title: Care provided and care setting transitions in the last three months of life of cancer patients: a nationwide monitoring study in four European countries.
abstract: BACKGROUND
  This is an international study across four European countries (Belgium[BE], the Netherlands[NL], Italy[IT] and Spain[ES]) between 2009 and 2011, describing and comparing care and care setting transitions provided in the last three months of life of cancer patients, using representative GP networks.
  
  
  METHODS
  General practitioners (GPs) of representative networks in each country reported weekly all non-sudden cancer deaths (+18y) within their practice. GPs reported medical end-of-life care, communication and circumstances of dying on a standardised questionnaire. Multivariate logistic regressions (BE as a reference category) were conducted to compare countries.
  
  
  RESULTS
  Of 2,037 identified patients from four countries, four out of five lived at home or with family in their last year of life. Over 50% of patients had at least one transition in care settings in the last three months of life; one third of patients in BE, IT and ES had a last week hospital admission and died there. In the last week of life, a treatment goal was adopted for 80-95% of those having palliation/comfort as their treatment goal. Cross-country differences in end-of-life care provision included GPs in NL being more involved in palliative care (67%) than in other countries (35%-49%) (OR 1.9) and end-of-life topics less often discussed in IT or ES. Preference for place of death was less often expressed in IT and ES (32-34%) than in BE and NL (49-74%). Of all patients, 88-98% were estimated to have distress from at least one physical symptom in the final week of life.
  
  
  CONCLUSIONS
  Although palliative care was the main treatment goal for most cancer patients at the end of life in all four countries, frequent late hospital admissions and the symptom burden experienced in the last week of life indicates that further integration of palliative care into oncology care is required in many countries.
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels and Ghent University, Ghent, Belgium. winne.ko@vub.ac.be.
authors.forename: Winne
authors.initials: W
authors.lastname: Ko
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Guido
authors.initials: G
authors.lastname: Miccinesi
authors.forename: Francesco
authors.initials: F
authors.lastname: Giusti
authors.forename: Sarah
authors.initials: S
authors.lastname: Moreels
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.forename: Bregje
authors.initials: B
authors.lastname: Onwuteaka-Philipsen
authors.forename: Oscar
authors.initials: O
authors.lastname: Zurriaga
authors.forename: Aurora
authors.initials: A
authors.lastname: López-Maside
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D009426:Netherlands; D010166:Palliative Care; D012189:Retrospective Studies; D013030:Spain; D013727:Terminal Care; D055815:Young Adult