The effect of palliative outpatient units on resource use for cancer patients in Finland

Olli Haltia*, Märt Vesinurm, Riikka Leena Leskelä, Eeva Rahko, Kristiina Tyynelä-Korhonen, Juho T. Lehto, Tiina Saarto, Outi M. Akrén

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background: As cancer incidences are increasing, the means to provide effective palliative care (PC) are called for. There is evidence, that PC may prevent futile treatment at the end of life (EOL) thus implicating that PC decreases resource use at the EOL, however, the effects of outpatient PC units remain largely unknown. We surveyed the national use of Finnish tertiary care PC units and their effects on resource use at the EOL in real-life environments. Patients and Methods: Cancer patients treated in the departments of Oncology at all five Finnish university hospitals in 2013 and deceased by 31 December 2014 were identified; of the 6010 patients 2007 were randomly selected for the study cohort. The oncologic therapies received and the resource usage of emergency services and hospital wards were collected from the hospitals’ medical records. Results: A PC unit was visited by 37% of the patients a median 112 days before death. A decision to terminate all life-prolonging cancer treatments was more often made for patients visiting the PC unit (90% vs. 66%, respectively). A visit to a PC unit was associated with significantly fewer visits to emergency departments (ED) and hospitalization during the last 90 days of life; the mean difference in ED visits decreased by 0.48 (SD 0.33 − 0.62, p < 0.001), and the mean inpatient days by 7.1 (SD 5.93 − 8.25, p < 0.001). A PC visit unit was independently associated with decreased acute hospital resource use during the last 30 and 90 days before death in multivariable analyses. Conclusion: Cancer patients’ contact with a PC unit was significantly associated with the reduced use of acute hospital services at the EOL, however; only one-third of the patients visited a PC unit. Thus, systematic PC unit referral practices for patients with advanced cancer are called for.

Original languageEnglish
Pages (from-to)1118-1123
Number of pages6
JournalActa Oncologica
Volume62
Issue number9
Early online date3 Aug 2023
DOIs
Publication statusPublished - 2023
MoE publication typeA1 Journal article-refereed

Keywords

  • cancer
  • end of life care
  • Palliative care
  • resource use

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