Referral Delays to Specialized Palliative Care among Oncology Inpatients in a Portuguese Cancer Centre

Access to specialized palliative care is a key component of quality cancer care, yet delays remain common in Portugal and institution-level data on referral pathways are scarce. We performed a retrospective observational study including all oncology inpatients referred to specialized palliative care units at a Portuguese comprehensive cancer center between January 2022 and June 2024, and we analysed referral outcomes and waiting times from referral to admission or death. Of 3177 hospitalized oncology patients, 208 (6.5%) were referred to palliative care, and nearly two-thirds (63.0%) died before admission. The median waiting time from referral to admission was 29.5 days (IQR 20.0 - 41.0), while patients who were not admitted died a median of 34.0 days (IQR 20.0 - 54.0) after referral. Among admitted patients, median length of stay in palliative care units was 21.5 days (IQR 10.0 - 40.5). These findings show that most hospitalized oncology patients referred to specialized palliative care do not reach admission in time, reflecting substantial delays in access despite referral. Improving referral pathways and strengthening system capacity are essential to ensure timely palliative care for patients with advanced cancer in Portugal.