Anna Collins1, Vijaya Sundararajan1,2, Jeremy Millar3, Jodie Burchell1, Brian Le4, Mei Krishnasamy5, Sue-Anne McLachlan6, Peter Hudson7,8, Linda Mileshkin9, Jennifer Philip1,4. 1. Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Vic., Australia. 2. Department of Public Health, La Trobe University, Melbourne, Vic., Australia. 3. Radiation Oncology, Alfred Health, Melbourne, Vic., Australia. 4. Parkville Integrated Palliative Care Service, Victorian Comprehensive Cancer Centre, Melbourne, Vic., Australia. 5. Department of Nursing, University of Melbourne, Melbourne, Vic., Australia. 6. Medical Oncology, St Vincent's Hospital, Melbourne, Vic., Australia. 7. Centre for Palliative Care, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Vic., Australia. 8. Vrije University, Brussels, Belgium. 9. Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.
Abstract
OBJECTIVES: To describe health service use, symptom and survival characteristics in metastatic prostate cancer (mPCa) in order to outline usual care practices and identify future opportunities to improve the quality of care in this patient group. PATIENTS AND METHODS: This population cohort study, conducted in Victoria, Australia, used 10 years (2000-2010) of linked hospital discharge, emergency visit, and death registration data, to track patients from their first inpatient admission with mPCa until death. Descriptive statistics on inpatient health service use, symptoms, procedures, survival, and place of death are presented. RESULTS: In all, 4436 patients survived a median (interquartile range [IQR]) of 4 (1, 12) months from their first multiday admission with mPCa. They had a median (IQR) of 3 (1, 9) admissions, 1 (0, 2) emergency department presentation, and 35 (18, 63) days admitted to hospital. Lower urinary tract symptoms were common (50%), and 21% underwent lower urinary tract procedures, whilst 48% had blood product transfusions. In the last month of life, 3685 (83%) had at least one indicator of aggressive end-of-life care, including 48% with more than one acute hospital admission, and 55% staying ≥14 days. Hospital-based palliative care was accessed by 2657 (60%), occurring a median (IQR) of 30 (11, 74) days before death. In all, 23% died in the community, whilst 77% died in hospital, of whom 55% died in an acute hospital bed. CONCLUSION: Half of all decedents first admitted for a multiday stay with mPCa survived <4 months thereafter. They had a marked symptom burden, underwent multiple procedures and had multiple admissions. In all, 40% of patients did not receive any hospital-based palliative care. Several opportunities exist to improve the timely transition to palliative care services with mPCa. These data form a benchmark against which future improvements to palliative care integration may be measured.
OBJECTIVES: To describe health service use, symptom and survival characteristics in metastatic prostate cancer (mPCa) in order to outline usual care practices and identify future opportunities to improve the quality of care in this patient group. PATIENTS AND METHODS: This population cohort study, conducted in Victoria, Australia, used 10 years (2000-2010) of linked hospital discharge, emergency visit, and death registration data, to track patients from their first inpatient admission with mPCa until death. Descriptive statistics on inpatient health service use, symptoms, procedures, survival, and place of death are presented. RESULTS: In all, 4436 patients survived a median (interquartile range [IQR]) of 4 (1, 12) months from their first multiday admission with mPCa. They had a median (IQR) of 3 (1, 9) admissions, 1 (0, 2) emergency department presentation, and 35 (18, 63) days admitted to hospital. Lower urinary tract symptoms were common (50%), and 21% underwent lower urinary tract procedures, whilst 48% had blood product transfusions. In the last month of life, 3685 (83%) had at least one indicator of aggressive end-of-life care, including 48% with more than one acute hospital admission, and 55% staying ≥14 days. Hospital-based palliative care was accessed by 2657 (60%), occurring a median (IQR) of 30 (11, 74) days before death. In all, 23% died in the community, whilst 77% died in hospital, of whom 55% died in an acute hospital bed. CONCLUSION: Half of all decedents first admitted for a multiday stay with mPCa survived <4 months thereafter. They had a marked symptom burden, underwent multiple procedures and had multiple admissions. In all, 40% of patients did not receive any hospital-based palliative care. Several opportunities exist to improve the timely transition to palliative care services with mPCa. These data form a benchmark against which future improvements to palliative care integration may be measured.
Authors: Holly E L Evans; Cynthia C Forbes; Daniel A Galvão; Corneel Vandelanotte; Robert U Newton; Gary Wittert; Suzanne Chambers; Andrew D Vincent; Ganessan Kichenadasse; Nicholas Brook; Danielle Girard; Camille E Short Journal: Pilot Feasibility Stud Date: 2021-01-11
Authors: Jennifer Philip; Roslyn Le Gautier; Anna Collins; Anna K Nowak; Brian Le; Gregory B Crawford; Nicole Rankin; Meinir Krishnasamy; Geoff Mitchell; Sue-Anne McLachlan; Maarten IJzerman; Robyn Hudson; Danny Rischin; Tanara Vieira Sousa; Vijaya Sundararajan Journal: BMC Health Serv Res Date: 2021-05-27 Impact factor: 2.655