Changes In Symptoms And Inpatient Mortality Among Advanced Cancer Patients Admitted To A Palliative Care Unit In A Comprehensive Cancer Center

9065 Background: Accurate prediction of hospital death in advanced cancer patients would allow oncologists and palliative care specialists to share more appropriate care plan with patients and families. Although several symptoms have been shown to predict survival, little is known of the association between changes in symptoms and inpatient mortality. Methods: This is a retrospective study approved by the institutional review board. We reviewed the medical records of 166 consecutive cancer patients admitted to our palliative care unit (PCU) from the emergency center (EC) or clinic from 06/2006 to 12/2007. We recorded symptoms as rated by Edmonton Symptom Assessment Scale and the presence of delirium as determined by Memorial Delirium Assessment Scale both on admission (baseline) and on the 3rd, 4th, or 5th day, whichever appeared first (follow-up). The primary end point was the vital status at discharge. Paired T test was used to test changes in symptoms over time. Univariate (UVA) and multivariate analyses (MVA) were used to estimate the odds of dying in PCU between various patient groups. Results: 134 patients (80.7%) were discharged alive and 32 (19.3%) died in PCU. All symptoms significantly improved at follow-up. In UVA, persistent delirium over time was significantly associated with inpatient mortality (odds ratio [OR] 2.59, 95% confidence interval [CI] 1.09-6.17, p=0.031), though presence of delirium at baseline was not. MVA revealed that greater risk of dying was jointly correlated with a high level of baseline dyspnea (OR 1.35, 95% CI 1.13-1.61, p=0.001), a high level of baseline drowsiness (OR 1.25, 95%CI 1.04-1.50, p=0.02), transfer from the EC (OR 6.78, 95%CI 1.99-23.14, p=0.002) and a decreasing level of baseline anxiety (OR 0.83, 95%CI 0.70-0.99, p=0.038). Worsened depression over time was significantly related with death in UVA (OR 1.30, 95%CI 1.08-1.56, p<0.001), but not in MVA. Conclusions: We observed a significant association of certain factors with increased likelihood of PCU death in advanced cancer patients. Changes in certain symptoms, such as worsened depression and persistent delirium, were suggested as important predictors of inpatient death. No significant financial relationships to disclose.