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Palliative medicine favourably influences end-of-life cancer care intensity: a large retrospective database study
  1. Maria Vittoria Chiaruttini1,
  2. Oscar Corli1,
  3. Massimo Pizzuto2,
  4. Alessandro Nobili3,
  5. Gianpaolo Fortini4,
  6. Ida Fortino5,
  7. Olivia Leoni5 and
  8. Cristina Bosetti1
  1. 1Dipartimento di Oncologia, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
  2. 2ASST Nord Milano, Milano, Italy
  3. 3Dipartimento di Politiche per la Salute, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
  4. 4ASST Sette Laghi, Varese, Italy
  5. 5Regione Lombardia Direzione Generale Welfare, Milano, Italy
  1. Correspondence to Dr Cristina Bosetti; cristina.bosetti{at}marionegri.it

Abstract

Objectives Hospice and home palliative care have been associated to a reduction of aggressive treatments in the end-of-life, but data in the Italian context are scanty. Therefore, we aim to investigate the role of palliative care on indicators of end-of-life intensity of care among patients with cancer in Lombardy, the largest Italian region.

Methods Within a retrospective study using the healthcare utilisation databases of Lombardy, Italy, we selected all residents who died in 2019 with a diagnosis of cancer. We considered as exposure variables admission to palliative care and time at palliative care admission, and as indicators of aggressive care hospitalisations, diagnostic/therapeutic procedures, in-hospital death, emergency department visits and chemotherapy over a time window of 30 days before death; chemotherapy in the last 14 days was also considered.

Results Our cohort included 26 539 individuals; of these, 14 320 (54%) were admitted to palliative care before death. Individuals who were admitted to palliative care had an odds ratio (OR) of 0.27 for one hospitalisation, 0.14 for ≥2 hospitalisations, 0.25 for hospital stay ≥12 days, 0.38 for minor diagnostic/therapeutic procedures, 0.18 for major diagnostic/therapeutic procedures, 0.02 for in-hospital death, 0.35 for one emergency department visit, 0.29 for ≥2 emergency department visits and 0.66 for chemotherapy use in the last 30 days; the OR was 0.56 for chemotherapy use in the last 14 days.

Conclusions This large real-world analysis confirms and further support the importance of palliative care assistance for patients with cancer in the end- of- life; this is associated to a significant reduction in unnecessary treatments.

  • cancer
  • end of life care
  • hospice care
  • home care
  • service evaluation

Data availability statement

Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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Footnotes

  • Contributors MVC performed the statistical analyses and contributed to drafting the manuscript. OC and MP provided their clinical knowledge for the study design and interpretation of study results, and contributed to drafting the manuscript. AN, GF, IF, and OL gave access to data and contributed to the interpretation of study results. CB conceived the project, drafted the manuscript and is responsible for the overall content as the guarantor. All authors discussed the results and approved the final version of the manuscript.

  • Funding This study was supported by contributions from the Ministry of Health of the Lombardy Region as part of the EPIFARM-Pharmaco-Epidemiology Agreement between the Istituto di Ricerche Farmacologiche Mario Negri IRCCS and the Lombardy Region.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.