End-of-life care for patients with cancer: clinical, geographical, and sociocultural differences or, in Italian, «End-of-life treatments for cancer patients: clinical, geographical and sociocultural differences».
This is the title of the scientific article which, signed by Rita Ostan, Silvia Varani, Francesco Pannuti, Raffaella Pannuti (President of the Ant Foundation), Guido Biasco ed Eduardo Bruera and just published in the magazine Palliative & Supportive Care (Cambridge University Press), proves – once again – the existence of a two-sided scenario in Italy. The one, reconstructed from the survey through data from Ant’s assistance activities, which tells us about the many differences between the central-northern and central-southern areas of the country, in terms of quality of services provided, in the context of palliative care – Cp for terminal cancer patients.
Well, against the background of a branch of the world of assistance to which in Italy, in spite of themselves, almost 500,000 patients approach each year, the research conducted on 1,721 cancer patients (919 residing in the Centre-North and 802 in the Centre-South) entered Ant home palliative care program in the year 2020 and deceased by August 31, 2021, tells of various critical issues. Part of which deriving from an effective coverage of national needs that barely reaches 19% of those entitled.
Taking account, then, of “significant inter-regional differences, especially as regards home care”, which start from the age and severity of the patient at the time of entry into the CP system. In fact, the patients of the Centre-South are at the same time on average “younger” and “in a more advanced stage of the disease compared to the Centre-North”. Because they are burdened, already when Ant takes care of them, by a greater frequency of “symptoms such as asthenia, nausea, cachexia, anxiety, dyspnoea, delirium and alterations of the bowel habit”. Not to mention that «the survival of patients assisted by the Foundation in the Centre-South, starting from the moment of taking charge, is shorter than in the Centre-North».
This on a general level, while in detail the analysis of the association between demographic data, pathological progress index, symptoms and therapies at admission and the number of clinical services provided during the last month of life highlights various other problems. It is precisely the younger patients, on average more numerous in a central-southern area of the country where taking care of them is more complicated, who, moreover, “seem to need more intense and complex assistance at the end of life”. By tending to «manifest a greater level of suffering and distress in the advanced stages of the disease” and also representing “a heavier emotional burden both for the family and for the health professionals”.
«Not to mention (it must be pointed out without false modesty, for the sake of truth)», concludes the note from the Foundation, «that even the economic costs of long and stormy oncological courses are very high for Ant and for that NHS which finances some of the care efforts at home made by the latter”.