Acute symptomatic complications among patients with advanced cancer admitted to acute palliative care units: A prospective observational study.

Abstract

BACKGROUND:

Limited information is available on the symptomatic complications that occur in the last days of life.

AIM:

We documented the frequency, clinical course, and survival for 25 symptomatic complications among patients admitted to acute palliative care units.

DESIGN:

Prospective longitudinal observational study.

MEASUREMENTS:

Their attending physician completed a daily structured assessment of symptomatic complications from admission to discharge or death.

SETTING/PARTICIPANTS:

We enrolled consecutive advanced cancer patients admitted to acute palliative care units at MD Anderson Cancer Center, USA, and Barretos Cancer Hospital, Brazil.

RESULTS:

A total of 352 patients were enrolled (MD Anderson Cancer Center = 151, Barretos Cancer Hospital = 201). Delirium, pneumonia, and bowel obstruction were the most common complications, occurring in 43%, 20%, and 16% of patients on admission, and 70%, 46%, and 35% during the entire acute palliative care unit stay, respectively. Symptomatic improvement for delirium (36/246, 15%), pneumonia (52/161, 32%), and bowel obstruction (41/124, 33%) was low. Survival analysis revealed that delirium (p < 0.001), pneumonia (p = 0.003), peritonitis (p = 0.03), metabolic acidosis (p < 0.001), and upper gastrointestinal bleed (p = 0.03) were associated with worse survival. Greater number of symptomatic complications on admission was also associated with poorer survival (p < 0.001).

CONCLUSION:

Symptomatic complications were common in cancer patients admitted to acute palliative care units, often do not resolve completely, and were associated with a poor prognosis despite active medical management.

• Authors: David Hui, Renata dos Santos, Suresh Reddy, Maria Salete de Angelis Nascimento, Donna S Zhukovsky, Carlos Eduardo Paiva, Shalini Dalal, Everaldo Donizeti Costa, Paul Walker, Heloisa Helena Scapulatempo, Rony Dev, Camila Souza Crovador, Maxine De La Cruz, Eduardo Bruera
• Journal: Palliative medicine (Palliat Med) Vol. 29 Issue 9 Pg. 826-33 (Oct 2015) ISSN: 1477-030X [Electronic] England
• PMID: 25881622 (Publication Type: Journal Article, Observational Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2015.

Topics

• Acute Disease (epidemiology)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cancer Care Facilities (statistics & numerical data)
• Delirium (etiology)
• Female
• Gastrointestinal Diseases (etiology)
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Neoplasms (complications)
• Palliative Care (statistics & numerical data)
• Pneumonia (etiology)
• Prospective Studies
• Texas (epidemiology)
• Young Adult