Earlier specialist palliative care contact halves in-hospital deaths in colorectal cancer, though most deaths still occur in hospital

A Finnish nationwide register cohort of 1,445 patients with colorectal and related intestinal cancers examined how the timing of specialist palliative care (SPC) contact relates to end-of-life healthcare use Primary Study. Patients whose first SPC contact came more than 30 days before death, compared with those with late or no specialist contact, had fewer emergency department attendances (43% versus 54%), fewer hospitalisations (21% versus 49%) and fewer in-hospital deaths (59% versus 80%). Even with early SPC contact, however, most deaths still occurred in hospital rather than at home or in a hospice setting.

Nationwide register data gives this finding stronger population-level generalisability than a single-site study would carry, though it is specific to colorectal and related intestinal cancers and to the Finnish health system. The persistence of a majority in-hospital death rate even with early specialist contact is a genuine ceiling in this evidence, not a limitation of the analysis — it indicates that referral timing alone does not close the gap to preferred place of death.

This supports earlier specialist palliative care referral triggers for cancer pathways generally, while tempering expectations that timing alone will substantially shift where death actually occurs — other factors evidently continue to drive in-hospital death even where specialist contact happens early.