Towards early integration of palliative care in oncology: a descriptive study of the health needs of patients with metastatic cancer in Ile-de-France, and the match between these needs and health services

A large body of literature shows the benefits of integrated palliative care in oncology, and many learned societies recommend the early association of palliative care with usual oncological management of patients with advanced cancer, within 8 to 12 weeks of diagnosis. However, systematic involvement of a palliative care team at the diagnosis of advanced cancer may not be feasible in France, and may not be necessary for all patients. A targeted approach, based no longer on a delay in relation to diagnosis, but centered on patients' real-life needs is proposed by some authors and seems better suited to the realities of patients and our healthcare system.

The main aim of the BESACE study is to describe the nature and estimate the prevalence of healthcare needs of patients with advanced cancer and their primary caregiver, cared for in a sample of Ile-de-France hospitals, from diagnosis of incurability to death. To this end, a self-assessment of their health needs is carried out by the patient and their primary caregiver (self-questionnaires: EORTC-QLQ C30, SCNS-SF34, EPICES, Zarit Scale).

Secondary objectives are:

- Determine the proportion of these patients with an indication for specialized palliative care according to the criteria described by Hui and colleagues, and describe the adequacy of healthcare needs and services for this population.

- Search for associations between the patient's clinical trajectory and indication for specialized palliative care.

- Seek associations between the integration of palliative care services and the adequacy of healthcare services to patients' needs.

- Study factors related to disease, clinical trajectory, or management, associated with patient survival at 1 year.

For this purpose, the secondary endpoints are:

• Social-familial description of the population
• Descriptive criteria of pathology and clinical trajectory
• Proportion of patients with an indication for specialized palliative care and suitability for referral to a specialized palliative care team
• Health services received by the patient
• Integration of palliative care teams
• 1-year survival

The BESACE study is a descriptive, observational, cross-sectional, multicenter study exploring three axes:

- An assessment of the health needs usually sought during a palliative care evaluation of a representative population of metastatic cancer patients managed in hospitals in Ile-de-France, and their primary caregiver. This multidimensional medico-psycho-social assessment is based on validated self-questionnaires and clinical data from the patient's medical records. The patient's socio-familial data and information concerning cancer pathology and the patient's previous medical trajectory are sought.

- Health services received by patients at home and in hospital will be researched: care by a palliative care team, health professionals mobilized in hospital or at home.

- The integration of palliative care services within oncology management will be assessed by means of a questionnaire given to the palliative care team at each investigating center.

To address the last secondary objective, a cohort of patients will be set up (follow-up for one year).

Eligible patients will be adults (>18 years) with a diagnosis of metastatic cancer, managed in one of the investigating centers, in HDJ, consultation or hospitalization on the day of the study in the investigating center. It is planned to include 400 patients in 10 investigating centers. The study has received a positive opinion from the CPP Nord-Ouest 1.