Interventions and symptom relief in hospital palliative cancer care: results from a prospective longitudinal study

Morten Thronæs,Tora Skeidsvoll Solheim,Gunnhild Jakobsen,Erik Torbjørn Løhre,Elisabeth Brenne,Arne Solberg,Martine Kjølberg Moen,Kathrine Otelie Aalberg,Pål Klepstad,Anne Kvikstad,Robin Norvaag

doi:10.1007/s00520-021-06248-z

Morten Thronæs, Tora Skeidsvoll Solheim + Show 9 more

Open Access

https://doi.org/10.1007/s00520-021-06248-z

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Abstract

PurposeTo study the use of interventions and symptom relief for adult patients with incurable cancer admitted to an acute palliative care unit providing integrated oncology and palliative care services.MethodsAll admissions during 1 year were assessed. The use of interventions was evaluated for all hospitalizations. Patients with assessments for worst and average pain intensity, tiredness, drowsiness, nausea, appetite, dyspnea, depression, anxiety, well-being, constipation, and sleep were evaluated for symptom development during hospitalization. Descriptive statistics was applied for the use of interventions and the paired sample t-test to compare symptom intensities (SIs).ResultsFor 451 admissions, mean hospital length of stay was 7.0 days and mean patient age 69 years. More than one-third received systemic cancer therapy. Diagnostic imaging was performed in 66% of the hospitalizations, intravenous rehydration in 45%, 37% received antibiotics, and 39% were attended by the multidisciplinary team. At admission and at discharge, respectively, 55% and 44% received oral opioids and 27% and 45% subcutaneous opioids. For the majority, opioid dose was adjusted during hospitalization. Symptom registrations were available for 180 patients. Tiredness yielded the highest mean SI score (5.6, NRS 0–10) at admission and nausea the lowest (2.2). Significant reductions during hospitalization were reported for all assessed SIs (p ≤ 0.01). Patients receiving systemic cancer therapy reported symptom relief similar to those not on systemic cancer therapy.ConclusionClinical practice and symptom relief during hospitalization were described. Symptom improvements were similar for oncological and palliative care patients.

Highlights

Cancer patients treated with palliative intent suffer from a diversity of symptoms [1,2,3]
Four hundred fifty-one admissions were registered during the 1-year study period, of which 302 (67%) were emergency admissions
Improvements were similar for patients on systemic cancer therapy and palliative care patients, supporting a benefit of early integration of palliative care into cancer care

Summary

Introduction

Cancer patients treated with palliative intent suffer from a diversity of symptoms [1,2,3]. The symptom burden remains high over time, both on a population level and throughout the disease trajectory [4,5,6,7]. The relevant and ongoing attention to effectiveness of healthcare services warrants a focus on the interventions used to achieve symptom improvement [9,10,11]. Systematic symptom assessment is pivotal in palliative care and may improve survival [12, 13]. The patient perspective is an important element of cancer care, as the healthcare providers tend to underestimate the patient’s symptom burden [12, 14, 15].

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