Changes in medication profile among patients with advanced cancer admitted to an acute palliative care unit

Purpose The decision-making process for medication use in the last weeks of life is complex because of patient frailty and poor prognosis. Limited literature is available on medication use in the palliative care setting, particularly in acute palliative care units (APCUs). We examined the changes in...

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Bibliographic Details
Published in:Supportive care in cancer 2015-02, Vol.23 (2), p.427-432
Main Authors: Hui, David, Li, Zhijun, Chisholm, Gary B., Didwaniya, Neha, Bruera, Eduardo
Format: Article
Language:English
Subjects:
Adult
Aged
Antipsychotic drugs
Cancer
Cancer patients
Corticosteroids
Critical care
Decision making
Drug therapy
Drugs
Female
Humans
Male
Medication Therapy Management - statistics & numerical data
Medicine
Medicine & Public Health
Middle Aged
Neoplasm Staging
Neoplasms - pathology
Neoplasms - therapy
Nursing
Nursing Research
Oncology
Original Article
Pain Medicine
Palliative care
Palliative Care - methods
Palliative treatment
Patient Admission - statistics & numerical data
Patient Care Team
Prognosis
Referral and Consultation
Rehabilitation Medicine
Retrospective Studies
Symptom Assessment - methods
United States
Withholding Treatment
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Summary:Purpose The decision-making process for medication use in the last weeks of life is complex because of patient frailty and poor prognosis. Limited literature is available on medication use in the palliative care setting, particularly in acute palliative care units (APCUs). We examined the changes in medication profile among hospitalized patients with advanced cancer before their palliative care inpatient consultation team referral, after palliative care consultation, at the time of APCU admission, and at APCU discharge or death. Methods We included consecutive patients with advanced cancer who were first seen by our inpatient palliative care consultation team and subsequently admitted to the APCU. We retrieved data on all scheduled medications at the prespecified time points. Results Among the 100 patients, the median duration of hospitalization was 10.5 days (interquartile range 8–15 days), and the median APCU stay was 5 days (interquartile range 3–7 days). The average number of medications before palliative care inpatient consultation team referral, after palliative care consultation, at APCU admission and at APCU discharge/death was 9.2 (standard deviation [SD] 4.5), 9.9 (SD 4.2), 10.3 (SD 3.8), and 10.1 (SD 3.8), respectively ( P  = 0.03). An increasing proportion of patients received medications for symptom control over their course of hospitalization, including systemic corticosteroids, laxatives, neuroleptics, and antiulcer agents ( P  
ISSN:0941-4355
1433-7339
DOI:10.1007/s00520-014-2390-1