1443 - A retrospective study of the factors tended to transfer to palliative home care from palliative care unit at a comprehensive cancer center in Japan
|Date||28 September 2012|
|Event||ESMO Congress 2012|
|Topics|| Palliative Care
T. Miura1, Y. Matsumoto1, A. Okizaki2, M. Oishi3, S. Motonaga2, Y. Higashi1, A. Sekimoto4, K. Abe5, M. Fukui1, H. Kinoshita1
There are significant differences in the proportion of home death of cancer patients, 8.3% in Japan and 27.4% in the United Kingdom. However 63% of Japanese population hope home palliative care in their last 6 months. The palliative care unit (PCU) at the National Cancer Center Hospital East changed the administrative policy to amend patients unmet needs and strengthen the transition to palliative home care. Previous studies about the discharge from hospice indicated the factor of old age, female and poor performance status (PS). This study aimed to identify the factors tended to transfer to palliative home care in Japan.Methods
We reviewed the medical records of 333 consecutive cancer patients admitted to our PCU during period from October 2010 until September 2011. Patients transferred to other hospitals were excluded in this study.
We identified variables associated with the discharged group and the deceased at PCU group, using the univariate and multivariate analyses.Results
There were 311 patients (Pts) during periods, 68 Pts (21.9%) discharged to palliative home care and 243 Pts (78.1%) deceased in our PCU. Characteristics of discharged group (68 Pts) were below: over 65 year-old (32%), female (53.0%), PS 4 (7.4%), a relatively good amount of oral intake in first hospital day (76.1%), morphine use over 120mg/day at admission (23.5%), living alone (9.7%), married (74.6%), primary caregiver was partner (67.7%).
Univariate and multivariate analysis identified: admission from their own home (OR 4.41; 95%CI 2.08-9.75), a good PS of > 4 (OR 6.21; 95%CI 2.11-23.18), a heart rate < 100 beats per minute (OR 3.72; 95%CI 1.21-14.22), a good amount of oral intake (OR 1.71; 95%CI 1.26-2.43), dyspnea (OR 3.14; 95%CI 1.24-8.56), fatigue (OR 4.98; 95%CI 1.35-24.54) and abdominal distention (OR 11.00; 95%CI 1.94-209.60) as predictions of a transition to home from our PCU.Conclusion
Our study indicated the factors tended to transfer to palliative home care from PCU in Japan, however this study had some limitations. A prospective study is required to validate these factors.Disclosure
All authors have declared no conflicts of interest.