Frequency of Symptom Distress and Poor Prognostic Indicators in Palliative Cancer Patients Admitted to a Tertiary Palliative Care Unit, Hospices, and Acute Care Hospitals

Abstract

The Edmonton Regional Palliative Care Program was established to increase access to palliative care for terminal cancer patients in the region. Inpatient care is delivered, in decreasing order of distress, at the tertiary palliative care unit, by consult teams in acute care facilities, and in hospices. We reviewed the admission data for all patients discharged from the program between November 1,1997, and October 31,1998, in order to determine if demographical and clinical variables suggested appropriate use of the three levels of care. Patients admitted to the tertiary palliative care unit were significantly younger than those admitted to acute care of hospices (61 years versus 68 years and 71 years respectively, p<O.0001), had a higher frequency of positive screening for alcoholism in the CAGE questionnaire (27% versus 16% and 14% respectively, p<O.0001), and a higher frequency of poor prognostic pain syndromes as compared to acute care admissions (87% versus 65%, p<O.0001). Overall, frequency of symptoms and severe symptoms was significantly higher in patients admitted to the palliative care unit than those admitted to the other two settings. Our results suggest that patients with demographic and clinical indications of higher distress are more frequently admitted to the tertiary palliative care unit. The clinical tools are useful predictors of utilization that can be used for monitoring health care delivery.

Characteristics, Findings, and Outcomes of Palliative Care Inpatient Consultations at a Comprehensive Cancer Center

“…Fatigue was the most frequently reported symptom, and pain, depression, and anxiety were the most distressing symptoms for patients with advanced cancer in various palliative care settings according to two analysis. 9,17 The frequency of these symptoms could be related to the cancer type (e.g., a patient with lung cancer may have dyspnea as his main symptom, whereas a patient with bone cancer may mainly complain of pain), the cancer stage (e.g., an asymptomatic patient newly diagnosed with prostate cancer (stage I) may complain of back pain when his disease becomes advanced), and the setting of care (e.g., a patient newly diagnosed with metastatic colon cancer could be asymptomatic and receiving chemotherapy in the outpatient setting and could be delirious in the palliative care unit). Further research is needed to determine the characteristics of the symptom burden for each cancer at any point in its course and in specific care settings.…”

Symptom Burden, Depression, and Suicidality in Chinese Elderly Patients Suffering from Advanced Cancer

“…4,5 Fatigue was the most prevalent symptom. When compared with previous local studies targeting general geriatric population, a much higher rate of depression and suicidal ideation was found in our study group.…”

Lessons from an Ukrainian woman with clubbing and back pain

“…Regarding her probable past abuse of alcohol, it is recognised that a history of alcohol abuse is a negative prognostic factor in the outcome of pain control. Bruera, following a retrospective analysis looking at distress in cancer patients, stated that those presenting a higher degree of distress were significantly younger and had a higher frequency of positive screening for alcoholism in the CAGE questionnaire compared with patients showing a lesser degree of distress [3]. Although we believed that the patient probably abused alcohol in the past, we did not deem the answers provided by her to the CAGE test as reliable.…”