Symptomatic treatment of infections in patients with advanced cancer receiving hospice care

Abstract

8069 Background: Symptom control is one of the primary goals of hospice care. We prospectively followed patients with advanced cancer receiving outpatient hospice care to determine if the use of antimicrobials for a clinically suspected infection improved infection related symptoms. Methods: During a 24 month period, 1,731 patients with a cancer diagnosis were admitted to a community based outpatient hospice program. 1,598 patients (median age 63.1 yrs, range 27–89; 50% male) consented to be prospectively monitored for infection related symptoms (cough, disorientation, dyspnea, dysuria, fever, frequency, pain). 89% of the patients had a Karnofsky performance of ≤ 60%. 623 of 1,598 study patients were diagnosed with a total of 685 infections. 633 of the clinically suspected infections were treated with antimicrobials for at least 72 hours. Symptoms were recorded, clinically indicated cultures were obtained, and the choice of antimicrobial was instituted at the discretion of the attending physician. Patients were subsequently monitored to determine the effects of antimicrobials on infection related symptoms. Results: A complete or a partial response of infection related symptoms was observed in 79% of 265 patients with urinary tract infections, 43% of 221 patients with respiratory tract infections, 46% of 63 patients with oral cavity infections, 41% of 59 patients with skin or subcutaneous infections, and none of 25 patients with bacteremia. 52 of the infections were not evaluable due to refusal of antimicrobials or receipt of less than 72 hours of antimicrobials. Patient survival was not affected by the presence of infection or the use of antimicrobials. Conclusions: Although the use of antimicrobials improved symptoms in the majority of patients with urinary tract infections, symptom control was less successful in infections of the respiratory tract, mouth/pharynx, skin/subcutaneous tissue, or blood. There are limitations of the use of antimicrobials in patients with advanced cancer receiving hospice care. Treatment guidelines are proposed emphasizing the importance of patient preferences and the use of symptom control as the major indication for the use of antimicrobials in this patient population. No significant financial relationships to disclose.