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.
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 cancerpatients 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 cancerpatients admitted to acute palliative care units, often do not resolve completely, and were associated with a poor prognosis despite active medical management.
Authors: Meghan Karuturi; Melisa L Wong; Tina Hsu; Gretchen G Kimmick; Stuart M Lichtman; Holly M Holmes; Sharon K Inouye; William Dale; Kah P Loh; Mary I Whitehead; Allison Magnuson; Arti Hurria; Michelle C Janelsins; Supriya Mohile Journal: J Geriatr Oncol Date: 2016-06-07 Impact factor: 3.599
Authors: Sebastiano Mercadante; Francesco Masedu; Isabella Balzani; Daniela De Giovanni; Luigi Montanari; Cristina Pittureri; Raffaella Bertè; Domenico Russo; Laura Ursini; Franco Marinangeli; Federica Aielli Journal: Support Care Cancer Date: 2017-10-05 Impact factor: 3.603
Authors: Kea Turner; Naomi C Brownstein; Zachary Thompson; Issam El Naqa; Yi Luo; Heather S L Jim; Dana E Rollison; Rachel Howard; Desmond Zeng; Stephen A Rosenberg; Bradford Perez; Andreas Saltos; Laura B Oswald; Brian D Gonzalez; Jessica Y Islam; Amir Alishahi Tabriz; Wenbin Zhang; Thomas J Dilling Journal: Radiother Oncol Date: 2021-12-23 Impact factor: 6.280