Timing of specialist palliative care and acute healthcare utilization at the end of life among adults who died of cancer: a nationwide cohort study

Cancer is one of the leading causes of death worldwide, with high healthcare utilization in the last months of life. Specialist palliative care (SPC) may reduce unnecessary healthcare utilization, but nationwide evidence on timing is limited. This nationwide cohort study examined whether the timing of SPC was associated with end-of-life healthcare utilization among adults who died of cancer in Finland. We conducted a nationwide retrospective cohort study using register data. All adults who died of cancer in 2019 were identified from the national Causes of Death Register (n = 12879). Timing of first SPC contact was categorized as first SPC contact > 30 days before death, first SPC contact ≤ 30 days before death, or no SPC contact. Outcomes included emergency department (ED) contacts, hospitalizations, hospital readmissions, use of SPC services in the last 30 days of life, and place of death. Analyses were stratified analyses by age, sex, and municipality type. Overall, 2617 patients (20%) had first SPC contact > 30 days before death, 1256 (10%) had first SPC contact ≤ 30 days before death, and 9006 (70%) had no SPC contact. Compared with patients with no SPC contact, those with first SPC contact > 30 days before death had fewer ED contacts (46% vs. 57%), fewer secondary care hospitalizations (26% vs. 53%), and fewer secondary care readmissions (8% vs. 20%). In stratified analyses by age, sex, and municipality type, first SPC contact > 30 days before death was consistently associated with lower acute healthcare utilization. Patients with first SPC contact > 30 days before death and those with first SPC contact ≤ 30 days before death were less likely to die in hospital than those with no SPC contact. Initiation of SPC more than 30 days before death was associated with reduced acute healthcare utilization and fewer hospital deaths, supporting integration of SPC into cancer care.