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Open Access 14-05-2024 | Original Research

Standardizing Integrated Oncology and Palliative Care Across Service Levels: Challenges in Demonstrating Effects in a Prospective Controlled Intervention Trial

Authors: Anne-Tove Brenne, Erik Torbjørn Løhre, Anne Kari Knudsen, Jo-Åsmund Lund, Morten Thronæs, Bardo Driller, Cinzia Brunelli, Stein Kaasa

Published in: Oncology and Therapy | Issue 2/2024

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Abstract

Introduction

Patients with cancer often want to spend their final days at home. In Norway, most patients with cancer die in institutions. We hypothesized that full integration of oncology and palliative care services would result in more time spent at home during end-of-life.

Methods

A prospective non-randomized intervention trial was conducted in two rural regions of Mid-Norway. The hospitals’ oncology and palliative care outpatient clinics and surrounding communities participated. An intervention including information, education, and a standardized care pathway was developed and implemented. Adult non-curative patients with cancer were eligible. Proportion of last 90 days of life spent at home was the primary outcome.

Results

We included 129 patients in the intervention group (I) and 76 patients in the comparison group (C), of whom 82% of patients in I and 78% of patients in C died during follow-up. The mean proportion of last 90 days of life spent at home was 0.62 in I and 0.72 in C (p = 0.044), with 23% and 36% (p = 0.073), respectively, dying at home. A higher proportion died at home in both groups compared to pre-study level (12%). During the observation period the comparison region developed and implemented an alternative intervention to the study intervention, with the former more focused on end-of-life care.

Conclusion

A higher proportion of patients with cancer died at home in both groups compared to pre-study level. Patients with cancer in I did not spend more time at home during end-of-life compared to those in C. The study intervention focused on the whole disease trajectory, while the alternative intervention was more directed towards end-of-life care. “Simpler” and more focused interventions on end-of-life care may be relevant for future studies on integration of palliative care into oncology.

Trial Registration

ClinicalTrials.gov Identifier: NCT02170168.
Appendix
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Metadata
Title
Standardizing Integrated Oncology and Palliative Care Across Service Levels: Challenges in Demonstrating Effects in a Prospective Controlled Intervention Trial
Authors
Anne-Tove Brenne
Erik Torbjørn Løhre
Anne Kari Knudsen
Jo-Åsmund Lund
Morten Thronæs
Bardo Driller
Cinzia Brunelli
Stein Kaasa
Publication date
14-05-2024
Publisher
Springer Healthcare
Published in
Oncology and Therapy / Issue 2/2024
Print ISSN: 2366-1070
Electronic ISSN: 2366-1089
DOI
https://doi.org/10.1007/s40487-024-00278-3

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