Dying with cancer. An international perspective (EURO-IMPACT).
Cancer is one of the leading causes of death in many countries around the world. Palliative care has been developed traditionally within the cancer group as an approach to “improve the quality of life of patients and their families facing the problem associated with life-threatening illness” and palliative care aims at addressing the various needs of patients and their families in a multidisciplinary manner. This thesis aims to understand the provision of cancer palliative care across Europe in a input-process-output system.
Two international databases and one Belgian database were used to deal with four challenges identified in contemporary cancer palliative care, namely cross-country cancer palliative care, care in the last months of life for cancer patients, place of death and preferences, and quality of life. The thesis is divided into three parts, on the care provided to cancer patients in the final months of life, preferences of place of death of cancer patients according to GPs, and place of death & quality of life of advanced lung cancer patients.
The thesis found through a cross-country comparison (Belgium, the Netherlands, Italy, Spain) that the provision of palliative care to cancer patients, final transitions to place of death as well as the awareness of place of death preferences by GPs varied across these countries. Moreover, an international study of place of death revealed the differences of place of death between lung cancer and COPD patients, and some patterns were consistent across many countries.
Finally, a Belgian study on the quality of life among advanced lung cancer patients informed us about the changes in individual patients’ quality of life which worth attention. Implications from this thesis include more routine assessments among cancer patients, timely communication about endof-life preferences, a public health approach in monitoring palliative care and more future cross-national research using trials or mixed methods are needed.