Cancer Center’s Hospice Addition Promotes Continuity of Care

Adding an inpatient hospice to an acute supportive/palliative care unit at a comprehensive cancer center can improve continuity of care and avoid uncomfortable transfers to external hospices.

In a study published online ahead of print in Supportive Care in Cancer, authors from La Maddalena Cancer Center in Palmero, Italy, characterized patients admitted to their center’s hospice, which launched in November 2019.

“This study provided interesting information regarding some clinical aspects of patients admitted to a hospice in a comprehensive cancer center with a pre-existing acute supportive/palliative care unit, where experience and clinical footprint were shared between the two teams,” they wrote.

The study included 177 patients admitted in the 13 months following the hospice opening. Researchers retrieved data on symptoms and the use of analgesic and adjuvant drugs at hospice admission, 1 and 2 weeks afterward, and the day before death.

At admission, total Edmonton Symptom Assessment Scale scores were significantly lower in patients from the acute supportive/palliative care unit than patients from other wards, hospitals, or home palliative care. Patients referred by palliative care settings were more likely to be prescribed opioids at admission. At the day-before-death timepoint, the use of morphine and haloperidol increased significantly, the study found.

Among 141 patients who died in hospice, 17% died within 48 hours. Palliative sedation was provided to 10% of patients, mainly for delirium, dyspnea, and distress. The mean hospice stay was 16 days, which did not differ between patients who died in hospice and patients who died at home.

“The short time of hospice staying or time to death, however, imply an inacceptable timing for patients with several problems presumed to be present early during the course of disease, at least for patients referred from other settings,” researchers wrote.

“Indeed,” they added, “an extremely late referral or multiple hospital admissions in the last 3 months of life indicates a missed opportunity for timely intervention by the palliative care teams designed to address the physical, psychological, social, emotional, and spiritual aspects of care for patients with serious illnesses.”

Reference:
Mercadante S, Giuliana F, Bellingardo R, Albegiani G, Di Silvestre G, Casuccio A. Pattern and characteristics of patients admitted to a hospice connected with an acute palliative care unit in a comprehensive cancer center. Support Care Cancer. 2022;30(3):2811-2819. doi:10.1007/s00520-021-06685-w