Care trajectories of women with advanced breast cancer at the end of life.

The groups were not randomly assigned; classification depended on the care model present in the last 30 days, so differences may reflect who was referred to palliative care rather than the effect of palliative care. The palliative care group had more advanced disease features, including more metastases and more central nervous system involvement, which can influence both care needs and outcomes. The study was done in a single public reference hospital in Rio de Janeiro, so the findings may not apply to settings with fewer multidisciplinary teams, supplies, or community support. Data came from retrospective records, so completeness and accuracy of documentation may have affected the results. The study did not measure patient preferences, perceived quality of care, symptom burden, or functional outcomes. No multivariate adjustment was performed, so the reported differences cannot be treated as independent effects. The palliative care model included several coordinated components, so the contribution of any single component cannot be separated.

Do not read the lower emergency visits, transfusions, and last-day hospitalization as proof that palliative care caused less aggressive end-of-life care or reduced total hospital stay. Total hospitalization days did not differ, the groups were not randomly assigned, and the palliative care group had more advanced disease, so selection and clinical severity may explain the pattern.