Acute symptomatic complications among patients with advanced cancer admitted to acute palliative care units: A prospective observational study. (October 2015)

• Record Type: Journal Article
• Authors: Hui, David; dos Santos, Renata; Reddy, Suresh; de Angelis Nascimento, Maria Salete; Zhukovsky, Donna S; Paiva, Carlos Eduardo; Dalal, Shalini; Costa, Everaldo Donizeti; Walker, Paul; Scapulatempo, Heloisa Helena; Dev, Rony; Crovador, Camila Souza; De La Cruz, Maxine; Bruera, Eduardo
• Is Part Of: Palliative medicine. Volume 29:Number 9(2015)
• Page Start: 826
• Page End: 833
• Publication Date: 2015-10
• Subjects: Complications -- hemorrhage -- infection -- intestinal obstruction -- morbidity -- neoplasms -- palliative care; Pain -- Treatment -- Periodicals; Cancer -- Palliative treatment -- Periodicals; Palliative Care -- Periodicals; Palliatieve behandeling; 616.029
• DOI: 10.1177/0269216315583031
• Languages: English
• ISSNs: 0269-2163

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.