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Haltia O, Vesinurm M, Leskelä RL, Rahko E, Tyynelä-Korhonen K, Lehto JT, Saarto T, Akrén OM. The effect of palliative outpatient units on resource use for cancer patients in Finland. Acta Oncol 2023; 62:1118-1123. [PMID: 37535611 DOI: 10.1080/0284186x.2023.2241988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
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.
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Affiliation(s)
- Olli Haltia
- Helsinki Health Care Center; Faculty of Medicine, Department of General Practice and Primary Health Care, Helsinki University, Helsinki, Finland
| | - Märt Vesinurm
- Nordic Healthcare group, Helsinki, Finland
- Department of Industrial Engineering and Management, Institute of Healthcare Engineering and Management (HEMA), Aalto University School of Science, Espoo, Finland
| | | | - Eeva Rahko
- Cancer Center, Oulu University Hospital, Oulu, Finland
| | | | - Juho T Lehto
- Palliative Care Centre, Department of Oncology, Tampere University Hospital and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Tiina Saarto
- Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Outi M Akrén
- Palliative Center, Turku University Hospital and Faculty of Medicine, Turku University, Turku, Finland
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Haltia O, Hirvonen OM, Saarto T, Lehto JT. Impact of the Regional Palliative Care Pathway on Emergency Room Visits and Hospitalizations. Anticancer Res 2021; 41:1701-1706. [PMID: 33788768 DOI: 10.21873/anticanres.14934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To explore the effect of palliative care (PC) pathway including home care and end-of-life care beds in the community hospitals supported by a PC unit in the secondary hospital on ER visits and hospitalizations. PATIENTS AND METHODS Patients with advanced cancer and no further oncologic therapies who visited the ER of the Hyvinkää hospital before (2009) and after (2015) the establishment of the PC pathway were evaluated. RESULTS A total of 112 patients visited the ER in both years, but revisits decreased from 59% to 38% (p<0.01). The most common symptoms necessitating the visit were pain (20%) and dyspnoea (14%). The proportion of patients admitted to a secondary hospital were 56% and 45% (p=0.016) and to community hospitals 12% and 28% (p<0.001) in 2009 and 2015, respectively. CONCLUSION Organizing a PC pathway for cancer patients together with primary and secondary care decreases revisits to ER and admissions to secondary hospitals.
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Affiliation(s)
- Olli Haltia
- Faculty of Medicine, Helsinki University and Hyrylä Health Care Center, Keski-Uudenmaan Sote, Tuusula, Finland;
| | - Outi M Hirvonen
- Palliative Center of Turku University Hospital, Turku, Finland
| | - Tiina Saarto
- Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Juho T Lehto
- Palliative Care Centre, Department of Oncology, Tampere University Hospital and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
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Hirvonen OM, Leskelä RL, Grönholm L, Haltia O, Voltti S, Tyynelä-Korhonen K, Rahko EK, Lehto JT, Saarto T. The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study. BMC Palliat Care 2020; 19:37. [PMID: 32209075 PMCID: PMC7093948 DOI: 10.1186/s12904-020-00547-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/17/2020] [Indexed: 11/16/2022] Open
Abstract
Background In order to avoid unnecessary use of hospital services at the end-of-life, palliative care should be initiated early enough in order to have sufficient time to initiate and carry out good quality advance care planning (ACP). This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death. Methods A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013 –Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision (the decision to terminate life-prolonging anticancer treatments and focus on symptom centered palliative care) and use of PC unit services were studied in relation to emergency department (ED) visits, hospital inpatient days and place of death. Results A PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients had an appointment at the PC unit (> 180 days prior to death 72% and < 14 days 10%). The number of ED visits and inpatient days were highest for patients with no PC decision and lowest for patients with both a PC decision and an PC unit appointment (60 days before death ED visits 1.3 vs 0.8 and inpatient days 9.9 vs 2.9 respectively, p < 0.01). Patients with no PC decision died more often in secondary/tertiary hospitals (28% vs. 19% with a PC decision, and 6% with a decision and an appointment to a PC unit). Conclusions The PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. Contact with a PC unit further increased the likelihood of EOL care at primary care.
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Affiliation(s)
- Outi M Hirvonen
- Department of Oncology and Radiotherapy, Turku University Hospital and Department of Clinical Oncology, University of Turku, PO Box 52, FI-20521, Turku, Finland.
| | | | - Lotta Grönholm
- Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Olli Haltia
- Tuusula Health Care Centre, Tuusula, Finland
| | | | | | - Eeva K Rahko
- Department of Clinical Oncology, Oulu University Hospital, Oulu, Finland
| | - Juho T Lehto
- Department of Oncology, Palliative Care Unit, Tampere University Hospital and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Tiina Saarto
- Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, Helsinki University, Helsinki, Finland
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Hirvonen OM, Leskelä RL, Grönholm L, Haltia O, Rissanen A, Tyynelä-Korhonen K, Rahko EK, Lehto JT, Saarto T. Assessing the utilization of the decision to implement a palliative goal for the treatment of cancer patients during the last year of life at Helsinki University Hospital: a historic cohort study. Acta Oncol 2019; 58:1699-1705. [PMID: 31742490 DOI: 10.1080/0284186x.2019.1659512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: To avoid aggressive treatments at the end-of-life and to provide palliative care (PC), physicians need to terminate futile anti-cancer treatments and define the palliative goal of the treatment in time. This single center study assesses the practices used to make the decision that leads to treatment with a palliative goal, i.e., the PC decision and its effect on anti-cancer treatments at the end of life.Material and methods: Patients with a cancer diagnosis treated in tertiary hospital during 1st January 2013 - 31st December 2014 and deceased by the end of 2014 were identified in the hospital database (N = 2737). Of these patients, 992 were randomly selected for this study. The PC decision was screened from patient records, i.e., termination of cancer-specific treatments and a focus on symptom-centered PC.Results: The PC decision was defined in 82% of the patients during the last year of life (49% >30 days and 33% ≤30 days before death, 18% with no decision). The median time from the decision to death was 46 days. Systemic cancer therapy was given during the last month of life in 1%, 36% and 38% (p < .001) and radiotherapy 22%, 40% and 31% (p = .03) cases, respectively; referral to a PC unit was made in 62%, 22% and 11%, respectively (p < .001). In logistic regression analyses younger age, shorter duration of the disease trajectory and type of cancer (e.g., breast cancer) were associated with a lack or late timing of the PC decision.Conclusion: The decision to initiate a palliative goal for the treatment was frequently made for cancer patients but occurred late for every third patient. Younger age and certain cancer types were associated with late PC decisions, thus leading to anti-cancer treatments continuing until close to the death with low access to a PC unit.
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Affiliation(s)
- Outi M. Hirvonen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
- Department of Clinical Oncology, University of Turku, Turku, Finland
| | | | - Lotta Grönholm
- Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Olli Haltia
- Tuusula Health Care Centre, Tuusula, Finland
| | | | | | - Eeva K. Rahko
- Department of Clinical Oncology, Oulu University Hospital, Oulu, Finland
| | - Juho T. Lehto
- Department of Oncology, Palliative Care Unit, Tampere University Hospital and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Tiina Saarto
- Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
- Department of Palliative Care, Comprehensive Cancer Center, University of Helsinki, Helsinki, Finland
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Haltia O, Färkkilä N, Roine RP, Sintonen H, Taari K, Hänninen J, Lehto JT, Saarto T. The indirect costs of palliative care in end-stage cancer: A real-life longitudinal register- and questionnaire-based study. Palliat Med 2018; 32:493-499. [PMID: 28895471 DOI: 10.1177/0269216317729789] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Palliative care needs are increasing as more people are dying from incurable diseases. Healthcare costs have been reported to be highest during the last year of life, but studies on the actual costs of palliative care are scarce. AIM To explore the resource use and costs of palliative care among end-stage breast, colorectal and prostate cancer patients after termination of life-prolonging oncological treatments, that is, during the palliative care period. DESIGN A real-life longitudinal register- and questionnaire-based study of cancer patients' resource use and costs. PARTICIPANTS In total, 70 patients in palliative care with no ongoing oncological treatments were recruited from the Helsinki University Hospital or from the local hospice. Healthcare costs, productivity costs and informal care costs were included. RESULTS The mean duration of the palliative care period was 179 days. The healthcare cost accounted for 55%, informal care for 27% and productivity costs for 18% of the total costs. The last 2 weeks of life contributed to 37% of the healthcare cost. The costs of the palliative care period were higher in patients living alone, which was mostly caused by inpatient care ( p = 0.018). CONCLUSION The 45% share of indirect costs is substantial in end-of-life care. The healthcare costs increase towards death, which is especially true of patients living alone. This highlights the significant role of caregivers. More attention should be paid to home care and caregiver support to reduce inpatient care needs and control the costs of end-of-life care.
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Affiliation(s)
- Olli Haltia
- 1 Tuusula Health Care Centre, Tuusula, Finland
| | - Niilo Färkkilä
- 2 Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Risto Paavo Roine
- 3 University of Eastern Finland, Kuopio, Finland.,4 University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Sintonen
- 2 Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Kimmo Taari
- 5 Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Juho Tuomas Lehto
- 7 Department of Oncology, Palliative Care Unit, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Tiina Saarto
- 8 Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Haltia O, Törmänen S, Eräranta A, Jokihaara J, Nordhausen K, Rysä J, Ruskoaho H, Tikkanen I, Mustonen J, Pörsti I. Vasopeptidase Inhibition Corrects the Structure and Function of the Small Arteries in Experimental Renal Insufficiency. J Vasc Res 2015; 52:94-102. [PMID: 26184548 DOI: 10.1159/000431368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/05/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We studied whether vasopeptidase inhibition corrects the structure and function of the small arteries in experimental chronic renal insufficiency (CRI). METHODS After 5/6 nephrectomy (NX) surgery was performed on rats, there was a 14-week follow-up, allowing CRI to become established. Omapatrilat (40 mg/kg/day in chow) was then given for 8 weeks, and the small mesenteric arterial rings were investigated in vitro using wire and pressure myographs. RESULTS Plasma and ventricular B-type natriuretic peptide (BNP) concentrations were increased 2- to 2.7-fold, while systolic blood pressure (BP) increased by 32 mm Hg after NX. Omapatrilat treatment normalized the BNP and reduced the BP by 45 mm Hg in the NX rats. Endothelium-dependent vasorelaxation was impaired but the response to acetylcholine was normalized after omapatrilat treatment. Vasorelaxations induced by nitroprusside, isoprenaline and levcromakalim were enhanced after omapatrilat, and the responses were even more pronounced than in untreated sham-operated rats. Arterial wall thickness and wall-to-lumen ratio were increased after NX, whereas omapatrilat normalized these structural features and improved the strain-stress relationship in the small arteries; this suggests improved arterial elastic properties. CONCLUSION Omapatrilat treatment reduced BP, normalized volume overload, improved vasorelaxation and corrected the dimensions and passive elastic properties of the small arteries in the NX rats. Therefore, we consider vasopeptidase inhibition to be an effective treatment for CRI-induced changes in the small arteries.
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Affiliation(s)
- Olli Haltia
- Schools of Medicine, University of Tampere, Tampere, Finland
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