title: Characteristics, treatment and prognostic factors of patients with gynaecological malignancies treated in a palliative care unit at a university hospital.
abstract: BACKGROUND
  Limited clinical data have been published on patients suffering from advanced gynaecological malignancies treated in palliative care units, and little is known about prognostic factors.
  
  
  METHODS
  In a retrospective study, the data of 225 patients with breast, ovarian and cervical cancer treated in the palliative care unit of a university hospital between 1998 and 2009 were assembled. Clinical aspects and baseline symptoms, laboratory parameters, the clinical course, and outcome were evaluated.
  
  
  RESULTS
  225 patients (497 cases; cancer diagnoses: breast 79%, ovarian 13%, and cervix 8%) were included in the analysis. The main symptoms were weakness/fatigue (71%), pain (65%), anorexia/nausea (62%), and dyspnea (46%). Pain control was achieved in 85% of all cases, satisfying control of other symptoms in 80%. The median overall survival (OS) was 59 days. 53% of the patients died at the palliative care unit. In the Cox proportional hazards model, 8 parameters indicated an unfavourable outcome: anorexia/nausea, disordered mental status, elevated lactate dehydrogenase, γ-glutamyltransferase, leukocyte count, hypoalbuminaemia, anaemia and hypercalcaemia. Based on these parameters 3 risk groups were defined: low risk (0-2 factors), intermediate risk (3-5 factors), and high risk (6-8 factors). Median survival for high-risk group was 13 days, for intermediate group 61 days, and for low-risk patients 554 days (p < 0.0001).
  
  
  CONCLUSIONS
  Weakness/fatigue, pain and anorexia were the main symptoms leading to the hospitalisation of patients with gynaecological malignancies. Symptom and pain control was accomplished in 80% of cases. 8 parameters were identified as indicating a poor outcome, and patients showing at least 6 or more of these factors had a very limited prognosis. Although studied retrospectively, these results may be helpful for individual treatment decisions in patients with advanced gynaecological malignancies. Prospective data and the introduction of documentation systems could help to gain more powerful knowledge about the quality of palliative care.
authors.affiliation: III. Medizinische Klinik, Hämatologie und Onkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Germany.
authors.forename: Samantha
authors.initials: S
authors.lastname: Aeckerle
authors.forename: Marina
authors.initials: M
authors.lastname: Moor
authors.forename: Lothar R
authors.initials: LR
authors.lastname: Pilz
authors.forename: Deniz
authors.initials: D
authors.lastname: Gencer
authors.forename: Ralf-Dieter
authors.initials: RD
authors.lastname: Hofheinz
authors.forename: Wolf-Karsten
authors.initials: WK
authors.lastname: Hofmann
authors.forename: Dieter
authors.initials: D
authors.lastname: Buchheidt
mesh_terms: D000368:Aged; D015984:Causality; D015897:Comorbidity; D005260:Female; D005833:Genital Neoplasms, Female / Q000401:mortality* / Q000451:nursing*; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D010146:Pain / Q000401:mortality* / Q000451:nursing*; D010166:Palliative Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome