Antibiotic Therapy in Integrated Oncology and Palliative Cancer Care: An Observational Study

Abstract

Decision-making for antibiotic therapy in palliative cancer care implies avoiding futile interventions and to identify patients who benefit from treatment. We evaluated patient-reported outcome-measures (PROMs), physiological findings, and survival in palliative cancer care patients hospitalized with an infection. All acute admissions during one year, directly to a University Hospital unit that provided integrated services, were included. Serious infection was defined as a need to start intravenous antibiotics. PROMs, clinical and paraclinical variables, and survival were obtained. Sixty-two of 257 patients received intravenous antibiotic treatment. PROMs were generally similar in the infection group and the non-infection group, both in respect to intensities at admission and improvements during the stay. There were more physiological and paraclinical deviations at admission in patients in the infection group. These deviations improved during the stay. Survival was not poorer in the infection group compared to the non-infection group. Patients in integrated cancer care were as likely to be put on intravenous antibiotics but had longer survival. In integrated oncology and palliative cancer services, patients with an infection had similar outcomes as those without an infection. This argues that the use of intravenous antibiotics is appropriate in many patients admitted to palliative care.

Parenteral Nutrition in Palliative Cancer Care: Detrimental, Futile, or Beneficial?

“…PN may result in a variety of treatment-related complications, like hyperglycemia, refeeding syndrome, thrombosis, and serious infections [32]. We previously demonstrated that approximately one-quarter of the patients acutely admitted to the APCU received intravenous antibiotics [33]. Taking the inherent limitations of a short observation period and a restricted number of patients into account, we were not able to detect any difference in infection prevalence for hospitalized patients treated with PN compared to patients not receiving this intervention.…”