title: Study of hormone refractory prostate cancer: hospital care and palliative care resource use at a VA medical center.
abstract: Palliative care plays a central role in the management of hormone refractory prostate cancer patients (HRPC), yet little is known about palliative care resource use. Computerized medical records of a retrospective cohort of 89 consecutive HRPC patients seen at a VA medical center from 1994 to 1999 were reviewed for hospital and palliative care resource use in the last 6 months of life. There were 51 Caucasian and 38 African American patients; 95% of patients were admitted to the hospital for symptom management (median of 2 admissions); 98% visited clinics (median 19 visits); 35% went to the emergency room (median of 1 visit); 60% died in the hospital (median length of last hospitalization of 22 days); 49% received palliative radiation; 52% used rehabilitation; 57% received blood transfusion (median 2 units). Thirty-five patients (40%) received hospice care (median stay 35 days). The most frequently prescribed medications included opioids (90%), laxatives (89%), H2-blockers (57%), antiemetics (55%), diuretics (49%), and corticosteroids (43%). The prevalence of patients receiving opioids, as well as the dose of opioids increased over time. There was no difference in categories of palliative care resource use or survival by race. The median survival for all patients was 13 months. The results begin to highlight the extent of care and resources needed by patients with end-stage HRPC. This information will be of importance in planning palliative care for patients with HRPC and in designing future prospective studies.
authors.affiliation: Section Hematology/Oncology (111), VA New Jersey Health Care System at East Orange, East Orange, New Jersey 07018, USA. shirley.hwang@med.va.gov
authors.forename: Shirley S
authors.initials: SS
authors.lastname: Hwang
authors.forename: Victor T
authors.initials: VT
authors.lastname: Chang
authors.forename: Yvette
authors.initials: Y
authors.lastname: Alejandro
authors.forename: Shalini
authors.initials: S
authors.lastname: Mulaparthi
authors.forename: Janet
authors.initials: J
authors.lastname: Cogswell
authors.forename: Shanti
authors.initials: S
authors.lastname: Srinivas
authors.forename: Basil
authors.initials: B
authors.lastname: Kasimis
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D015331:Cohort Studies; D017051:Hospice Care; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D044465:White People