Use of symptom-focused oncological cancer therapies in hospices: a retrospective analysis

Abstract

Background There is controversy regarding the practical implementation of symptom-focused oncological cancer therapies to hospice residents. In this study, we aim to analyse the use and indication of supportive-oncological cancer therapies in hospices. Methods We conducted a retrospective survey of all residents of two hospice centres in the government district of Lower Bavaria, Germany. Hospice 1 (H1) was a member of an oncological–palliative medical network, and hospice 2 (H2) was independently organized. The evaluation period was the first 40 months after the opening of the respective hospice care centre. Demographical and epidemiological data as well as indications and type of supportive-oncological cancer therapies were recorded. A descriptive analysis and statistical tests were performed. Results Of the 706 residents, 645 had an underlying malignant disease. The average age was 72 years and the mean residence time was 28 days. The most frequent cancer types were gastrointestinal cancers, gynaecological cancers and bronchial carcinomas. Overall 39 residents (33 in H1 and 6 in H2, p < 0.01) received symptom-focused oncological cancer therapy. The average age of these residents was 68 years, and the mean residence time was 55 days. The most common therapeutic indications were dyspnoea and pain. The most common symptom-focused oncological cancer therapies were bisphosphonates, transfusions (erythrocyte- and platelet- concentrates), radiotherapy and anti-proliferative drugs (chemotherapy, anti-hormonal- and targeted- therapies). Patients with therapy lived significantly longer than patients without therapy (p < 0.01). Conclusions Symptom-focused oncological cancer therapies can be implemented in hospices; however, their implementation seems to require certain structural and organizational prerequisites as well as careful patient selection. As a palliative medical approach, the focus is to ameliorate the symptoms and not prolong life. Symptom-focused oncology treatment could be a further and important part for the therapy of hospice patients in the future.

Trends in palliative care and life-sustaining procedure provision for patients with cervical cancer in the United States

“…The well-balanced application of cancer therapy and PC is useful and can reduce the use of aggressive therapy [32]. Controlling symptoms associated cancer include chemotherapy, radiotherapy, or blood transfusions, which are applied in symptomatic anemia, symptomatic bone metastasis, or uncontrolled tumor bleeding [33]. Nevertheless, the utilization of cancer therapy should be carefully considered, especially during the late in life, to prevent deterioration in quality of life and excessive therapy.…”

Tageshospize – wichtige organisatorische und grundlegende versorgungsrelevante Aspekte aus der Perspektive von Patienten und Angehörigen

“…Eine 24stündige medizinische Betreuung ist dabei für die betroffenen Patienten nicht nötig. Insbesondere Tumorpatienten können auch in einer weit fortgeschrittenen, palliativen Erkrankungssituation über Monate überleben [3] und bedürfen dann eine ihrer Tumorerkrankung angepassten Betreuung. Hierzu gehören neben spiritueller, sozialer und psychoonkologischer Unterstützung auch die Möglichkeit spezieller medizinischer Interventionen wie spezielle Wundversorgung, Pflege von Schmerzpumpen, parenterale Ernährung, Portnadelwechsel und Versorgung von Aszites-und Pleurakathetern.…”