title: Cancer patients use hospital-based care until death: a further analysis of the Dutch Bone Metastasis Study.
abstract: OBJECTIVE
  To describe health care utilization (HCU) at the end of life in cancer patients. These data are relevant to plan palliative care services, and to develop training programs for involved health care professionals.
  
  
  METHODS
  The Dutch Bone Metastasis Study (DBMS) was a nationwide study proving equal effectiveness of single fraction palliative radiotherapy compared with multiple fractions for painful bone metastases in 1157 patients. The 860 (74%) patients who died during follow-up were included in the current analysis. The main outcome was the frequency of hospital-based (outpatient contact or admission) and/or general practitioner (GP) contact during the last 12 weeks of life. Changes in HCU towards death were related to data on quality of life and pain intensity using a multilevel regression model.
  
  
  RESULTS
  Hospital-based HCU was reported in 1801 (63%) returned questionnaires, whereas GP contact was stated in 1246 (43%). In 573 (20%) questionnaires, both types of HCU were reported. In multilevel regression analyses, the frequency of outpatient contacts remained constant during the weeks towards death, whereas the frequency of GP contacts increased. Lower valuation of quality of life was related to both GP- and hospital-based HCU.
  
  
  CONCLUSIONS
  There was a high consumption of hospital-based HCU in the last 12 weeks of life of cancer patients with bone metastases. Hospital-based HCU did not decrease during the weeks towards death, despite an increase in GP contacts. Future planning of palliative care and training programs should encompass close collaboration between medical specialists and GPs to optimize end-of-life care.
authors: Department of Internal Medicine, University Medical Center Groningen, The Netherlands.
authors: Jan J
authors: JJ
authors: Meeuse
authors: Yvette M
authors: YM
authors: van der Linden
authors: Wendy J
authors: WJ
authors: Post
authors: Rinus
authors: R
authors: Wanders
authors: Rijk O B
authors: RO
authors: Gans
authors: Jan Willem H
authors: JW
authors: Leer
authors: Anna K L
authors: AK
authors: Reyners
mesh_terms: D000368:Aged; D001859:Bone Neoplasms; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D009426:Netherlands; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*