Earlier specialist palliative contact roughly halves end-of-life hospitalisation in pancreatic cancer, national Finnish cohort finds

A nationwide Finnish register-based cohort covered all 1,199 patients who died of pancreatic cancer in Finland in a single calendar year [Primary Study]. Just over a third (36%) had any specialist palliative care (SPC) contact, and 22.5% had their first SPC contact more than 30 days before death. Compared with patients whose first SPC contact came within 30 days of death or not at all, those with earlier contact had far fewer secondary-care hospitalisations in their last month of life (25% versus 56%) and fewer emergency department contacts (50% versus 61%); they were also more likely to receive hospital-at-home services (44% versus 9%) or care on an SPC ward (23% versus 5%), and more likely to die in an SPC ward (22% versus 5%) or at home (19% versus 13%) rather than in general hospital.

This is a whole-population national register study, not a trial: the association is observational, and the authors cannot rule out that patients selected for earlier SPC referral differed systematically — for instance in symptom burden or prognosis — from those who were not.

The scale of the association is nonetheless striking: roughly half the hospitalisation rate, and more than four times the hospital-at-home use, associated with earlier SPC contact. The authors conclude that integration of specialist palliative care in time should be ensured for all patients with advanced pancreatic cancer — a case for oncology services to audit how early SPC referral currently occurs in their own pathways, while recognising this as association rather than proven causal benefit.