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Scand J Caring Sci; 2011 Preference for place-of-death among terminally ill cancer patients in Denmark Achieving home death is often seen as an important endpoint in palliative care, but no studies of the preferred place-of-death have yet been conducted in Scandinavia. Furthermore, we do not know if professionals' report on deceased patients' preference of place-of-death is a valid information. The aim of this study was to describe where terminally ill Danish cancer patients prefer to die and to determine if their preference changed during the palliative period, as reported retrospectively by bereaved relatives, general practitioners (GPs) and community nurses (CNs) and to assess the agreement of their accounts. The study was a population-based, cross-sectional combined register and questionnaire study in Aarhus County, Denmark. The population comprised 599 deceased adult cancer patients who had died from 1 March to 30 November 2006 and were identified through merging of health registers. Relatives returned 198 questionnaires about patients' preferred place-of-death, GPs 333 and CNs 201. The study showed that most terminally ill cancer patients preferred home death (up to 80.7%). The reported preference for home death weakened as death approached (down to 64.4%). A better congruence was seen between relatives' and GPs' accounts of preference for place of death at the end of the palliative period (κ 0.71) than between relatives' and CNs' accounts (κ 0.37). In conclusion, bereaved relatives (and GPs and CNs) report retrospectively that most terminally ill cancer patients wish to die at home. The preference weakened significantly as death approached. The agreement between relatives' and GPs' accounts on patients' preferences at the end of the palliative period was 'substantial', whereas the agreement between relatives' and CNs' accounts at the same time was significantly less outspoken. This indicates that CNs may be facing a problem in assessing their patients' wishes retrospectively.

Background: In most western countries, the majority of palliative cancer patients wish to die at home, where GPs are often deeply involved. However, most research focuses on specialised palliative care, which results in a lack of reliable predictors of home death in primary care.Aim: To analyse predictors of home death among deceased palliative cancer patients in a primary care setting.Methods: Using Danish registers, we identified 787 deceased cancer patients and sent a questionnaire to their GPs. The questions concerned the GPs' involvement and the duration of the palliative period at home. We analysed the data using a model adjusted for confounders (e.g. patient's sex, age, marital status, type of cancer), with independent variables such as the GP's knowledge of the patient prior to the palliative period, whether the GP had made home visits, whether the GP had planned who to contact out-of-hours, and whether the GP had had contact with the relatives.Results: 350 questionnaires were filled out. In the preliminary analysis we found that even though many patients died in hospital, this group spent nearly as much of their last time at home as the patients who actually died at home. The analysis of the GPs' involvement is still ongoing.Conclusion: The results of GP involvement in home death will be presented. More specific research concerning palliation in primary care is still needed.

Udgivelsesdato: 2008-Dec OBJECTIVE: This study explores former cancer patients' psychosocial rehabilitation needs after hospital discharge. METHOD: Three focus-group interviews with 15 patients. RESULTS: Five main areas were identified: (1) Need for continuous support and information about rehabilitation opportunities; (2) Support to the family; (3) Psychological help also addressing fear of relapse of cancer; (4) Needs for social support; (5) Needs pertaining to how friends and acquaintances relate to the patients. CONCLUSION: Each of these aspects should be carefully considered for each patient, preferably by one assigned healthcare provider. Fear of cancer relapse prevails among the patients, the family and the social network and it is important in relation to psychosocial rehabilitation.

Udgivelsesdato: 30. april

Bone metastases are a frequent condition leading to fractures, hypercalcaemia and spinal compression. The treatment will depend on the possibility to treat the cancer. Secondly local treatment should be considered. To relief pain radiotherapy, given as 1 fraction with 8 Gy, is an effective treatment. Radiotherapy can also be used to treat complications from the metastasis. The use of bisphosphonates is now established in the treatment of breast cancer with bone metastasis to prevent complications from bone metastasis. Surgery is a growing possibility both as treatment of manifest fractures and prophylactic. Selection of patients to surgery is important to keep complication rate low. Udgivelsesdato: 2007-Oct-29

Medical treatments including chemotherapy, endocrine therapy, and antibody therapy effectively reduce the risk of recurrence after breast cancer and are also used against metastatic disease. This article reviews patients' experience of these treatments. Common side effects of chemotherapy include hair loss, nausea, hot flushes, mucositis, fatigue, and cognitive side effects. Overall quality of life, social relations, and sexuality may also be affected. Endocrine therapies are characterised by hot flushes, vaginal dryness, arthralgias, and reduced libido. Udgivelsesdato: 2007-Sep-10