Online citations, reference lists, and bibliographies.
Please confirm you are human
(Sign Up for free to never see this)
← Back to Search

Discharge Outcomes And Survival Of Patients With Advanced Cancer Admitted To An Acute Palliative Care Unit At A Comprehensive Cancer Center.

D. Hui, A. Elsayem, S. Palla, M. de la Cruz, Z. Li, S. Yennurajalingam, E. Bruera
Published 2010 · Medicine

Save to my Library
Download PDF
Analyze on Scholarcy
Share
BACKGROUND Acute palliative care units (APCUs) are new programs aimed at integrating palliative and oncology care. Few outcome studies from APCUs are available. OBJECTIVES We examined the frequency, survival, and predictors associated with home discharge and death in our APCU. METHODS All patients discharged from the APCU between September 1, 2003 and August 31, 2008 were included. Demographics, cancer diagnosis, discharge outcomes, and overall survival from discharge were retrieved retrospectively. RESULTS The 2568 patients admitted to APCU had the following characteristics: median age, 59 years (range, 18-101); male, 51%; median hospital stay, 11 days; median APCU stay, 7 days; and median survival 21 days (95% confidence interval [CI] 19-23 days). Five hundred ninety-two (20%), 89 (3%), and 1259 (43%) patients were discharged to home, health care facilities, and hospice, respectively, with a median survival of 60, 29, and 14 days, respectively (p < 0.001). Nine hundred fifty-eight (33%) patients died during admission (median stay, 11 days). Compared to hospice transfers, home discharge (hazard ratio = 0.35, 95% CI 0.30-0.41, p < 0.001) was associated with longer survival in multivariate analysis, with a 6-month survival of 22%. Multivariate logistic regression revealed that male gender, specific cancer primaries, and admissions from oncology units were associated with death in the APCU, while younger age and direct admissions to the APCU were associated with home discharge. CONCLUSIONS Our APCU serves patients with advanced cancer with diverse clinical characteristics and survival, and discharged home a significant proportion with survival greater than 6 months. RESULTS from this simultaneous care program suggest a pattern of care different from that of traditional hospice and palliative care services.
This paper references
10.1089/jpm.2008.0053
Variability in access to hospital palliative care in the United States.
B. Goldsmith (2008)
10.1089/JPM.2006.0259
Predictors of access to palliative care services among patients who died at a Comprehensive Cancer Center.
N. Fadul (2007)
10.1097/01.CCM.0000215112.84523.F0
Acute Physiology and Chronic Health Evaluation (APACHE) IV: Hospital mortality assessment for today’s critically ill patients*
J. Zimmerman (2006)
10.1007/BF01788838
The Cleveland Clinic Foundation Harry R. Horvitz Palliative Care Center
Pamela Goldstein (2005)
10.1191/026921698674135173
The use of the Edmonton Symptom Assessment Scale (ESAS) within a palliative care unit in the UK
E. Rees (1998)
10.1089/109662101753123913
Survey of palliative care programs in United States teaching hospitals.
J. Billings (2001)
10.3322/canjclin.50.2.123
Completing the continuum of cancer care: Integrating life‐prolongation and palliation
I. Byock (2000)
10.1016/J.JPAINSYMMAN.2004.03.002
Simultaneous care: a model approach to the perceived conflict between investigational therapy and palliative care.
F. Meyers (2004)
10.1177/082585970001600106
Home versus Hospice Inpatient Care: Discharge Characteristics of Palliative Care Patients in an Acute Care Hospital
R. Fainsinger (2000)
10.1016/S0885-3924(99)00084-6
Terminal cancer patients and timing of referral to palliative care: a multicenter prospective cohort study. Italian Cooperative Research Group on Palliative Medicine.
M. Costantini (1999)
10.1111/j.1742-1241.2004.00169.x
A simple and accurate prediction model to estimate the intrahospital mortality risk of hospitalised cancer patients
H. Bozcuk (2004)
10.1007/s00520-006-0093-y
Bringing palliative care to a Canadian cancer center: the palliative care program at Princess Margaret Hospital
C. Zimmermann (2006)
10.2190/KU5Q-LL8M-FPPA-LT3W
Are We Making Progress? Not in Haematology!
P. Mcgrath (2002)
10.1089/JPM.2006.9.894
Impact of a palliative care service on in-hospital mortality in a comprehensive cancer center.
A. Elsayem (2006)
10.1177/082585970001600304
Frequency of Symptom Distress and Poor Prognostic Indicators in Palliative Cancer Patients Admitted to a Tertiary Palliative Care Unit, Hospices, and Acute Care Hospitals
E. Bruera (2000)
10.1177/1049909106295292
Acute Inpatient Palliative Medicine in a Cancer Center: Clinical Problems and Medical Interventions—A Prospective Study
R. Lagman (2007)
10.1007/s11606-009-1030-9
Understanding their Options: Determinants of Hospice Discussion for Older Persons with Advanced Illness
J. M. Thomas (2009)
10.1089/JPM.2005.8.1025
Interval between palliative care referral and death among patients treated at a comprehensive cancer center.
W. Cheng (2005)
10.1001/ARCHINTE.164.1.83
The comprehensive care team: a controlled trial of outpatient palliative medicine consultation.
M. Rabow (2004)
10.1177/1049909109333928
Length of Survival in Hospice for Cancer Patients Referred From a Comprehensive Cancer Center
T. Younis (2009)
10.1089/JPM.2006.9.137
Promoting excellence in end-of-life care: a report on innovative models of palliative care.
I. Byock (2006)
10.1002/cncr.23909
Impact of opening an acute palliative care unit on administrative outcomes for a general oncology ward
A. Rigby (2008)
10.1200/JCO.2003.01.104
Simultaneous care: disease treatment and palliative care throughout illness.
F. Meyers (2003)
10.1053/J.SEMINONCOL.2004.11.015
Integration of palliative medicine into comprehensive cancer care.
R. Lagman (2005)
10.1177/1049909107307375
A Day in the Life: A Case Series of Acute Care Palliative Medicine—The Cleveland Model
R. Lagman (2008)
10.1200/JCO.2004.11.003
Palliative care inpatient service in a comprehensive cancer center: clinical and financial outcomes.
A. Elsayem (2004)
10.1007/s00520-005-0834-3
Edmonton symptom assessment scale: Italian validation in two palliative care settings
C. Moro (2005)
10.1016/S0885-3924(01)00263-9
Quality of life assessment and outcome of palliative care.
E. Paci (2001)
10.1089/10966210252785051
Development and implementation of an inpatient acute palliative care service.
Philip H Santa-Emma (2002)



This paper is referenced by
10.1177/0269216319830860
Thromboprophylaxis for inpatients with advanced cancer in palliative care settings: A systematic review and narrative synthesis
Runting Cai (2019)
10.1200/jco.2019.37.31_suppl.53
Symptom burden and characteristics of patients who die in the acute palliative care unit of a tertiary cancer center.
Y. T. Kim (2019)
10.1007/s00520-018-4303-1
Correction to: Can early palliative care with anticancer treatment improve overall survival and patient-related outcomes in advanced lung cancer patients? A review of the literature
M. Ambroggi (2018)
10.1200/JCO.2010.29.5618
Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care.
E. Bruera (2010)
10.1007/s00520-010-0903-0
Palliative care is a key component of daily practice in oncology: descriptive study of hospitalisation events at an oncology treatment centre
E. Espinosa (2010)
10.1089/jpm.2013.0596
Factors associated with in-hospital death by site of consultation among elderly inpatients receiving pain and palliative care consultations.
K. Sekiguchi (2014)
10.1089/jpm.2008.0053
Variability in access to hospital palliative care in the United States.
B. Goldsmith (2008)
10.1002/cncr.29602
A diagnostic model for impending death in cancer patients: Preliminary report
D. Hui (2015)
10.1016/j.jpainsymman.2014.10.020
The frequency and factors associated with the use of a dedicated Supportive Care Center Telephone Triaging Program in patients with advanced cancer at a comprehensive cancer center.
Lindsey E. Pimentel (2015)
10.1097/COC.0000000000000510
Factors Influencing Clinical and Setting Pathways After Discharge From an Acute Palliative/Supportive Care Unit
S. Mercadante (2019)
10.1590/s1980-220x2017037503305
Analysis of the Perroca Scale in Palliative Care Unit.
C. E. Santos (2018)
10.1080/03007995.2017.1315332
Delirium assessed by Memorial Delirium Assessment Scale in advanced cancer patients admitted to an acute palliative/supportive care unit
S. Mercadante (2017)
10.1007/s11739-017-1619-7
Characteristics of patients with an unplanned admission to an acute palliative care unit
S. Mercadante (2017)
10.1111/ecc.13022
What's Love Got to do with it? Marital status and survival of head and neck cancer.
N. Osazuwa-Peters (2019)
10.1007/978-3-319-74698-2_144-1
Palliative Care in Critically Ill Cancer Patients
Ali Haider (2019)
10.1371/journal.pone.0157300
The Palliative-Supportive Care Unit in a Comprehensive Cancer Center as Crossroad for Patients’ Oncological Pathway
S. Mercadante (2016)
10.1177/1049909117691280
Post-Acute Care Facility as a Discharge Destination for Patients in Need of Palliative Care in Brazil
L. G. Soares (2018)
10.1634/theoncologist.2018-0288
Phase Angle and the Diagnosis of Impending Death in Patients with Advanced Cancer: Preliminary Findings
D. Hui (2019)
10.1016/J.GMB.2011.08.002
Sociodemographic characteristics by primary cancer diagnosis of patients dying in a palliative care unit: A retrospective analysis
G. Costa-Requena (2011)
10.1016/j.jpainsymman.2011.09.012
Till death do us part: getting married at the end of life.
Joseph A Arthur (2012)
10.1200/JCO.18.02123
Models of Palliative Care Delivery for Patients With Cancer.
D. Hui (2020)
10.1089/jpm.2012.0147
Conceptual models for integrating palliative care at cancer centers.
E. Bruera (2012)
10.1634/theoncologist.2013-0457
Clinical signs of impending death in cancer patients.
D. Hui (2014)
10.1177/0269216318772735
The difficulties of discharging hospice patients to care homes at the end of life: A focus group study
T. Thomas (2018)
10.1002/cncr.29048
Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study
D. Hui (2015)
10.1002/cncr.28628
Impact of timing and setting of palliative care referral on quality of end‐of‐life care in cancer patients
D. Hui (2014)
10.1007/s00520-017-4037-5
Characteristics and care pathways of advanced cancer patients in a palliative-supportive care unit and an oncological ward
S. Mercadante (2018)
Primary thromboprophylaxis for inpatients with advanced cancer
B. Hannon (2018)
10.1007/s00520-017-3604-0
Characteristics of advanced cancer patients who were readmitted to an acute palliative/supportive care unit
S. Mercadante (2017)
10.3109/08958378.2011.638947
A new time-series methodology for estimating relationships between elderly frailty, remaining life expectancy, and ambient air quality
C. Murray (2012)
10.1001/jama.2010.258
Availability and integration of palliative care at US cancer centers.
D. Hui (2010)
10.1002/cncr.28614
Quality of end‐of‐life care in patients with hematologic malignancies: A retrospective cohort study
D. Hui (2014)
See more
Semantic Scholar Logo Some data provided by SemanticScholar