[Treatment of oncology patients in the final stadium of disease by prehospital emergency physicians].

BACKGROUND: Presently and even more in the near future more cancer patients will be treated at home especially in the final stage of their disease. For this reason the prehospital emergency system will be confronted with the specific needs of these patients. Palliative care is not part of the German model of post-graduate training regulations for emergency medicine and palliative care teams (PCT) are only involved in the treatment of cancer patients in emergency situations.
METHODS: Over a 12-month period we retrospectively analysed all emergency cases that had been categorised as final cancer stage at 2 emergency sites (one air-based, the other ground-based) involving physicians in an out-of-hospital setting. We analysed all cases for indications of emergency call, prehospital treatment and involvement of a PCT in the treatment of symptoms.
RESULTS: For this period we analysed 2,765 emergency documents and identified more than 2.5% as emergency calls by cancer patients or their relatives (the majority of patients had been in the final stage of the disease). Most emergency calls occurred at times when no general practitioner was on duty and acute dyspnoea (42.7%) was the prominent diagnosis. After emergency treatment 61.8% patients had been admitted to hospital. In most settings a PCT was not involved in the treatment of palliative care patients or their relatives (92.7%).
CONCLUSIONS: Our data demonstrate that care of cancer patients in the final stage of the disease is relevant in emergency medicine. These patients are in need of help based on principles of palliative care. Under these circumstances cooperation of the medical disciplines (emergency and palliative medicine) concerned seems to be necessary. This may increase the possibility for patients to stay at home for the last days of their life. Because of this we are convinced that basic knowledge of palliative care should be integrated into the German model of post-graduate training regulations for emergency care. Combining parts of the curricula (palliative and emergency medicine) it would be possible for emergency physicians to guide their treatment by the ideas and strategies of palliative care. But we are also convinced that the system of PCT should increase and become more involved in prehospital care in emergency cases of palliative care patients.