ORIGINAL ARTICLE Practices and opinions of specialized palliative care physicians regarding early palliative care in oncology Anna Sorensen 1 & Kirsten Wentlandt 1,2 & Lisa W. Le 3 & Nadia Swami 1 & Breffni Hannon 1,4 & Gary Rodin 1,5,6 & Monika K. Krzyzanowska 4,7 & Camilla Zimmermann 1,4,5 Received: 4 March 2019 /Accepted: 14 May 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Purpose To describe the practices and opinions of specialized palliative care (SPC) physicians regarding early palliative care for patients with cancer, determine characteristics associated with receiving early referrals; and solicit opinions regarding renaming the specialty Bsupportive care.^ Methods The survey was distributed by mail and e-mail to physicians who had previously self-identified as providing palliative care. SPC physicians were defined as receiving palliative care referrals from other physicians and not providing palliative care only for their own patients. Results The response rate was 71% (531/746), of whom 257 (48.4%) practiced SPC. Of these SPC physicians, 84% provided mainly cancer care; > 90% supported early palliative care referral in oncology and had referral criteria facilitating this, but only 20% received early referrals (> 6-month prognosis). There was ambivalence regarding caring for patients with full resuscitation status and responsibility for managing cancer treatment-related complications. SPC physicians receiving early referrals were more likely to be female (p = 0.02) and have a postgraduate degree (p = 0.02), and less likely to provide mainly cancer care (p = 0.03) and to agree that patients should stop chemotherapy before referral (p = 0.009). Although 60% agreed that patients perceive the term Bpalliative care^ negatively and 39% believed a name change to supportive care would encourage early referral, only 21% supported renaming the specialty. Conclusions Although most SPC physicians supported early palliative care in oncology, the timing of referrals was often late, and was associated with characteristics of SPC physicians. Few SPC physicians supported renaming palliative care. Keywords Cancer . Oncology . Palliative care . Referral . Survey Introduction There is now considerable evidence for the benefits of early palliative care for patients with cancer. Large randomized con- trolled trials have demonstrated benefits in quality of life, symptom control, mood, and satisfaction with care [1–5], and these findings have been substantiated by recent system- atic reviews [6, 7]. Early palliative care is encouraged by in- ternational agencies [8, 9], and practice guidelines recommend involvement of dedicated palliative care services for patients with advanced cancer early in the disease course, concurrent with active treatment [10]. Despite this growing evidence, there is a gap between the recommendation for early palliative care, and clinical practice, in which referral to specialized palliative care (SPC) is pre- dominantly late [11–13]. In an effort to identify reasons for this gap, the opinions of oncologists have been solicited in * Camilla Zimmermann camilla.zimmermann@uhn.ca 1 Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave., 16-712, Toronto, Ontario M5G 2M9, Canada 2 Department of Family and Community Medicine, University of Toronto, Toronto, Canada 3 Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada 4 Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada 5 Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada 6 Department of Psychiatry, University of Toronto, Toronto, Canada 7 Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada Supportive Care in Cancer https://doi.org/10.1007/s00520-019-04876-0