Mercadante Sebastiano, Grassi Yasmine, Adile Claudio, Sapienza Giorgio, Lo Cascio Alessio, Casuccio Alesssandra
Main Regional of 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. 2025 Sep 24;33(10):876. doi: 10.1007/s00520-025-09938-0.
The aim of this study was, other than assessing clinical outcomes after a comprehensive palliative care treatment in APCU, to report the activity and functioning of APCU in influencing subsequent care trajectory and settings of patients with advanced cancer.
A consecutive sample of patients with cancer who were admitted to an acute palliative care unit (APCU) was prospectively assessed. All patients underwent comprehensive palliative care treatment. At admission (T0), patients' demographics, reasons for admission, referral, and recent anticancer treatments were recorded, along with whether they were on/off treatment or uncertain. Subsequent referrals to next care settings and the pathway of oncologic treatment were reconsidered. Symptom intensity was measured by Edmonton Symptom Assessment Scale (ESAS).
Five-hundred and twenty patients were surveyed. Clinical deterioration was the most frequent indication for APCU admission. Most admissions were planned (60.8%). At discharge, a significant decrease in the number of "on therapy" patients was reported, and concomitantly, the number of "off-therapy" patients increased (p < 0.0005) in comparison with data recorded at admission. A significant number of patients was assigned to a palliative care setting, including home palliative care or hospice at the time of discharge (p < 0.0005). All ESAS items that significantly improved during admission were significant. Being "off therapy" was independently associated with a lower Karnofsky (p = 0.002), higher global ESAS at discharge (p = 0.032), and discharge to a palliative setting (hospice or home palliative care) (p < 0.0005).
Data from the present study has shown that APCU results in a crossroad for patients with advanced cancer, allowing selection for transition of care.
本研究的目的除了评估急性姑息治疗单元（APCU）进行全面姑息治疗后的临床结局外，还在于报告APCU在影响晚期癌症患者后续护理轨迹和护理机构方面的活动及功能。
对入住急性姑息治疗单元的癌症患者连续样本进行前瞻性评估。所有患者均接受全面姑息治疗。入院时（T0），记录患者的人口统计学信息、入院原因、转诊情况及近期抗癌治疗情况，以及他们是否正在接受治疗/停止治疗或情况不明。重新考虑后续向下一级护理机构的转诊及肿瘤治疗路径。采用埃德蒙顿症状评估量表（ESAS）测量症状强度。
共调查了520例患者。临床病情恶化是APCU入院最常见的指征。大多数入院是计划性的（60.8%）。出院时，报告“正在接受治疗”的患者数量显著减少，与此同时，“停止治疗”的患者数量较入院时记录的数据有所增加（p < 0.0005）。大量患者在出院时被安排到姑息治疗机构，包括居家姑息治疗或临终关怀机构（p < 0.0005）。入院期间所有显著改善的ESAS项目均有统计学意义。“停止治疗”与较低的卡氏评分（p = 0.002）、出院时较高的ESAS总体评分（p = 0.032）以及出院到姑息治疗机构（临终关怀或居家姑息治疗）独立相关（p < 0.0005）。
本研究数据表明，APCU是晚期癌症患者护理的一个转折点，有助于选择护理过渡方案。
