Symptoms, care needs and diagnosis in palliative cancer patients in acute care hospitals: a 5-year follow-up survey.
BACKGROUND
Palliative cancer care in acute hospitals is scarcely studied. We therefore described and compared symptoms, care needs and types of cancer sites in 2002 compared to 2007 and analysed the relationships between these factors.


METHODS
The study was population-based with a cross-sectional design and was carried out in medical, surgical and oncology wards in two acute care hospitals with no advanced palliative home care service. In 2002, 82 one-day-inventories were done (1 352 patients) compared to 142 one-day-inventories in 2007 (2 972 patients). Symptoms, care needs and cancer site were registered according to a questionnaire. Multiple logistic regression models were used to analyse associations between symptoms, care needs and cancer site.


RESULTS
The proportion of palliative cancer patients had decreased during a five year period (14% vs. 11%, p<0.01). The patients were older in 2007 (74 vs. 70 years, p<0.001) and had more symptoms and care needs per patient (2.6 vs. 1.6, p<0.001). The most common symptoms were pain and deterioration and the most common cancer sites were prostate and colorectal cancer in both samples. Associations between symptoms, care needs and cancer site were mostly weak. Deterioration was associated with colorectal cancer, whereas pain was not associated with any specific cancer site. In haematological malignancies there was a high occurrence of infections and a high need of blood transfusions and infusions. Stomach/oesophagus cancers were significantly associated with nausea, nutritional problems and need of infusions while unknown primary malignancies were associated with abdominal surgery and infusions.


CONCLUSIONS
Although we do not know all the causes for hospitalization, this study indicates that more focus should be on the symptoms instead of the specific cancer diagnosis. The findings also indicate that many palliative cancer patients' problems would be suitable for advanced palliative home care instead of acute hospital care.
Sandgren
Anna
A
School of Health Sciences and Social Work, Växjö University, Växjö, Sweden. anna.sandgren@ltkronoberg.se
Fridlund
Bengt
B
Nyberg
Per
P
Strang
Peter
P
Petersson
Kerstin
K
Thulesius
Hans
H
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000379:methods*; D015995:Prevalence; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology