Format

Send to

Choose Destination

See 1 citation found by title matching your search:

Support Care Cancer. 2019 Jun 13. doi: 10.1007/s00520-019-04906-x. [Epub ahead of print]

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

Author information

1
Center of Expertise Palliative Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands. m.verhoef@lumc.nl.
2
Center of Expertise Palliative Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
3
Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands.
4
Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.
5
Department of Emergency Medicine, Leiden University Medical Center, Leiden, the Netherlands.
6
Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
7
Department of Medical Oncology, Haaglanden Medical Center, The Hague, the Netherlands.
8
Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
9
Mathematical Institute, Leiden University, Leiden, the Netherlands.

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 (2011-2014). 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.

CONCLUSION:

ED visits of advanced cancer patients often lead to hospitalization and in-hospital deaths. Timely recognition of patients with limited life expectancies and urgent palliative care needs, and awareness among ED staff of the potential of ED-initiated palliative care may improve the end-of-life trajectory of these patients.

KEYWORDS:

Emergency department; Oncology; Palliative care; Terminal care

PMID:
31197539
DOI:
10.1007/s00520-019-04906-x

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center