title: 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.
abstract: OBJECTIVE
  To examine and compare end-of-life care in patients with cancer dying in Belgium and the Netherlands.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors: Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium. koen.meeussen@vub.ac.be
authors: Koen
authors: K
authors: Meeussen
authors: Lieve
authors: L
authors: Van den Block
authors: Michael A
authors: MA
authors: Echteld
authors: Nicole
authors: N
authors: Boffin
authors: Johan
authors: J
authors: Bilsen
authors: Viviane
authors: V
authors: Van Casteren
authors: Ebun
authors: E
authors: Abarshi
authors: Gé
authors: G
authors: Donker
authors: Bregje
authors: B
authors: Onwuteaka-Philipsen
authors: Luc
authors: L
authors: Deliens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001530:Belgium; D003142:Communication; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D009426:Netherlands; D010166:Palliative Care; D012189:Retrospective Studies; D013727:Terminal Care