ADMISSION TO PALLIATIVE CARE AND INDICATORS OF END-OF-LIFE INTENSITY OF CARE IN CANCER PATIENTS FROM THE LOMBARDY REGION, ITALY

Objectives: Hospital-based and home palliative care have been associated to a reduction of aggressive treatments in the end-of-life, but data in the Italian context are scanty. We aim therefore investigate the role of palliative care on indicators of end-of-life intensity of care among cancer patients in Lombardy, the largest Italian region. Methods: Within a retrospective study using the healthcare utilization databases of Lombardy, we selected all residents who died in 2019 with a diagnosis of cancer. We considered as exposure variables admission to palliative care and time at palliative care admission, and as indicators of aggressive care hospitalizations, diagnostic/therapeutic procedures, in-hospital death, emergency department visits, and chemotherapy over a time-window of 30 days before death; chemotherapy in the last 14 days was also considered. Results: Our cohort included 26,539 individuals; of these, 14,320 (54%) were admitted to palliative care before death. Individuals who were admitted to palliative care had an odds ratio of 0.27 for one hospitalization, 0.14 for ≥2 hospitalizations, 0.25 for hospital stay ≥12 days, 0.38 for minor diagnostic/therapeutic procedures, 0.18 for major diagnostic/therapeutic procedures, 0.02 for in-hospital death, 0.35 for one emergency department visit, 0.29 for ≥2 emergency department visits, and 0.66 for chemotherapy use in the last 30 days; the odds ratio was 0.56 for chemotherapy use in the last 14 days. Conclusions: This large real-world analysis confirms and further support the importance of palliative care assistance for cancer patients in the end-of-life; this is associated to a significant reduction in unnecessary treatments

Le cure palliative in Lombardia: analisi dell’offerta assistenziale nel 2019

Summary. Objective. The Lombardy Region has one of the most widespread and advanced models of Palliative Care (PC) in the country. However, there is a relative lack of updated data referring to the activity of the Lombardy PC network. Methods. This work aims to describe the activity carried out in the two main PC care settings (home care and hospice) in 2019 through the analysis of the data sent by each Unit to the Lombardy Region. Data were analysed on a regional basis and considering the 8 Health Protection Agencies (ATS) separately. Results. In 2019, PC activity was provided by 114 home care units (1.14/100,000 inhabitants) and 70 hospice for a total of 812 beds (8.1 beds/100,000 inhabitants). Overall, 25,514 patients were assisted for a total of 29,892 care pathway. 77.6% of the patients assisted were oncologic and about 67% of the patients who died of cancer in Lombardy were intercepted by CP. 54.4% of patients were taken care of in home care, although with a significant difference between cancer patients (58%) and non-cancer patients (42%). In home care, average activation time was 2.8 days and in 81% of cases the assistance was activated within 24-48 hours; in hospice, average activation time was 3.5 days, with 60% of admissions within 24 hours and over 30% with waiting time ≥3 days. The median duration of home palliative care was approximately 21 days (average 40.5), that in hospice was 9 days (average 17.2). In the home care pathways, the prevalent outcome was the death of the patient at home (64%) and hospitalization in hospice (17.2%), while 86% of hospitalizations in hospice ended with death. Conclusions. This accurate report of the Lombardy PC activity indicates that PC satisfy various qualitative indicators of structural and care process identified by national regulations. However, PC still remain predominantly intended for cancer patients, with relatively short duration of care, particularly in the hospice setting