Characteristics of deaths in a department of oncohaematology within a general hospital

Abstract

We aimed to perform a prospective analysis of the main characteristics of deaths occurring in the oncohaematology department of a general hospital. From November 1995 to February 1997, a total of 81 patients died in our unit, 50 of whom (61.7%) were male. Their mean age was 67.8 (range 19-96) years. Underlying diseases were: multiple myeloma (9 cases), acute myeloid leukaemia (22), lymphoma (14), chronic lymphocytic leukaemia (6), acute lymphoblastic leukaemia (4), myelodysplastic syndromes (3), solid tumours (11), and other (12). The previous disease duration ranged from 5 days to 276 months (mean 31.9 months). The duration of the last hospital stay varied between 0 (death on arrival or on way to hospital) and 40 days (mean 9.3 days). Two patients died in the emergency unit just before entering our department (1 suicide). Only 15 patients had been admitted for the first time. In 70% of these cases death appeared predictable, as the consequence of refractory or end-stage disease. In these cases, all the "do not resuscitate" orders were in place at least 48 h before death. About half the patients died without any relative present. The frequencies of the clinical complaints evaluated were the following: pain necessitating opiates 27%; infection- or disease-related fever 40%; dyspnoea 44%; haemorrhage 20%; CNS disturbances 25%. The percentages of use of therapy tools chosen as indicators were: benzodiazepines 80%; chemotherapy 46%; anti-infectious agents 47%; transfusions 42%; major analgesics 27%; and steroids 40%. The circumstances and quality of patient deaths must be regularly evaluated so that palliative care in the final stages of life can be improved.

Symptom burden and supportive care in patients with acute leukemia

“…However, while there has been extensive study of the symptom burden in patients with solid tumor cancers [1][2][3], there has been little systematic study of symptoms in patients with acute leukemia. Retrospective studies in patients with leukemia and other hematological malignancies have revealed that in the last month of life, pain is reported by 27-76% [4,5], shortness of breath by 44-50% [4][5][6], and fatigue by 88% [6]. However, these studies did not document symptoms earlier in the course of disease [5,6] and were not limited to patients with acute leukemia.…”

Epidemiology, features and outcome of pain in patients with advanced hematological malignancies followed in a home care program: an Italian survey

“…This symptom has traditionally been believed to be a rare manifestation compared to solid tumor settings [1][2][3]. Nevertheless, more recent studies have shown a high prevalence of this symptom in the hematological population [4][5][6][7], in which the occurrence of specific pain syndromes has been described [8]. However, no study on this topic concerning patients with blood-related neoplasm in the home care (HC) setting has been reported.…”

Clinical, sociodemographic, and local system factors associated with a hospital death among cancer patients

“…Clinical factors associated with a hospital death are the type of cancer [6,9], extension of the disease (stage) [1,5], the presence of comorbidities [7,22], and survival time [16]. Sociodemographic factors include race [9,18], socioeconomic status [16], age [10], gender [10,12,16], marital status [10,16], and type of insurance [8,30].…”