The impact of specialist palliative care on healthcare utilization among patients with breast cancer: a nationwide register-based cohort study

TL;DR

This study shows that early specialist palliative care for breast cancer patients reduces hospital use and increases chances of dying in a care ward.

Contribution

The study provides nationwide evidence on the impact of early specialist palliative care on healthcare utilization in breast cancer patients.

Findings

Patients with early SPC contact had fewer emergency department visits and hospitalizations.

Early SPC contact increased use of hospital-at-home services and SPC wards for end-of-life care.

Timely SPC was linked to fewer acute hospital contacts and lower likelihood of dying in the hospital.

Abstract

The incidence of breast cancer and the related mortality in Finland are among the highest in the world. Specialist palliative care (SPC) has been shown to improve quality of life and potentially reduce intensive resource use at the end of life among patients with advanced cancer. We aimed to perform a nationwide evaluation of the timing of the first SPC contact and its impact on hospital resource utilization in patients with breast cancer.

A nationwide retrospective cohort analysis included 881 breast cancer patients who died in Finland in 2019, with data drawn from national registries. Patients were divided into two groups according to the time of their first SPC contact: Group I (> 30 days before death) and Group II (≤ 30 days before death or no SPC contact).

SPC contact was established for 288 (35%) patients, with a median interval of 89 days from initial SPC contact to death. During the last month of life, patients in Group I had fewer emergency department contacts (46% vs. 58%, p = 0.004) and fewer hospitalizations in secondary care (28% vs. 48%, p < 0.001), compared patients in Group II. Additionally, patients in Group I utilized hospital-at-home services more often (42% vs. 7%, p < 0.001) and had a higher likelihood of dying in SPC wards (15% vs. 3%, p < 0.001) rather than in hospital (65% vs. 77%, p < 0.001).

Timely SPC contact was associated with fewer acute hospital contacts and a reduced likelihood of hospital death, underscoring the importance of timely palliative care integration for patients with advanced breast cancer.

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