Decrease in length of hospitalization before death of cancer patients in the Italian province of Imperia

Although the overall cure rates for cancer in Italy are comparable to those of other developed countries, these results are the product of very heterogeneous facilities. In order to assess the possible impact of improved acute cancer care services on the last phase of life, a retrospective study was carried out which included 4238 patients registered at the Division of Medical Oncology of Imperia Province from January 1995 to December 2002. In 1998 the Province of Imperia, with a population of 217,000, had only two doctors and five day-hospital beds. During 1999 and 2000, resources increased to include five oncology specialists and 10 day-hospital beds. Compared to 1998, in 2002 the number of new patients registering at the Division of Medical Oncology and the number of day-hospital treatments increased by 76% and 67%, respectively. Since end-of-life care for advanced cancer patients is expensive, the length of hospitalization of cancer patients dying in acute hospital settings was analyzed for the years 1995-2002. Of the 4238 patients registered during the eight-year period, 1433 (33.8%) died before 31 December 2002. Among these 1433 patients, the records relative to hospitalization and death were available for 571 cancer patients, 324 males (56.7%) and 247 females (43.3%) with a median age of 70 years (range, 21-91). The average number of days of hospitalization declined from 14.6 (range, 1-76) in 1998 to 8.2 (range, 1-29) in 2002, a decrease of approximately 44%. The length of hospitalization prior to death has declined considerably for cancer patients in the Imperia Province and the costs of acute hospital facilities for end-of-life care in cancer patients have decreased. In addition, fewer days in hospital before death may have had an important impact on the quality of life of these cancer patients.