Antineoplastic therapy use in patients with advanced cancer admitted to an acute palliative care unit at a comprehensive cancer center

Abstract

BACKGROUND:Cancer patients admitted to a palliative care unit generally have a poor prognosis. The role of antineoplastic therapy (ANT) in these patients remains controversial. In the current study, the authors examined the frequency and predictors associated with ANT use in hospitalized patients who required admission to an acute palliative care unit (APCU). METHODS: Included in the study were all 2604 patients admitted over a 5-year period to a 12-bed APCU located within a National Cancer Institute comprehensive cancer center, in which patients had access to both palliative care and ANT. Institutional databases were used to retrospectively retrieve data regarding patient demographics, cancer diagnosis, ANT use, length of hospital stay, and survival from time of admission. RESULTS: The median hospital stay was 11 days, and the median survival was 22 days. During hospitalization, 435 patients (17%) received ANT, including chemotherapy (N ¼ 297; 11%), hormonal agents (N ¼ 54; 2%), and targeted therapy (N ¼ 155; 6%). No significant change in the frequency of ANT use was detected over the 5-year period. Multivariate logistic regression analysis revealed that younger age, specific cancer diagnoses, and longer admissions were independently associated with ANT use. CONCLUSIONS: The use of ANT during hospitalization that included an APCU stay was limited to a small percentage of patients and did not increase over time. ANT use was associated with younger age, specific cancer diagnoses, and longer admissions. The APCU facilitates simultaneous care for patients receiving ANT.

Access to Palliative Care Among Patients Treated at a Comprehensive Cancer Center

“…Our results are consistent with other studies demonstrating that these patients are more likely to receive aggressive therapy at the end of life [14], to die in an intensive care unit [5], and to have late PC referral [21]. Our finding raises important concerns regarding the quality of end-of-life care for patients with hematologic malignancies.…”

Palliative Care Consultation Service and Palliative Care Unit: Why Do We Need Both?

“…They separately reported on patients cared for in their PCU and by their PCCS in a number of different publications [4,35,37]. As in previous studies by our own group, many patients had to be admitted to the PCU even though they had already received PC support from the PCCS [9].…”

“…In general, patients admitted to PCUs are in refractory stages of their disease; thus, antineoplastic agents are seldom administered and cardiopulmonary resuscitation is no longer indicated [7,12]. This clinical practice therefore differs from some PCUs [4,35], where, in some centers, diseasemodifying therapy (e.g., systemic i.v. chemotherapy) plays a significant role.…”

The Accuracy of Probabilistic Versus Temporal Clinician Prediction of Survival for Patients with Advanced Cancer: A Preliminary Report

“…This 12-bed APCU provides intensive symptom support and transition of care for patients with advanced cancer and their families. It is staffed by an interdisciplinary team of physicians, nurses, social workers, physiotherapists, pharmacists, and a chaplain [14].…”