Real-world insights of patterns of palliative and end-of-life care in patients with advanced cancer: LMIC single-center wake-up call.

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Background: Early integration of palliative care (PC) is recommended in advanced cancer to improve quality of life and reduce aggressive end-of-life (EOL) care. However, these patterns are poorly characterised in real-world settings and are critical targets for quality improvement. Methods: We conducted a retrospective analysis of 250 patients with advanced solid tumors who died at a single tertiary care center between 2024 and 2025. Data extracted included demographics, cancer type, last chemotherapy timing, ICU and ward admissions in the last month of life, PC referral timing, place of death, and EOL care (EOLC) provision. Descriptive statistics were performed. Results: Median age was 53 years (range 21–85), 59% female. Common malignancies included lung (29%), breast (23%), and gastrointestinal cancers (25%). Chemotherapy was administered within one month of death in 57% of patients and within two weeks in 27%. ICU admission in the last month occurred in 81% of patients, and 69% died in the ICU. PC referral done in 66% of cases. Late referrals in 31% of patients hindering proper PC services. EOLC was provided to only 24% of patients; family hesitancy and late presentation were frequent barriers. Conclusions: In this cohort, advanced cancer patients frequently received aggressive care near death, with high rates of late chemotherapy, ICU utilization, and in-ICU deaths. Despite most patients being referred to PC, referrals were often delayed and EOLC was markedly underutilized. These findings highlight a critical gap in the systematic interventions, namely early integration of palliative principles and a potential over-reliance on intensive care at the EOL. Implications: Oncology programs should implement routine PC referral at advanced cancer diagnosis, develop protocols for appropriate ICU admission in terminal illness, and enhance clinician communication training to address family barriers and focus on patient-centered EOL goals and improve the quality of life in advanced cancer.