Merikari Martti, Akrén Outi, Nuutinen Mikko, Mäkitie Antti, Saarto Tiina, Carpén Timo
Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, HUS, P.O. Box 180, 00029, Helsinki, Finland.
Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Oncol Ther. 2025 Apr 6. doi: 10.1007/s40487-025-00335-5.
The end of life of patients with head and neck cancer (HNC) is plagued by significant morbidity and high symptom burden, emphasizing the need for palliative care. Our aim was to evaluate the utilization of health care services, including specialist palliative care (SPC), among patients with HNC at the end of life. In addition, we wanted to explore the timing of SPC contact on the utilization of health care services at the end of life.
The study population consisted of all 281 patients who died of HNC in 2019 in Finland. Data were collected from nationwide registries. Patients were divided into two groups according to the timing of their first contact with an SPC unit: early (> 30 days before death), and late/no (≤ 30 days before death or no contact).
Mean age at death was 72 years, and 66% were male. The hospital was the most common place of death (82%). Ninety-three (33%) patients had contact with an SPC unit, and the median time of the first SPC contact was 62 days before death. Comparing those with early and late/no SPC contact, the early group was significantly associated with lower secondary health care hospitalization (31% vs. 53%; p = 0.002) and emergency care utilization (33% vs. 52%; p = 0.006) during the last month of life. The early SPC group was also associated with higher utilization of home care (52% vs. 36%; p = 0.021), SPC outpatient clinic (24% vs. 5%; p < 0.001), SPC ward (22% vs. 4%; p < 0.001), and palliative hospital-at-home services (45% vs. 5%; p < 0.001) during the last month of life. Among patients with the early SPC contact, SPC ward was significantly more likely to be the place of death (18% vs. 4%, p < 0.001) compared with patients with late/no SPC contact.
Patients with HNC utilize health care services at high rates at the end of life. Early SPC contact is associated with increased SPC service use and decreased utilization of secondary health care and emergency care, highlighting the need for early and greater access to SPC services for patients with HNC.
头颈部癌（HNC）患者的临终阶段存在严重的发病率和高症状负担，这凸显了姑息治疗的必要性。我们的目的是评估HNC患者临终时医疗服务的利用情况，包括专科姑息治疗（SPC）。此外，我们还想探讨SPC接触时间对临终时医疗服务利用情况的影响。
研究人群包括2019年在芬兰死于HNC的所有281名患者。数据从全国登记处收集。根据患者首次接触SPC单位的时间将患者分为两组：早期（死亡前>30天）和晚期/无（死亡前≤30天或无接触）。
平均死亡年龄为72岁，66%为男性。医院是最常见的死亡地点（82%）。93名（33%）患者与SPC单位有接触，首次SPC接触的中位时间为死亡前62天。比较早期和晚期/无SPC接触的患者，早期组在生命的最后一个月与较低的二级医疗住院率（31%对53%；p=0.002）和急诊利用率（33%对52%；p=0.006）显著相关。早期SPC组在生命的最后一个月还与更高的家庭护理利用率（52%对36%；p=0.021）、SPC门诊利用率（24%对5%；p<0.001）、SPC病房利用率（22%对4%；p<0.001）和姑息性居家医院服务利用率（45%对5%；p<0.001）相关。在早期接触SPC的患者中，与晚期/无SPC接触的患者相比，SPC病房更有可能成为死亡地点（18%对4%，p<0.001）。
HNC患者在临终时医疗服务利用率很高。早期SPC接触与SPC服务使用增加以及二级医疗和急诊利用率降低相关，这凸显了HNC患者需要尽早并更多地获得SPC服务。
