Chapter 3 52 ABSTRACT Purpose Patients with advanced cancer commonly visit the Emergency department (ED) during the last three months of life. Identification of these patients and their palliative care needs helps initiating appropriate care according to patients’ wishes. Our objective was to provide insight into ED visits of advanced cancer patients at the end of life. Methods Adult palliative patients with solid tumours who died <3 months after their ED-visit were included (2011-2014). Patients, ED-visits, and follow-up were described. Factors associated with approaching death were assessed using Cox proportional hazards models. Results 420 patients were included, 54.5% was male, median age 63 years. 54.6% was on systemic anti-cancer treatments and 10.5% received home care ≥1 per day. ED-visits were initiated by patients and family in 34.0% and 51.9% occurred during out-of-office hours. Dyspnoea (21.0%) or pain (18.6%) were most reported symptoms. Before the ED-visit, limitations on life-sustaining treatments were discussed in 33.8%, during or after the ED-visit in 70.7%. Median stay at the ED was 3:29h (range 00:12-18:01h), 319 (76.0%) were hospitalized. Median survival was 18 days (IQ-range 7-41). 104 (24.8%) died within 7 days after the EDvisit, of which 71.2% in-hospital. Factors associated with approaching death were lung cancer, neurologic deterioration, dyspnoea, hypercalcemia, and jaundice. Conclusion ED-visits of advanced cancer patients often lead to hospitalization and in-hospital deaths. Timely recognition of patients with limited life expectancies and urgent palliative care needs, and awareness among ED-staff of the potential of ED-initiated palliative care may improve the end-of-life trajectory of these patients.
RkJQdWJsaXNoZXIy MTk4NDMw