Effect of home care on the place of death of advanced cancer patients

This study presents a prospective evaluation of the home care programme for patients with advanced cancer at the National Cancer Institute of Milan. Demographic, psychosocial and physical variables were evaluated. The Therapy Impact Questionnaire was used for symptom and quality of life assessment....

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Bibliographic Details
Published in:European journal of cancer (1990) 1996-06, Vol.32 (7), p.1142-1147
Main Authors: De Conno, F., Caraceni, A., Groff, L., Brunelli, C., Donati, I., Tamburini, M., Ventafridda, V.
Format: Article
Language:English
Subjects:
advanced cancer
Aged
Biological and medical sciences
cancer pain
Female
General aspects
home care
Home Care Services
Hospitalization - statistics & numerical data
Humans
Italy
Male
Medical sciences
Middle Aged
Neoplasms - complications
Neoplasms - nursing
palliative care
Palliative Care - organization & administration
place of death
Prospective Studies
quality of life
Socioeconomic Factors
Terminal Care - organization & administration
Tumors
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Summary:This study presents a prospective evaluation of the home care programme for patients with advanced cancer at the National Cancer Institute of Milan. Demographic, psychosocial and physical variables were evaluated. The Therapy Impact Questionnaire was used for symptom and quality of life assessment. The association of clinical and demographic variables with the place of death was investigated, considering that the aim of the home care programme is to follow up patients until death in their houses. Eighty-six per cent (86%) of patients died at home and 14% in hospitals. Multivariate analysis showed that only a higher degree of family support was associated with home death. Several changes in symptoms and quality of life items scores were seen, pain improved while physical debility and cognitive functions worsened throughout the home care duration to death. High intensity pain and dyspnoea were still present in, respectively, 23.8 and 15.3% of patients in the last week of life. Psychological distress was high at the end of life and did not seem to be affected by treatment. Home care is a feasible alternative for implementing palliative care in a selected population of patients with advanced cancer. Palliation of physical symptoms is more easily achieved than the control of psychological suffering. Family and economical issues implied by home care models should be part of the discussion in implementing palliative care for advanced cancer patients.
ISSN:0959-8049
1879-0852
DOI:10.1016/0959-8049(96)00036-6