How does an acute palliative care unit work in a comprehensive cancer center?

PURPOSE: The aim of this study was, other than assessing clinical outcomes after a comprehensive palliative care treatment in APCU, to report the activity and functioning of APCU in influencing subsequent care trajectory and settings of patients with advanced cancer. PATIENTS AND METHODS: A consecutive sample of patients with cancer who were admitted to an acute palliative care unit (APCU) was prospectively assessed. All patients underwent comprehensive palliative care treatment. At admission (T0), patients’ demographics, reasons for admission, referral, recent anticancer treatments, being on/off treatment or uncertain. Subsequent referral to next care settings and the pathway of oncologic treatment was re-considered. Symptom intensity was measured by Edmonton Symptom Assessment Scale (ESAS). RESULTS: Five-hundred and twenty patients were surveyed. Clinical deterioration was the most frequent indication for APCU admission. Most admissions were planned (60.8%). At discharge a significant decrease of the number of “on therapy” patients was reported, and concomitantly the number of “off-therapy” patients increased (p<0.0005) in comparison with data recorded at admission. A significant number of patients was assigned to a palliative care setting, including home palliative care or hospiceat time of discharge (p<0.0005). All ESAS items significantly improved during admission were significant. Being “off therapy” was independently associated with a lower Karnofsky (p=0.002), higher global ESAS at discharge (p=0.032), and discharge to a palliative setting (hospice or home palliative care); (p<0.0005). CONCLUSION: Data from the present study has shown that APCU results in a cross-road for patients with advanced cancer, allowing selection for transition of care