Palliative care services are bieng provided to advanced cancer patients, and have traditionally included symptom directed therapy, counselling regarding goals of care and discussions centered around aggressiveness of care. An early palliative mliaison is bieng offered to patients with recently diagnosed tumours, but the ambit, purview and scope of these services has remained essentially unchanged.
Details of 127 patients admitted to the ward between over the course of three months were recorded and analysed.
Analgesic titration (54 percent), interventional pain management (15 percent) and provision of supportive care services (23 percent) were the most common indications for admission. 44/123 patients (35.7 percent) received services which can be considered to be within the purview of supportive care. Bisphosphonate infusion for prevention of skeletal related events (12), pigtail catheter insertion for malignant pleural effusion (4), ultrasound guided therapeutic paracentesis (5), octreotide infusion for symptom control in neuroendocrine tumours and malignant bowel obstruction (3), management of difficult to control symptoms including dyspnoea and pain, malignant bowel obstruction (2), chemotherapy related complications (including febrile neutropenia, mucositis and diarrhea) were among services provided upon inpatient admission. 3 patients recieved chemotherapy. 13/127 recieved consultation liasion during their stay in the ward. Medical oncology liaison was the most commonly sought. The most commonly prescribed opioid was morphine followed by fentanyl and tramadol. Average duration of stay was 1.2 days with the longest admission lasting 5 days. The duration of stay was significantly longer for those who also recieved supportive care (p<0.01). Morphine equivalent daily dose, number of medications prescribed and Eastern cooperative oncology group performance status did not have any effect on the duration of stay.
The nature of services provided under the purview of this model, has the potential to ignite a larger debate on the impending and urgent need to redefine the scope of conventional Palliation.
Rahul D. Arora.
Has not received any funding.
The author has declared no conflicts of interest.