Treatable complications of cancer patients referred to an in-patient hospice

This paper illustrates the importance of accurate diagnoses and treatments of complications in terminally ill cancer patients. The paper reports on five hospice in-patients who completely recovered from life-threatening complications; three of them had been incorrectly labeled as “imminently dying” by the referring physicians.

The paper concludes that it would be beneficial for patients to receive examinations and a trial of medical treatment in their continuing treatment settings.

Demographic, symptom, and medication profiles of cancer patients seen by a palliative care consult team in a tertiary referral hospital

In this retrospective study, the charts of 100 consecutive cancer patients who had been referred to a palliative care consult team within a tertiary acute care hospital were reviewed. Demographic characteristics, including reason for admission and disease status upon admission, length of stay, and discharge and admission location, were recorded. Symptom acuity, cognitive status, and risk for substance abuse were evaluated. Medications before and after the consult were tabulated and compared to recommended medications; compliance with the recommendations was assessed. Five patients were not palliative at the time of the consult. Only 46/95 (48%) were known to have untreatable cancer at the time of their admission. The CAGE questionnaire for alcoholism and the Mini-Mental State Questionnaire (MMSQ) were abnormal in 19/78 (24%) and 40/91 (44%), respectively. The most intense symptoms, as measured by the 100-mm scales of the Edmonton Symptom Assessment Scale (ESAS) were fatigue (72 +/- 24), appetite (60 +/- 32), and well-being (50 +/- 29). Eighty-nine of the 95 patients were living at home prior to admission and 34/95 were able to return home. Twenty died during hospitalization, 23 were transferred to a palliative care unit, and the remaining 18 were discharged to another hospital or long-term care. The patient's physician complied with the palliative care consult team's recommendation in 122/137 cases (89%).

Is a "palliative" patient always a palliative patient? Two case studies

Review of the literature suggests that misdiagnosis of terminal illness is infrequent. In the first 6 months of the recently established Edmonton Regional Palliative Care Program, two of 330 referrals proved to be in the category of erroneous diagnosis of terminal disease. These two cases are reported, along with discussion of aspects of the time-honored usefulness of careful history and physical examination. This experience highlights the importance of assessment, investigation, and aggressive therapy, even in "terminal" patients, including those in the geriatric population.