The TPs are chronically consumed due to the disease itself, and the different treatments in the early stage caused reactions such as nausea and vomiting, pain, etc., which will lead to metabolic disorders and QoL progressive decline[25, 26]. TGCPs are a particular group with complicated disease trajectories, often accompanied by problems in physical function, emotion, and cognition which increase their vulnerability[27–29]. The incidence of moderate or severe pain in advanced cancer patients is about 70%. Pain will affect the patient's feelings, emotions, other aspects and also bring psychological burdens such as anxiety and fear to the families[21, 30–32]. For this reason, TGCPs suffer from many symptoms both physically, mentally, and psychologically, resulting in poor QoL. Therefore, how to reduce the symptoms of TGCPs and improve the QoL has important clinical significance.
HC focuses on the management of TPs’ symptoms and meeting their overall reasonable needs, aimed at improving QoL, prevention and relief of suffering, affirmation of life, and making them pass away in peace and dignity[1–3]. And the guidelines emphasize that physical symptoms, psychological, and spiritual needs require to be optimized for the entire treatment process of cancers[13, 14]. So, the participation of multiple parties should be required for high-quality HC[1–3, 13, 14]. Terminal cancers are a type of restrictive disease. Studies have shown that LSTs may not improve QoL and clinical benefits[6, 7, 32]. Therefore, there is much concern about the treatment options for TGCPs and whether LSTs need to be accepted.
At present, there is no unified evaluation standard or interventions model for the treatment of TGCPs. Therefore, we implemented comprehensive management of symptoms and collected STs, alleviation in functional areas and symptom areas, daily drug costs, collaboration ability, etc. These were to evaluate the clinical outcomes of the two groups of patients after treatment with different modes.
It was firstly found that the incidence of some symptoms of TGCPs was high and had an impact on the QoL. In terms of emotional function and symptoms, patients undergoing ICHC had improved significantly compared to before treatment (P < 0.01), and the degree of improvement was significantly better than those of LSTs (P < 0.05). There was no significant statistical in the MST between the two groups (P > 0.05), suggesting that ICHC reduced emotional and mental stress disturbances, and relieved patients' symptoms, improved their QoL, but had no significant impact on patient's survival time. Symptoms such as pain, etc were negatively correlated with the QoL of patients[33–35]. HC could relieve symptoms of TPs, thereby improving QoL, but it had little effect on the survival time of TPs. There were no relevant reports on the improvement of symptoms and survival time of TGCPs after the ICHC treatment. Our study was consistent with them.
In addition, there was a gap in the overall MST of receiving ICHC (10–12 days) between our study and a study from the USA (19 days), suggesting that the overall MST of HC in our study is relatively short and needs to be improved. It may be due to the less understanding and acceptance of HC service. Our study found that, compared with LSTs, ICHC had significantly fewer MADDCs and MTDCs incurred in the last 2 days (P < 0.01), with the decrease rate of about 30%, suggesting that ICHC can reduce medical care, resource utilization rates, and cost. This is consistent with other reports on HC/PC which also greatly reduced medical expenses[38–40]. Other studies mainly focused on the treatment impact on overall medical insurance costs, but not on ADDCs. Our study investigated the impact of TGCPs on the MADDCs and the MTDCs in the last 2 days.
In addition, ICHC was significantly better than LSTs in healthcare satisfaction and collaboration capabilities (P < 0.01), suggesting that ICHC can meet the reasonable needs of patients and caregivers, enhance doctor-patient trust, and improve medical satisfaction. Which may be associated with ICHC's core intervention measures consisting of patient-centered, effective collaboration, participation, and communication of team members throughout the process.
Based on the above results, the overall MST for HC used in China is relatively short, and there is a gap in the outcome of interventions between China and developed countries in Europe and America, which may be due to factors such as the late start of HC in China, lack of understanding of HC, and cultural differences. Although ICHC had no significant impact on the proximal survival time of TGCPs, it had a positive impact in reducing the suffering and improving the QoL of patients, reducing the burden of symptoms, reducing the waste of medical resources, and strengthening doctor-patient collaboration and participation. ICHC could provide TGCPs with coordinated, comfortable, high-quality, and humanistic care.
This study has the following limitations. Firstly, the sample size is relatively small, this study did not in multi-site practices or large healthcare systems. Secondly, the included research subjects are relatively limited. Further, there may be a difference in the scoring among members, and the time points of the scale scores are relatively small. Because of these factors, large-scale prospective multi-center research based on the advanced, optimal, and feasible treatment concept for TGCPs is still needed.