Patients with incurable malignancy represent a diverse cohort whose clinical status can change rapidly. Acute hospital admissions are common but may be avoidable. Inpatient beds are a precious resource hence minimising avoidable admissions is imperative. As a first step, we need to better understand patient, disease and treatment factors impacting admissions.
We audited the electronic medical records of patients with advanced solid tumours from January, 2015. Clinical and demographic details, route and reason for admission, length of stay, referral to palliative care, frequency of readmission and the date / place of subsequent death were collected.
Forty consecutive patient charts with advanced cancer were reviewed. Most common primary tumour sites were colorectal (24%); other gastrointestinal (16%) and gynaecologic (25%). The majority were admitted via emergency department. Admission was under 1 week in 63%. Reasons for admission were symptoms related to disease progression (45%), uncontrolled pain (15%), chemotherapy toxicity (13%) and infection (10%). 50% were known to palliative care. During admission, no patient required the medical emergency response team.50% had no documented acute resuscitation plan. Nineteen (48%) were seen in outpatients within the prior week and 15 (38%) had received chemotherapy within 2 weeks.
Our review demonstrated that most admissions were due to symptoms related to progression of their cancer. Chemotherapy toxicity was an infrequent cause of admission. A significant proportion were not known to palliative care and/or had been recently seen in outpatient clinic. This suggests some admissions might have been avoidable. We plan to explore this issue further.