Advertisement

Internal and Emergency Medicine

, Volume 12, Issue 5, pp 587–592 | Cite as

Characteristics of patients with an unplanned admission to an acute palliative care unit

  • Sebastiano MercadanteEmail author
  • Claudio Adile
  • Patrizia Ferrera
  • Alessandra Casuccio
IM - ORIGINAL

Abstract

The aim of this cohort study is to compare the symptom burden of patients who have an unplanned admission to an acute palliative care unit (APCU) with patients who have a regular planned admission. A consecutive sample of advanced cancer patients who were admitted to an APCU was prospectively assessed. The reasons and the kind of admission were recorded (unplanned, UP, or planned, P). Anticancer treatments, whether patients were on/off treatment or uncertain, previous care setting, and who referred the patient to the unit were also recorded. The Edmonton Symptom Assessment Scale (ESAS) was used at admission and at time of discharge, as well as the Memorial Delirium Assessment Scale. Analgesics and their doses at admission and discharge were recorded. Hospital staying was also recorded. At the time of discharge, subsequent referral to other care settings, and the pathway of oncologic treatment were re-considered. Fifty-five (17.5%) of 314 consecutive admissions recorded in a period of 10 months were UP. UP-patients are more frequently referred from other hospitals (P = 0.0005), and are reported by physicians of other units (P = 0.05). UP-patients have a longer hospital admission (P = 0.032), a higher hospital death rate (P = 0.025), and are less frequently discharged home (P = 0.031). A significant decrease in intensity of ESAS items was observed in both groups, with no differences in symptom burden either at admission and time for discharge. At discharge, opioid doses are higher in UP-patients. An APCU may admit UP-patients at any stage of disease, providing effective treatment outcomes, as reported with P-patients. This study suggests that patients referred from other settings or hospitals may provide specialist advice and rapid symptom control. Although symptom burden is similar, these patients have longer hospital admission, higher hospital death rate, and are less frequently discharged home, suggesting the need for more complex treatments. Such units in a comprehensive cancer center might improve symptom control and pose as referral centers for non-cancer hospitals, emergency departments, or the territory.

Keywords

Cancer Early palliative care Symptom control Emergency Unplanned admission 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

Procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national). This was not an experimental study, and animals were not used. Ethical approval from the ethical committees was obtained and reported for the primary study (this is a secondary analysis).

Informed consent

Informed consent was obtained and reported for the primary study (this is a secondary analysis).

References

  1. 1.
    Aprile G, Pisa FE, Follador A, Foltran L, De Pauli F, Mazzer M, Lutrino S, Sacco CS, Mansutti M, Fasola G (2013) Unplanned presentations of cancer outpatients: a retrospective cohort study. Support Care Cancer 21:397–404CrossRefPubMedGoogle Scholar
  2. 2.
    Mercadante S, Vitrano V (2010) Palliative care in Italy: problems areas emerging from the literature. Minerva Anestesiol 76:1060–1071PubMedGoogle Scholar
  3. 3.
    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. Support Care Cancer 21:935–939CrossRefPubMedGoogle Scholar
  4. 4.
    Cheng WW, Willey J, Palmer JL, Zhang T, Bruera E (2005) Interval between palliative care referral and death among patients treated at a comprehensive cancer center. J Palliat Med 8:1025–1032CrossRefPubMedGoogle Scholar
  5. 5.
    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 27:3052–3058CrossRefPubMedGoogle Scholar
  6. 6.
    Rocque GB, Barnett AE, Illig L, Eickhoff JC, Bailey HH, Vampbell TC, Stewart JA, Cleary JF (2013) Inpatient hospitalization of oncology patients: are we missing an opportunity for end-of-life care? J Oncol Pract 9:51–54CrossRefPubMedGoogle Scholar
  7. 7.
    Saito AM, Landrum MB, Neville BA, Ayanian JZ, Earle CC (2011) The effect on survival of continuing chemotherapy to near death. BMC Palliat Care 10:14CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hui D, Elsayem A, Palla S, De La Cruz M, Li Z et al (2010) Discharge outcomes and survival of patients with advanced cancer admitted to an acute palliative care unit at a comprehensive cancer center. J Palliat Med 12:49–57CrossRefGoogle Scholar
  9. 9.
    Hui D, Bruera E (2015) Models of integration of oncology and palliative care. Ann Palliat Med 4:89–98PubMedGoogle Scholar
  10. 10.
    Hui D, Kim YJ, Park JC, Zhang Y, Strasser F, Cherny N, Kaasa S, Davis MP, Bruera E (2015) Integration of oncology and palliative care: a systematic review. Oncologist 20:77–83CrossRefPubMedGoogle Scholar
  11. 11.
    Amano K, Morita T, Tatara R, Katayama H, Uno T, Takagi I (2015) Association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of care at the end of life. J Palliat Med 18:270–273CrossRefPubMedGoogle Scholar
  12. 12.
    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 17(383):1721–1730CrossRefGoogle Scholar
  13. 13.
    Maltoni M, Scarpi E, Dall’Agata M, Schiavon S, Biasini C, Codecà C, Broglia CM, Sansoni E, Bortolussi R, Garetto F, Fioretto L, Cattaneo MT, Giacobino A, Luzzani M, Luchena G, Alquati S, Quadrini S, Zagonel V, Cavanna L, Ferrari D, Pedrazzoli P, Frassineti GL, Galiano A, Casadei Gardini A, Monti M, Nanni Nanni, Early Palliative Care Italian Study Group (EPCISG) (2016) Systematic versus on-demand early palliative care: a randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life. Eur J Cancer 69:110–118CrossRefPubMedGoogle Scholar
  14. 14.
    Bruera E, Hui D (2010) Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care. J Clin Oncol 28:4013–4017CrossRefPubMedGoogle Scholar
  15. 15.
    Mercadante S, Villari P, Ferrera P (2003) A model of acute symptom control unit: pain Relief and Palliative Care Unit of La Maddalena Cancer Center. Support Care Cancer 11:114–119PubMedGoogle Scholar
  16. 16.
    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 patient’s oncological pathway. PLoS One 11:e0157300CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Shin SH, Hui D, Chisholm GB, Kwon JH, San Miguel MT, Allo JA, Yennurajalingam S, Frisbee-Hume SI, Bruera E (2013) Characteristics and outcomes of patients admitted to the acute palliative care unit from Emergency center. J Pain Symptom Manag 47:1028–1034CrossRefGoogle Scholar
  18. 18.
    Gardiner C, Gott M, Ingleton C, Seymour J, Cobb M, Noble B, Bennett M, Ryan T (2012) Extent of palliative care need in the acute hospital setting: a survey of two acute hospital in the UK. Palliat Med 27:76–83CrossRefPubMedGoogle Scholar
  19. 19.
    Pantilat SZ, O’Riordan DL, Dibble SL, Landefeld CS (2010) Hospital-based palliative medicine consultation: a randomized controlled trial. Arch Intern Med 170:2038–2040CrossRefPubMedGoogle Scholar
  20. 20.
    Mercadante S, Intravaia G, Villari P, Ferrera P, David F et al (2008) Clinical and financial analysis of an acute palliative care unit in an oncological department. Palliat Med 22:760–767CrossRefPubMedGoogle Scholar
  21. 21.
    Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton Symptom Assessment Scale (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–7PubMedGoogle Scholar
  22. 22.
    Chang VT, Hwang SS, Feurman M (2000) Validation of the Edmonton Symptom Assessment Scale. Cancer 88:2164–2171CrossRefPubMedGoogle Scholar
  23. 23.
    de la Cruz M, Fan J, Yennu S, Tanco K, Shin S, Wu J, Liu D, Bruera E (2015) The frequency of missed delirium in patients referred to palliative care in a comprehensive cancer center. Support Care Cancer 23:2427–2433CrossRefPubMedGoogle Scholar
  24. 24.
    Gibson S, McConigley R (2016) Unplanned oncology admissions within 14 days of non-surgical discharge: a retrospective study. Support Care Cancer 24:311–317CrossRefPubMedGoogle Scholar
  25. 25.
    Granda-Cameron C, Behta M, Hovinga M, Rundio A, Mintzer D (2015) Risk factors associated with unplanned hospital readmissions in adults with Cancer. Oncol Nurs Forum 42:E257–E268CrossRefPubMedGoogle Scholar
  26. 26.
    Delgado-Guay MO, Rodriguez-Nunez A, Shin SH, Chisholm G, Williams J, Frisbee-Hume S, Bruera E (2016) Characteristics and outcomes of patients with advanced cancer evaluated by a palliative care team at an emergency center: a retrospective study. Support Care Cancer 24:2287–2295CrossRefPubMedGoogle Scholar
  27. 27.
    Wu FM, Newman JM, Lasher A, Brody AA (2013) Effects of initiating palliative care consultations in the emergency department on inpatient length of stay. J Palliat Med 16:1362–1367CrossRefPubMedGoogle Scholar
  28. 28.
    Grudzen CR, Hwang U, Cohen JA, Fishman M, Morrison RS (2012) Characteristics of emergency department patients who receive a palliative consultation. J Palliat Med 15:396–399CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Mercadante S, Porzio G, Valle A, Aielli F, Costanzo V, Adile C, Spedale V (2012) Casuccio A; Home Care Italy Group (HOCAI). Emergencies in patients with advanced cancer followed at home. J Pain Symptom Manag 44:295–300CrossRefGoogle Scholar
  30. 30.
    Mercadante S, Masedu F, Valenti M, Mercadante A, Aielli F (2016) The characteristics of advanced cancer patients followed at home, but admitted to the hospital for the last days of life. Intern Emerg Med 11:713–718CrossRefPubMedGoogle Scholar
  31. 31.
    Hjermstad MJ, Kolflaath J, Løkken AO, Hanssen SB, Normann AP, Aass N (2013) Are emergency admissions in palliative cancer care always necessary? Results from a descriptive study. BMJ Open 3(5). doi: 10.1136/bmjopen-2012-002515
  32. 32.
    Da Silva Soares D, Nunes CM, Gomes B (2016) Effectiveness for emergency department based palliative care for adults with advanced disease: a systematic review. J Palliat Med 19:601–609CrossRefGoogle Scholar

Copyright information

© SIMI 2017

Authors and Affiliations

  • Sebastiano Mercadante
    • 1
    • 2
    Email author
  • Claudio Adile
    • 1
    • 2
  • Patrizia Ferrera
    • 1
    • 2
  • Alessandra Casuccio
    • 1
    • 2
  1. 1.Anesthesia and Intensive Care Unit and Supportive-Palliative Care UnitLa Maddalena Cancer CenterPalermoItaly
  2. 2.Department of Sciences for Health Promotion and Mother Child CareUniversity of PalermoPalermoItaly

Personalised recommendations