Association between clinical factors and the choice of palliative care setting among cancer patients: A post-hoc analysis of a cohort study.

Abstract

In the literature, the data about the factors related to the choice of the setting at patient's first palliative care admission visit are scanty. In fact it seems that the choice between home or hospice care is mainly based on the opinions and needs of patients, families and physicians. This study aims to address the association between the clinical factors detected at the first palliative visit in advanced cancer patients and the choice of palliative care setting (i.e., hospice or home care). This is a monocentric, prospective cohort study. A total of 1811 consecutive patients with advanced cancer, admitted to the VIDAS Palliative Care service (hospice/ home care), Milan, Italy in 2018-2020 were included. In the univariate analysis, several clinical comorbidities and physiological deficits were associated with hospice admittance; while patients with more severe symptoms of anxiety, asthenia, depression, and pain were associated with home care admittance. In the multivariate logistic analysis, six clinical factors were associated with the risk of hospice admission: anxiety (OR 0.16), brain metastases (OR 1.67), severe sleep-wake rhythm upset (OR 1.79), bone/vertebral fractures (OR 2.12), intestinal occlusion or sub-occlusion (OR 2.16), and cachexia (OR 2.25). The multivariate cluster analysis confirmed the link observed with the previous statistical analyses. The results of this analysis showed that some clinical factors were closely related to the chosen palliative care setting and should be taken into consideration a priori to deciding the most appropriate place of care.