{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T21:22:05Z","timestamp":1779139325741,"version":"3.51.4"},"reference-count":46,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100010711","name":"sy\u00f6p\u00e4s\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health&amp;#65533;Serv&amp;#65533;Insights"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There is a lack of studies concerning the end of life (EOL) of patients with head and neck cancer (HNC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To investigate whether the timing of palliative care decision (PCD), that is, decision to terminate life-prolonging anticancer treatments, is associated with reduced secondary health care utilization and medical procedures at the EOL among patients with head and neck cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and methods:<\/jats:title>\n                    <jats:p>A total of 108 patients with HNC treated at the Helsinki University Hospital Comprehensive Cancer Center were reviewed retrospectively. Three study groups were formed according to the timing of PCD: (1) the early PCD group (PCD &gt;30\u2009days prior to death), (2) the late PCD group (\u2a7d30\u2009days prior to death), and (3) the no PCD group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      PCD was made for 78 patients (72%), of which 57 (73%) were considered as early PCD and 21 (27%) as late. The median interval between PCD and death was 71\u2009days (IQR 108). During the last month of life, a significantly smaller proportion of patients with an early PCD was hospitalized (19% vs 67%, OR\u2009=\u20090.12, CI [0.04-0.37],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001 and 19% vs 47%, OR\u2009=\u20090.27, CI [0.10-0.72],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.007) and readmitted (5% vs 29%, OR\u2009=\u20090.14, CI [0.03-0.62],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.004 and 5% vs 20%, OR\u2009=\u20090.22, CI [0.05-0.96],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.032) in secondary health care compared with the patients with late or no PCD. Early PCD also associated with less ED visits (28% vs 52%, OR\u2009=\u20090.36, CI [0.126-0.997],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.045) compared with the late PCD in the last month of life. Compared with the late PCD group, early PCD group was more likely to receive palliative radiotherapy (42% vs 14%, OR 4.36, 95% CI [1.15-16.51],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.022).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Early PCD associated with reduced utilization of secondary health care and emergency services at the EOL. The disease trajectories for patients with HNC should warrant more attention to the earlier timing of PCD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11786329251412688","type":"journal-article","created":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T06:38:59Z","timestamp":1769323139000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The Association of Palliative Care Decision on Secondary Health Care Utilization and Cancer Treatment at the End of Life Among Patients with Head and Neck Cancer: A Single-Center Retrospective Study"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4702-6840","authenticated-orcid":false,"given":"Martti","family":"Merikari","sequence":"first","affiliation":[{"name":"Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital, Finland"},{"name":"Faculty of Medicine, University of Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3310-3490","authenticated-orcid":false,"given":"Tiina","family":"Saarto","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9255-2958","authenticated-orcid":false,"given":"Riikka-Leena","family":"Leskel\u00e4","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Helsinki, Finland"},{"name":"Nordic Healthcare Group, Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0451-2404","authenticated-orcid":false,"given":"Antti","family":"M\u00e4kitie","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Helsinki, Finland"},{"name":"Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Finland"},{"name":"Department of Otorhinolaryngology \u2013 Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Finland"},{"name":"Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0117-8559","authenticated-orcid":false,"given":"Timo","family":"Carp\u00e9n","sequence":"additional","affiliation":[{"name":"Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital, Finland"},{"name":"Faculty of Medicine, University of Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9037-0557","authenticated-orcid":false,"given":"Outi","family":"Akr\u00e9n","sequence":"additional","affiliation":[{"name":"Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital, Finland"},{"name":"Faculty of Medicine, University of Helsinki, Finland"},{"name":"Palliative Center, Turku University Hospital and University of Turku, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,24]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"The Finnish Cancer Registry. 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