Gender differences in palliative care needs among Swedish cancer patients prior to specialist palliative care referral.

Abstract

Background and purpose: Few studies, in Sweden or internationally, have examined gender differences regarding the use of palliative care. This study investigates gender differences in palliative care needs prior to referral in a regional cohort of Swedish cancer patients. Patient/material and methods: Adult cancer patients who died throughout 1 year and were referred to a specialized palliative care service in southern Sweden during their last 3 years of life (n = 192) were included. Information on gender, age, diagnosis, performance status, admissions to hospital, and serious illness conversations was collected through chart review.

Results: Ninety-nine (52%) women and 93 (48%) men were included. Survival from diagnosis until death was comparable (p = 0.27) for women (341.0 days, IQR 77.0-902.0) and men (463.0 days, IQR 141.0-1035.0), as was survival from palliative care referral (p = 0.06) (women 48.0 days, IQR 19.0‑107.5; men 36.0 days, IQR 17.0‑85.0). Performance status at the time of referral was also comparable (p = 0.59). Gender differences were observed in healthcare utilization with fewer hospitalizations and emergency department visits for women in the 6 months prior to referral (p = 0.03) and significantly more men among those with the highest healthcare utilization (≥4 hospitalizations and emergency department visits) (p = 0.005). During the month before referral, women were more likely to have a serious illness conversation (p = 0.01).

Interpretation: Compared to women, men have more hospitalizations and fewer serious illness conversations prior to referral to specialized palliative care, suggesting greater unmet palliative care needs.