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End-of-life care for patients with cancer: Clinical, geographical, and sociocultural differences

Published online by Cambridge University Press:  13 February 2023

Rita Ostan Open the ORCID record for Rita Ostan [Opens in a new window] ,
Silvia Varani Open the ORCID record for Silvia Varani [Opens in a new window] ,
Francesco Pannuti ,
Raffaella Pannuti ,
Guido Biasco  and
Eduardo Bruera
Rita Ostan
Affiliation:
Training and Research Department, National Tumor Assistance (ANT), Bologna, Italy
Silvia Varani*
Affiliation:
Training and Research Department, National Tumor Assistance (ANT), Bologna, Italy
Francesco Pannuti
Affiliation:
Nethical S.r.l., Bologna, Italy
Raffaella Pannuti
Affiliation:
Training and Research Department, National Tumor Assistance (ANT), Bologna, Italy
Guido Biasco
Affiliation:
Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
Eduardo Bruera
Affiliation:
Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA
*
Author for correspondence: Silvia Varani, Training and Research Department, National Tumor Assistance (ANT), Via Jacopo di Paolo, 36, Bologna 40128, Italy. Email: silvia.varani@ant.it
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Abstract

Objectives

Timely, effective and personalized identification of the multidimensional needs in patients with advanced cancer are major goals of appropriate palliative care (PC) delivery. However, there is considerable variation in structures, processes, and patient demographics that might influence the intensity of end-of-life care. This study aims to characterize patterns in clinical and demographic characteristics at the inception point and their association with the intensity of care during the last month of life in advanced cancer patients assisted at home.

Methods

Cancer patients entered in home PC during 2020 in Italy were considered. The association between home PC services during the last month of life (primary outcome) and demographic data, performance status (Karnofsky Performance Score [KPS]), symptoms, and therapies at the entry was explored in this retrospective study.

Results

Among 1,721 consecutive patients (919 in Centre-North and 802 in Centre-South Italy), patients from Centre-South were younger (p < 0.001), had worse KPS (p < 0.001), and shorter survival (p = 0.010). Patient age was inversely associated with the number of total/physician/nurses services during the last month of life (p < 0.001, p = 0.001, and p = 0.008, respectively). Patients with severe symptoms (asthenia, pain, and anxiety) at inception needed more PC services at the end of life (p = 0.026, p = 0.008, and p = 0.038, respectively). The distribution of workload differed according to the geographical area, with higher number of PC services provided by physicians (p < 0.001) in Centre-North and by nurses (p = 0.002) in Centre-South.

Significance of results

These findings highlight major disparity in access and nature of PC in a country with universal access to health services. Studies aimed at comparing PC models among different countries should pay attention to the local heterogeneity within each health-care system.

Keywords

Palliative careEnd of lifeCancerSymptomsHome care
Type
Original Article
Information
Palliative & Supportive Care , Volume 22 , Issue 1 , February 2024 , pp. 155 - 162
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Copyright
© The Author(s), 2023. Published by Cambridge University Press.

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