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), and the risk factors for death in APCU.

Methods: Adult 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) and MDAS (Memorial Delirium Assessment Scale) 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 were found in MDAS (p = < 0.0005), admission for cognitive/clinical decline (p = < 0.0005), referral from specialistic home palliative care (p < 0.0005), cachexia (p = 0.018), being off cancer treatment (p = < 0.0005), and symptom burden (total ESAS) (p = 0.002). At the multivariate analysis, independent factors associated with dying in APCU were MDAS (p = 0.006), referral from specialistic home palliative care (p = 0.025), being off cancer treatment (p = 0.002), pain and dyspnea intensity (< 0.05 and p = 0.038, respectively), and total ESAS (p = 0.025).

Conclusion: Mortality risk in APCU is associated with home palliative care referral, high symptom burden, and being off-cancer treatment. More proactive and timely end-of-life care is needed for these patients.