Palliative Care Inpatient Service in a Comprehensive Cancer Center: Clinical and Financial Outcomes

Elsayem, Ahmed; Swint, Kay; Fisch, Michael J.; Palmer, J. Lynn; Reddy, Suresh; Walker, Paul; Zhukovsky, Donna S.; Knight, Patti; Bruera, Éduardo

doi:10.1200/jco.2004.11.003

Cited by 211 publications

(179 citation statements)

References 23 publications

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“…The ESAS, which has been used to assess symptom burden and monitor changes after clinical interventions, 15,16 was used in the present study, and as it is validated in different languages, it may be useful for home care teams as a means of survival prediction. Recently, ESAS scores have been found to worsen in the last four weeks before death compared with those in the previous months.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors of Survival in Patients With Advanced Cancer Admitted to Home Care

Mercadante

Valle²,

Porzio

et al. 2013

Journal of Pain and Symptom Management

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Context. Data regarding prognostication of life expectancy in patients with advanced cancer are of paramount importance to patients, families, and clinicians. However, data regarding patients followed at home are lacking.Objectives. The aim of this study was to evaluate the correlation between various factors recorded at the beginning of home care assistance and survival.Methods. A sample of consecutive patients admitted to two home care programs was surveyed. A preliminary consensus was achieved as to the possible variables easy to be recorded at home. These included age at the time of home care admission, gender, residence, marital status, primary cancer diagnosis, Karnofsky Performance Status (KPS) score, measures of systolic blood pressure and heart rate, cyanosis, use of oxygen, and body temperature. The Edmonton Symptom Assessment System was used to record the intensity of each symptom. Patients were divided into two groups: patients with a survival of less than 10 days (short survival) and patients with a survival of 10 days or more (medium-long survival).Results. Three hundred seventy-four consecutive patients admitted to home care programs were surveyed, of which 187 were male. The mean AE SD age was 72.1 AE 12.7 years. The mean survival was 56.2 AE 65 days. Mean survival was 71.5 AE 67 days (287 patients) and 5.6 AE 2.7 days (87 patients) in the short and medium-long survival groups, respectively. No association between type of tumor and survival was observed (P ¼ 0.162). Univariate logistic regression analysis revealed that male gender (P ¼ 0.020), older age (P ¼ 0.012), lower KPS scores (P < 0.0005), systolic blood pressure less than 100 mm Hg (P ¼ 0.003), heart rate greater than 100 beats per minute (P ¼ 0.0006), delirium (P ¼ 0.004), the use of oxygen (P ¼ 0.002), intensity of fatigue (P ¼ 0.006), drowsiness (P < 0.0005), anorexia (P < 0.0005), dyspnea (P < 0.0005), poor sense of well-being (P < 0.0005), and distress score (P < 0.0005) were associated with a survival of less than 10 days. Marital status, residence, cognitive function, fever, pain, depression, and anxiety were not found to be significantly correlated with survival. In a multiple logistic regression model, low systolic blood pressure and high heart rate, gender, delirium, use of oxygen, KPS score, drowsiness, anorexia, and dyspnea were significantly correlated with a shorter survival. Conclusion. Low systolic blood pressure and high heart rate, male gender, poor KPS score, anorexia, and dyspnea were correlated with a shorter survival. Moreover, patients with low systolic blood pressure and high heart rate, male gender, poor KPS score, and greater intensity of anorexia and dyspnea are more likely to die within one week. The combination of physical symptoms from the Edmonton Symptom Assessment System and other parameters included in this study, which are simple to assess and are repeatable at home, should be further explored in future studies to provide a simple tool for use with patients with advanced cancer admitted to a home...

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Section: Discussionmentioning

confidence: 99%

Prognostic Factors of Survival in Patients With Advanced Cancer Admitted to Home Care

Mercadante

Valle²,

Porzio

et al. 2013

Journal of Pain and Symptom Management

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“…3,[11][12][13][14][15][16] Palliative care should be initiated by the primary oncology team (including physicians, nurses, social workers, mental health professionals, chaplains, physician assistants, pharmacists, and dietitians) and then augmented via collaboration with an interdisciplinary team of palliative care experts to address intractable symptoms and/or complex psychosocial issues. When further anticancer therapy is unlikely to provide additional benefit or is expected do more harm than good, palliative care becomes the predominant care offered to patients with advanced cancer.…”

Section: Introductionmentioning

confidence: 99%

NCCN Guidelines Insights: Palliative Care, Version 2.2017

Dans¹,

Smith²,

Back³

et al. 2017

J Natl Compr Canc Netw

109

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“…Clinical care in the PCU is managed directly by the palliative care team. 14 The purpose of this study was to characterize symptom distress and outcomes in ICU patients referred to a PCT in a comprehensive cancer center.…”

mentioning

confidence: 99%

“…The PCT consults with patients in all areas of the institution about symptom control and palliative care issues through a consult team, 13 an outpatient palliative care clinic, and a 12-bed inpatient palliative care unit (PCU). 14 The consult team provides services to patients who are treated by our medical and surgical oncology departments and is staffed by palliative care physicians certified by the American Board of Hospice and Palliative Medicine, 1 full-time palliative care advanced practice nurse, and 1 palliative medicine fellow in training. 15 The reasons for referrals include uncontrolled symptom distress, family distress, and end-of-life care.…”

mentioning

confidence: 99%

Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team

Delgado-Guay

Parsons

et al. 2009

Cancer

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110

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BACKGROUND:The symptom burden of intensive care unit (ICU) patients who are referred to a palliative care team (PCT) has not been characterized to the authors' knowledge, and the response of these symptoms to the palliative care intervention has not been reported.METHODS:The authors retrospectively reviewed PCT consults for ICU patients who were seen between July 2006 and October 2007. To characterize symptom distress and outcomes in ICU patients who were referred to PCT in a cancer center, information and descriptive statistics about patients' demographics, comorbidities, PCT findings, interventions, and outcomes were obtained. The chi‐square test was used to analyze ICU and PCT mortality, and the signed‐rank test was used to analyze PCT interventions.RESULTS:Of 1637 PCT consults, 88 consults (5%) were from the ICU. The median patient age was 60 years (range, 22‐87 years), and 41 patients (46%) were women. The types of cancers were hematologic (19 patients; 22%), gastrointestinal (19 patients; 22%), lung (18 patients; 20%), and others (24 patients; 26%). Nineteen patients were on mechanical ventilation (MV), and 24 patients were on bilevel positive airway pressure (BIPAP). The findings were delirium (71 patients; 81%), dyspnea (67 patients; 76%), pain (74patients; 84%), fatigue (84 patients; 95%), and anxiety (57 patients; 65%). The interventions used were opioid management (99%), steroids (70%), antipsychotics (76%), and counseling (100%), do not resuscitate conversion (62 of 88 patients; 70%), withdrawal of MV (15 of 19 patients; 79%), and withdrawal of BIPAP (26 of 26 patients; 100%). Improvement was reported in pain (67 patients; 90%), dyspnea (60 patients; 90%), anxiety (51 patients; 80%), and delirium (31 patients; 44%). Thirty‐five patients (40%) were transferred to the palliative care unit (PCU). Fifty‐one ICU/PCT patients (58%) died during admission versus 130 of 1549 (8%) non‐ICU PCT patients (P < .0001). Twenty‐three of 35 patients who were transferred to the PCU (66%) died there versus 212 of 629 patients (34%) who were admitted to the PCU from another service (P < .0001). Thirty‐seven of 88 ICU/PCT patients (42%) were discharged alive.CONCLUSIONS:ICU patients who are referred to the PCT have severe symptom distress. The PCT was able to identify multiple problems and make numerous pharmacologic and nonpharmacologic recommendations that improved these symptoms, including the participation in do not resuscitate conversion and withdrawal of MV and BIPAP. Although many patients in this population died, a significant subset, including those who were transferred to the PCU, survived to discharge. Cancer 2009. © 2009 American Cancer Society.

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Palliative Care Inpatient Service in a Comprehensive Cancer Center: Clinical and Financial Outcomes

Abstract: The PCIS has been accepted in our tertiary cancer center on the basis of its clinical utility and financial viability.

Cited by 211 publications

References 23 publications

Prognostic Factors of Survival in Patients With Advanced Cancer Admitted to Home Care

Prognostic Factors of Survival in Patients With Advanced Cancer Admitted to Home Care

NCCN Guidelines Insights: Palliative Care, Version 2.2017

Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team

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