A 6 years experience in Home-Care: Efficient and cost-effective strategy of treatment in terminal cancer care

Abstract

8183 Background: The G.R.A.D.O. Association (Gruppo Ricerca Assistenza Domiciliare Oncologica) providing home-care for cancer patients was begun in June 1998. The drawing thought of our work is that, in the advanced phases of cancer, the best place of treatment should be the patients’ home, considering that house is the natural container of persons’ life which, with a convenient help, would prefer to spend the terminal phases of their life at home rather than hospital. Patients and Methods: Patients are visited at home by an oncologist and a professional nurse; they together draw up the assistance program. The professional teem is also composed of an internist, a physician for pain therapy, a psychologist, a physiotherapist. Assistance is completely free for the patients and their families. The professional team is also supported by a group of trained volunteers who are responsible for the social aspects of the patients’ life. During these six years of activity 455 patients, the mean age was 64.7 yrs (16–90), have been followed: they requested 3352 oncological visits, 991 medical visits, 25 chemotherapies, 288 thoracentesis, 292 paracentesis, 2538 nurse interventions, 2839 supportive treatments, 35 physiotherapeutic interventions and 661 psychological supports. The median follow up were 37 days (3–359). The 88% of the patients died at home. Conclusion: The data regarding our activity showed us that this specifically oriented medical assistance permits education and adaptation of patients and their families with the disease and diminishes the hospitalization of these patients, resulting in an improvement of their quality of life (better preserved in their family environment). During our years of activity we have distributed 31.439 days of medical services and it has certainly helped in saving the expenses of the welfare state. So considering the mean cost of a day in a general hospital approximately equivalent to 700,00$ and considering a day of medical services= a day of non-hospitalization, our work allowed an economical benefit of 22.007.300,00$ for the public health resources (3.667.883,33$/year). Home-Care models could be the successful instruments and strategies of treatment in advanced cancer care. No significant financial relationships to disclose.