There is a global consensus that at the end of life relief of symptoms and suffering must be guaranteed. It is considered by our national health system as a priority goal in advanced cancer to address all the needs both the patient and the family, and improve their quality of life. Palliative Care Units (PCU) are intended to achieve this objective. In the last months of life, despite these advances, active treatments continue to predominate over palliative care.
We conducted a retrospective observational study selecting all patients with a first consultation in the Medical Oncology Unit of the Puerta de Hierro University Hospital during 2014 and 2015, who died before December 31st, 2017. Treatments carried out, assessment by a PCU and home palliative care services (HPCS), during the last 6 months of life and place of death (hospital, home or PCU) were reviewed. We aim to assess quality of care evaluating the use of active therapies and PCU using a novel approach considering what was done during the last six months of life.
622 patients were selected (36% female/64% male), median age of 69 years (IQR 61-76). 89% were stage IV. Lung (32%) and gastrointestinal (31%) cancer were the most frequent. In the last 6 months of life, 59% of patients received chemotherapy (CT), 26% radiotherapy (RT) and 8% undergone surgery. Median time from the last CT and RT to death was 39 days (IQR 23-75) and 57 days (IQR 21-100) respectively. 28% of patients were not assessed by a PCU from whom 52% were first evaluated in the last 30 days before death and 28% had been followed for more than 60 days. Only 44% were followed by HPCS. In patients with HPCS, the number of deaths at home (41%) and at PCU (29%) was significantly higher, with only 30% dying at hospital. By contrast, among those never assessed by HPCS: these figures were 12%, 24% and 64% respectively (p < 0,001).
1/3 of patients had never been assessed by a PCU and the selection of patients who benefit from active therapies in the last months of life must be clearly improved. The association between place of death and assessment by a HPCS suggests the efficiency of these units and the benefit of increasing their resources. The objective of a global approach for palliative care to all patients with advanced cancer is close but not achieved yet.
Clinical trial identification
Legal entity responsible for the study
Medical Oncology Department, Puerta de Hierro University Hospital.
Has not received any funding.
All authors have declared no conflicts of interest.