Admittance to specialized palliative care (SPC) of patients with an assessed need: a study from the Danish palliative care database (DPD)

Figures & data

Figure 1. The study design in the present study compared with the design of previous studies.

Table 1. Comparison of EAPC recommendations with regard to the number of SPC beds and teams versus the number in Denmark (2012).

		SPC beds, EAPC recommendation versus Denmark			Hospital-based palliative care teams, EAPC recommendation versus Denmark
Regions in Denmark	InhabitantsN	EAPC; 80–100 beds per one million inhabitants [23], N	Denmark; SPC beds (hospices and SPC units), N	‘Deficiency’, N	EAPC; one team for 100,000 inhabitants [23], N	Denmark; hospital-based palliative care team/unit, N	‘Deficiency’, N
Capital region of Denmark	1,729,952	138–173	90	48–63	17	8	9
Region Zealand	816,670	65–82	36	29–46	8	4	4
Region of Southern Denmark	1,201,547	96–120	60	36–60	12	4	8
Central Denmark region	1,271,223	102–127	50	52–77	13	6	7
North Denmark region	580,273	46–58	35	11–23	6	4	2
Total	5,599,665	448–560	271	177–289	56	26	30

Table 2. Characteristics of the study population.

	N (%)
Sex
Women	10,763 (49.8)
Men	10,834 (50.2)
Age (years)
Mean: 69.7; median: 70; SD: 11.9
18–39	283 (1.3)
40–49	933 (4.3)
50–59	2756 (12.8)
60–69	6200 (28.7)
70–79	6733 (31.2)
80+	4692 (21.7)
Diagnosis (cancer site, ICD-10 code)
Oral cavity, nasopharyngeal (etc.) (C00–C14)	469 (2.2)
Oesophageal (C15)	599 (2.8)
Stomach (C16)	752 (3.5)
Small intestine (C17)	82 (0.4)
Colorectal (C18–C20)	2582 (12.0)
Liver (etc.) (C22)	434 (2.0)
Pancreatic (C25)	1541 (7.1)
Laryngeal (C32)	93 (0.4)
Trachea, bronchus and lung (C33–C34)	5304 (24.6)
Melanoma skin cancer (C43)	433 (2.0)
Sarcoma (C46–C49)	230 (1.1)
Breast (C50)	1767 (8.2)
Cervical (C53)	179 (0.8)
Uterine (C54–C55)	256 (1.2)
Ovarian (etc.) (C56, C570–C574)	665 (3.1)
Prostate (C61)	1536 (7.1)
Testicular (C62)	13 (0.1)
Kidney (etc.) (C64–C66)	568 (2.6)
Bladder (C67)	579 (2.7)
Brain/CNS (C70–C71, C751–C753)^a	711 (3.3)
Thyroid (C73)	64 (0.3)
Unknown primary tumor (C76–C80)	888 (4.1)
Hodgkin disease (C81)	12 (0.1)
Non-Hodgkin lymphoma (C82–C85)	223 (1.0)
Multiple myeloma (C90)	175 (0.8)
Leukemia (C91–C95)	253 (1.2)
Other cancer (all other C codes)	1189 (5.5)
Region
Capital region of Denmark	5657 (26.2)
Region Zealand	3648 (16.9)
Region of Southern Denmark	4709 (21.8)
Central Denmark region	4572 (21.2)
North Denmark region	3011 (13.9)
Referral unit
General practitioner	5902 (27.3)
Hospital department	14,967 (69.3)
Other	728 (3.4)
Time from referral to death (days)
Mean: 64.6; median: 29; SD: 97.4
<8	4122 (19.1)
8–21	4882 (22.6)
22–59	5905 (27.3)
60+	6688 (31.0)
Total	21,597 (100)

^a Including the following D-codes: D32, D42, D330–332, D352–354, D430–432, D443–445, D333–339 and D433–439.

Figure 2. Flow chart of the patients referred to SPC in 2010–2012 and included in the study population.

Table 3. Admittance to SPC of Danish cancer patients with an assessed need for SPC in relation to sex, age, region, diagnosis, referral unit and time from referral to death (N = 21,597).

	Admittance to SPC % (N)	Unadjusted model^a, OR (95% CI)	p	Adjusted model 1^b, OR (95% CI)	p	Adjusted model 2^c, OR (95% CI)	p
Total	82.3 (17,769)
Sex
Women	82.8 (8906)	1.07 (1.00–1.14)	.07	1.16 (1.07–1.26)	<.001	1.02 (0.93–1.12)	.67
Men	81.8 (8863)	1.00 (ref)		1.00 (ref)		1.00 (ref)
Age (years)
18–39	94.0 (266)	4.65 (2.83–7.62)	<.001	5.35 (3.24–8.83)	<.001	3.90 (2.22–6.86)	<.001
40–49	90.4 (843)	2.79 (2.22–3.50)		3.13 (2.48–3.95)		2.77 (2.13–3.62)
50–59	86.4 (2381)	1.89 (1.66–2.15)		2.03 (1.78–2.33)		1.77 (1.52–2.08)
60–69	84.2 (5221)	1.59 (1.44–1.75)		1.65 (1.50–1.83)		1.46 (1.29–1.64)
70–79	80.8 (5442)	1.25 (1.15–1.37)		1.29 (1.18–1.42)		1.21 (1.08–1.35)
80+	77.1 (3616)	1.00 (ref)		1.00 (ref)		1.00 (ref)
Diagnosis (cancer site)
Oral cavity, nasopharyn geal (etc.)	85.9 (403)	1.27 (0.98–1.65)	<.001	1.20 (0.92–1.56)	<.001	0.80 (0.59–1.10)	<.001
Oesophageal	83.8 (502)	1.08 (0.87–1.34)		1.15 (0.92–1.43)		1.03 (0.79–1.35)
Stomach	83.5 (628)	1.06 (0.87–1.28)		1.03 (0.84–1.25)		1.15 (0.91–1.45)
Small intestine	85.4 (70)	1.22 (0.67–2.20)		1.27 (0.70–2.10)		1.79 (0.89–3.60)
Colorectal	83.5 (2156)	1.06 (0.94–1.19)		1.10 (0.97–1.24)		1.03 (0.89–1.19)
Liver (etc.)	74.9 (323)	0.61 (0.49–0.75)		0.62 (0.50–0.77)		0.81 (0.62–1.06)
Pancreatic	83.8 (1292)	1.08 (0.94–1.25)		1.12 (0.97–1.30)		1.20 (1.00–1.42)
Laryngeal	92.5 (86)	2.56 (1.22–5.38)		2.56 (1.21–5.39)		2.26 (0.98–5.20)
Trachea, bronchus and  lung	81.8 (4337)	0.94 (0.85–1.03)		0.94 (0.85–1.03)		0.97 (0.87–1.08)
Melanoma skin cancer	83.8 (363)	1.08 (0.84–1.39)		1.03 (0.80–1.34)		1.13 (0.84–1.53)
Sarcoma	87.8 (202)	1.50 (1.02–2.21)		1.33 (0.90–1.96)		1.49 (0.94–2.37)
Breast	82.5 (1458)	0.98 (0.86–1.13)		0.89 (0.77–1.03)		0.92 (0.78–1.09)
Cervical	86.0 (154)	1.28 (0.86–1.94)		1.05 (0.69–1.59)		0.97 (0.52–1.44)
Uterine	82.8 (212)	1.00 (0.73–1.38)		0.98 (0.71–1.36)		0.97 (0.65–1.43)
Ovarian (etc.)	84.8 (564)	1.16 (0.94–1.44)		1.08 (0.87–1.35)		1.10 (0.85–1.42)
Prostate	84.9 (1304)	1.17 (1.01–1.36)		1.39 (1.18–1.62)		0.97 (0.80–1.17)
Kidney (etc.)	86.4 (491)	1.33 (1.05–1.69)		1.30 (1.02–1.66)		1.29 (0.97–1.71)
Bladder	78.8 (456)	0.77 (0.63–0.95)		0.85 (0.69–1.04)		0.89 (0.70–1.14)
Brain/CNS^d	86.8 (617)	1.37 (1.10–1.70)		1.16 (0.93–1.45)		0.74 (0.58–0.96)
Thyroid	82.8 (53)	1.00 (0.54–1.88)		1.04 (0.55–1.96)		1.16 (0.56–2.43)
Unknown primary tumor	73.8 (655)	0.59 (0.50–0.69)		0.62 (0.53–0.73)		0.89 (0.73–1.08)
Non-Hodgkin lymphoma	72.2 (161)	0.54 (0.41–0.72)		0.57 (0.42–0.76)		0.58 (0.41–0.83)
Multiple myeloma	76.0 (133)	0.66 (0.47–0.93)		0.69 (0.49–0.97)		0.60 (0.40–0.91)
Leukemia	70.0 (177)	0.49 (0.37–0.63)		0.55 (0.42–0.73)		0.63 (0.45–0.87)
Other cancer	80.1 (972)	0.84 (0.72–0.97)		0.90 (0.77–1.05)		0.99 (0.83–1.19)
Average of all diagnoses	–	1.00 (ref)		1.00 (ref)		1.00 (ref)
Region
Region Zealand	85.7 (3126)	1.75 (1.56–1.95)	<.001	1.81 (1.62–2.03)	<.001	2.29 (1.99–2.63)	<.001
North Denmark region	88.0 (2650)	2.14 (1.89–2.43)		2.26 (1.99–2.57)		2.45 (2.10–2.86)
Central Denmark region	85.5 (3909)	1.72 (1.55–1.91)		1.74 (1.57–1.94)		2.07 (1.82–2.35)
Region of Southern Denmark	78.7 (3705)	1.08 (0.98–1.18)		1.04 (0.94–1.14)		1.05 (0.93–1.18)
Capital Region of Denmark	77.4 (4379)	1.00 (ref)		1.00 (ref)		1.00 (ref)
Referral unit
General practitioner	83.6 (4934)	1.00 (ref)	.004	1.00 (ref)	<.001	1.00 (ref)	.52
Hospital department	81.7 (12,229)	0.88 (0.81–0.95)		0.79 (0.73–0.86)		0.96 (0.87–1.06)
Other	83.2 (606)	0.98 (0.79–1.20)		0.95 (0.79–1.18)		1.06 (0.82–1.36)
Time from referral to death (days)
<8	41.5 (1709)	–	–	–	–	0.15 (0.14–0.17)	<.001
8–21	81.2 (3963)	–	–	–	–	1.00 (ref)
22–59	94.2 (5561)	–	–	–	–	3.78 (3.31–4.31)
60+	97.7 (6536)	–	–	–	–	9.58 (8.02–11.45)

^a Univariate logistic regression.

^b Multivariate logistic regression including sex, age diagnosis, region, referral unit and year of death.

^c Multivariate logistic regression model including variables as in model 1 and time from referral to death.

^d Including the following D-codes: D32, D42, D330–332, D352–354, D430–432, D443–445, D333–339 and D433–439.

Table 4. Mean and median time from referral to SPC to death based on sex and referral unit (N = 21,597).

	Time from referral to death (days)
	Mean (SD)	Median (IQR)
Sex
Women	67 (101)	31 (10–73)
Men	62 (94)	28 (11–78)
Referral unit
General practitioner	68 (95)	34 (12–82)
Hospital department	63 (98)	27 (10–73)
Other	65 (101)	30 (11–72)

SD: standard deviation; IQR: interquartile range.

Radbruch L, Payne S. White Paper on standards and norms for hospice and palliative care in Europe: part 2. Eur J Palliat Care. 2010;17:22–33.

 Google Scholar