[Effectiveness and challenges in cancer palliative home-care services: a retrospective cohort study.] / Efficacia e criticità nelle cure palliative domiciliari per il paziente oncologico: studio retrospettivo di coorte.

INTRODUCTION: Management by the palliative care network (RLCP) has been identified as one of the major determinants of clinical appropriateness and reduction of hospital admissions in cancer patient's end of life. The patient's transition process from hospital cancer care to palliative home care is particularly frail from both a clinical and organizational point of view, requiring a multidimensional assessment (VMD) and the draft of an individual care plan (PAI). The aim of this study was to assess the impact of appropriate home-based palliative care in reducing hospitalizations, and also to identify critical issues in the patient's transition to home palliative care. METHODS: Retrospective cohort study enrolling all 375 patients listed by the Local Health Authority No.8, Veneto Region (North-East Italy), as dying of cancer in 2017 and living at home during the last six months before death. RESULTS: Of the cohort considered, 40% patients had been taken into care by a palliative home-care team. These patients were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life than patients who were not taken into palliative network's care. Reporting of the oncologist to the Primary Care Doctor (MAP) for activation of home palliative care services takes place on average 120 days prior to death. 18.8% of these reports are not acknowledged and do not result in the MAP request for palliative home care. The time interval between the reporting of the need by the oncologist and the execution of the VMD is on average 36.8 days. The absence of the palliative care specialist during the VMD is associated with lower likelihood of being taken into care by palliative care teams (52.4% vs 97.3%) and a delay in their activation (56.3 vs 3.81 days), compared to cases in which the palliative care provider was present. DISCUSSION AND CONCLUSIONS: Our findings indicate that the access to a palliative care network enables more terminally ill consenting cancer patients to spend their last days at home with relatives, reducing end-of-life hospital utilization and in-hospital deaths. There's evidence of critical issues in coordination and integration of professionals operating within the palliative network, precluding or delaying access to appropriate palliative care. These results could be useful to palliative care providers in order to review their networks and make them accessible, effective, compliant with current legislation and sustainable over time.

Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: a retrospective cohort study.

BACKGROUND: It has been demonstrated that most patients in the terminal stages of cancer would benefit from palliative home-care services. AIM: The aim of this study was to assess the effectiveness of appropriate palliative home-care services in reducing hospital admissions, and to identify factors predicting the likelihood of patients treated at home being hospitalized. DESIGN: Retrospective cohort study. SETTING/PARTICIPANTS: We enrolled all 402 patients listed by the Local Health Authority No. 5, Veneto Region (North-East Italy), as dying of cancer in 2011. RESULTS: Of the cohort considered, 39.9% patients had been taken into care by a palliative home-care team. Irrespective of age, gender, and type of tumor, patients taken into care by the palliative home-care team were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life. Among the patients taken into care by the palliative home-care team, those with hematological cancers and hepatocellular carcinoma were more likely to be hospitalized, and certain symptoms (such as dyspnea and delirium) were predictive of hospitalization. CONCLUSIONS: Our study confirms the effectiveness of palliative home care in enabling patients to spend the final period of their lives at home. The services of a palliative home-care team reduced the consumption of hospital resources. This study also provided evidence of some types of cancer (e.g. hematological cancers and hepatocellular carcinoma) being more likely to require hospitalization, suggesting the need to reconsider the pathways of care for these diseases.

Gemcitabine (GEM) and vindesine (VDS) in advanced non-small cell lung cancer (NSCLC): a phase II study in elderly or poor performance status patients.

The aim of the study was to assess the activity and tolerability of the combination of gemcitabine (GEM) and vindesine (VDS) in elderly or poor performance patients with advanced non-small cell lung cancer. Forty four patients (36 males and 8 females with a median age of 70 years and a median Karnofsky performance score of 60) were recruited between January 1998 and June 2001; 9 (20.5%) were stage IIIB patients and 35 (79.5%) were stage IV patients; 20 (45.5%) had squamous carcinoma and 24 (54.5%) non-squamous carcinoma. The patients received GEM 1000 mg/m(2) and VDS 3mg/m(2) (max 5mg) on days 1 and 8 every 3 weeks, and were all evaluable for response and toxicity: 17 (38.6%) were partial responders, 17 (38.6%) experienced stable disease, and 10 (22.3%) progressive disease. Grade 3-4 anemia, neutropenia and thrombocytopenia were observed in, respectively, 6.8, 9.1 and 2.3% of the patients, and grade 2-3 fatigue, paresthesias and skin toxicity in, respectively, 11.4, 20.4 and 2.3%. After a median follow-up of 54 months, 43/44 patients died; median survival was 12 months, and a clinical benefit was observed in 54.5% of cases. GEM plus VDS is an active and well-tolerated schedule.

Relationship between the thymidine labeling and Ki-67 proliferative indices in 126 breast cancer patients.

Proliferative activity has been proposed as a prognostic and predictive marker for breast cancer; Ki-67 is one of the most frequently used markers to assess proliferative activity. In the current study, Ki-67 immunoreactivity was comparatively assessed, even in terms prognostic relevance, with 3H-thymidine labeling index as a reference standard for proliferation in 126 patients with stage I and II breast cancer. There was a significant but weak correlation between Ki-67 values and the 3H-thymidine labeling index (r = 0.19, P = 0.03). Analysis of variance showed that the mean 3H-thymidine labeling index values were not statistically different in terms of pathologic size (T1, T2. T3, T4), number of pathologically positive axillary nodes (neg, pos 1-3, pos > 3), and grading classes (1, 2, 3), but significantly and inversely correlated with estrogen receptor status (P = 0.033) and progesterone receptor status (P = 0.08). The Ki-67 values significantly correlated with N status (P = 0.041), estrogen receptor status (P < 0.001), progesterone receptor status (P < 0.001), and grading (P < 0.001). The median follow-up was 37 months. In terms of prognosis, Ki-67 was associated significantly with overall survival (P = 0.01) and marginally with disease-free survival (P = 0.095). A significant difference in prognosis was found for both disease-free survival (P = 0.024) and overall survival (P = 0.040) when a 3H-thymidine labeling index cut-off of 6.5% was used (P = 0.024). The results suggest that, although both are indicators of proliferative activity, 3H-thymidine labeling index and Ki-67 seem to identify breast cancers with different phenotypes.