{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T21:05:07Z","timestamp":1785186307430,"version":"3.55.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008376","name":"Helsingin ja Uudenmaan Sairaanhoitopiiri","doi-asserted-by":"publisher","award":["Y253S24011"],"award-info":[{"award-number":["Y253S24011"]}],"id":[{"id":"10.13039\/100008376","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007797","name":"Helsingin Yliopisto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007797","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007797","name":"University of Helsinki","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007797","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Support Care Cancer"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>Esophageal and gastric cancer patients, with poor prognoses and complex symptom burdens, require comprehensive end-of-life care. This study evaluated the impact of specialist palliative care (SPC) on end-of-life healthcare utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed nationwide healthcare utilization data for all adults who died of esophageal or gastric cancer in Finland in 2019, using National Health and Social Care Registers. Patients were compared based on timing of first SPC contact: early (&gt;\u200930\u00a0days before death) or no\/late (\u2264\u200930\u00a0days).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort included 732 patients (median age 72\u00a0years), with 233 (32%) having SPC contact, including 156 (21%) with early SPC. Most patients (79%) had late\/no SPC. The median time for first SPC contact was 120\u00a0days before death for early SPC group, and 12\u00a0days for no\/late group,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001.\n                    <\/jats:p>\n                    <jats:p>\n                      Early SPC group, compared to no\/late SPC, had fewer emergency department contacts (44% vs. 60%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and secondary care hospitalizations (32% vs. 61%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) in the last month. Early SPC increased access to hospital-at-home (56% vs. 6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and SPC wards (19% vs. 4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Patients with early SPC died more often in SPC wards (19% vs. 4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Overall, 122 (17%) received hospital-at-home care, and were more likely to die at home (19% vs. 11%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011) or in SPC wards (15% vs. 5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Few patients with advanced esophageal or gastric cancer receive SPC. Early SPC was associated with reduced healthcare utilization and improved access to SPC services, highlighting the importance of timely SPC initiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00520-025-09587-3","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T03:09:47Z","timestamp":1749092987000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Specialist palliative care is associated with reduced healthcare utilization in patients with advanced esophageal and gastric cancer: a nationwide register-based study"],"prefix":"10.1007","volume":"33","author":[{"given":"Pauliina","family":"Kitti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anu","family":"Anttonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikko","family":"Nuutinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Carp\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiina","family":"Saarto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,5]]},"reference":[{"key":"9587_CR1","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1093\/annonc\/mdx757","volume":"29","author":"K Jordan","year":"2018","unstructured":"Jordan K, Aapro M, Kaasa S et al (2018) European Society for Medical Oncology (ESMO) position paper on supportive and palliative care. 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