Abstract 1513P
Background
Palliative care is the most important treatment in patients with cancer at the end of life. In the rural setting reaching medical centers is often challenging, especially for people with poor performance status, which is why Home Palliative Care Units (HPCU) play a crucial role in our environment. We aim to study the impact of HPCU assistance in the number of emergency room visits and hospital admissions of patients with cancer.
Methods
A retrospective observational study was performed including patients diagnosed with cancer who died from January 2017 to December 2018 in the Medical Department of Hospital Virgen de los Lirios (Alcoi, Spain). Demographic characteristics, active treatment, and emergency care and hospital admissions were gathered from the last 3 months of life. Multivariate logistic regression model was used to assess the impact of clinical variables and HPCU assistance on emergency care unit visits and hospital admissions.
Results
We included 388 patients. Median age: 72 years; range (28-98). 65% were males. ECOG 0-2: 68%; 3-4: 32%. Most frequent primary tumors were lung (23%), upper gastrointestinal (19%) and colorectal cancer (16%). Most common symptoms leading to hospital admission were deterioration of the general condition (51%), dyspnoea (12%) and infection (10%). On multivariate analysis, attention by HPCU was the only significant feature to reduce the number of emergency care unit visits and hospital admissions (OR 5.67, CI95% 3.15-10.20, p=<.001 and OR 8.62, CI95% 5.14-14.45, p=<.001, respectively). Data shown in table. Table: 1513P
Multivariate analysis: Logistic Regression Model
| Hospital admissions (0-1 vs. ≥2) | Emergency care unit visits (0-2 vs. ≥3) | |||
| OR (CI 95%) | p-value | OR (CI 95%) | p-value | |
| ECOG | 1.25 (0.89-1.75) | 0.201 | 0.99 (0.69-1.42) | 0.957 |
| Age groups (young <70vs. older) | 0.77 (0.47-1.27) | 0.300 | 0.98 (0.57-1.69) | 0.942 |
| Active treatment in previous 3 months (yes vs. no) | 0.87 (0.50-1.53) | 0.638 | 1.08 (0.59-1.97) | 0.796 |
| Attention by HPCU (yes vs. no) | 8.62 (5.14-14.45) | <0.001 | 5.67 (3.15-10.20) | <0.001 |
Conclusions
Patients receiving HPCU assistance have lower number of emergency room visits and hospital admissions which leads to decreases the public health spending, and improvement in quality of life. Thus, providing adequate resources to HPCU should be a priority for the management of oncologic patients at the end of life.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.