Skip to main content

Advertisement

Log in

The last 3 months of life of cancer patients: Medical aspects and role of home-care services in southern Switzerland

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

The clinical data on terminal cancer patients who have died since the establishment of a program of collaboration between community services and the cancer center of Canton of Ticino, southern Switzerland, were retrospectively analyzed to describe the characteristics of patients seen and the effect on them of a home-care program coordinated by the cancer center. The home-care program is based on five geographically grouped community-based domiciliary services, with the addition of one nurse responsible for coordination and one physician from the oncology center. Selection criteria for participation in the home-care program are defined. The main outcome measures were: number of hospitalizations and median hospital stay during the last 3 months of life; reasons for and median length of last hospitalization; place of death of patients who had home care and those who did not. In the group of 993 patients analyzed, the median contact time with the cancer center was 9.5 months (10th percentile: 1 month, 90th percentile: 71 months); the most frequent neoplasm was lung cancer (22%) with the briefest contact time (7.5 months; 10th percentile: 1 month; 90th percentile: 21 months); 13.5% of patients were never hospitalized; half of the patients had a total hospital stay of 24 days or longer and 23% died at home. The sociodemographic and medical characteristics of home-care users were similar to those of the home-care nonusers and to those of the overall group. In the group of home-care users (32% of the total) 22% were never hospitalized, half of the patients had a total hospital stay of 17 days or longer, and 43.5% of them died at home. These values were significantly different (P<0.001) from those reported in the group of home-care non-users. Palliative care, provided at home through community-based domiciliary services, is associated with less frequent and shorter hospitalizations in the last 3 months of life. Medical oncology and palliative treatments should be mutually complementary to improve patients care. Cancer centers should be involved in the planning and coordination of supportive-care domiciliary services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Ahmedzai S (1990) Palliative care in oncology: making quality the endpoint (editorial). Ann Oncol 1:396–398

    PubMed  Google Scholar 

  2. Armitage P, Berry G (1987) Statistical methods in medical research, 2nd edn. Blackwell, Oxford

    Google Scholar 

  3. Ashby M, Stoffell B (1991) Therapeutic ratio and defined phases: proposal of ethical framework for palliative care. BMJ 302:1322–1324

    PubMed  Google Scholar 

  4. Boyd KJ (1992) The working patterns of hospice based home care teams. Palliat Med 6:131–139

    Google Scholar 

  5. British Medical Journal (1984) Editorial: problems of hospices. BMJ 288:1178–1179

    Google Scholar 

  6. Coluzzi PH, Grant M, Doroshow JH, Rhiner M, Ferrel B, Rivera L (1995) Survey of the provision of supportive care services at National Cancer Institute — designated cancer centers. J Clin Oncol 13:756–764

    PubMed  Google Scholar 

  7. Hicks F, Corcoran G (1993) Hospice management of patients receiving cytotoxic chemotherapy: problems and opportunities. Br J Cancer 68:1205–1209

    PubMed  Google Scholar 

  8. Hunt R, Roder D, McHarper T (1989) The impact of hospice services on places of death of South Australians. Cancer Forum 13:110–113

    Google Scholar 

  9. Keenan JM, Fanale JE (1989) Home care: past and present, problems and potential. J Am Geriatr Soc 37:1076–1083

    PubMed  Google Scholar 

  10. Lancet (1991) Editorial: who cares about homecare? Lancet 338:1303–1304

    PubMed  Google Scholar 

  11. McCusker J (1984) The terminal period of cancer: definition and descriptive epidemiology. J Chron Dis 37:377–385

    PubMed  Google Scholar 

  12. McQuay H, Moore A (1994) Need for rigorous assessment of palliative care. BMJ 309:1315–1316

    PubMed  Google Scholar 

  13. McWhinney IR, Bass MJ, Donner A (1994) Evaluation of a palliative care service: problems and pitfalls. BMJ 309:1340–1342

    PubMed  Google Scholar 

  14. Porzsolt F, Tannock I (1993) Goals of palliative cancer therapy. J Clin Oncol 11:378–381

    PubMed  Google Scholar 

  15. Rubens RD, Towlson KE, Ramirez AJ, Coltart S, Slevin ML, Terrel C, Timothy AR (1992) Appropriate chemotherapy for palliating advanced cancer. BMJ 304:35–40

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sessa, C., Roggero, E., Pampallona, S. et al. The last 3 months of life of cancer patients: Medical aspects and role of home-care services in southern Switzerland. Support Care Cancer 4, 180–185 (1996). https://doi.org/10.1007/BF01682337

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01682337

Key words