European urology open science · 2026
The Impact of Specialist Palliative Care on the Utilization of Health Care Services at the End of Life Among Patients With Prostate Cancer: A Nationwide Register-based Study.
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Carpén Timo P, Nåhls Nelli-Sofia A, Nuutinen Mikko S J, Saarto Tiina H
Аннотация
BACKGROUND AND OBJECTIVE: Prostate cancer is one of the leading causes of cancer mortality worldwide. Palliative care is essential for symptom management and quality of life. This study examined end-of-life (EOL) health care use among Finnish patients with prostate cancer and the association of timing of specialist palliative care (SPC) contact.
METHODS: Nationwide retrospective cohort study of all men who died of prostate cancer in 2019 (n = 921). Data from national registries. Patients categorized into Group I (SPC contact >30 d before death) or Group II (SPC contact ≤30 d/none).
OUTCOMES: Emergency department (ED) contacts, hospitalizations, SPC use, and place of death. Multivariable logistic regression adjusted for age and municipality type.
KEY FINDINGS AND LIMITATIONS: Median age 81 yr. Only 30% of patients received SPC (median 101 d before death). In the last month, patients in Group I had fewer secondary hospitalizations (21% vs 38%, p < 0.001), lower readmissions (19% vs 26%, p = 0.035), and greater use of SPC inpatient unit (15% vs 2.1%, p < 0.001) and hospital-at-home (40% vs 4.4%, p < 0.001). Multivariable analysis: Group II had higher odds of ED contacts (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.06-2.00) and secondary hospitalizations (OR 2.66, 95% CI 1.83-3.88). Limitations were retrospective design and no clinical data on disease severity or patient preferences.
CONCLUSIONS AND CLINICAL IMPLICATIONS: EOL health care use in prostate cancer is intensive. Patients with SPC contact more than 30 d before death had lower odds of acute hospital service use and higher odds of SPC service use during the last month of life compared with patients with later or no SPC contact. Findings support earlier SPC referral to improve patient-centered EOL care.
PATIENT SUMMARY: Among Finnish men dying of prostate cancer, most used hospital services heavily and died in hospital. Earlier access to palliative care was associated with reduced acute health care use and increased care in SPC inpatient units.
METHODS: Nationwide retrospective cohort study of all men who died of prostate cancer in 2019 (n = 921). Data from national registries. Patients categorized into Group I (SPC contact >30 d before death) or Group II (SPC contact ≤30 d/none).
OUTCOMES: Emergency department (ED) contacts, hospitalizations, SPC use, and place of death. Multivariable logistic regression adjusted for age and municipality type.
KEY FINDINGS AND LIMITATIONS: Median age 81 yr. Only 30% of patients received SPC (median 101 d before death). In the last month, patients in Group I had fewer secondary hospitalizations (21% vs 38%, p < 0.001), lower readmissions (19% vs 26%, p = 0.035), and greater use of SPC inpatient unit (15% vs 2.1%, p < 0.001) and hospital-at-home (40% vs 4.4%, p < 0.001). Multivariable analysis: Group II had higher odds of ED contacts (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.06-2.00) and secondary hospitalizations (OR 2.66, 95% CI 1.83-3.88). Limitations were retrospective design and no clinical data on disease severity or patient preferences.
CONCLUSIONS AND CLINICAL IMPLICATIONS: EOL health care use in prostate cancer is intensive. Patients with SPC contact more than 30 d before death had lower odds of acute hospital service use and higher odds of SPC service use during the last month of life compared with patients with later or no SPC contact. Findings support earlier SPC referral to improve patient-centered EOL care.
PATIENT SUMMARY: Among Finnish men dying of prostate cancer, most used hospital services heavily and died in hospital. Earlier access to palliative care was associated with reduced acute health care use and increased care in SPC inpatient units.