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End-of-life care can be delivered in a variety of settings, whereby the majority of terminally-ill cancer patients prefer to die at home. The aim of our study is to evaluate health services utilisation during the last year of life, and to compare terminally ill patients who have received home-specialised palliative care services (HSPCS) with patients who died receiving home non-specialised palliative care services. The study included 120 and 515 patients, respectively, who died between 1999-2000. Age and gender distribution were similar in both groups. During the last year of life, mean health services cost per person among the HSPCS group was lower by more then 30% ( P<0.005). The median cost per patient was as low as one-fifth in the last month. Men and the older age group of 65 and above, cost significantly less compared with women and younger patients, respectively, regardless of provider setting. The main differences in health services utilisation were in hospitalisations and oncology treatments ( P < 0.01 and P < 0.05, respectively). [ABSTRACT FROM AUTHOR]

A previous survey of patients treated by our palliative care service showed that most patients with advanced cancer wished to be cared for at home. This is in contrast with the fact that these patients were increasingly frequently hospitalized because of their belief that a hospital, in spite of its shortcomings, is the place where medical and nursing care are more advanced.A prospective survey was carried out on 120 advanced cancer patients under the palliative care service of the Cremona Hospital, Italy. The survey recorded all the inadequacies of their care from the time patients were seen until death occurred. Five times as many inadequacies occurred in hospital than at home (an average of 4.4 ± 5.0 every 100 days against 0.8 ± 2.0 every 100 days; p < 10E -6). The most frequent inadequacies of care at home were caused by both narcotic and drug misuse, and unjustified alterations in the therapy; in the hospital they were related to therapeutic regimes and failure to report new symptoms. These data support the view that general hospital care in Italy today does not necessarily provide the best solutions to the problems of the terminally ill patient. A palliative care programme should include the option of organized home care. [ABSTRACT FROM PUBLISHER]