nach oben

Erschienen in:

08.01.2018 | Original Article

Characteristics and care pathways of advanced cancer patients in a palliative-supportive care unit and an oncological ward

verfasst von: Sebastiano Mercadante, Paolo Marchetti, Claudio Adile, Amanda Caruselli, Patrizia Ferrera, Andrea Costanzi, Alessandra Casuccio

Erschienen in: Supportive Care in Cancer | Ausgabe 6/2018

Einloggen, um Zugang zu erhalten

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

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 CrossRefPubMed

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(2):397–404. https://doi.org/10.1007/s00520-012-1524-6 CrossRefPubMed

Mercadante S, Vitrano V (2010) Palliative care in Italy: problems areas emerging from the literature. Minerva Anestesiol 76(12):1060–1071PubMed

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 21:935–939

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(1):51–54. https://doi.org/10.1200/JOP.2012.000698 CrossRefPubMed

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 CrossRef

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(1):14. https://doi.org/10.1186/1472-684X-10-14 CrossRefPubMedPubMedCentral

Earle C, Landrum MB, Souza J, Neville B, Weeks J et al (2008) Aggressiveness of cancer care near the end of life: is it a quality-of- care issue? J Clin Oncol 26(23):3860–3866. https://doi.org/10.1200/JCO.2007.15.8253 CrossRefPubMedPubMedCentral

Breuer B, Fleishman SB, Cruciani R, Portenoy RK (2011) Medical oncologists’ attitudes and practice in cancer pain management; a national survey. J Clin Oncol 29:4769–4775CrossRef

10.

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(5):1025–1032. https://doi.org/10.1089/jpm.2005.8.1025 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

12.

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 12:49–57CrossRef

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 113:3267–3274

14.

Smith T, Coyne P, Cassel B, Penberthy L, Hopson A et al (2003) A high volume specialist palliative care unit and team may reduce in-hospital end-of life care costs. J Palliat Med 6(5):699–705. https://doi.org/10.1089/109662103322515202 CrossRefPubMed

15.

Braiteh F, El Osta B, Palmer L, Reddy S, Bruera E (2007) Characteristics, findings, and outcomes of palliative care inpatient consultations at a comprehensive cancer center. J Palliat Med 10(4):948–955. https://doi.org/10.1089/jpm.2006.0257 CrossRefPubMed

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 24:20–28

17.

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(25):4013–4017. https://doi.org/10.1200/JCO.2010.29.5618 CrossRefPubMed

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 27:76–83CrossRef

19.

Nathaniel JD, Garrido M, Chai EJ, Goldberg G, Goldstein NE (2016) Cost saving associated with an inpatient palliative care unit: results from the first two years. J Pain Symptom Manag 50:147–154CrossRef

20.

Pantilat SZ, O'Riordan DL, Dibble SL, Landefeld CS (2010) Hospital-based palliative medicine consultation: a randomized controlled trial. Arch Intern Med 170(22):2038–2040. https://doi.org/10.1001/archinternmed.2010.460 CrossRefPubMed

21.

Gade G, Venohr I, Conner D, McGrady K, Beane J, Richardson RH, Williams MP, Liberson M, Blum M, Della Penna R (2008) Impact of an inpatient palliative care team: a randomized control trial. J Palliat Med 11(2):180–190. https://doi.org/10.1089/jpm.2007.0055 CrossRefPubMed

22.

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(2):114–119. https://doi.org/10.1007/s00520-002-0403-y CrossRefPubMed

23.

Mercadante S, Intravaia G, Villari P, Ferrera P, David F, Casuccio A, Mangione S (2008) Clinical and financial analysis of an acute palliative care unit in an oncological department. Palliat Med 22(6):760–767. https://doi.org/10.1177/0269216308094338 CrossRefPubMed

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 CrossRefPubMed

25.

Albanese TH, Radwany S, Mason H, Gayomali C (2013) Assessing the financial impact of an inpatient acute palliative care unit in a tertiary care teaching hospital. J Palliat Med 16:1–6CrossRef

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 CrossRefPubMed

27.

Mercadante S, Prestia G, Ranieri M, Giarratano A, Casuccio A (2013) Opioid use and effectiveness of its prescription at discharge in an acute pain relief and palliative care unit. Support Care Cancer 21:1853–1859CrossRef

28.

Mercadante S, Adile C, Ferrera P, Casuccio A (2017) Characteristics of advanced cancer patients who were readmitted to an acute palliative/supportive care unit. Support Care Cancer 25(6):1947–1952. https://doi.org/10.1007/s00520-017-3604-0 CrossRefPubMed

29.

Mercadante S, Adile C, Ferrera P, Casuccio A (2017) Characteristics of patients with an unplanned admission to an acute palliative care unit. Intern Emerg Med 12:587–592. https://doi.org/10.1007/s11739-017-1619-7 CrossRef

Titel: Characteristics and care pathways of advanced cancer patients in a palliative-supportive care unit and an oncological ward
verfasst von: Sebastiano Mercadante
Paolo Marchetti
Claudio Adile
Amanda Caruselli
Patrizia Ferrera
Andrea Costanzi
Alessandra Casuccio
Publikationsdatum: 08.01.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 6/2018
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-017-4037-5

Springer Medizin

Characteristics and care pathways of advanced cancer patients in a palliative-supportive care unit and an oncological ward