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

• Published in: European journal of cancer (1990) Vol. 32; no. 7; pp. 1142 - 1147
• Main Authors: De Conno, F., Caraceni, A., Groff, L., Brunelli, C., Donati, I., Tamburini, M., Ventafridda, V.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.06.1996; Elsevier
• 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; Italy; cancer pain; home care; advanced cancer; place of death; quality of life; palliative care; Human; Treatment; At home; Palliative care; Death; Advanced stage; Terminal stage; Malignant tumor; Quality of life
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/0959-8049(96)00036-6

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.