{"id":{"repo_id":"helsinki","oai_identifier":"oai:helda.helsinki.fi:10138/601062"},"canonical_url":"https://search.dev.ndltd.org/etd/helsinki/oai:helda.helsinki.fi:10138/601062","repository":{"repo_id":"helsinki","name":"University of Helsinki","base_url":"https://helda.helsinki.fi/server/oai/request"},"display":{"title":"Assessing palliative care and healthcare resource utilization, and the role of chemoradiation in esophageal and gastric cancer","abstract":"Patients with advanced esophageal and gastric cancer have a poor prognosis, and they often experience a high burden of symptoms impairing the quality of life. As a result, they frequently require comprehensive end-of-life care. Palliative care is an essential aspect of managing patients with advanced cancer, aiming to improve quality of life by addressing physical, emotional, and social needs. This dissertation consists of three retrospective cohort studies. Studies I and II evaluated the impact of palliative care decision and specialist palliative care on end-of-life healthcare utilization in adults with esophageal or gastric cancer. Study III focused on patients with esophageal cancer who received chemoradiation. In approximately half of patients with advanced esophageal or gastric cancer, the decision to transition to palliative care and terminate anticancer treatments—referred to as the palliative care decision—was made late or not at all. Only a small proportion of patients received specialist palliative care. We observed that early palliative care intervention, defined as palliative care decision or specialist palliative care contact, was associated with reduced hospitalizations and emergency department contacts in the last month of life. Furthermore, early palliative care decreased the likelihood of dying in a hospital setting. Palliative hospital-at-home care was associated with a higher probability of home death. We also found that in patients with esophageal cancer who received chemoradiation the overall clinical condition and cancer stage had a significant impact on treatment decisions, often leading to overtreatment. Patients with better prognoses were more likely to proceed to surgery after chemoradiation, despite no evidence from prior randomized trials of improved survival outcomes. Conversely, patients with advanced disease and poor general health had poor outcomes, even after definitive chemoradiation. Smoking was an independent prognostic factor for poorer survival, highlighting the importance of smoking cessation. This dissertation has elucidated the factors influencing treatment decisions and the use and impact of palliative care in the treatment of patients with advanced esophageal or gastric cancer. Early palliative care reduces healthcare utilization and improves access to specialist palliative care services, highlighting the importance of timely initiation of palliative care.","abstract_html":"Patients with advanced esophageal and gastric cancer have a poor prognosis, and they often experience a high burden of symptoms impairing the quality of life. As a result, they frequently require comprehensive end-of-life care. Palliative care is an essential aspect of managing patients with advanced cancer, aiming to improve quality of life by addressing physical, emotional, and social needs. This dissertation consists of three retrospective cohort studies. Studies I and II evaluated the impact of palliative care decision and specialist palliative care on end-of-life healthcare utilization in adults with esophageal or gastric cancer. Study III focused on patients with esophageal cancer who received chemoradiation. In approximately half of patients with advanced esophageal or gastric cancer, the decision to transition to palliative care and terminate anticancer treatments—referred to as the palliative care decision—was made late or not at all. Only a small proportion of patients received specialist palliative care. We observed that early palliative care intervention, defined as palliative care decision or specialist palliative care contact, was associated with reduced hospitalizations and emergency department contacts in the last month of life. Furthermore, early palliative care decreased the likelihood of dying in a hospital setting. Palliative hospital-at-home care was associated with a higher probability of home death. We also found that in patients with esophageal cancer who received chemoradiation the overall clinical condition and cancer stage had a significant impact on treatment decisions, often leading to overtreatment. Patients with better prognoses were more likely to proceed to surgery after chemoradiation, despite no evidence from prior randomized trials of improved survival outcomes. Conversely, patients with advanced disease and poor general health had poor outcomes, even after definitive chemoradiation. Smoking was an independent prognostic factor for poorer survival, highlighting the importance of smoking cessation. This dissertation has elucidated the factors influencing treatment decisions and the use and impact of palliative care in the treatment of patients with advanced esophageal or gastric cancer. Early palliative care reduces healthcare utilization and improves access to specialist palliative care services, highlighting the importance of timely initiation of palliative care.","abstract_has_math":false,"creators":["Kitti, Pauliina"],"institution":"Helsingin yliopisto","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025-10-10","date_published":"2025-10-10","updated_at":"2026-08-21T22:21:56Z","subjects":["lääketiede"],"languages":["eng"],"rights":["This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.","Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.","Publikationen är skyddad av upphovsrätten. Den får läsas och skrivas ut för personligt bruk. Användning i kommersiellt syfte är förbjuden."],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/10138/601062","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"source_record":{"url":"https://helda.helsinki.fi/server/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Ahelda.helsinki.fi%3A10138%2F601062","prefix":"dim"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Kitti, Pauliina"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2025-09-11T10:26:31Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2025-09-11T10:26:31Z"]},{"key":"dc:date.issued","label":"Date","values":["2025-10-10"]},{"key":"dc:publisher","label":"Institution","values":["Helsingin yliopisto","Helsingfors universitet","University of Helsinki"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["lääketiede"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["eng"]},{"key":"dc:rights","label":"Dc Rights","values":["This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.","Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.","Publikationen är skyddad av upphovsrätten. Den får läsas och skrivas ut för personligt bruk. Användning i kommersiellt syfte är förbjuden."]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://hdl.handle.net/10138/601062"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Patients with advanced esophageal and gastric cancer have a poor prognosis, and they often experience a high burden of symptoms impairing the quality of life. As a result, they frequently require comprehensive end-of-life care. Palliative care is an essential aspect of managing patients with advanced cancer, aiming to improve quality of life by addressing physical, emotional, and social needs. This dissertation consists of three retrospective cohort studies. Studies I and II evaluated the impact of palliative care decision and specialist palliative care on end-of-life healthcare utilization in adults with esophageal or gastric cancer. Study III focused on patients with esophageal cancer who received chemoradiation. In approximately half of patients with advanced esophageal or gastric cancer, the decision to transition to palliative care and terminate anticancer treatments—referred to as the palliative care decision—was made late or not at all. Only a small proportion of patients received specialist palliative care. We observed that early palliative care intervention, defined as palliative care decision or specialist palliative care contact, was associated with reduced hospitalizations and emergency department contacts in the last month of life. Furthermore, early palliative care decreased the likelihood of dying in a hospital setting. Palliative hospital-at-home care was associated with a higher probability of home death. We also found that in patients with esophageal cancer who received chemoradiation the overall clinical condition and cancer stage had a significant impact on treatment decisions, often leading to overtreatment. Patients with better prognoses were more likely to proceed to surgery after chemoradiation, despite no evidence from prior randomized trials of improved survival outcomes. Conversely, patients with advanced disease and poor general health had poor outcomes, even after definitive chemoradiation. Smoking was an independent prognostic factor for poorer survival, highlighting the importance of smoking cessation. This dissertation has elucidated the factors influencing treatment decisions and the use and impact of palliative care in the treatment of patients with advanced esophageal or gastric cancer. Early palliative care reduces healthcare utilization and improves access to specialist palliative care services, highlighting the importance of timely initiation of palliative care.","Edennyttä ruokatorvi- ja mahasyöpää sairastavien potilaiden ennuste on huono, ja heillä on usein paljon oireita, jotka heikentävät elämänlaatua. Siksi he tarvitsevat usein kokonaisvaltaista hoitoa elämän loppuvaiheessa. Palliatiivinen hoito on tärkeä osa edenneen syövän hoitoa. Sen tavoitteena on parantaa elämänlaatua huomioimalla potilaiden fyysiset, psyykkiset ja sosiaaliset tarpeet. Tämä väitöskirja koostuu kolmesta tutkimuksesta. Tutkimuksissa I ja II arvioitiin, miten palliatiivisen hoitopäätöksen tekeminen ja erityistason palliatiivinen hoito vaikuttivat terveydenhuollon palvelujen käyttöön elämän viimeisten kuukausien aikana potilailla, joilla oli ruokatorvi- tai mahasyöpä. Tutkimus III keskittyi ruokatorvisyöpää sairastaviin potilaisiin, jotka saivat kemosädehoitoa. Noin puolella edennyttä ruokatorvi- tai mahasyöpää sairastavista potilaista päätös siirtyä palliatiiviseen hoitoon tehtiin vasta hyvin myöhään tai ei ollenkaan. Vain pieni osa potilaista sai erityistason palliatiivista hoitoa. Havaitsimme, että silloin kun palliatiivinen hoito aloitettiin ajoissa, potilailla oli vähemmän sairaalajaksoja ja päivystyskäyntejä elämän viimeisen kuukauden aikana. Lisäksi varhain aloitettu palliatiivinen hoito pienensi sairaalassa kuolemisen riskiä. Palliatiivisen kotisairaalan tuki lisäsi todennäköisyyttä siihen, että potilas kuoli kotona. Tutkimuksessa havaittiin myös, että ruokatorvisyöpäpotilaiden hoitopäätöksiin kemosädehoidon yhteydessä vaikuttivat erityisesti yleiskunto ja syövän levinneisyys. Osalle potilaista annettiin liian raskaita hoitoja. Parempikuntoiset potilaat ohjautuivat useammin leikkaukseen kemosädehoidon jälkeen, vaikka aiemmat satunnaistetut tutkimukset eivät ole osoittaneet selvää hyötyä elossaoloaikaan. Sen sijaan pitkälle edenneessä taudissa ja heikkokuntoisilla potilailla ennuste pysyi huonona, vaikka potilas sai kemosädehoidon. Tupakointi todettiin itsenäiseksi tekijäksi, joka heikensi elossaoloa, mikä korostaa tupakoinnin lopettamisen tärkeyttä. Tämä väitöskirja toi lisätietoa siitä, mitkä tekijät vaikuttavat hoitopäätöksiin ja millaisia vaikutuksia palliatiivisella hoidolla on edennyttä ruokatorvi- tai mahasyöpää sairastavilla potilailla. Tulokset osoittivat, että varhain aloitettu palliatiivinen hoito vähentää terveydenhuollon resurssien käyttöä ja parantaa mahdollisuuksia päästä erityistason palliatiivisiin palveluihin. Tämä korostaa sitä, kuinka tärkeää on aloittaa palliatiivinen hoito oikeaan aikaan."]},{"key":"dc:format.mimetype","label":"Dc Format Mimetype","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Assessing palliative care and healthcare resource utilization, and the role of chemoradiation in esophageal and gastric cancer"]}]}],"canonical_facts":{"dc:creator":["Kitti, Pauliina"],"dc:date.accessioned":["2025-09-11T10:26:31Z"],"dc:date.available":["2025-09-11T10:26:31Z"],"dc:date.issued":["2025-10-10"],"dc:description.abstract":["Patients with advanced esophageal and gastric cancer have a poor prognosis, and they often experience a high burden of symptoms impairing the quality of life. As a result, they frequently require comprehensive end-of-life care. Palliative care is an essential aspect of managing patients with advanced cancer, aiming to improve quality of life by addressing physical, emotional, and social needs. This dissertation consists of three retrospective cohort studies. Studies I and II evaluated the impact of palliative care decision and specialist palliative care on end-of-life healthcare utilization in adults with esophageal or gastric cancer. Study III focused on patients with esophageal cancer who received chemoradiation. In approximately half of patients with advanced esophageal or gastric cancer, the decision to transition to palliative care and terminate anticancer treatments—referred to as the palliative care decision—was made late or not at all. Only a small proportion of patients received specialist palliative care. We observed that early palliative care intervention, defined as palliative care decision or specialist palliative care contact, was associated with reduced hospitalizations and emergency department contacts in the last month of life. Furthermore, early palliative care decreased the likelihood of dying in a hospital setting. Palliative hospital-at-home care was associated with a higher probability of home death. We also found that in patients with esophageal cancer who received chemoradiation the overall clinical condition and cancer stage had a significant impact on treatment decisions, often leading to overtreatment. Patients with better prognoses were more likely to proceed to surgery after chemoradiation, despite no evidence from prior randomized trials of improved survival outcomes. Conversely, patients with advanced disease and poor general health had poor outcomes, even after definitive chemoradiation. Smoking was an independent prognostic factor for poorer survival, highlighting the importance of smoking cessation. This dissertation has elucidated the factors influencing treatment decisions and the use and impact of palliative care in the treatment of patients with advanced esophageal or gastric cancer. Early palliative care reduces healthcare utilization and improves access to specialist palliative care services, highlighting the importance of timely initiation of palliative care.","Edennyttä ruokatorvi- ja mahasyöpää sairastavien potilaiden ennuste on huono, ja heillä on usein paljon oireita, jotka heikentävät elämänlaatua. Siksi he tarvitsevat usein kokonaisvaltaista hoitoa elämän loppuvaiheessa. Palliatiivinen hoito on tärkeä osa edenneen syövän hoitoa. Sen tavoitteena on parantaa elämänlaatua huomioimalla potilaiden fyysiset, psyykkiset ja sosiaaliset tarpeet. Tämä väitöskirja koostuu kolmesta tutkimuksesta. Tutkimuksissa I ja II arvioitiin, miten palliatiivisen hoitopäätöksen tekeminen ja erityistason palliatiivinen hoito vaikuttivat terveydenhuollon palvelujen käyttöön elämän viimeisten kuukausien aikana potilailla, joilla oli ruokatorvi- tai mahasyöpä. Tutkimus III keskittyi ruokatorvisyöpää sairastaviin potilaisiin, jotka saivat kemosädehoitoa. Noin puolella edennyttä ruokatorvi- tai mahasyöpää sairastavista potilaista päätös siirtyä palliatiiviseen hoitoon tehtiin vasta hyvin myöhään tai ei ollenkaan. Vain pieni osa potilaista sai erityistason palliatiivista hoitoa. Havaitsimme, että silloin kun palliatiivinen hoito aloitettiin ajoissa, potilailla oli vähemmän sairaalajaksoja ja päivystyskäyntejä elämän viimeisen kuukauden aikana. Lisäksi varhain aloitettu palliatiivinen hoito pienensi sairaalassa kuolemisen riskiä. Palliatiivisen kotisairaalan tuki lisäsi todennäköisyyttä siihen, että potilas kuoli kotona. Tutkimuksessa havaittiin myös, että ruokatorvisyöpäpotilaiden hoitopäätöksiin kemosädehoidon yhteydessä vaikuttivat erityisesti yleiskunto ja syövän levinneisyys. Osalle potilaista annettiin liian raskaita hoitoja. Parempikuntoiset potilaat ohjautuivat useammin leikkaukseen kemosädehoidon jälkeen, vaikka aiemmat satunnaistetut tutkimukset eivät ole osoittaneet selvää hyötyä elossaoloaikaan. Sen sijaan pitkälle edenneessä taudissa ja heikkokuntoisilla potilailla ennuste pysyi huonona, vaikka potilas sai kemosädehoidon. Tupakointi todettiin itsenäiseksi tekijäksi, joka heikensi elossaoloa, mikä korostaa tupakoinnin lopettamisen tärkeyttä. Tämä väitöskirja toi lisätietoa siitä, mitkä tekijät vaikuttavat hoitopäätöksiin ja millaisia vaikutuksia palliatiivisella hoidolla on edennyttä ruokatorvi- tai mahasyöpää sairastavilla potilailla. Tulokset osoittivat, että varhain aloitettu palliatiivinen hoito vähentää terveydenhuollon resurssien käyttöä ja parantaa mahdollisuuksia päästä erityistason palliatiivisiin palveluihin. Tämä korostaa sitä, kuinka tärkeää on aloittaa palliatiivinen hoito oikeaan aikaan."],"dc:format.mimetype":["application/pdf"],"dc:identifier.uri":["http://hdl.handle.net/10138/601062"],"dc:language.iso":["eng"],"dc:publisher":["Helsingin yliopisto","Helsingfors universitet","University of Helsinki"],"dc:rights":["This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.","Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.","Publikationen är skyddad av upphovsrätten. Den får läsas och skrivas ut för personligt bruk. Användning i kommersiellt syfte är förbjuden."],"dc:subject":["lääketiede"],"dc:title":["Assessing palliative care and healthcare resource utilization, and the role of chemoradiation in esophageal and gastric cancer"]},"updated_at":"2026-08-21T22:21:56Z"}