Supportive and palliative care: experience at the Institut Jules Bordet

Abstract

The Supportive and Palliative Care Unit of the Institut Jules Bordet officially started its activities in February 1999. Our Unit comprises eight beds (four rooms with one bed each and two rooms with two beds each). We admit advanced cancer patients presenting with severe symptoms whose control is going to require all the expertise of a multidisciplinary team. Whilst these eight beds are identified geographically in the hospital, the team's mobility assures continuity of care for patients who wish to stay in another department. The infrastructure of the Unit and its rooms allow close family members who wish to sleep close to the patients to do so. Otherwise, visits are allowed round the clock, though always with due consideration for patients' comfort. Patients are referred either by a physician working in our Institution (medical oncologist, surgeon, or radiotherapist) or by their family physicians. Less frequently, patients themselves specifically ask to be admitted to our Unit. The activity of the Unit itself during its first year of functioning can be summarized as follows. We admitted 155 advanced cancer patients, for a total number of 210 hospitalizations. Patients were admitted a median of 35 months after their diagnosis and a median of 20 days before death. Stays were generally short (median 11 days). We systematically used quantitative assessment tools (MMSQ, MDAS,EFAT and various VAS) to detect and monitor their symptoms and any complications. The main symptoms on admission were pain, anorexia, asthenia, dyspnea and anxiety/depression. Pain, nausea/vomiting, constipation and cough were controlled in almost all patients, whereas control of asthenia and anorexia was most often insufficient. In 51% of our cases the patients could be discharged home; 40% died in the unit; 4% were transferred to long-term palliative care units and 1% to other units within our Institution (4% were still hospitalized at the time of this analysis).

The Supportive Care Task Force at the University of L’Aquila: 2-years experience

“…We registered excellent results regarding treatment of pain, nausea and dyspnea while psychological symptoms, anorexia and asthenia proved more difficult to treat. These results are similar to previously published data [7].…”

“…Lengths of stay were similar to those observed at the Institut Jules Bordet but significant longer than that reported by Mercadante at the La Maddalena Cancer Center [7,9]. A possible explanation is due to the absence in our town of a long-term palliative care unit; therefore, in particular circumstances, we served as an in-hospital palliative care unit, lengthening the median stay.…”

Symptom and medication profiles among cancer patients attending a palliative care clinic

“…Patients with terminal cancer experience distressful symptoms due to advanced malignancy, with many patients requiring hospitalization to treat such symptoms [1][2][3]. In addition, cancer patients commonly receive numerous medications to treat complications from treatment, cancerrelated symptoms, and comorbid illnesses [4,5].…”

The Effect of Palliative Care in Home Care and Hospital on Quality of Life

“…The patient's physical symptoms and psychological, social, emotional, and mental problems may be described as ''palliative needs,'' that is, symptoms and problems for which the patient expects intervention upon arrival at a palliative care unit or when he or she first comes into contact with a specialized palliative home care team. Many different questionnaires are used in palliative care [8][9][10][11][12][13][14][15][16][17][18][19][20][21] ; however, no selection of questionnaires will ever be able to cover all palliative needs of each patient. 22 To minimize the burden on patients, the questionnaires should be brief and manageable.…”