Causes of Admission to A Palliative Care Inpatient Unit in An Egyptian Cancer Center
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- Category: Vol. 78, December 2010
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Causes of Admission to A Palliative Care Inpatient Unit in An Egyptian Cancer Center,KHALED M. GALAL, SALAH EL-MESIDY, EMAN ALI and SAMY AL-SIRAFY
Abstract
Introduction: During this early stage of development of palliative care (PC) in Egypt, research is warranted to identify PC needs of advanced cancer patients and to develop suitable PC models. One of the PC models is the hospital-based inpatient palliative care unit (HB-IPCU). This report describes causes of admission to a new HB-IPCU in an Egyptian cancer center.
Methods: We retrospectively reviewed 70 admissions related to 61 advanced cancer patients admitted to HB-IPCU from June, 2009 to end of January, 2010. Primary end point was determination of main causes of hospital admissions for palliative care, while secondary end points were the principal lines of palliative treatment and average length of hospital stay.
Results: Median age was 50 years (range, 27-76 years). Female admissions constituted 66% of all admissions. Average period from date of first presentation to PC unit till admission was 28 days (range, 0-90 days). Average length of stay was 6 days (range, 1-22 days). Median number of problems listed upon admission was three (range, 1-5). Uncontrolled pain, vomiting, dehydration, fever were the most common problems and constituted 66%, 31%, 23% and 23% respectively. Other problems included severe anaemia, constipation, respiratory distress, venous thrombo-embolism, bleeding, electrolytes disturbances, and renal impairment. In 74% of admissions, opioids were used to control pain. Other lines of treatment included infection management, blood transfusion, anticoag-ulation and parenteral hydration.
Conclusion: Pain was the main cause of admission to HB-IPCU in our setting. In Egypt, many barriers exist to cancer pain control including immediate release morphine unavailability and restrictive regulations. An immediate action is needed to overcome these barriers. Many of the listed problems could be managed at home to avoid unnecessary hospitalization. Our results provide provisional guidance for future PC development in our center and similar settings in Egypt.