Structure, organisation and clinical outcomes in cancer patients of hospital support teams in Spain
- Albert Tuca-Rodriguez1,
- Xavier Gómez-Batiste2,3,
- Jose Espinosa-Rojas2,3,
- Marisa Martínez-Muñoz2,3,
- Nuria Codorniu4 and
- Josep Porta-Sales4
- 1Supportive and Palliative Care Unit, Cancer and Hematologic Diseases Institute, Hospital Clínic Barcelona, Barcelona University, Barcelona, Spain
- 2WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
- 3Chair of Palliative Care Department, Universitat de Vic, Barcelona, Spain
- 4Palliative Care Service, Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
- Correspondence to Dr Albert Tuca, Supportive and Palliative Care Unit, Cancer and Hematologic Diseases Institute, Hospital Clínic de Barcelona, Barcelona University, c/Villarroel 170, Barcelona 08036, Spain;
Objectives To describe the structure, characteristics of patients and basic clinical outcomes in cancer patients receiving care from palliative care hospital support teams (HSTs) in Spain.
Method A multi-centre observational two phase study. Phase I: A descriptive survey of all HSTs in Spain. Phase II: A quasi-experimental prospective cohort study to describe the clinical outcomes, symptom severity and survival.
Results 60 HSTs in Spain met the inclusion criteria. All HSTs were multidisciplinary with wide experience (mean 6.8 years). HSTs coverage was 21.5% of all cancer deaths in Spain. A total number of 364 advanced cancer patients were included in the cohort study; 76% were classified as moderate or high complexity. Overall, 64% were male subjects and the most frequent primary cancer site was lung (26%). Half of the patients had no detailed information about cancer staging and only 19% knew their short-term prognosis. The mean length of intervention was 6.5 days (mean three visits per patient). Outcomes were: 34% deaths during the admission process; 38% were discharged home; and 28% were transferred to another medium-term-stay specialist unit. The main symptoms were pain (68%), dyspnoea (43%), vomiting (24%), anorexia (72%), asthenia (78%), insomnia (50%), anxiety (45%) and depression (35%). After the HSTs intervention, the symptom severity was significantly reduced (p<0.001) for all symptoms, except for weakness and anorexia. The mean survival from inclusion was 111 days.
Conclusions Palliative intervention of HSTs is characterised by being adjusted to patient needs and short duration. Their care was focused on the preterminal phase of cancer patients of moderate–high complexity.
- Received 24 August 2011.
- Accepted 16 August 2012.
- Published Online First 15 October 2012
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions