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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Palliative Care 1/2014

Hospitalizations of cancer patients in the last month of life: quality indicator scores reveal large variation between four European countries in a mortality follow-back study

BMC Palliative Care > Ausgabe 1/2014
Maaike L De Roo, Anneke L Francke, Lieve Van den Block, Gé A Donker, Jose E Lozano Alonso, Guido Miccinesi, Sarah Moreels, Bregje D Onwuteaka-Philipsen, Andrea Salvetti, Luc Deliens
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-684X-13-54) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MLDR analyzed the data and drafted the manuscript. ALF and LD supervised MLDR during this process. GM participated in the data analysis. LVDB, GM, BDOP and LD conceived of and designed the study. GAD and AS participated in the data collection. All authors read, critically appraised and approved the final manuscript.



Repeated and long hospitalizations of cancer patients at the end of life have been suggested as indicators of low quality of palliative care. Comparing the care delivered between different countries with the help of these quality indicators may identify opportunities to improve practice. Our objective is twofold: firstly, to describe the scores for the existing quality indicators “the percentage of time spent in hospital” and “the proportion of adult patients with more than one hospitalization in the last 30 days of life” in populations of cancer patients in four European countries and to see whether these countries met previously defined performance standards; secondly, to assess whether these scores are related to receiving palliative care from their GP.


A mortality follow-back study was conducted, based on data recorded by representative GP networks for samples of cancer patients living at home who died non-suddenly in Belgium (n = 500), the Netherlands (n = 310), Italy (n = 764), and Spain (n = 224).


The quality indicator score for “the percentage of time spent in hospital” in the last month of life was 14.1% in the Netherlands, 17.7% in Spain, 22.2% in Italy, and 24.6% in Belgium, which means that none of the countries met the performance standard of <10%. For the “proportion of patients with more than one hospitalization in the last 30 days of life”, two countries met the performance standard of <4%: the Netherlands (0.6%) and Italy (3.1%). Spain had a score of 4.0% and Belgium scored 5.4%. When patients received palliative care from their GP, significantly less time was spent in hospital in the last month and fewer hospitalizations took place.


European countries differ regarding the frequency and duration of hospitalizations of cancer patients in the last month of life. This reflects country-specific differences in the organization of palliative care and highlights the important role of the GP in palliative care provision.
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