The systematic monitoring of VAS by nurses at a medical oncology inpatients' ward is feasible with a good patient compliance. The reliability of the procedure in terms of guiding the analgesic treatment has yet to be demonstrated.
BackgroundChemotherapy (CT) in patients with advanced cancer (ACP) near the end of life is an increasing practice of oncology units. A closer integration with palliative care (PC) services could reduce the use of potentially harmful CT. This prospective study is aimed at assessing whether a more integrated care model could reduce CT use near the end of life and increase local PC service utilisation.MethodsThe study enrolled sequentially two cohorts of ACP with an estimated life expectancy of ≤6 months. In the first cohort, the usual oncologist’s practice to prescribe CT and to activate local PC services were recorded. In cohort 2, the oncologist’s decision was taken after an in-hospital consultation with the local PC teams. After patient death, a follow-back survey was carried out.ResultsThe two cohorts included 109 and 125 evaluable patients, respectively. The oncologist’s decision to prescribe CT occurred in 51.4% and 60%, respectively: the percentages of patients receiving the final CT administration in the last 30 days of life did not differ in the two cohorts (33.9% and 29.3%, respectively,p=0.83). Conversely, an increase in home PC service utilisation (from 56.9% to 82.4%, p=0.00), at home deaths (from 40.4% to 56.8%, p=0.01) and in-hospice deaths (from 8.3% to 19.2%, p=0.00) occurred in cohort 2.ConclusionThe implementation of an initial in-hospital consultation of oncologists and experienced home PC teams has not reduced the use of CT near the end of life but increased PC service utilisation and reduced in-hospital deaths.
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