Patterns of care at the end of life: a retrospective study of Italian patients with advanced breast cancer.
Breast cancer
End of life
Palliative care
Journal
BMC palliative care
ISSN: 1472-684X
Titre abrégé: BMC Palliat Care
Pays: England
ID NLM: 101088685
Informations de publication
Date de publication:
22 May 2024
22 May 2024
Historique:
received:
01
08
2023
accepted:
15
05
2024
medline:
23
5
2024
pubmed:
23
5
2024
entrez:
22
5
2024
Statut:
epublish
Résumé
To better understand the type of care offered to Italian patients with advanced breast cancer at the End-of-Life (EoL), we conducted a retrospective observational study. EoL was defined as the period of six months before death. One hundred and twenty-one patients with advanced breast cancer (ABC) treated at IRCCS San Martino Policlinic Hospital who died between 2017 and 2021 were included. Data about patient, disease, and treatment characteristics from breast cancer diagnosis to death, along with information about comorbidities, medications, imaging, specialist evaluations, hospitalization, palliative care and home care, hospice admissions, and site of death were collected. 98.3% of the patients received at least one line of active treatment at EoL; 52.8% were hospitalized during the selected period. Palliative (13.9%), psychological (7.4%), and nutritional evaluations (8.2%) were underutilized. Palliative home care was provided to 52% of the patients. Most of the patients died at home (66.1%) and fewer than one out of five (18.2%) died at the hospital. Among the patients who died at home, 27.3% had no palliative support. Our findings indicate that palliative care in EoL breast cancer patients is still inadequate. Only a minority of patients had psychological and nutritional support While low nutritional support may be explained by the fact that typical symptoms of ABC do not involve the gastrointestinal tract, the lack of psychological support suggests that significant barriers still exist. Data on the site of death are encouraging, indicating that EoL management is increasingly home centered in Italy.
Identifiants
pubmed: 38778303
doi: 10.1186/s12904-024-01460-0
pii: 10.1186/s12904-024-01460-0
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
129Informations de copyright
© 2024. The Author(s).
Références
Madden DL. From a patient advocate’s perspective: does cancer immunotherapy represent a paradigm shift? Curr Oncol Rep. 2018;20:8.
doi: 10.1007/s11912-018-0662-5
pubmed: 29411148
Smith TJ, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30:880–7.
doi: 10.1200/JCO.2011.38.5161
Ferrell BR, Temel JS, Temin S, et al. Integration of palliative care into standard oncology care: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2017;35:96–112. https://doi.org/10.1200/JCO.2016.70.1474 .
doi: 10.1200/JCO.2016.70.1474
pubmed: 28034065
Temel JS, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733–42.
doi: 10.1056/NEJMoa1000678
pubmed: 20818875
Hui D, Cerana MA, Park M, Hess K, Bruera E. Impact of oncologists’ attitudes toward end-of-life care on patients’ access to palliative care. Oncologist. 2016;21:1149–55.
doi: 10.1634/theoncologist.2016-0090
pubmed: 27412394
pmcid: 5016076
Earle CC, et al. Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol Off J Am Soc Clin Oncol. 2008;26:3860–6.
doi: 10.1200/JCO.2007.15.8253
Harrison RA, et al. Aggressiveness of care at end of life in patients with high-grade glioma. Cancer Med. 2021;10:8387–94.
doi: 10.1002/cam4.4344
pubmed: 34755486
pmcid: 8633215
Abedini NC, et al. Interventions to reduce aggressive care at end of life among patients with cancer: a systematic review. Lancet Oncol. 2019;20:e627–36.
doi: 10.1016/S1470-2045(19)30496-6
pubmed: 31674321
Anders CK, Peppercorn J. Treating in the dark: unanswered questions on costs and benefits of late line therapy for metastatic breast cancer. Cancer Invest. 2009;27:13–6.
doi: 10.1080/07357900802484944
pubmed: 19160108
Cardona-Morrell M, et al. Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem. Int J Qual Health Care J Int Soc Qual Health Care. 2016;28:456–69.
doi: 10.1093/intqhc/mzw060
Taylor R, et al. A scoping review of initiatives to reduce inappropriate or non-beneficial hospital admissions and bed days in people nearing the end of their life: much innovation, but limited supporting evidence. BMC Palliat Care. 2020;19:24.
doi: 10.1186/s12904-020-0526-2
pubmed: 32103745
pmcid: 7045380
Effendy C, Yodang Y, Amalia S, Rochmawati E. Barriers and facilitators in the provision of palliative care in adult intensive care units: a scoping review. Acute Crit Care. 2022;37:516–26.
doi: 10.4266/acc.2022.00745
pubmed: 36330738
pmcid: 9732202
Bennardi M, et al. Palliative care utilization in oncology and hemato-oncology: a systematic review of cognitive barriers and facilitators from the perspective of healthcare professionals, adult patients, and their families. BMC Palliat Care. 2020;19:47.
doi: 10.1186/s12904-020-00556-7
pubmed: 32284064
pmcid: 7155286
An A, Hui D. Immunotherapy versus hospice: treatment decision-making in the modern era of novel cancer therapies. Curr Oncol Rep. 2022;24:285–94.
doi: 10.1007/s11912-022-01203-5
pubmed: 35113356
Zachariah FJ, et al. Prospective comparison of medical oncologists and a machine learning model to predict 3-month mortality in patients with metastatic solid tumors.
Temel JS, et al. Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29:2319–26.
doi: 10.1200/JCO.2010.32.4459
Weeks JC, et al. Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA. 1998;279:1709–14.
doi: 10.1001/jama.279.21.1709
pubmed: 9624023
Lobbezoo DJA, et al. Prognosis of metastatic breast cancer: are there differences between patients with de novo and recurrent metastatic breast cancer? Br J Cancer. 2015;112:1445–51.
doi: 10.1038/bjc.2015.127
pubmed: 25880008
pmcid: 4453676
Schmitz RSJM, et al. Healthcare use during the last six months of life in patients with advanced breast cancer. Cancers. 2021;13:5271.
doi: 10.3390/cancers13215271
pubmed: 34771434
pmcid: 8582356
Assi T, et al. Treatment of cancer patients in their last month of life: aimless chemotherapy. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2016;24:1603–8.
Tanguy-Melac A, et al. Intensity of care, expenditure, place and cause of death people with lung cancer in the year before their death: a French population based study. Bull Cancer (Paris). 2020;107:308–21.
doi: 10.1016/j.bulcan.2019.11.011
pubmed: 32035648
Wadhwa D, et al. Systemic anti-cancer therapy use in palliative care outpatients with advanced cancer. J Palliat Care. 2021;36:78–86.
doi: 10.1177/0825859720975949
pubmed: 33241732
Longo F, et al. Le cure palliative in Italia: . L.Salute, M. della. Rapporto al Parlamento sullo stato di attuazione della Legge n. 38 del 15 marzo 2010 ‘Disposizioni per garantire l’accesso alle cure palliative e alla terapia del dolore’. https://www.salute.gov.it/portale/documentazione/p6_2_2_1.jsp?lingua=italiano&id=2814 .
Hui D, Heung Y, Bruera E. Timely palliative care: personalizing the process of referral. Cancers. 2022;14:1047.
doi: 10.3390/cancers14041047
pubmed: 35205793
pmcid: 8870673
Hui D, et al. Quality of end-of-life care in patients with hematologic malignancies: a retrospective cohort study. Cancer. 2014;120:1572–8.
doi: 10.1002/cncr.28614
pubmed: 24549743
Jordan RI, et al. Duration of palliative care before death in international routine practice: a systematic review and meta-analysis. BMC Med. 2020;18:368.
doi: 10.1186/s12916-020-01829-x
pubmed: 33239021
pmcid: 7690105
Scibetta C, Kerr K, Mcguire J, Rabow MW. The costs of waiting: implications of the timing of palliative care consultation among a cohort of decedents at a comprehensive cancer center. J Palliat Med. 2016;19:69–75.
doi: 10.1089/jpm.2015.0119
pubmed: 26618636
Beatty L, et al. A systematic review of psychotherapeutic interventions for women with metastatic breast cancer: context matters. Psychooncology. 2018;27:34–42.
doi: 10.1002/pon.4445
pubmed: 28432855
Tanguy-Melac A, et al. Intensity of care, expenditure, and place of death in French women in the year before their death from breast cancer: a population-based study. Cancer Control. 2020;27:1073274820977175.
doi: 10.1177/1073274820977175
pubmed: 33356850
pmcid: 8480356
Rabow M, et al. The value of embedding: integrated palliative care for patients with metastatic breast cancer. Breast Cancer Res Treat. 2018;167:703–8.
doi: 10.1007/s10549-017-4556-2
pubmed: 29086230
Check DK, Rosenstein DL, Dusetzina SB. Early supportive medication use and end-of-life care among medicare beneficiaries with advanced breast cancer. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2016;24:3463–72.
Wu X-C, et al. Impact of the AYA HOPE comorbidity index on assessing health care service needs and health status among adolescents and young adults with cancer. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2015;24:1844–9.
doi: 10.1158/1055-9965.EPI-15-0401