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The outcomes of acute palliative care unit at a comprehensive cancer center

Other Titles
 종합병원 암 센터에서의 급성기 완화의료 병동의 성과 
 College of Medicine (의과대학) 
 Others (기타) 
Issue Date
BACKGROUND: Acute palliative care units aim to actively control physical and psychosocial distress of advanced cancer patients and their families. They also help patients receive the care they need by connecting them to adequate facilities. Our interest was to retrospectively analyze the admission results of patients who utilized the acute palliative care unit of the Yonsei Cancer Center and look forward to finding effective ways to operate the acute palliative care unit. MATERIALS AND METHODS: The admission data between April 2014 and April 2015 were retrospectively reviewed. Two hundred and five patients used the acute palliative care unit for a total of 289 admissions. Medication changes and interventions during the acute palliative care unit stay were investigated. The Edmonton Symptom Assessment System was used to estimate symptom severity initially at admission and one week afterwards to check how much the symptom severity was lowered. Differences between deceased and alive discharged patients were also compared. RESULTS: The 205 admitted patients had the following characteristics: male 53.2%, median age 60 years (range 53-69), and median acute palliative care unit stay 9 days (range 5.0-14.0). Hepatobiliary-pancreatic cancer and gastrointestinal cancer patients accounted for the largest portion (n=72, 35.1%; n=42, 20.5% respectively). Most patients were referred from department of oncology (n=166, 81%). One hundred and fifty-eight (77.1%) patients were referred to the acute palliative care unit after anti-cancer treatments were all finished. Forty-six (22.4%) patients died during their stay. Patients who were discharged due to death were most likely admitted from other wards (n=31, p=0.0006) and were finished with anti-cancer treatment before admission (n=42, p=0.0009). There was a significant improvement in ESAS scores for fatigue, lack of appetite, dyspnea, constipation, and depression, but pain was not controlled significantly. Forty patients requiring ongoing treatment were well-linked to hospices. CONCLUSION: Most patients admitted to the acute palliative care unit at the Yonsei Cancer Center were at the end stages of their disease or finished with their anti-cancer treatments. Overall symptoms improved with some drawbacks during the acute palliative care unit stay. To improve acute palliative care unit’s role, a more aggressive symptom management and a system for early access are necessary.
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