[Improvement of palliative outpatient treatment of terminally ill cancer patients - SUPPORT as example - The ethically preferable alternative to euthanasia].

INTRODUCTION: Industrial countries are experiencing substantial increases in cancer prevalence. While advanced cancer therapies resulted in prolonged survival most neoplasms still are incurable. Especially advanced stages of cancer are often accompanied by severe pain and other disabling symptoms. Sufficient pain and symptom control is needed to maintain a decent quality of life for cancer patients. However, expert palliative care for patients suffering from cancer pain is still insufficient. These deficits have encouraged pro-euthanasia pressure groups demanding legitimation of physician-assisted-suicide in Germany. Acting under the guise of promoting patient's autonomy these groups are gaining additional momentum from similar legislation passed in the Netherlands.
METHODS: Hospice movement and specialists in palliative medicine reject euthanasia as unethical and instead push for the global development of palliative care services. To address these issues the project SUPPORT was established in the Southern part of Lower-Saxony in 1996 with approval by the local ethics committee and sponsored by the German Ministry of Health. A palliative-care-team (PCT) of nurses and physicians with expert knowledge in palliative medicine supports patients after discharge from hospital by providing state-of-the-art palliative care at home. The PCT is available as a 24/7 standby service and can be called on demand by general practitioners, members of outpatient nursing services as well as by patients and their relatives. By cooperating with the PCT these professional and lay caregivers improve their knowledge and skills regarding pain and symptom control for terminally ill patients.
RESULTS: During almost 4 years of practical work more than 50 % of the patients enrolled in the project died at home compared to about 20 % under regular conditions. These data point out quite impressively that due to the PCT-interventions recurrent hospitalisations in a majority of cancer pain patients can be avoided when expert knowledge and help is available at home for patients, their relatives and caregivers whenever needed.
CONCLUSION: When sufficiently supported at home by palliative experts the number of patients dying at home is reasonably higher than the rate observed under regular conditions. This would also comply with the wishes of most patients who prefer to die in the privacy of their own home. The project data suggest that the concept of SUPPORT should be capable to improve the current state of palliative medicine in other areas of Germany as well.