Palliative Care Unit at Home: Impact on Quality of Life in Cancer Patients at the End of Life in a Rural Environment

Abstract

Introduction: Advanced cancer is accompanied by a substantial burden of symptoms, and palliative care (PC) plays an essential role, especially at the end of life (EOL). In fact, a comprehensive PC through Home Palliative Care Units (HPCU) has been associated with reducing potentially aggressive care at the EOL. We aim to study the impact of HPCU on the quality of assistance of cancer patients at Alcoy Health Department. Methods: A retrospective study was conducted including patients diagnosed with terminal cancer at the Medical Department of Hospital Virgen de los Lirios who died between January 2017 and December 2018. The Multivariate Cox regression model was used to assess the impact of HPCU assistance on the quality of life indicators. Results: 388 patients were included. The median age was 71 years; 65% patients were male, and 68% presented with a 0-2 score on the ECOG scale. On the multivariate analysis, a lack of assistance by HPCU was associated with a higher risk of consulting in the emergency department (OR = 1.29, 95% CI: 1.02-1.67), of hospital admissions (OR = 4.72, 95% CI: 2.45-9.09), a higher probability of continuing active treatment (OR = 2.59, 95% CI: 1.44-4.67), and a greater probability of dying in hospital (OR = 6.52, 95% CI: 3.78-11.27). Conclusions: Patients receiving HPCU assistance have a lower number of emergency room visits and hospital admissions, and are more likely to die at home. Taken together, these results support the relevance of HPCU providing a high quality attention of cancer patients.

Factors associated with emergency room visit or hospitalization in care oncology home care: an integrative review /Fatores associados à visita à emergência ou hospitalização em cuidados paliativos oncológicos domiciliares: uma revisão integrativa

“…The data from this ILR reinforce that RVH improve the quality of life of cancer patients, increase the length of stay at home and reduce the risk of RVH. 7,9,13,15,28,32 Despite the benefits offered by HPC, the percentage of cancer patients who resort to RVH is still high, either due to physical signs and symptoms inherent to the advanced stage of the disease; 6,7,9,15,19,[26][27][29][30][31][32][33][34][35] factors inherent to certain types of cancer; 6,9,13,26 social/family factors; 6,[32][33] cultural factors or characteristics of the healthcare network. 27,30,35 The increased risk of hospitalization in patients with hematologic tumors was demonstrated in two articles 9,13 of this review coinciding with previous study data 36 in which patients with non-solid tumors were more likely to die in hospital, which was attributed to the existence of multiple treatment options, even in advanced stages of disease.…”

“…[4][5] The place where the patient wishes to receive care, including at the end of life, is usually at home, which requires preparation and structure to make this feasible. 4,[6][7] There are Home Care (HC) services specialized in PC oncology, whose benefits include favoring the relief of physical, psychological, social or spiritual signs and symptoms, reducing the demand for emergency care, avoiding unnecessary hospitalizations, reducing the death rate in the hospital environment and allowing patients to stay longer at home with their families, also reducing hospital costs. [8][9][10][11][12][13][14] However, cancer patients in Home Palliative Care (HPC) may require care in the emergency room in situations of complications and/or decline in general condition, caused by the natural evolution of the disease, effects of anticancer therapy or by lack of symptom control.…”

Surgical Care Services in inaccessible zones: Targeted Palliative Care Accessibility Models for patients in resource‐limited settings

“…To assess the substantial burden of symptoms and palliative care in advanced cancer, especially at the end of life, Moncho et al 7 described the role of Home Palliative Care Units (HPCU) in emergency department consultations in Spain. The authors found that lack of HPCU care was associated with a higher risk of emergency department consultation (OR = 1.29, 95% CI: 1.02–1.67), of hospital admissions (OR = 4.72, 95% CI: 2.45–9.09), and a higher probability of continuing active treatment (OR = 2.59, 95% CI: 1.44–4.67) and of dying in hospital (OR = 6.52, 95% CI: 3.78–11.27).…”

Targeted Palliative Care Accessibility Models for patients in a resource‐limited setting: Review of alternatives in inaccessible zones

“…This could be also modified based on language and cultural characteristics to make people from a rural setting/resource-limited setting understand terms and concerns of palliative care therapy in cancer patients, since the complex terminology can be confusing to patients and their local caregivers. 5 These mentioned models [2][3][4] and examples [2][3][4][5] of palliative care between inaccessible case zones in low-cost and resource-limited settings draw our attention to the palliative care provided to individuals suffering from oncological problems (Figure 1). We thank the authors on their studies and possible models for the elaboration and implementation of new public health policies in this field.…”