Publicaciones científicas
Characteristics of the case mix, organisation and delivery in cancer palliative care: a challenge for good-quality research
Hjermstad MJ (1), Aass N (2), Aielli F (3), Bennett M (4), Brunelli C (5), Caraceni A (5), Cavanna L (6), Fassbender K (7), Feio M (8), Haugen DF (9), Jakobsen G (10), Laird B (11), Løhre ET (12), Martinez M (13), Nabal M (14), Noguera-Tejedor A (15), Pardon K (16), Pigni A (17), Piva L (18), Porta-Sales J (19), Rizzi F (20), Rondini E (21), Sjøgren P (22), Strasser F (23), Turriziani A (24), Kaasa S (25); European Palliative Care Cancer Symptom study (EPCCS).
OBJECTIVES:
Palliative care (PC) services and patients differ across countries. Data on PC delivery paired with medical and self-reported data are seldom reported. Aims were to describe (1) PC organisation and services in participating centres and (2) characteristics of patients in PC programmes.
METHODS:
This was an international prospective multicentre study with a single web-based survey on PC organisation, services and academics and patients' self-reported symptoms collected at baseline and monthly thereafter, with concurrent registrations of medical data by healthcare providers. Participants were patients ≥18 enrolled in a PC programme.
RESULTS:
30 centres in 12 countries participated; 24 hospitals, 4 hospices, 1 nursing home, 1 home-care service. 22 centres (73%) had PC in-house teams and inpatient and outpatient services. 20 centres (67%) had integral chemotherapy/radiotherapy services, and most (28/30) had access to general medical or oncology inpatient units.
Physicians or nurses were present 24 hours/7 days in 50% and 60% of centres, respectively. 50 centres (50%) had professorships, and 12 centres (40%) had full-time/part-time research staff. Data were available on 1698 patients: 50% females; median age 66 (range 21-97); median Karnofsky score 70 (10-100); 1409 patients (83%) had metastatic/disseminated disease; tiredness and pain in the past 24 hours were most prominent.
During follow-up, 1060 patients (62%) died; 450 (44%) <3 months from inclusion and 701 (68%) within 6 months. ANOVA and χ2 tests showed that hospice/nursing home patients were significantly older, had poorer performance status and had shorter survival compared with hospital-patients (p<.0.001).
CONCLUSIONS:
There is a wide variation in PC services and patients across Europe. Detailed characterisation is the first step in improving PC services and research.
CITA DEL ARTÍCULO BMJ Support Palliat Care. 2018 Dec;8(4):456-467. doi: 10.1136/bmjspcare-2015-000997. Epub 2016 May 31.