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Clinical Outcomes of Operating an Acute Palliative Care Unit at a Comprehensive Cancer Center

 Eun Hee Jung  ;  Si Won Lee  ;  Yu Jung Kim  ;  Beodeul Kang  ;  Koung Jin Suh  ;  Ju Hyun Lee  ;  Esther Jeon  ;  Dahee Kim  ;  Sung Soun Hur  ;  Ji Yun Lee  ;  Ji-Won Kim  ;  Se Hyun Kim  ;  Jin Won Kim  ;  Jeong-Ok Lee  ;  Keun-Wook Lee  ;  Jee Hyun Kim  ;  Soo-Mee Bang  ;  Jong Seok Lee  ;  Eduardo Bruera 
 JCO ONCOLOGY PRACTICE, Vol.18(10) : e1661-e1667, 2022-10 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Critical Care ; Female ; Hospice and Palliative Care Nursing* ; Hospitalization ; Humans ; Male ; Middle Aged ; Neoplasms* / epidemiology ; Neoplasms* / therapy ; Palliative Care ; Retrospective Studies ; Young Adult
Purpose: Acute palliative care units (APCUs) are inpatient services in tertiary hospitals that provide intensive symptom management and assist in hospital discharge for transitions to hospice care. We aimed to analyze the clinical outcomes of operating an APCU at a comprehensive cancer center.

Patients and methods: We retrospectively reviewed the medical records of 1,440 consecutive patients admitted to the APCU and analyzed demographic and clinical information, discharge outcomes, symptom assessments using the Edmonton Symptom Assessment System, spiritual distress, and financial distress.

Results: The median age of patients was 67.0 (range, 23-97) years, and 41% were female. The most common primary cancer types were lung (21.9%), hepatopancreatobiliary (14.1%), and colorectal cancers (12.9%). The median length of stay was 8.0 days (range, 1-60 days), and 31.0% of patients died in the APCU. Death in the APCU showed a significant decrease over time, and overall inpatient death in oncology wards did not increase after APCU opening. In total, 44.7% of patients were discharged to government-certified hospice centers. The proportion of patients discharged to certified hospice centers increased from 32.2% in 2015 to 62.4% in 2018. Among 715 patients with a follow-up evaluation 1 week after admission, Edmonton Symptom Assessment System symptom scores, spiritual distress, and financial distress showed statistically significant improvements compared with the baseline symptom scores (P < .001). This improvement was limited to patients who did not die in the APCU.

Conclusion: Patients with advanced cancer admitted to the APCU may experience significant improvements in distressing symptoms. The majority of patients requiring transition to hospice were successfully transferred to certified hospice centers. The percentage discharged alive improved over time.
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Yonsei Authors
Lee, Si Won(이시원) ORCID logo https://orcid.org/0000-0002-2144-4298
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