Prospective cohort study of quality of care (QC) and quality of life (QL) of palliative cancer patients in three different situations: In-patient hospitalization (IN), palliative care unit (PA) and home care (HO). Final analysis

Abstract

20670 Background: The aim of the study was to assess QC and QL in advanced cancer patients receiving palliative care during (i) in-patient hospitalization in a comprehensive cancer center, (ii) in-patient hospitalization in a palliative care unit, (iii) home-care. Methods: After giving informed consent, the patient chose one of the three possibilities. QC was assessed by the STASS questionnaire, QL by the EORTC QLQ-C30, mood disturbance by Spielberger questionnaire and pain by VAS. The impact on family members was assessed by semi- structured interviews. Evaluations were conducted at days 0, 15, 30 and then monthly until death (max four months). Results: 51 men and 49 women were included (median-age: 61 years). The choices expressed by the patients were IN 14%, PA 20% and HO 66%. The type of care actually provided was IN 26%, PA 19%, HO 55%. At the end of the study (85% patients died before 4 months), the distribution was IN 50%, PA 24% and HO 26%. Symptom evaluation was consistent between patients and care-givers. QC, QL and pain assessment were similar between the three cohorts. IN nurses were more anxious and considered that patients had a better estimation of their prognosis. The level of anxiety among patients and families was lower in HO. Re hospitalization was correlated with Karnofsky index alteration but not with pain, patient or family anxiety. Conclusions: The majority of patients choose home hospitalization, but families frequently find it difficult to cope. Even if the family agrees with the patient’s choice, re-hospitalization is frequently required at the end of life. Physical and psychological symptoms are frequent but under control and do not differ between the three cohorts. Home palliative care demands special attention and specific support for family members. No significant financial relationships to disclose.