End-of-Life and Palliative Care in Patients with Metastatic Renal Cancer

This retrospective study analyzes the implementation of palliative care services in patients with metastatic renal cancer (mRC) at our center between September 2012 and September 2019.

Despite established evidence supporting early palliative care integration in advanced cancer management, our findings demonstrate significant gaps in implementation, particularly:

While 49% of patients had contact with palliative care services, only 5.3% received early referral (>90 days before death)
58,6% of patients died in hospital settings (38.6% in palliative care units and 21% in other units)
22.8% of patients visited the emergency department multiple times in their last month of life
Only 1.8% required ICU admission in the final month of life

The findings highlight the persistent confusion between palliative and end-of-life care, with most patients receiving palliative services only in terminal stages rather than as part of comprehensive cancer management. These results underscore the need for standardized referral criteria, improved provider education, and systematic approaches to integrate palliative care earlier in the disease trajectory.

The study provides important insights (by using quality indicators) that can guide quality improvement initiatives in cancer care delivery and help bridge the gap between evidence-based recommendations and clinical practice.

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Written by: G. Lendínez-Cano,¹ C. Roldán Cumbreras,² C. B. Congregado Ruíz,³ R. A. Medina López¹

Urology and Nephrology Department, Oncologic Urology Unit, University Hospital Virgen del Rocío, Seville, Spain; Biomedical Institute of Seville (IBiS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain.
Urology and Nephrology Department, Oncologic Urology Unit, University Hospital Virgen del Rocío, Seville, Spain.

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