Gender differences in palliative care needs among Swedish cancer patients prior to specialist palliative care referral

Few studies, in Sweden or internationally, have examined gender differences regarding the use of palliative care. This study investigates gender differences in palliative care needs prior to referral in a regional cohort of Swedish cancer patients. Patient/material and methods: Adult cancer patients who died throughout 1 year and were referred to a specialized palliative care service in southern Sweden during their last 3 years of life (n = 192) were included. Information on gender, age, diagnosis, performance status, admissions to hospital, and serious illness conversations was collected through chart review.

Ninety-nine (52%) women and 93 (48%) men were included. Survival from diagnosis until death was comparable (p = 0.27) for women (341.0 days, IQR 77.0-902.0) and men (463.0 days, IQR 141.0-1035.0), as was survival from palliative care referral (p = 0.06) (women 48.0 days, IQR 19.0‑107.5; men 36.0 days, IQR 17.0‑85.0). Performance status at the time of referral was also comparable (p = 0.59). Gender differences were observed in healthcare utilization with fewer hospitalizations and emergency department visits for women in the 6 months prior to referral (p = 0.03) and significantly more men among those with the highest healthcare utilization (≥4 hospitalizations and emergency department visits) (p = 0.005). During the month before referral, women were more likely to have a serious illness conversation (p = 0.01).

Compared to women, men have more hospitalizations and fewer serious illness conversations prior to referral to specialized palliative care, suggesting greater unmet palliative care needs.