Mercadante Sebastiano, Cascio Alessio Lo, Casuccio Alessandra
Main Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy.
Support Care Cancer. 2024 Dec 21;33(1):48. doi: 10.1007/s00520-024-09102-0.
To evaluate the characteristics of patients with advanced cancer who die in an acute palliative care unit (APCU), and the risk factors for death in APCU.
Adult consecutive patients with advanced cancer admitted to the APCU in a period of 13 months were prospectively assessed. At APCU admission, epidemiologic data, characteristics of admission, cachexia, being on-off anticancer treatment, and Edmonton Symptom Assessment System (ESAS) and MDAS (Memorial Delirium Assessment Scale) were assessed. Patients who died in APCU were extrapolated from the entire sample. A similar random sample of patients who were discharged alive in the same study period, matched for age and gender, was selected for comparison.
Fifty-four patients (12%) died in APCU. Statistical differences between died and discharged patients were found in MDAS (p = < 0.0005), admission for cognitive/clinical decline (p = < 0.0005), referral from specialistic home palliative care (p < 0.0005), cachexia (p = 0.018), being off cancer treatment (p = < 0.0005), and symptom burden (total ESAS) (p = 0.002). At the multivariate analysis, independent factors associated with dying in APCU were MDAS (p = 0.006), referral from specialistic home palliative care (p = 0.025), being off cancer treatment (p = 0.002), pain and dyspnea intensity (< 0.05 and p = 0.038, respectively), and total ESAS (p = 0.025).
Mortality risk in APCU is associated with home palliative care referral, high symptom burden, and being off-cancer treatment. More proactive and timely end-of-life care is needed for these patients.
评估在急性姑息治疗病房（APCU）死亡的晚期癌症患者的特征，以及APCU中的死亡危险因素。
对连续13个月入住APCU的成年晚期癌症患者进行前瞻性评估。在APCU入院时，评估流行病学数据、入院特征、恶病质、是否接受抗癌治疗、埃德蒙顿症状评估系统（ESAS）和纪念谵妄评估量表（MDAS）。从整个样本中推断出在APCU死亡的患者。选择在同一研究期间存活出院、年龄和性别匹配的类似随机样本进行比较。
54名患者（12%）在APCU死亡。在MDAS（p = <0.0005）、因认知/临床衰退入院（p = <0.0005）、来自专科家庭姑息治疗的转诊（p < 0.0005）、恶病质（p = 0.018）、停止抗癌治疗（p = <0.0005）和症状负担（ESAS总分）（p = 0.002）方面，死亡患者和出院患者之间存在统计学差异。在多变量分析中，与在APCU死亡相关的独立因素是MDAS（p = 0.006）、来自专科家庭姑息治疗的转诊（p = 0.025）、停止抗癌治疗（p = 0.002）、疼痛和呼吸困难强度（分别为p < 0.05和p = 0.038）以及ESAS总分（p = 0.025）。
APCU中的死亡风险与家庭姑息治疗转诊、高症状负担和停止抗癌治疗有关。这些患者需要更积极、及时的临终关怀。
