TY - JOUR
T1 - Acute symptomatic complications among patients with advanced cancer admitted to acute palliative care units
T2 - A prospective observational study
AU - Hui, David
AU - Dos Santos, Renata
AU - Reddy, Suresh
AU - De Angelis Nascimento, Maria Salete
AU - Zhukovsky, Donna S.
AU - Paiva, Carlos Eduardo
AU - Dalal, Shalini
AU - Costa, Everaldo Donizeti
AU - Walker, Paul
AU - Scapulatempo, Heloisa Helena
AU - Dev, Rony
AU - Crovador, Camila Souza
AU - De La Cruz, Maxine
AU - Bruera, Eduardo
N1 - Publisher Copyright:
© The Author(s) 2015.
PY - 2015/10/22
Y1 - 2015/10/22
N2 - 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.
AB - 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.
KW - Complications
KW - hemorrhage
KW - infection
KW - intestinal obstruction
KW - morbidity
KW - neoplasms
KW - palliative care
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U2 - 10.1177/0269216315583031
DO - 10.1177/0269216315583031
M3 - Article
C2 - 25881622
AN - SCOPUS:84941954510
SN - 0269-2163
VL - 29
SP - 826
EP - 833
JO - Palliative Medicine
JF - Palliative Medicine
IS - 9
ER -