Characteristics and care pathways of advanced cancer patients in a palliative-supportive care unit and an oncological ward
- 282 Downloads
A supportive palliative care unit (SPCU) may have a positive impact on patients’ care. The aim of this study was to compare the pattern of patients admitted to a specialized SPCU and to a traditional oncologic ward (OW) in a consecutive sample of advanced cancer patients.
Data on patients demographics, reasons for and kind of admission, care-giver, anticancer treatments, being on/off treatment or uncertain, origin setting, who proposed hospital admission, the use of opioids, and hospitalization were gathered. The same parameters were recorded at discharge. A follow-up was performed by phone 1 month after discharge.
Two-hundred patients were surveyed. Awareness of disease was more complete in OW patients (P = 0.001). Uncontrolled pain and symptoms were the prevalent reasons for admission to SPCU (P < 0.0005). Toxicity from chemotherapy was more frequently reported by OW patients (P = 0.001). SPCU patients received higher doses of opioids (P = 0.004). More SPCU patients were referred from home and were discharged home (P < 0.0005 and P = 0.018, respectively). Emergency admissions were more frequently reported in OW patients (P < 0.0005). One month after, more SPCU patients were at home and were still on active treatment (P = 0.002, and P = 0.05, respectively). More OW patients died within 1 month (P = 0.001).
SPCU allows a better planning admission to hospital and a better care trajectory in advanced cancer patients in comparison to a busy OW, where unselected emergencies more frequently occur.
KeywordsSupportive care Palliative care Advanced cancer patients Hospital admission Emergency
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Ferris FD, Bruera E, Cherny N, Cummings C, Currow D, Dudgeon D, Janjan N, Strasser F, von Gunten CF, Von Roenn JH (2009) Palliative cancer care a decade later: accomplishments, the need, next steps—from the American Society of Clinical Oncology. J Clin Oncol 27(18):3052–3058. https://doi.org/10.1200/JCO.2008.20.1558 CrossRefPubMedGoogle Scholar
- 4.Mercadante S, Valle A, Sabba S, Orlando A, Guolo F, et al. (2013) Pattern and characteristics of advanced cancer patients admitted to hospice in Italy 21:935–939Google Scholar
- 6.Mercadante S, Valle A, Porzio G, Costanzo BV, Fusco F, Aielli F, Adile C, Fara B, Casuccio A, Home Care—Italy (HOCAI) Group (2011) How do cancer patients receiving palliative care at home die? A descriptive study. J Pain Symptom Manag 42(5):702–709. https://doi.org/10.1016/j.jpainsymman.2011.01.014 CrossRefGoogle Scholar
- 11.Mercadante S, Adile C, Caruselli A, Ferrera P, Costanzi A, Marchetti P, Casuccio A (2016) The Palliative-supportive care unit in a comprehensive cancer center as crossroad for patients’ oncological pathway. PLoS One 11(6):e0157300. https://doi.org/10.1371/journal.pone.0157300 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Rigby A, Krzyanowska M, Le LW, Swami N, Coe G et al (2008) Impact of opening an acute palliative care unit on administrative outcomes for a general oncology ward. J Clin Oncol 113:3267–3274Google Scholar
- 16.Lagman R, Rivera N, Walsh D, LeGrand S, Davis M (2007) Acute inpatient palliative medicine in a cancer center: clinical problems and medical interventions. A prospective study. J Palliat Med 24:20–28Google Scholar
- 24.Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, Moore M, Rydall A, Rodin G, Tannock I, Donner A, Lo C (2014) Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 383(9930):1721–1730. https://doi.org/10.1016/S0140-6736(13)62416-2 CrossRefPubMedGoogle Scholar
- 26.Mercadante S, Guccione C, Di Fatta S, Alaimo V, Prestia G, Bellingardo R, Gebbia V, Giarratano A, Casuccio A (2013) Cancer pain management in an oncological ward in a comprehensive cancer center with an established palliative care unit. Support Care Cancer 21(12):3287–3292. https://doi.org/10.1007/s00520-013-1899-z CrossRefPubMedGoogle Scholar