Comparing Clinical Profiles,Symptom Burden,Care Delivery,and Outcomes Between Oncologic and Non-Oncologic Patients in a Public Home-Based Palliative Care Program

Abstract

Background

Home-based palliative care (HBPC) is central to high-quality end-of-life care; however, most evidence and care models remain cancer-oriented, with non-cancer populations underrepresented.

Objective

To compare clinical profiles, symptom burden, care delivery intensity, and outcomes between patients with oncological and non-oncological diagnoses enrolled in a publicly funded HBPC program in Brazil.

Methods

We conducted a retrospective cross-sectional study of 719 consecutive patients (65.5% oncological; 34.5% non-oncological) enrolled in the Serviço de Atenção Domiciliar em Cuidados Paliativos (SAD-CP) between 2013 and 2023. Medical records were reviewed for sociodemographic characteristics, Palliative Performance Scale (PPS) scores, comorbidities, symptoms, healthcare visits, and survival.

Results

Non-oncological patients were older (mean 80.8 vs 69.6 years; P < 0.001) and more functionally impaired at admission (PPS ≤30: 45.6% vs 36.3%). Cancer patients reported a higher prevalence of pain, nausea, anxiety, and depression, whereas dysphagia was more frequent among non-cancer patients. Median daily medical (0.37 vs 0.31; P = 0.0206) and urgent visits (0.08 vs 0.06; P = 0.0116) were higher among oncological patients. Median survival was slightly shorter in cancer patients (48 vs 50 days; P = 0.0021). Overall, 99.6% of patients died at home.

Conclusions

Publicly funded HBPC can support a high intensity of medical and nursing care and enable successful home death for both oncological and non-oncological patients, even in socioeconomically vulnerable populations. While symptom profiles and care needs differ by diagnosis, functional status remains a key determinant of outcomes. These findings underscore the importance of PPS-guided care planning and workforce capacity to deliver equitable, scalable palliative care across disease groups.