department visits or hospitalization related to a cancer complication in the past three months).\u003c/p\u003e\u003cp\u003eFinally, one-year survival data were obtained by consulting the national death registry.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDescriptive variables were labelled by their number and percentage for categorical variables, and by their mean and standard deviation for continuous variables. The number of missing data was specified for each variable, and the percentages were calculated based on the available data.\u003c/p\u003e\u003cp\u003eThe responses to the EORTC QLQ-C30 and SCNS-SF34 were converted into 0\u0026ndash;100 scales according to the scoring manuals, and mean scores were calculated.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\u003cp\u003ePatients referred to a palliative care team were compared with those not referred in terms of socio-demographic and clinical characteristics as well as heath needs, using a Chi2 or Fisher test for categorical parameters and a Student\u0026rsquo;s or Wilcoxon test for continuous parameters.\u003c/p\u003e\u003cp\u003eThe factors associated with palliative care team involvement were assessed using multivariate analysis with a logistic regression model. The model included all variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in the univariate analysis, except for \"palliative care only\" as a recent treatment of cancer (only 6 patients) and the type of cancer (not representative). Multiple imputations combined with a stepwise model based on the Wald statistic were applied. The number of imputed datasets was set to 50. For each imputed dataset, palliative care team involvement was analyzed, and a set of variables was retained. The final model included all variables selected in at least 50% of cases.\u003c/p\u003e\u003cp\u003eSurvival differences between the two groups (with and without palliative care team involvement) were analyzed using Kaplan-Meier's plots and log-rank tests.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis trial was registered on ClinicalTrial.gov PRS under the ID APHP210724. None of the investigators had conflicts of interest to disclose. The study was conducted in accordance with the World Medical Association Declaration of Helsinki. In compliance with French law governing non-interventional studies, each patient and caregiver received oral and written information, and their non-opposition was documented by the investigator. This study was approved by the French National Commission for Data Protection and Freedom on February 25, 2022 (Northwest 1 People Protection Committee, SI: 21.03698.000038).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eStudy population characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were met by 696 patients; however, 279 were not included due to saturation of the investigators\u0026apos; inclusion possibilities, and 56 refused to participate. The study sample included 361 patients; however, data concerning palliative care involvement were missing for six of these patients, leaving 355 patients available for the initial evaluation. Subsequently, one patient with no palliative care involvement withdrew consent during the follow-up period, reducing the sample size for the survival analysis to 354 patients.\u003c/p\u003e\n\u003cp\u003eMore than a quarter of patients included in the study (25.9%) were recruited from hospitalization settings, 47.9% from day-hospital, and 26.8% from consultation, indicating that 74.7% of patients were recruited from ambulatory settings. The mean age of the study population was 66 years, ) 52.4% were women. A majority of patients lived with a spouse or partner (64.8%), while 24.7% lived alone. Social vulnerability was observed in 40.3% of patients. They presented with cancer of various origins. Performance status \u0026lt; 2 applied to 67.9% of patients. Furthermore, 88.2% of patients received systemic treatment within the last 30 days, with 59% undergoing their first or second line of treatment (table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1- Sociodemographic characteristics of patients and characteristics of the cancer with and without palliative care involvement\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"714\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo palliative care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePalliative care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003ePlace of inclusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eConsultation (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e95 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e70 (31.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e25 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eDay hospital (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e170 (47.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e109 (49.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e61 (45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eHospitalization department (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e90 (25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e43 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e47 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e65.7(12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e66.6(12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e64.3(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.167*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e67.0[58.0;75.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e68.0[59.0;75.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e66.0[54.0;74.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e24.0-93.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e27.0-93.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e24.0-88.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMen (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e169 (47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e110 (49.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e59 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.402\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eWomen (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e186 (52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e112 (50.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e74 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003eMatrimonial status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMarried or PACS (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e197 (58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e128 (62.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e69 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eDivorced or separated (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e57 (17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e30 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e27 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eWidower (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e27 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e14 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e13 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eNever married (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e54 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e33 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e21 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003eLiving conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eLive with a spouse or partner (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e215 (64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e138 (67.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e77 (60.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.378\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eLive with another person (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e35 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e20 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e15 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eLive alone (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e82 (24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e46 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e36 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003eLevel of study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eLevel 1-2-3 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e45 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e29 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e16 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eLevel 4 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e121 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e63 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e58 (45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eLevel 5-6 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e81 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e53 (27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e28 (21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eLevel 7-8 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e77 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e50 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e27 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eEPICES \u0026nbsp;(social vulnerability)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eSocial vulnerability (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e122 (40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e63 (34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e59 (49.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eNo social vulnerability (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e181 (59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e121 (65.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e60 (50.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMissing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e52\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e38\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003ePerformance status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e0 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e89 (27.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e68 (34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e21 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e1 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e129 (40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e83 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e46 (37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e2 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e80 (24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e38 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e42 (34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e3 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e20 (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e8 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e12 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e4 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e3 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e2 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003eType of cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eGynecological (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e26 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e23 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e3 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eLiver and biliary tracts (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e3 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e3 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eENT (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e7 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e5 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e2 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003ePancreas (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e44 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e30 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e14 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eSkin (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e42 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e21 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e21 (15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eLung (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e65 (18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e49 (22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e16 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eProstate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e19 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e15 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e4 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eKidney (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e7 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e3 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eBreast (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e38 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e23 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e15 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eDigestive tract (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e64 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e25 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e39 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eOther (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e40 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e24 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e16 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003eTime between diagnosis and the 1st metastasis (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e14.6(34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e14.2(30.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e15.3(41.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.6[0.0;14.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0.5[0.0;13.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0.6[0.0;16.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-345.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0.0-170.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0.0-345.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003eTreatment received in the past\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eSurgery (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e197 (55.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e122 (55.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e75 (56.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.878\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eRadiotherapy (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e158 (44.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e99 (44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e59 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eSystemic treatments (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e344 (96.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e214 (96.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e130 (97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.547\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eSimple monitoring (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e6 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e2 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003ePalliative care only (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003eTreatment received in the last 30 days\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eSurgery (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e4 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e3 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eRadiotherapy (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e21 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e12 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e9 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.769\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eSystemic treatments (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e313 (88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e193 (86.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e120 (90.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.448\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eSimple monitoring (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e32 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e24 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e8 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003ePalliative care only (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e6 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e5 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003eNumber of previous treatment lines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e0 ou 1 Line (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e203 (59.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e131 (61.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e72 (55.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e2 Lines (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e66 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e39 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e27 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e3 Lines (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e36 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e24 (11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e12 (9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMore of 4 lines (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e39 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e20 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e19 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003eType of systemic treatment (in the last 30 days)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eChemotherapy (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e199 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e115 (59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e84 (70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eImmunotherapy (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e120 (38.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e79 (40.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e41 (34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eTargeted therapy (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e27 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e13 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e14 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 165px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eHormonotherapy (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e21 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e17 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e4 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency, place and timing of palliative care team involvment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e37.5% of patient had met a palliative care team within the past 3 months, at home \u0026nbsp;and/or in a hospital. Of the 27 patients who had met a home-based palliative care team in the past 3 months, 17 also met a hospital-based team. The median time between the first metastasis diagnosis and the first palliative care consultation was 6.7 months (IQ 4.4 ;35.9) (table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2- Frequency, place and timing of palliative care involvment\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"467\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eConsultation with a palliative care team in the last 3 months (hospital-based and/or at home)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e133 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eConsultation with an hospital-based palliative care team in the last 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e123 (34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eConsultation with a home-based palliative care team in the last 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e27 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eTime between diagnosis and 1st evaluation by a palliative care team (months)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e31.6(52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e16.6[4.4;35.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.0-346.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e269\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eTime between the 1st metastasis and the 1st evaluation by a palliative care team (months)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e16.2(36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e6.7[1.4;20.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e-55.1-261.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003eTime between the 1st evaluation by a palliative care team and death (months)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eMean (std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e7.8(7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eMed [IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e4.7[3.6;8.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003eMin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.2-33.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with palliative care team involvement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnivariate analysis revealed significant associations between palliative care team involvement and sociodemographic factors: the place of inclusion (hospitalization department or day-hospitalization versus consultation), social vulnerability, and type of cancer (p\u0026lt;0.05). Cancer treatment dit not differ between patients who met the palliative care team and the others (table 1).\u003c/p\u003e\n\u003cp\u003ePatients who met a palliative care team exhibited poorer performance status (p\u0026lt;0.0001, table 1) and more severe conditions and symptoms for all items of EORTC-QLQC30 (p\u0026lt;0.05) except for dyspnea and insomnia (table 3). The SCNS-SF34 demonstrated that patients followed by a palliative care team had more psychological needs (p=0.012), health system and information needs (p=0.015) and physical and daily living needs (p=0.001) (table 4).\u003c/p\u003e\n\u003cp\u003ePatient receiving integrated palliative care exhibited a higher frequency of recent hospitalization due to their cancer (52.4% versus 29.6%, p\u0026lt;0.0001), yet the frequency of recent emergency department visits (p=0.332) and hospitalization in intensive care unit (11 patients in both groups, p=0.378) remained comparable (table 5).\u003c/p\u003e\n\u003cp\u003eIn the multivariate analysis, social vulnerability was independently associated with palliative care, with an odds ratio (OR) of\u0026nbsp;1.70 ( CI 1.04-2.77, p=0.035)\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3- Results of the EORCT QLQ-C30 with and without palliative care team involvment\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo palliative care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePalliative care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003ePhysical functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e69(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e72.8(26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e63(28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e75.0[53.3;93.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e80.0[60.0;93.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e66.7[41.2;86.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eRole functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e68(34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e73.3(32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e59.4(35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e83.3[50.0;100.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e83.3[66.7;100.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e66.7[33.3;100.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eEmotional functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e71.5(25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e74.3(24.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e67.2(26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e75.0[58.3;91.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e83.3[60.4;91.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e75.0[50.0;83.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eCognitive functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e80.2(22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e82.4(22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e76.6(21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e83.3[66.7;100.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e83.3[66.7;100.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e83.3[66.7;100.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eSocial functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e64.1(32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e68.6(31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e56.9(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e66.7[33.3;100.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e83.3[50.0;100.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e50.0[33.3; 83.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e49.1(28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e44.3(28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e56.8(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e44.4[33.3;66.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33.3[22.2;66.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e55.6[33.3;77.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eNausea and vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e13.7(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e11.1(21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e18(25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0[0.0;16.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0[0.0;16.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e8.3[0.0;33.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e32.2(31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e25.8(29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e42.3(31.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33.3[0.0;50.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e16.7[ 0.0;50.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33.3[16.7;66.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eDyspnea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e28(30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e27.7(29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e28.6(31.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.904\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33.3[0.0;33.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33.3[0.0;33.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33.3[0.0;33.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eInsomnia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e35.9(35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e34.8(34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e37.5(36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33.3[0.0;66.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33.3[0.0;66.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33.3[0.0;66.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eAppetite loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33.5(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e27.3(34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e43.2(39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33.3[0.0;66.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.0[0.0;33.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e33.3[0.0;66.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eConstipation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e23.2(33.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e19.2(30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e29.7(36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0[0.0;33.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0[0.0;33.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0[0.0;66.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eDiarrhoea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e18.6(29.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e15.4(27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e23.7(32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0[0.0;33.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0[0.0;33.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0[0.0;33.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eFinancial difficulties\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e11.5(25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e9.1(22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e15.3(29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0[0.0;0.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0[0.0; 0.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0[0.0;33.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eGlobal health status/QoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e56.4(24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e61.5(23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e48.4(23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e58.3[41.7;75.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e66.7[50.0;83.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e50.0[33.3;66.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003eEORTC-QLQ-C30\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e70.8(18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e74.4(17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e65.2(19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e73.5[58.9;85.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e78.1[63.4;88.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e66.5[49.5;81.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e18.3-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e18.3-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e25.1- 98.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4- Results of the SCNS-SF34 with and without palliative care team involvement\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"657\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo palliative care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePalliative care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003ePsychological needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e38(27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e35.1(26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e42.5(26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e35.0[15.0;58.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e30.6[12.5;52.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e40.0[20.0;64.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eHealth system and information needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e32(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e29.5(19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e36(22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e27.3[20.5;40.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e25.0[18.2;38.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e29.5[23.3;52.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0- 97.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003ePhysical and daily living needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e33.7(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e30.6(26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e38.9(25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e25.0[15.0;50.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e25.0[10.0;45.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e35.0[20.0;60.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003ePatient care and support needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e26.5(19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e24.9(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e29(20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e25.0[15.0;30.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e25.0[15.0;30.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e25.0[20.0;35.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\n \u003cp\u003eSexuality needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emean(std)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e24.3(29.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e22.9(28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e26.6(31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emed[IQ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e8.3[0.0;41.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;8.3[0.0;41.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e16.7[0.0;50.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003emin-max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0-100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 295px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5- Unscheduled care during the past 90 days with and without palliative care team involvement\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"685\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 341px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnscheduled care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo palliative care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePalliative care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 341px;\"\u003e\n \u003cp\u003eCancer-related emergency department consultation in the last 90 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e87 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e49 (24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e38 (30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 341px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 341px;\"\u003e\n \u003cp\u003eCancer-complication related hospitalization in the last 90 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e125 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e59 (29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e66 (52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 341px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 341px;\"\u003e\n \u003cp\u003eCancer complication related hospitalization in intensive care unit in the last 90 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e22 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e11 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e11 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.378\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 341px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eOne year survival\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e82 patients were deceased one year after their inclusion: 37 (27.8%) from the group of patients who had already met a palliative care team before inclusion, and 45 (20.4%) from the other group. The survival between the two groups dit not differ significantly (p=0.083, figure 1, supplementary material).\u003c/p\u003e\n\u003cp\u003eAmong the deceased patients in the palliative care group, the date of first contact with the palliative care team was available for 33 individuals, and the median time between the first evaluation by a palliative care team and death was 4.7 months (table 1).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOne third of the patients in our study met a palliative care team, with a median of 6.7 months from first metastasis diagnosis, and 4.7 months before death. Although generally in good condition, patients who met a palliative care team had poorer performance status, reported more symptoms and supportive care needs, and were more frequently hospitalized for cancer complications in univariate analysis. Social vulnerability remained associated with the intervention of a palliative care team in multivariate anlaysis.\u003c/p\u003e\n\u003cp\u003eAmong patients with metastatic cancer who had met a palliative care team, a large proportion of them were undergoing systemic treatment, and almost 70% had a good performance status (\u0026lt;2), meaning it is now possible in France to get out of the curative versus palliative care dichotomy.\u003c/p\u003e\n\u003cp\u003eConsidering the new oncologic treatments offering reduced toxicities and prolonged survival, the growing incidence of cancer and the scarcity of palliative care resources, the current medical literature and professional recommendations have shifted from a systematic time-based palliative care referral towards need-based interventions targeting the right patients at the right time.[14–17]. In our study, patients referred to palliative care teams had more symptoms and supportive care needs. Their disease had more functional and social impact on their daily life, whereas the number of previous lines of systemic treatment did not differ between the two groups. Thus, patients referred to palliative care seem to have been selected on need-based criteria. Nevertheless, no systematic strategy for screening supportive care needs or referring patients is currently recommended in France, nor is it implemented in the centers participating in the study. Therefore, it is impossible to determine if the patients’ needs were correctly detected or if the patients were referred only based on the appreciation or habit of the oncologist, leading to potential inconsistencies or delayed referral. Given the significant supportive care needs of this population of patients,[18]\u0026nbsp;a need-based approach should be associated with a systematic screening of symptoms and healthcare needs to guarantee equal and appropriate access to palliative care.[16]\u003c/p\u003e\n\u003cp\u003eOther types of studies have already assessed the implementation of palliative care teams for advanced cancer patients. Most of them are retrospective series of deceased patients [3,5,19]\u0026nbsp;or retrospective cohorts\u0026nbsp;[20,21]. French studies showed that 40 to 65% of deceased patients met a palliative care team before death, with a median time between the first palliative care consultation and death of 24 days to 2.3 months, depending on the centers and the type of cancer. In a prospective study conducted in 2014 in the Ile de France region, the median time between the first consultation with a palliative care team and death was 31 days for cancer patients.\u0026nbsp;[4].\u0026nbsp;In an Italian study of 229 deceased patients with metastatic lung cancer, 43% met a palliative care team at a median time of 20 days before death.[22] In Ireland, a retrospective series of 102 deceased patients found 92% of palliative care referrals occuring 64 days before death.[23] In 2016, Hui et al. evaluated the «\u0026nbsp;ESMO Designated Centers of Integrated Oncology and Palliative Care\u0026nbsp;» (ESMO-DCs), 70% of patients with advanced cancer had a palliative care consultation before death at a median time of 90 days for outpatients and 21 days for inpatients. Early referral to palliative care (\u0026gt;6 months before death) occurred only in 24 (20%) of ESMO-DCs.[24]\u0026nbsp;Other institutions are able to provide earlier palliative care as reported in a retrospective study on 200 patients reffered to the Supportive Care Outpatient Clinic at the University of Texas MD Anderson Cancer Center, with a median survival of 14 months following first attendance at the palliative care outpatient unit.[25]\u003c/p\u003e\n\u003cp\u003eThe cross-sectional design of our study allows us to consider the population of patients with metastatic cancer as a whole, from the diagnosis of incurability to death. Survival didn’t differ significantly between the two groups, and only 27.8% of patients who met a palliative care team died in the year following the inclusion. Thus, our study enables us to individualize patients who benefit from early palliative care referral more effectively than series focusing solely on deceased patients. This explains the low frequency of recent palliative care team consultations in our population compared to retrospective studies, and the longer interval between the first palliative care consultation and death.\u003c/p\u003e\n\u003cp\u003eOur results also emphasize patients’ needs regarding information about the healthcare system and cancer care. Although patients with advanced cancer want to be involved in discussions regarding their care and the prognosis of their disease,[26]\u0026nbsp;few of them have these discussions with their oncologist.[27]\u0026nbsp;In previous studies, younger age, being more educated, believing they have less time to live, having strong faith, and poor ability to perform daily activities were associated with more information needs.[18,26]\u0026nbsp;We found that patients who met a palliative care team expressed more information needs in univariate analysis, but this result was not confirmed in multivariate analysis. This suggests that information needs may stem from the poorer clinical conditions of patients referred to palliative care teams. However, we cannot exclude that the need for information of more symptomatic or distressed patients may motivate oncologists to refer them to palliative care teams.\u003c/p\u003e\n\u003cp\u003eIt is important to determine what type of information is needed for each patient. The «\u0026nbsp;Health system and information\u0026nbsp;» section of the SCNS-SF34 includes questions that assess various requests for information such as oral or written information on the practical course of care and results of medical tests, explanations of the benefits and side effects of treatments, information on what can help them get better, need to find individual or group support, and finally to have the choice to follow or not an exam or a treatment. These varied information needs do not call for the same response: some are addressed to oncology teams or coordinating nurses, others could be a first step towards advanced care planning. The capacity and willingness of patients to engage in advanced care planning and to cope with the implications of their prognosis present complex challenges. This may be where palliative care teams could be most helpful. A tool like the Autonomy Preference Index could be particularly useful to understand what kind of prognostic information is desired and acceptable for each patient.[28]\u003c/p\u003e\n\u003cp\u003eOur study raises several public health questions. We found that socially vulnerable patients, as identified by the EPICES score, were more often referred to palliative care teams. Studies in the United States reported reduced access to palliative care for socially deprived patients, due to cultural differences and financial barriers.[29]\u0026nbsp;France provides universal social security coverage, ensuring free access \u0026nbsp; to palliative care. Janah et al. found no impact of social deprivation on palliative care access in the French national health system database.[30]\u0026nbsp;On the contrary, Frasca et al. reported lower referral to hospital palliative care teams for socially deprived patients in the Gironde regionparticularly those living in rural areas.[21]\u0026nbsp;Our study took place in the urban area of Paris and its suburbs, which offer more palliative care access than other regions.[20,31]\u0026nbsp;These divergent results raise questions about inequalities in acess to early palliative care across France.\u0026nbsp;[31]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, we found that patients with metastatic cancer who met a palliative care team usually did so at the hospital. If a majority of cancer patients prefer to die in their own homes,[32] little is known about patients’ preferences regarding the place of early palliative care. Some authors report the feasibility and the challenges of home-based early palliative care for patients with cancer in other health systems.\u0026nbsp;[33–35]\u0026nbsp;In our study, only a few met a home palliative care team. One possible explanation could be the good general conditions of the included patients, who may not have wanted or needed home-care interventions. But we cannot exclude that this is the result of a lack of resources for home palliative care teams in these areas.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinally, patients referred to palliative care teams had more frequent recent hospitalization for cancer complication, with no increase in emergency room visits. Palliative care teams could improve care pathways by anticipating and coordinating care, thereby reducing unplanned hospitalizations. By detecting needs and anticipating potential complications, palliative care teams can improve the patient care trajectory from primary care to hospital settings and avoid unexpected or unnecessary care.[16]Thus, early palliative care in cancer could lead to healthcare cost savings.[36]\u0026nbsp;More research is needed to determine the respective roles and coordination of hospital and home-based palliative care teams in the French health system, and the most efficient and cost-effective models of organization.\u003c/p\u003e\n\u003cp\u003eOur study has several limitations. First, the distribution of cancers in our study is not representative of that in the general French population, with an overrepresentation of lung and colorectal cancers. The type of cancer could influence the palliative care referral since it has been shown that colorectal, prostate and breast cancer have less referral, unlike lung cancer, regardless of the cancer prognosis.[21]\u0026nbsp;This suggests that the professional habits of oncologists may influence palliative care referrals.\u003c/p\u003e\n\u003cp\u003eSecondly, the oncology departments in which the study was conducted were chosen by the palliative care team, and may have had more established palliative care integration practices than other departments. In addition, our study was conducted in the Île-de France region, which has better palliative care acess than many other regions in the country.[31]\u0026nbsp;Thus,our study may have overestimated the overall level of palliative care integration in France.\u003c/p\u003e\n\u003cp\u003eThird, we chose to estimate the median time between first referral to palliative care and death using the 1-year survival of patients who had already met a palliative care team by the day of inclusion. The study cannot determine if deceased patients in the other group had been seen by a palliative care team between inclusion and death, or whether the median duration of follow-up before death would have been longer had the cohort been followed for a longer period.\u003c/p\u003e\n\u003cp\u003eFinally, we cannot determine from these results whether the palliative care referral needs of our study population were comprehensively addressed, nor whether the actual palliative care interventions were effective in improving patient outcomes. Despite these limitations, this study is one of the first cross-sectionnal study assessing palliative care referral. \u0026nbsp;The study is particularly relevant due to its multicenter design, the inclusion of both outpatients and inpatients, and the study of the association between supportive care needs and palliative care referral for patients with metastatic cancer.\u0026nbsp;\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe integration of palliative care into oncologic care for patients with metastatic cancer is progressing in France, with earlier hospital-based referrals, targeting the more frail and symptomatic patients, and allowing better healthcare pathways between home and hospital. Ongoing efforts should be made to achieve earlier palliative care referral (\u0026gt;6 months before death). Research is ongoing to identify the need of metatastic cancer patients for referral to palliative care, and the modalities for an efficient and sustainable model of early palliative care involvement in oncologic care within the French health system.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e The study was conducted in accordance with the Declaration of Helsinki. This study was approved by a French ethics committee (Northwest 1 People Protection Committee). Non opposition was obtained from all individual participants included in the study, in accordance with the French law on non-interventional studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: Data are available upon reasonable request.\u0026nbsp;The procedures carried out with the French data privacy authority (CNIL, Commission nationale de l'informatique et des libertés) and the European regulation (GDPR) do not provide for the transmission of the database, nor the information and consent documents signed by the patients. Consultation by the editorial board or interested researchers of individual participant data that underlie the results reported in the article after deidentification may nevertheless be considered, subject to prior determination of the terms and conditions of such consultation and in respect for compliance with the applicable regulations.\u003c/p\u003e\n\u003cp\u003eFor all inquiries, please contact the following : [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The sponsor was Assistance Publique – Hôpitaux de Paris (Délégation à la Recherche Clinique et à l’Innovation). The study was funded by the Fondation de France and the Ile-de-France regional health agency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contribution:\u003c/strong\u003e MSI, PV, CB, IJ, BV, MJ and MS contributed to the study conception and design. Material preparation and data collection were performed by MSI, PV, CB, IJ, BV, LS, AC, FB. Analysis were performed by MJ and MG. The first draft of the manuscript was written by MSI and MS and all authors commented on previous versions of the manuscript. LY provided English proofreading. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAknowledgments\u003c/strong\u003e: We thank the Fondation de France and the Ile-de-France regional health agency for financing this study, the staff of the Clinical Research Unit AP-HP Paris Saclay Ouest involved in the project, and the Assistance Publique – Hôpitaux de Paris (Délégation à la Recherche Clinique et à l’Innovation) which was the promoter.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJordan RI, Allsop MJ, ElMokhallalati Y, Jackson CE, Edwards HL, Chapman EJ, et al. Duration of palliative care before death in international routine practice: a systematic review and meta-analysis. 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Eur J Cancer Care (Engl). 2021;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ecc.13473\u003c/span\u003e\u003cspan address=\"10.1111/ecc.13473\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Palliative care, Neoplasms, Public health, Needs assessment, Observational study","lastPublishedDoi":"10.21203/rs.3.rs-7021025/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7021025/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePalliative care was slow to be offered to patients with metastasic cancer. For 15 years, international recommendations and government programs have supported the early integration of palliative care into oncology care but the impact on clinical practice has not been evaluated. We assessed the frequency and timing of palliative care referral, and the sociodemographic and clinical factors associated with this referral.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted an observational, multicentric, cross-sectional study concerning inpatients and outpatients with metastatic cancer. The study assessed palliative care team involvement, quality of life (EORTC-QLQC30), supportive care needs (SCNS-SF34), social vulnerability (EPICES) and one-year survival.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e355 patients with solid incurable metastatic cancer were included. 37.5% of them had met a palliative care team, within a median time of 6.7 months after the diagnosis of first metastasis, and 4.7 months before death. Patients referred to palliative care teams were found to have higher levels of social vulnerability (49.6%, p = 0.011); poorer performance status (p \u0026lt; 0.0001); greater prevalence of symptoms and worse physical, emotional, cognitive, and social functionning scores (p \u0026lt; 0.05). They also had more psychological, physical and daily living and information needs (p \u0026lt; 0.05). In multivariate analysis, only social vulnerability was associated with referral to palliative care teams. One-year survival did not differ between patients with and without palliative care team involvement at the point of inclusion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEarly acess to palliative care is improving, especially for the patients with greater supportive care needs. Further studies are needed to identify the best criteria for palliative care team integration for metastatic cancer patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e: This trial was registered in ClinicalTrial.gov PRS under the ID APHP210724.\u003c/p\u003e","manuscriptTitle":"Towards a better integration of palliative care in oncology? A multicentric cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-31 15:30:43","doi":"10.21203/rs.3.rs-7021025/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"70725212725751385867630841299219594308","date":"2026-05-22T06:14:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-10T00:50:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51562368389105281320220821420432921596","date":"2025-08-17T15:54:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-29T17:02:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-04T10:18:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-04T02:08:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-04T02:07:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-07-01T13:42:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2087af1f-e113-4b4f-8d02-7548914d0017","owner":[],"postedDate":"July 31st, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"70725212725751385867630841299219594308","date":"2026-05-22T06:14:34+00:00","index":94,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-31T15:30:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-31 15:30:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7021025","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7021025","identity":"rs-7021025","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}