Characteristics of patients who die in an acute palliative care unit

Aim: To evaluate the characteristics of patients with advanced cancer who die in an acute palliative care unit (APCU). The second outcome was to evaluate the risk factors for death in APCU. Methods: Consecutive patients with advanced cancer admitted to the APCU in a period of 13 months were prospectively assessed. At APCU admission epidemiologic data, characteristics of admission, cachexia, being on-off anticancer treatment, and Edmonton Symptom Assessment System (ESAS) were assessed. Patients who died in APCU were extrapolated from the entire sample. A similar random sample of patients who were discharged alive in the same study period, matched for age and gender, was selected for comparison. Results: Fifty-four patients (12%) died in APCU. Statistical differences between died and discharged patients atadmission were found in MDAS (p=<0.0005), home palliative care referral (p<0.0005), cachexia (p=0.018), being off-therapy (p=<0.0005), cognitive/clinical decline (p=<0.0005), and symptom burden (P=0.002). At the multivariate analysis, independent factors associated with dying in APCU were MDAS (p=0.006), referral from home care (p=0.025), being off-therapy (p=0.002), pain (<0.05), and dyspnea intensity (p=0.038), and total ESAS (p=0.025). Conclusion: Mortality risk in APCU is associated with home palliative care referral, high symptom burden, cognitive failure, and general worsening of the clinical condition, as well being off-therapy. More proactive and timely end-of-life care is needed for these patients.