End-of-Life Care and Circumstances of Death in Patients Dying As a Result of Cancer in Belgium and the Netherlands: A Retrospective Comparative Study

Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.
Journal of Clinical Oncology (Impact Factor: 18.43). 11/2011; 29(32):4327-34. DOI: 10.1200/JCO.2011.34.9498
Source: PubMed


To examine and compare end-of-life care in patients with cancer dying in Belgium and the Netherlands.
A mortality follow-back study was undertaken in 2008 via representative nationwide sentinel networks of general practitioners (GPs) in Belgium and the Netherlands. By using similar standardized procedures, GPs reported on aspects of end-of-life care and the circumstances of nonsudden death of patients with cancer in their practice.
Of the 422 reported patients with cancer, most resided at home during the last year of life (Belgium, 91%; the Netherlands, 95%). Death occurred at home in 34% (Belgium) and 61% (the Netherlands) and in the hospital in 29% (Belgium) and 19% (the Netherlands). In the last month of life, end-of-life issues were more often discussed in the Netherlands (88%) than in Belgium (68%). In both countries, physical problems were discussed most often (Belgium, 49%; the Netherlands, 78%) and spiritual issues least often (Belgium, 20%; the Netherlands, 32%). Certain end-of-life treatment preferences were known for 43% (Belgium) and 67% (the Netherlands) of patients. In the last week of life, treatment was most often focused on palliation (Belgium, 94%; the Netherlands, 91%). Physical distress was reported in 84% (Belgium) and 76% (the Netherlands) of patients and psychological distress in 59% and 36%. Most distressing was lack of energy (Belgium, 73%; the Netherlands, 71%) and lack of appetite (Belgium, 61%; the Netherlands, 53%). Two thirds of patients were bedridden (Belgium, 67%; the Netherlands, 69%).
Although place of death and communication about end-of-life issues differ substantially, a palliative treatment goal is adopted for the vast majority of patients in both countries. However, GPs reported that the majority of patients experienced symptom distress at the end of life, which suggests important challenges remain for improving end-of-life care.

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Available from: Gé A Donker, Oct 03, 2015
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    • "The percentage of patients dying while hospitalized (61%) was much higher than percentages reported for Belgium and the Netherlands (29% and 19%, respectively, excluding patients suffering sudden death) [31] or the USA (38%) [32]. One reason for this finding may be a low availability of hospice care facilities in Switzerland. "
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    ABSTRACT: Background The use of cancer related therapy in cancer patients at the end-of-life has increased over time in many countries. Given a lack of published Swiss data, the objective of this study was to describe delivery of health care during the last month before death of cancer patients. Methods Claims data were used to assess health care utilization of cancer patients (identified by cancer registry data of four participating cantons), deceased between 2006-2008. Primary endpoints were hospitalization rate and delivery of cancer related therapies during the last 30 days before death. Multivariate logistic regression assessed the explanatory value of patient and geographic characteristics. Results 3809 identified cancer patients were included. Hospitalization rate (mean 68.5%, 95% CI 67.0-69.9) and percentage of patients receiving anti-cancer drug therapies (ACDT, mean 14.5%, 95% CI 13.4-15.6) and radiotherapy (mean 7.7%, 95% CI 6.7-8.4) decreased with age. Canton of residence and insurance type status most significantly influenced the odds for hospitalization or receiving ACDT. Conclusions The intensity of cancer specific care showed substantial variation by age, cancer type, place of residence and insurance type status. This may be partially driven by cultural differences within Switzerland and the cantonal organization of the Swiss health care system.
    BMC Cancer 05/2014; 14(1):306. DOI:10.1186/1471-2407-14-306 · 3.36 Impact Factor
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    • "This European study is an expansion of the SENTIMELC study which first started in 2004 in Belgium and in the Netherlands in 2005 with continuing registrations since then. Several results for these two individual countries have been reported in previous publications [19,21,24-28]. In Table 1 an overview of all partners of EURO SENTIMELC is provided. "
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    BMC Family Practice 06/2013; 14(73). DOI:10.1186/1471-2296-14-73 · 1.67 Impact Factor
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    ABSTRACT: Š Korevaar JC, Heins MJ, Donker GA, Rijken PM, Schellevis FG. Oncologie in de huisartsenpraktijk. Huisarts Wet 2013;56(1):6-10. Doel Kanker komt steeds vaker voor en de behandelingsmogelijkheden worden beter. De huisarts krijgt dus steeds meer mensen in zijn praktijk die in het verleden voor kanker zijn behandeld. Dit artikel geeft een overzicht van de impact van maligne aandoeningen in de huisartsenpraktijk. Methode Op basis van het Landelijk Informatie Netwerk Huisartsenzorg (LINH) hebben we de incidentie van de 10 meest voorkomende kankersoorten over de periode 2002-2010 bepaald, alsmede het aantal contacten met de praktijk in de eerste twee jaar na de diagnose. LINH is een landelijk representatief netwerk van 84 huisartsenpraktijken met meer dan 335.000 ingeschreven patiënten. Resultaten In een normpraktijk heeft een huisarts gemiddeld 73 volwassen patiënten bij wie de diagnose kanker minder dan 9 jaar geleden gesteld is. Bij 33 van deze patiënten is de diagnose minder dan 2 jaar geleden gesteld. Patiënten met kanker hebben de eerste 2 jaar na de diagnosestelling gemiddeld 11 contacten per jaar met de huisartsenpraktijk, waarbij het aantal contacten toeneemt met de leeftijd. Twee tot 3 contacten zijn gerelateerd aan de diagnose kanker. Van de overige contacten houden gemiddeld 3 contacten per jaar verband met alledaagse klachten, vindt er minder dan 1 contact plaats vanwege psychosociale problemen en heeft 1 contact te maken met infectieziekten. Ter vergelijking: alle Nederlanders van 18 jaar en ouder hebben gemiddeld 4 contacten per jaar met de huisartsenpraktijk, dus ruim minder dan de helft van het aantal van kankerpatiënten. Conclusie Gezien de verwachte toename van het aantal patiënten met kanker, gecombineerd met de hogere zorgvraag die deze groep patiënten heeft en de mogelijke verschuiving van de oncologische zorg van de tweede naar de eerste lijn, zullen patiënten met kanker een groter aandeel van de totale huisartsenzorg gaan opeisen. Het is van belang dat alle betrokken partijen tijdig anticiperen op deze groeiende zorgvraag.
    Huisarts en wetenschap 01/2013; 56(1). DOI:10.1007/s12445-013-0008-3
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