Palliative care needs of advanced cancer patients in the emergency department at the end of life: an observational cohort study

Abstract

Purpose Patients with advanced cancer commonly visit the emergency department (ED) during the last 3 months of life. Identification of these patients and their palliative care needs help initiating appropriate care according to patients' wishes. Our objective was to provide insight into ED visits of advanced cancer patients at the end of life. Methods Adult palliative patients with solid tumours who died < 3 months after their ED visit were included (2011)(2012)(2013)(2014). Patients, ED visits, and follow-up were described. Factors associated with approaching death were assessed using Cox proportional hazards models. Results Four hundred twenty patients were included, 54.5% was male, median age 63 years. A total of 54.6% was on systemic anti-cancer treatments and 10.5% received home care ≥ 1 per day. ED visits were initiated by patients and family in 34.0% and 51.9% occurred during out-of-office hours. Dyspnoea (21.0%) or pain (18.6%) were most reported symptoms. Before the ED visit, limitations on life-sustaining treatments were discussed in 33.8%, during or after the ED visit in 70.7%. Median stay at the ED was 3:29 h (range 00:12-18:01 h), and 319 (76.0%) were hospitalized. Median survival was 18 days (IQ range 7-41). One hundred four (24.8%) died within 7 days after the ED visit, of which 71.2% in-hospital. Factors associated with approaching death were lung cancer, neurologic deterioration, dyspnoea, hypercalcemia, and jaundice.

COVID-19 and Palliative Care Services: Comparative Patterns of Inpatient, Outpatient, and Consultation Services in a Tertiary Care Center in Riyadh

“…The gender distribution in our patients also differed from Verhoef et al who reported 54.5% males and 45.5% females. The mean age of patients seen in our inpatient services in 2019 was 64 ± 16.44, which is similar to the median age (63 years) of patients needing palliative care observed by Verhoef et al [ 8 ]. The mean age of inpatients in our study significantly differed between the years, being 59.28 ± 17.66 years in 2020.…”

“…In our study, the top reasons for admission were similar in both groups/years with more than half of patients admitted for end-of-life care, followed by cancer pain. Verhoef et al also reported pain as the second most frequent symptom in cancer patients admitted for palliation [8]. All our patients received opioids and laxatives.…”

End-of-Life Trajectories of Patients With Hematological Malignancies and Patients With Advanced Solid Tumors Visiting the Emergency Department: The Need for a Proactive Integrated Care Approach

“…Detailed analysis of patients with ST is published elsewhere. 26 The period of 3 months was chosen because in the Netherlands, an estimated life expectancy of <3 months justifies referral to intensive palliative care at home, in nursing homes, and in hospices. Data collection occurred from May 2011 to January 2013.…”

Life-sustaining treatment preferences in older patients when referred to the emergency department for acute geriatric assessment: a descriptive study in a Dutch hospital

“…Both could lead to an over-or underestimation of the known number of preferences. However, in a recent study [33] the percentage of discussing and documenting limitations on life-sustaining treatments was almost equal (73.1 and 70.7% respectively). Additionally, it is important to note that only registered and accessible information can influence decision making by a physician other than the patients' own physician.…”