Many specialists do not refer cancer patients to palliative care or mental health care during their course of treatment, a survey of more than 240 oncologists found. The physicians cited a lack of understanding of palliative care as a leading barrier.

The data appeared in an Oncology Insights report from Cardinal Health. Among the respondents, 68% said they were aware that early access to palliative care correlates with better outcomes, but only 17% indicated that they refer patients to those services at the time of diagnosis. About 43% responded that clinicians needed more training on having goals of care conversations with cancer patients. Respondents included a mix of community-based and hospital physicians.

“The results are surprising when considering that several research studies have shown that a significant portion of patients with cancer are referred to palliative care too late,” according to the study.

A key barrier that limits access to palliative care include resistance to the idea from patients and families, often because of a lack of awareness of what these services are. Many mistakenly believe that palliative care is only available during a patient’s final days, often confusing those services with hospice. 

This is frequently an issue among clinicians as well, according to the surveyed oncologists. Between 25% and 50% of those physicians who indicated that some of their patients were receiving palliative care concurrently with curative care. About 21% said they only offered palliative care referrals when the patient is close to death.

The study also found that nearly 90% of oncologists are concerned about how the anxiety and depression that often accompany serious illness will affect their health outcomes. Nevertheless, only 51% indicated they frequently refer patients for mental health treatment, and 48% said that sufficient resources are not available to support these patients’ mental health.

“In total, the fact that oncologists have high levels of awareness of mental health distress among patients with cancer is encouraging,” Bruce Feinberg, D.O., vice president and chief medical officer of Cardinal Health Specialty Solutions wrote in the report. “However, the responses about referrals and interventions indicate that oncologists still need to take additional steps to ensure that patients will consistently receive the mental health care they need.”