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Abstract: Palliative care aims to enhance the quality of life of patients and their families facing progressive and incurable disease by addressing physical, psychological, social, and spiritual challenges. Despite being recognized as a human right, palliative care remains out of reach for most people worldwide, with only about 14% of those who need it receiving it. Global demand for palliative care is rising due to aging populations and the increasing burden of chronic diseases. While high-income countries focus on expanding access and inclusivity to this care, low-income countries face severe shortages in prevention, diagnostics and treatment of underlying diseases, which creates an urgent need for palliative care services. Cultural differences, a lack of trained professionals, limited opioid availability, and weak policy further deepen inequities. Conclusions. Historically rooted in religious and charitable care, modern palliative care emerged with Dame Cicely Saunders’ hospice movement, evolving into a medical specialty. Access varies widely – Europe has high integration in some countries but significant disparities in service distribution and opioid use. Africa, Latin America, and parts of Asia still lack widespread provision. In Slovenia, palliative care development began in the 1980s and has recently expanded to include some specialized palliative care services across the country. Despite this progress, palliative care in Slovenia remains underdeveloped due to limited coverage, regional disparities, workforce shortages, insufficient formal education, and an old and ineffective national policy. Opioid availability is slightly below the European average, and its use is declining, which raises concerns about further unmet needs.
Keywords: palliative care, inaccessibility, opioids, basic palliative care
Published in DiRROS: 01.04.2026; Views: 130; Downloads: 51
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Abstract: Background: There is a concern that terminally ill cancer patients may be aggressively treated due to the rapidly growing possibilities of anticancer treatment. The aim of this study was to evaluate the use of anticancer treatment at the end of life (EoL). Materials and methods: This retrospective study included adult patients with advanced solid cancers who were treated at the Institute of Oncology Ljubljana and died of cancer between January 2015 and December 2019. A multiple logistic regression model was used to assess an association between the aggressiveness of anticancer treatment (i.e. systemic therapy, radiotherapy and surgery) in the last 2 weeks of life and year of death, age at death, sex, prognosis of cancer and enrolment into the specialist palliative care (SPC). Results: We included 1736 patients in our analysis. Overall, 13.7% of patients were enrolled into the SPC and 14.4% received anticancer treatment in the last 2 weeks of life. The odds of receiving anticancer treatment significantly increased over time [odds ratio (OR) 1.15, 95% confidence interval (CI) 1.04-1.27]. There was an increased use of novel systemic therapy (e.g. small-molecule targeted therapy and immunotherapy) at the EoL. Older patients had significantly lower odds to receive anticancer treatment in the last 2 weeks of life as compared to younger patients (OR 0.96, 95% CI 0.95-0.98). As compared to patients receiving only a standard oncology care, those also enrolled into the SPC had significantly lower odds for anticancer treatment in the last 2 weeks of life (OR 0.22, 95% CI 0.12-0.43). Conclusions: Terminally ill cancer patients have increased odds for receiving anticancer treatment, especially novel systemic therapies, in the last 2 weeks of life. Younger patients and those not enrolled into the SPC are at particular risk for anticancer treatment at the EoL
Keywords: systemic therapy, aggressive treatment, anticancer drugs, palliative care
Published in DiRROS: 18.04.2024; Views: 1343; Downloads: 757
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Keywords: paliativna oskrba, onkologija, bolniki
Published in DiRROS: 24.05.2023; Views: 1365; Downloads: 405
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Abstract: Izhodišče: Del celostne obravnave bolnika z napredovalim rakom je tudi paliativna oskrba, ki bolniku in njegovim bližnjim omogoča kakovostno življenje. Paliativna oskrba se izvaja na dveh ravneh: osnovni in specializirani. Na Onkološkem inštitutu Ljubljana v okviru specializirane paliativne oskrbe izvajamo več dejavnosti: bolnišnično obravnavo bolnikov z najkompleksnejšimi težavami, ambulantno obravnavo za zgodnjo paliativno oskrbo, konziliarno (svetovalno) dejavnost in za bolnike doma telefonsko podporo ter obiske na domu. Mobilna paliativna enota je najnovejša dejavnost, ki se izvaja od septembra 2021. Metode: Analizirali smo podatke vseh bolnikov, vključenih v specializirano paliativno oskrbo med septembrom 2021, od pričetka delovanja mobilne paliativne enote, in koncem avgusta 2022. Opazovali smo starost, spol, kraj stalnega prebivališča, diagnozo ter kraj smrti in primerjali skupino bolnikov, ki so bili obravnavani v okviru specializirane paliativne oskrbe s podporo obiskov na domu, in skupino brez nje. Rezultati: Med opazovanim obdobjem je bilo v vse dejavnosti specializirane paliativne oskrbe Onkološkega inštituta vključenih 1086 bolnikov, od tega smo pri 347 bolnikih (32 % vseh) opravili 574 obiskov na domu (povprečno 1,7 obiska na bolnika (razpon 1–8)). 317 (91 %) bolnikov je imelo svoje stalno prebivališče v osrednjeslovenski regiji, 9 % obiskov je bilo izvedenih izven meja osrednjeslovenske regije. Primerjava skupin bolnikov, napotenih v specializirano paliativno oskrbo z vključitvijo mobilne paliativne enote ali brez nje, jasno kaže večji delež umrlih v domačem okolju, kadar podporo izvajamo tudi z obiski na domu (80 % v primerjavi z 62 %). Zaključek: Mobilna paliativna enota predstavlja pomemben element mreže paliativne oskrbe in zagotavlja pogostejše umiranje v domačem okolju.
Keywords: paliativna oskrba, umiranje, mobilna paliativna enota, onkologija
Published in DiRROS: 06.12.2022; Views: 2110; Downloads: 582
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Keywords: paliativna oskrba, obvladovanje raka, urgentna stanja
Published in DiRROS: 15.06.2020; Views: 2674; Downloads: 768
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