The impact of home palliative care on symptoms in advanced cancer patients.

Physical symptoms, which are highly prevalent in patients with cancer, have a major impact on many aspects of quality of life, and the best possible quality of life is the principal aim of palliative care. Few studies have reported the impact of home care on pain and symptoms among cancer patients living at home. The aim of this study was to evaluate the impact of home palliative care given by an experienced team on symptoms in advanced cancer patients. A consecutive series of 373 patients who were referred to a home palliative care program in the period 1993-1995 were prospectively evaluated. Patients were enrolled for the presence of different symptoms (pain, nausea and vomiting, dry mouth, dysphagia, gastric discomfort, constipation, diarrhea, dyspnea, drowsiness, weakness, confusion, psychological symptoms). For the purpose of the study we have selected 211 patients who, according to a retrospective assessment, survived for longer than 3 weeks and who were followed up until their deaths. Pain, nausea and vomiting, gastric discomfort, and diarrhea significantly decreased after palliative intervention. This improvement was maintained until death, whereas, after an initial improvement, dyspnea and constipation tended to increase in intensity in the last days of life. Drowsiness, weakness, and confusion increased in intensity in the last days of patients' lives. Similarly, fluid and food intake significantly decreased during the last days of life. Opioid dosage and frequency of opioid use increased with time, but this change did not reach statistical significance until the last days, when 70% of patients were taking opioids. These figures demonstrate the good impact of palliative care in this group of patients.