title: Acute symptomatic complications among patients with advanced cancer admitted to acute palliative care units: A prospective observational study.
abstract: BACKGROUND
  Limited information is available on the symptomatic complications that occur in the last days of life.
  
  
  OBJECTIVE
  We documented the frequency, clinical course, and survival for 25 symptomatic complications among patients admitted to acute palliative care units.
  
  
  METHODS
  Prospective longitudinal observational study.
  
  
  METHODS
  Their attending physician completed a daily structured assessment of symptomatic complications from admission to discharge or death.
  
  
  METHODS
  We enrolled consecutive advanced cancer patients admitted to acute palliative care units at MD Anderson Cancer Center, USA, and Barretos Cancer Hospital, Brazil.
  
  
  RESULTS
  A total of 352 patients were enrolled (MD Anderson Cancer Center = 151, Barretos Cancer Hospital = 201). Delirium, pneumonia, and bowel obstruction were the most common complications, occurring in 43%, 20%, and 16% of patients on admission, and 70%, 46%, and 35% during the entire acute palliative care unit stay, respectively. Symptomatic improvement for delirium (36/246, 15%), pneumonia (52/161, 32%), and bowel obstruction (41/124, 33%) was low. Survival analysis revealed that delirium (p < 0.001), pneumonia (p = 0.003), peritonitis (p = 0.03), metabolic acidosis (p < 0.001), and upper gastrointestinal bleed (p = 0.03) were associated with worse survival. Greater number of symptomatic complications on admission was also associated with poorer survival (p < 0.001).
  
  
  CONCLUSIONS
  Symptomatic complications were common in cancer patients admitted to acute palliative care units, often do not resolve completely, and were associated with a poor prognosis despite active medical management.
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA dhui@mdanderson.org.
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: dos Santos
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Suresh
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Maria Salete de Angelis
authors.initials: MS
authors.lastname: Nascimento
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Donna S
authors.initials: DS
authors.lastname: Zhukovsky
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Paiva
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Shalini
authors.initials: S
authors.lastname: Dalal
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Everaldo Donizeti
authors.initials: ED
authors.lastname: Costa
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Walker
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Heloisa Helena
authors.initials: HH
authors.lastname: Scapulatempo
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Rony
authors.initials: R
authors.lastname: Dev
authors.affiliation: Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Camila Souza
authors.initials: CS
authors.lastname: Crovador
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Maxine
authors.initials: M
authors.lastname: De La Cruz
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000208:Acute Disease / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D003693:Delirium / Q000209:etiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010166:Palliative Care / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000209:etiology; D011446:Prospective Studies; D013781:Texas / Q000453:epidemiology; D055815:Young Adult
keywords: Complications; hemorrhage; infection; intestinal obstruction; morbidity; neoplasms; palliative care