The Bologna Eubiosia Project: Hospital-at-Home Care for Advanced Cancer Patients

1992 ◽  
Vol 8 (2) ◽  
pp. 11-17 ◽  
Author(s):  
Franco Pannuti ◽  
Stephan Tanneberger
Keyword(s):  
Home Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Care Program ◽  
Advanced Cancer Patients ◽  
Eligibility Criteria ◽  
Hospital At Home ◽  
Hospital Wards ◽  
At Home

Since 1985 the Associazione Nazionale per lo Studio e la Cura dei Tumori Solidi (ANT), an Italian nonprofit anticancer organization, has provided a hospital-at-home care program for advanced and very advanced cancer patients. This program is part of the Eubiosia Project which also includes a number of complementary services. Teams of doctors, nurses, and psychologists work round-the-clock in the region and on hospital wards, assisted by diagnostic and therapeutic facilities applicable at home and by a round-the-clock on-call service seven days a week. The patients who were treated between December 1985 and December 1991 numbered 5603, of whom 2130 received treatment in 1991 alone, with 702 patients on line at the end of the period. The mean duration of home care for the first 2803 deceased patients was 62 days, and the percentage of deaths at home was 70%. We analyzed control of the main symptoms and the residual survival in three groups of patients—stomach, lung, and breast cancer sufferers — and found that acceptable pain control was achieved in 95% of cases. From the retrospective analysis of our data it can be seen that the eligibility criteria for entry to home care should not only depend upon performance status and the presence of symptoms, but should also take into account the factors that are inherent to the natural history of any kind of tumor as well as the social, domestic, and psychological characteristics of the patients.

The Importance of a Home Care Program for Patients with Advanced Cancer Pain

1985 ◽  
Vol 71 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Vittorio Ventafridda ◽  
Marcello Tamburini ◽  
Silvana Selmi ◽  
Luigi Valera ◽  
Franco De Conno
Keyword(s):  
Home Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Care Program ◽  
Pain Clinic ◽  
Advanced Cancer Patients ◽  
Sample Group ◽  
Significant Difference ◽  
Quality Of Life Index

At the Pain Clinic of the National Cancer Institute of Milan, a special Home Care Program has been set up to assist advanced cancer patients with pain and their families during their remaining survival. The Home Care Unit comprises a team of physicians, nurse clinicians, psychologists and many volunteers who are active both in the hospital and at the patient's home. This entire operation provides a continuous relationship between the family, the patient and the Home Care Unit. This Home Care Program, which is one of a kind with other forms of treatment for advanced cancer patients (i.e. hospices), has produced interesting results. Out of a sample group of 50 patients, 33 were monitored at home by the Home Care Unit while 17 had their families to do the monitoring. Over a six-week period the following results were reported: a) Improvement of psycho-emotional factors such as anxiety, weakness and mood for both patients and their families who entered the Home Care Program. b) The Quality of Life Index remained unchanged for the sample group that entered the Home Care Program whereas it deteriorated for patients monitored by their families. c) A decrease in the Integrated Pain Score for both groups; however, results showed a statistically significant difference in favor of patients on the Home Care Program. d) The Performance Status decreased by very little over the study period, and there was little difference between the two groups. These results confirm the need for a Home Care Program which must go hand in hand with the Pain Clinic as an effective way to control Total Pain.

scholarly journals Home Artificial Nutrition in Advanced Cancer

1997 ◽  
Vol 90 (11) ◽  
pp. 597-603 ◽  
Author(s):  
Loris Pironi ◽  
Enrico Ruggeri ◽  
Stephan Tanneberger ◽  
Stefano Giordani ◽  
Franco Pannuti ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Artificial Nutrition ◽  
Utilization Rate ◽  
Karnofsky Performance Score ◽  
Advanced Cancer Patients ◽  
At Home

Attitudes to home artificial nutrition (HAN) in cancer vary greatly from country to country. A 6-year prospective survey of the practice of HAN in advanced cancer patients applied by a hospital-at-home programme in an Italian health district was performed to estimate the utilization rate, to evaluate efficacy in preventing death from cachexia, maintaining patients at home without burdens and distress and improving patients' performance status, and to obtain information about costs. Patients were eligible for HAN when all the following were present: hypophagia; life expectancy 6 weeks or more, suitable patient and family circumstances; and verbal informed consent. From July 1990 to June 1996, 587 patients were evaluated; 164 were selected for HAN (135 enteral and 29 parenteral) and were followed until 31 December 1996. The incidence of HAN per million inhabitants was 18.4 in the first year of activity and 33.2–36.9 in subsequent years, being 4–10 times greater than rates reported by the Italian HAN registers. On 31 December 1996, 158 patients had died because of the disease and 6 were on treatment. Mean survival was 17.2 weeks for those on enteral nutrition and 12.2 weeks for those on parenteral nutrition. Prediction of survival was 72% accurate. 95 patients had undergone 155 readmissions to hospital, where they spent 15–23% of their survival time. Burdens due to HAN were well accepted by 124 patients, an annoyance or scarcely tolerable in the remainder. The frequency of major complications of parenteral nutrition was 0.67 per year for catheter sepsis and 0.16 per year for deep vein thrombosis. Karnofsky performance score increased in only 13 patients and body weight increased in 43. The fixed direct costs per patient-day (in European Currency Units) were 14.2 for the nutrition team, 18.2 for enteral nutrition and 61 for parenteral nutrition. The results indicate that definite entry criteria and local surveys are required for the correct use of HAN in advanced cancer patients, that HAN can be applied without causing additional burdens and distress, and that its costs are not higher than hospital costs.

Hospital-at-Home for Advanced Cancer Patients within the Framework of the Bologna Eubiosia Project: An Evaluation

1998 ◽  
Vol 84 (3) ◽  
pp. 376-382 ◽  
Author(s):  
Stephan Tanneberger ◽  
Franco Pennuti ◽  
Rossana Mirri ◽  
Achille Panetta ◽  
Paolo Mariano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Home Care ◽  
Statistical Significance ◽  
Performance Status ◽  
Advanced Cancer Patients ◽  
Evaluation Team ◽  
Alternative Setting ◽  
Hospital At Home ◽  
At Home

Aims and background An evaluation of the Bologna Hospital-at-Home (BHH) was undertaken to examine the following aspects: 1) median daily costs of the BHH; 2) delivery of medical services; 3) patient satisfaction with the care received and frequency of requests for transfer to the alternative setting. Delivery of services and patient's satisfaction in the BHH were compared with data collected for a traditional hospital (Ospedale Sant'Orsola Malpighi, Bologna - OSM). Methods Our analysis was performed as a cost analysis considering two periods of time in 1992 and 1993/94. Included were direct and indirect costs; no intangible costs were found. The patient's perspective was selected for the analysis. The observational study examining delivery of service and quality of life of patients admitted to the two care settings, BHH and OSM, considered patient's clinical history and an interview conducted by the evaluation team 6 weeks after admission to either facility. Data included patient's characteristics, quantity of diagnostic and therapeutic measures, circumstances of life, satisfaction with the care received, and intention for transfer to the alternative setting of nursing. The statistical significance of our assumption of comparable care intensity and better patient quality of life in the BHH was tested by the Pearson Chi-square test. Results A survey was carried out of 236 patients treated in the BHH or the OSM. The setting of assistance did not influence the provision of services. The time of “talking to the doctor” was notably higher for BHH than for OSM patients. The analysis of satisfaction showed that 98% of the surveyed BHH patients believed it matched the actual needs. The quality of life was considered to be reduced/bad in 67% of the OSM patients but in only 51% of BHH patients. An opinion was also requested with regard to transfer to the alternative setting of nursing: 47% of OSM patients judged BHH care would be better than traditional hospital. The median daily costs in BHH reached 118,789 Lire (range, 108,569-129,027 Lire, depending on performance status). Conclusions Although the economic advantage of hospital-at-home care certainly is important, we would like to stress that better quality and dignity of life should be the main point supporting the idea of hospital-at-home care.

scholarly journals “At home without pain”: a national project on real time pain monitoring system in advanced cancer patients assisted at home by the ANT Foundation

2017 ◽  
Vol 28 ◽  
pp. vi103
Author(s):  
A. Martoni ◽  
J. Tamanti ◽  
F.J. Pannuti ◽  
I. Malavasi ◽  
F. Pannuti ◽  
...  
Keyword(s):  
Real Time ◽  
Cancer Patients ◽  
Monitoring System ◽  
Advanced Cancer ◽  
Advanced Cancer Patients ◽  
National Project ◽  
At Home

scholarly journals Palliative Care and COVID-19 Pandemic: Retrospective Study of Factors Associated With Infection and Death at an Oncological Palliative Care Reference Center

2021 ◽  
pp. 104990912098696
Author(s):  
Livia Costa de Oliveira ◽  
Karla Santos da Costa Rosa ◽  
Ana Luísa Durante ◽  
Luciana de Oliveira Ramadas Rodrigues ◽  
Daianny Arrais de Oliveira da Cunha ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Tumor Type ◽  
Advanced Cancer Patients ◽  
Factors Associated ◽  
Reactive Protein

Background: Advanced cancer patients are part of a group likely to be more susceptible to COVID-19. Aims: To describe the profile of advanced cancer inpatients to an exclusive Palliative Care Unit (PCU) with the diagnosis of COVID-19, and to evaluate the factors associated with death in these cases. Design: Retrospective cohort study with data from advanced cancer inpatients to an exclusive PCU, from March to July 2020, with severe acute respiratory syndrome. Diagnostic of COVID-19 and death were the dependent variables. Logistic regression analyses were performed, with the odds ratio (OR) and 95% confidence interval (CI). Results: One hundred fifty-five patients were selected. The mean age was 60.9 (±13.4) years old and the most prevalent tumor type was breast (30.3%). Eighty-three (53.5%) patients had a diagnostic confirmation of COVID-19. Having diabetes mellitus (OR: 2.2; 95% CI: 1.1-6.6) and having received chemotherapy in less than 30 days before admission (OR: 3.8; 95% CI: 1.2-12.2) were associated factors to diagnosis of COVID-19. Among those infected, 81.9% died and, patients with Karnofsky Performance Status (KPS) < 30% (OR: 14.8; 95% CI 2.7-21.6) and C-reactive protein (CRP) >21.6mg/L (OR: 9.3; 95% CI 1.1-27.8), had a greater chance of achieving this outcome. Conclusion: Advanced cancer patients who underwent chemotherapy in less than 30 days before admission and who had diabetes mellitus were more likely to develop Coronavirus 2019 disease. Among the confirmed cases, those hospitalized with worse KPS and bigger CRP were more likely to die.

Prevalence of delirium in advanced cancer patients in home care and hospice and outcomes after 1 week of palliative care

2017 ◽  
Vol 26 (3) ◽  
pp. 913-919 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Francesco Masedu ◽  
Isabella Balzani ◽  
Daniela De Giovanni ◽  
Luigi Montanari ◽  
...  
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients

Symptom expression in advanced cancer patients admitted to hospice or home care with and without delirium

2018 ◽  
Vol 14 (4) ◽  
pp. 515-520 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Francesco Masedu ◽  
Marco Maltoni ◽  
Daniela De Giovanni ◽  
Luigi Montanari ◽  
...  
Keyword(s):  
Home Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Symptom Expression ◽  
Advanced Cancer Patients

scholarly journals Is early integration of palliative home care in oncology treatment feasible and acceptable for advanced cancer patients and their health care providers? A phase 2 mixed-methods study.

2020 ◽  
Author(s):  
Naomi Dhollander ◽  
Tinne Smets ◽  
Aline De Vleminck ◽  
Lore Lapeire ◽  
Koen Pardon ◽  
...  
Keyword(s):  
Home Care ◽  
Cancer Patients ◽  
Family Caregivers ◽  
Advanced Cancer ◽  
Health Care Providers ◽  
Control Group ◽  
Care Providers ◽  
Advanced Cancer Patients ◽  
Palliative Home Care ◽  
Early Integration

Abstract Background: To support the early integration of palliative home care (PHC) in cancer treatment, we developed the EPHECT intervention and pilot tested it with 30 advanced cancer patients in Belgium using a pre post design with no control group. We aim to determine the feasibility, acceptability and perceived effectiveness of the EPHECT intervention.Methods: Interviews with patients (n=16 of which 11 dyadic with family caregivers), oncologists and GPs (n=11) and a focus group with the PHC team. We further analyzed the study materials and logbooks of the PHC team (n=8). Preliminary effectiveness was assessed with questionnaires EORTC QLQ C-30, HADS and FAMCARE and were filled in at baseline and 12, 18 and 24 weeks.Results: In the interviews after the intervention period, patients reported feelings of safety and control and an optimized quality of life. The PHC team could focus on more than symptom management because they were introduced earlier in the trajectory of the patient. Telephone-based contact appeared to be insufficient to support interprofessional collaboration. Furthermore, some family caregivers reported that the nurse of the PHC team was focused little on them.Conclusion: Nurses of PHC teams are able to deliver early palliative care to advanced cancer patients. However, more attention needs to be given to family caregivers as caregiver and client. Furthermore, the home visits by the PHC team have to be further evaluated and adapted. Lastly, professionals have to find a more efficient way to discuss future care.

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