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Conventional strategy: patients will be managed regardless of their PALLIA-10 score. The need for additional care, including palliative care, will be assessed by the team in charge of the patient, as per routine practice.

Experimental strategy: patients will be systematically referred to a palliative care team.

Patients randomized in the experimental arm will be systematically referred to a palliative care team.

A follow-up in palliative care will be initiated for all within a maximum of 15 days after the date of randomization.

Systematic referral to a palliative care team

Gisèle CHVETZOFF, MD, PhD

Julien GAUTIER

Gisèle CHVETZOFF, MD,PhD

Muriel THOMASO, MD

Carole BOULEUC, MD

Marie-Ange MASSIANI, MD

Aline HENRY, MD

Christine MATEUS, MD

This is a randomized, multicenter, prospective, phase III study conducted in daily emergency rooms of French Regional Comprehensive Cancer Centers.

In the standard arm, patients will be managed regardless of their PALLIA-10 score, following conventional strategy. In the experimental arm, patients will be systematically referred to a palliative care team.

This is a randomized, multicenter, prospective, phase III study conducted in daily emergency rooms of French Regional Comprehensive Cancer Centers.

All patients undergoing a visit in the daily emergency room of a participating center and who need for palliative management (PALLIA 10 score \> 3/10) will be considered for inclusion in the PALLU study. After signing the written informed consent, patients will be randomized (1:1 ratio) in one of the following arms:

* Standard arm : conventional strategy; patients will be managed regardless of their PALLIA-10 score. The need for additional care, including palliative care, will be assessed by the team in charge of the patient, as per routine practice.
* Experimental arm : experimental strategy; patients will be systematically referred to a palliative care team.

Randomization will be stratified according to the investigation center and pre-existing follow-up by pain management team.

The difference of intervention will lie in the fact that patients will be referred or not to a palliative care team but patients from the standard arm may receive palliative care as deemed necessary by the medical oncology team. In this case, the content of palliative care for patients included in both groups will be identical.

The end of the study will be the Last Patient Last Visit (LPLV), defined as the date of the 6-month visit of the last patient still alive or when the 192nd death has occurred, whichever occurs first.

Randomization (ratio 1:1) will be stratified according to the investigation center and pre-existing follow-up by pain management team.

Efficacy of a Systematic Referral to Palliative Care of Patients Who Need for Palliative Care During an Unscheduled Visit in Comprehensive Anticancer Centers

A Randomized Comparative Prospective Multicenter Study of the Efficacy of a Systematic Referral to Palliative Care of Patients Who Need for Palliative Care During an Unscheduled Visit in Comprehensive Anticancer Centers

Percentage and number of patients who meet at least one of the following criteria :

* More than 1 hospitalization in the last 30 days of life;
* More than 1 visit in an emergency unit in the last 30 days of life;
* More than 14 days in hospital in the last 30 days of life;
* Hospitalization in a resuscitation unit in the last 30 days of life;
* Treatment with chemotherapy in the last 14 days of life;
* New chemotherapy regimen starting in the last 30 days of life;
* Patients dying in an acute care setting.

Percentage and number of patients having more than 1 hospitalization in the last 30 days of life

Percentage and number of patients having more than 1 visit in an emergency unit in the last 30 days of life

Percentage and number of patients having more than 14 days in hospital in the last 30 days of life

Percentage and number of patients having a hospitalization in a resuscitation unit in the last 30 days of life

Percentage and number of patients having a treatment with chemotherapy in the last 14 days of life

Percentage and number of patients having a new chemotherapy regimen starting in the last 30 days of life

Percentage and number of patients dying in an acute care setting

Medical resources mobilized in terms of palliative care (psychologist, social worker, nutritional counselling, etc.) will be described for the interventional group in terms of number and percentage of patients with at least one consultation with each specialist

The total score ranges from 0 and 28, with a higher score indicates better quality of life. Scores will be described per randomized group at each measurement time (inclusion,3 months and 6 months) using same criteria as for other quantitative variables (number of observations, mean, standard deviation, median, minimum and maximum values).

One score is generated for anxiety and one score for depression on a 0 to 21 points, with a higher score indicates higher level of trouble. Scores will be described per randomized group at each measurement time (inclusion,3 months and 6 months) using same criteria as for other quantitative variables (number of observations, mean, standard deviation, median, minimum and maximum values). Number and percentage of patients without anxiety or depression trouble (i.e. with a score of 7 or lower), moderate trouble (score between 8 to 10) and severe trouble (score of 11 or more) will be reported.

Pain, tiredness, drowsiness, nausea, lack of appetite, depression, anxiety, shortness of breath, and wellbeing and patient-specific symptoms are each described on a scale ranging from 0 to 10 (10 being the worst). The mean change in symptoms will be estimated from baseline and at each follow-up time. The ESAS symptom scores will be calculated according to the authors' recommendations and described per randomized group at each time point by mean, standard deviation, median and range.

Hospital and type of unit or home will be described per randomized group

Defined as the time from the date of inclusion to the date of death due to any cause.

Spots Global Cancer Trial Database for systematic referral to a palliative care team