Palliative Care in a National Cancer Center: Results in 1987 vs. 1993 vs. 2000

• Published in: Journal of pain and symptom management 2003-06, Vol.25 (6), p.499-511
• Main Authors: De Conno, Franco, Panzeri, Cristina, Brunelli, Cinzia, Saita, Luigi, Ripamonti, Carla
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cancer; Clinical death. Palliative care. Organ gift and preservation; diagnostic approach; hospitalization; Humans; Italy; Medical sciences; National Health Programs - organization & administration; Neoplasms - diagnosis; Neoplasms - therapy; palliative care; Palliative Care - organization & administration; therapeutic approach; Time Factors
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/S0885-3924(03)00069-1

In the last few years, palliative care for advanced and terminal cancer patients has undergone considerable evolution. We determined the characteristics of patients admitted to the 4-bed Palliative Care Unit (PCU) of the National Cancer Institute (NCI) of Milan in 1987, 1993 and 2000 to evaluate how our diagnostic and therapeutic approaches have changed over the years. We reviewed the charts of every patient admitted to the PCU in 1987, 1993, and the first ten months of 2000. We recorded demographic data; the primary tumor sites; the main reason for admission; the types of therapies administered (oncologic, analgesic, surgical, neurosurgical analgesic procedures, and supportive therapy); the type and number of cardiological, radiological and endoscopic examinations, as well as specialist consultations; the duration of stay and eventual death on the Unit. There were no significant differences regarding gender, age, primary tumor site and death in hospital of the patients admitted during these years. The time spent in hospital increased over time ( P = 0.006). A significant increase was observed in the percentage of patients admitted for supportive therapy ( P < 0.001) and investigation concerning the stage of the disease ( P < 0.001). There was a significant decrease in admission for invasive analgesic procedures ( P < 0.001), as well as for pain diagnosis and/or uncontrolled pain. Uncontrolled pain remained the most frequent reason for admission. Over the years, during hospitalization, 7% to 12% of the patients underwent radiotherapy,1% to 9% had computerized tomography, and 4% to 8% had palliative surgery. More than 50% of the patients received intravenous hydration; a few patients received hypodermoclysis in 1987. Over time, there was a significant increase in “as needed” administration of nonsteroidal anti-inflammatory drugs and a significant reduction in their regular administration (from 24% in 1987 and 1993 to 3% in 2000) ( P < 0.001). The use of codeine, tramadol and methadone increased ( P < 0.001), whereas the use of oral morphine, buprenorphine and oxycodone decreased in 2000 ( P < 0.001). There was a reduction in the use of antidepressants (no significant constant trend) and a significant increase in the use of anticonvulsants, laxatives and pamidronate ( P < 0.001). Regularly administered hypnotics decreased in 1993 and increased in 2000 ( P < 0.001). Over these years, no significant differences were found in the routes of opioid administration