title: Survival duration among patients with a noncancer diagnosis admitted to a palliative care unit: a retrospective study.
abstract: BACKGROUND
  Palliative care unit (PCU) beds are a limited resource in Canada, so PCU admission is restricted to patients with a short prognosis. Anecdotally, PCUs further restrict admission of patients with noncancer diagnoses out of fear that they will "oversurvive" and reduce bed availability. This raises concerns that noncancer patients have unequal access to PCU resources.
  
  
  OBJECTIVE
  To clarify survival duration of patients with a noncancer diagnosis, we conducted a retrospective review of all admissions to four PCUs in Toronto, Canada, over a 1-year period. We measured associations between demographic data, prognosis, Palliative Performance Score (PPS), length of stay (LOS), and waiting time.
  
  
  RESULTS
  We collected data for 1000 patients, of whom 21% had noncancer diagnoses. Noncancer patients were older, with shorter prognoses and lower PPS scores on admission. Noncancer patients had shorter LOS (14 versus 24, p<0.001) than cancer patients and a similar likelihood of being discharged alive to cancer patients. Noncancer patients had a trend to lower LOS across a broad range of demographic, diagnostic, prognostic, and PPS categories. Multivariable analysis showed that LOS was not associated with the diagnosis of cancer (p=0.36).
  
  
  CONCLUSIONS
  Noncancer patients have a shorter LOS than cancer patients and a similar likelihood of being discharged alive from a PCU than cancer patients, and the diagnosis of cancer did not correlate with survival in our study population. Our findings demonstrate that noncancer patients are not "oversurviving," and that referring physicians and PCUs should not reject or restrict noncancer referrals out of concern that these patients are having a detrimental impact on PCU bed availability.
authors.affiliation: University Health Network, Toronto, Ontario, Canada. james.downar@utoronto.ca
authors.forename: James
authors.initials: J
authors.lastname: Downar
authors.forename: Yang-Chieh
authors.initials: YC
authors.lastname: Chou
authors.forename: Doreen
authors.initials: D
authors.lastname: Ouellet
authors.forename: Ignazio
authors.initials: I
authors.lastname: La Delfa
authors.forename: Susan
authors.initials: S
authors.lastname: Blacker
authors.forename: Margaret
authors.initials: M
authors.lastname: Bennett
authors.forename: Catherine
authors.initials: C
authors.lastname: Petch
authors.forename: Siu Mee
authors.initials: SM
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009864:Ontario; D010166:Palliative Care; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D019452:Terminally Ill