Abstract
BackgroundThis is an international study across four European countries (Belgium[BE], the Netherlands[NL], Italy[IT] and Spain[ES]) between 2009 and 2011, describing and comparing care and care setting transitions provided in the last three months of life of cancer patients, using representative GP networks.MethodsGeneral practitioners (GPs) of representative networks in each country reported weekly all non-sudden cancer deaths (+18y) within their practice. GPs reported medical end-of-life care, communication and circumstances of dying on a standardised questionnaire. Multivariate logistic regressions (BE as a reference category) were conducted to compare countries.ResultsOf 2,037 identified patients from four countries, four out of five lived at home or with family in their last year of life. Over 50% of patients had at least one transition in care settings in the last three months of life; one third of patients in BE, IT and ES had a last week hospital admission and died there. In the last week of life, a treatment goal was adopted for 80-95% of those having palliation/comfort as their treatment goal. Cross-country differences in end-of-life care provision included GPs in NL being more involved in palliative care (67%) than in other countries (35%-49%) (OR 1.9) and end-of-life topics less often discussed in IT or ES. Preference for place of death was less often expressed in IT and ES (32-34%) than in BE and NL (49-74%). Of all patients, 88-98% were estimated to have distress from at least one physical symptom in the final week of life.ConclusionAlthough palliative care was the main treatment goal for most cancer patients at the end of life in all four countries, frequent late hospital admissions and the symptom burden experienced in the last week of life indicates that further integration of palliative care into oncology care is required in many countries.
Highlights
This is an international study across four European countries (Belgium[BE], the Netherlands[NL], Italy [IT] and Spain[ES]) between 2009 and 2011, describing and comparing care and care setting transitions provided in the last three months of life of cancer patients, using representative General practitioners (GP) networks
Using a mortality follow-back questionnaire design, GPs reported all deaths in their practices on the end of life (EOL) care provided in the final months of life on standardised forms
Home deaths were more common in the Netherlands (57.9%) and Spain (51.1%).Except for the Netherlands (17%), more than one third of cancer patients died in hospital in all countries (34%[BE], 38%[IT] and 35%[ES])
Summary
This is an international study across four European countries (Belgium[BE], the Netherlands[NL], Italy [IT] and Spain[ES]) between 2009 and 2011, describing and comparing care and care setting transitions provided in the last three months of life of cancer patients, using representative GP networks. Cross-country populationbased studies aimed at describing these variations in delivered EOL care for people with cancer in Europe are scarce [4,8,9]. Comparative and nationwide EU studies measuring across different care settings and cancer types could inform us on organising palliative care for dying cancer patients. We aim to use nationwide networks of GPs in four EU countries (Belgium [BE], the Netherlands [NL], Italy [IT] and Spain [ES]) to describe and compare the medical care process, patient-GP communication processes and the actual circumstances of dying of cancer patients in the four countries studied
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