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126 Lung cancer hospital admissions … Why are our patients dying in hospital?
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Poster abstracts, 12th Annual British Thoracic Oncology Group Conference, 2014: Other
Other 126 Lung cancer hospital admissions . . . Why are our patients dying in hospital? R. Williams *, H.E. Davies. University Hospital Llandough, Cardiff, UK Introduction: It was a local observation that “a lot of lung cancer patients die in hospital”. Evidence suggests patients’ preferred place of death is their home. This work explored why lung cancer patients are dying in hospital. Methods: We identified all lung cancer patients who died between April 2011 and April 2012. Demographic, lung cancer and admission data were collected. A subset analysis of patients’ final admission details was performed. Results: The most common reason for admission was breathlessness (60%). Total patient deaths from lung cancer in this period were 251 [n = 102 in-hospital deaths (41%)]. 67% of patients deteriorated too rapidly or were too unstable for transfer home. • Average age: 72.9 y • 58% had stage IV disease at time of diagnosis • 50% died within 3 months of diagnosis • The average length of stay was 14.8 days • Causes of death: see the figure.
Results: N = 51 (34 male) was 50% of all lung cancer diagnoses. Average (range) age 71 (50 90) years and length of stay 13.5 (1 40) days. 5 patients had stage 1, all incidental, 3 had Performance Status (PS) 3 4. 30/46 with stage 3 4 had PS 3 4. Patients with stage 3b 4 presented with symptoms relating directly to cancer (Table 1). 7/51 died during first admission, all stage 4. Thirty-day mortality was 10% and 3-month mortality was 55%. 9/24 deaths post-discharge occurred during readmission which was more likely if patient lived alone. 34% required inpatient diagnostic investigation, 9 received inpatient treatment (5 radiotherapy; 3 chemotherapy). 12 attended ED, 12 were seen in outpatients and 4 had a normal CXR in the preceding year. Conclusion: A significant proportion of new diagnoses were made during acute admissions. The majority had advanced disease and poor performance status requiring protracted stay and significant inpatient resources. Over half the group were dead at 3 months. Approximately half the group had contact with secondary care outpatient services in the prior 12 months, the majority for nonrespiratory reviews. Whilst emphasis should continue to be on early detection of lung cancer, significant resources need to be allocated to streamlining inpatient lung cancer services, including palliative care and early supported discharge. Additionally, screening high risk patients during non-respiratory attendances to hospital merits further exploration. Table 1. Presenting symptoms in patients admitted as an acute admission and diagnosed with lung cancer Stage 4 N = 36
Figure: Cause of death as stated in section 1A of the death certificate.
Conclusion: Whilst evidence suggests most lung cancer patients would prefer to die at home, 41% of our cohort died in hospital. The main symptoms prompting admission (breathlessness and general deteriorated) can be anticipated in patients with advanced lung cancer and should trigger early discussion about end of life care wishes. This may activate timely escalation of care provisions allowing patients to stay in their own home. If patients with lung cancer are admitted, discharge aims need to be assessed at the outset. However, it is important to recognise that not all patients wish to die at home and other options should be made available. 127 Identifying characteristics of patients diagnosed with lung cancer during emergency admission to hospital L.D. Calvert *, S. Chatterji, I. Allingham. Peterborough City Hospital NHS Foundation Trust, UK Introduction: Despite national cancer awareness campaigns and initiatives such as rapid access clinics, a high number of new lung cancer diagnoses are made during emergency admission to hospital. Identifying features common to this group of patients may be useful in targeting future interventions. Method: Retrospective case-note review of emergency admissions with a new diagnosis of lung cancer (excluding mesothelioma) January-June 2013. Patient demographics, diagnostic pathways, stage, performance status, survival and previous hospital contact were noted.
Pleural effusion Haemoptysis SCVO Chest pain SOB, weight loss, deterioration Hyponatraemia Persisting pneumonia Brain metastases Bone/spinal metastases Incidental
5 3 1 7 1 2 7 7 3
Stage 3b N=5
1 1 1 1 1
Stage 3a N=5
Stage 1 N=5
1 2 1
1
5
128 The impact of the Acute Oncology Service (AOS) on emergency admissions of lung cancer patients to a West Midlands hospital K. Herring *, S. Mansukhani, J. Thompson. Dept. Oncology, Heartlands Hospital, Birmingham, UK Introduction: Lung cancer continues to generate the highest number of cancer emergency bed days per year. The AOS focuses on the prompt management of patients admitted because of symptoms caused by cancer, or its treatment. Identifying those in-patients with problems directly related to their cancer, or treatment, is key to improving patient services, minimising length of hospital stay (LOS) and avoiding delays in ongoing cancer management. Method: The 50 most recent lung cancer patients reviewed by the AOS were identified. Relevant data was extracted from computerised patient records and outcomes compared to data collected prior to initiation of the AOS. Results: The median age of patients was 66 years. 36% of patients were referred through Oncology triage, 50% attended A&E, the remainder were referred by GP’s. 16% of admissions were the result of medical/surgical problems unrelated to their cancers. Of those admissions related to cancer, 28% were due to complications of treatment, 20% were due to disease progression and 36% were
Poster abstracts, 12th Annual British Thoracic Oncology Group Conference, 2014: Other
Other 126 Lung cancer hospital admissions . . . Why are our patients dying in hospital? R. Williams *, H.E. Davies. University Hospital Llandough, Cardiff, UK Introduction: It was a local observation that “a lot of lung cancer patients die in hospital”. Evidence suggests patients’ preferred place of death is their home. This work explored why lung cancer patients are dying in hospital. Methods: We identified all lung cancer patients who died between April 2011 and April 2012. Demographic, lung cancer and admission data were collected. A subset analysis of patients’ final admission details was performed. Results: The most common reason for admission was breathlessness (60%). Total patient deaths from lung cancer in this period were 251 [n = 102 in-hospital deaths (41%)]. 67% of patients deteriorated too rapidly or were too unstable for transfer home. • Average age: 72.9 y • 58% had stage IV disease at time of diagnosis • 50% died within 3 months of diagnosis • The average length of stay was 14.8 days • Causes of death: see the figure.
Results: N = 51 (34 male) was 50% of all lung cancer diagnoses. Average (range) age 71 (50 90) years and length of stay 13.5 (1 40) days. 5 patients had stage 1, all incidental, 3 had Performance Status (PS) 3 4. 30/46 with stage 3 4 had PS 3 4. Patients with stage 3b 4 presented with symptoms relating directly to cancer (Table 1). 7/51 died during first admission, all stage 4. Thirty-day mortality was 10% and 3-month mortality was 55%. 9/24 deaths post-discharge occurred during readmission which was more likely if patient lived alone. 34% required inpatient diagnostic investigation, 9 received inpatient treatment (5 radiotherapy; 3 chemotherapy). 12 attended ED, 12 were seen in outpatients and 4 had a normal CXR in the preceding year. Conclusion: A significant proportion of new diagnoses were made during acute admissions. The majority had advanced disease and poor performance status requiring protracted stay and significant inpatient resources. Over half the group were dead at 3 months. Approximately half the group had contact with secondary care outpatient services in the prior 12 months, the majority for nonrespiratory reviews. Whilst emphasis should continue to be on early detection of lung cancer, significant resources need to be allocated to streamlining inpatient lung cancer services, including palliative care and early supported discharge. Additionally, screening high risk patients during non-respiratory attendances to hospital merits further exploration. Table 1. Presenting symptoms in patients admitted as an acute admission and diagnosed with lung cancer Stage 4 N = 36
Figure: Cause of death as stated in section 1A of the death certificate.
Conclusion: Whilst evidence suggests most lung cancer patients would prefer to die at home, 41% of our cohort died in hospital. The main symptoms prompting admission (breathlessness and general deteriorated) can be anticipated in patients with advanced lung cancer and should trigger early discussion about end of life care wishes. This may activate timely escalation of care provisions allowing patients to stay in their own home. If patients with lung cancer are admitted, discharge aims need to be assessed at the outset. However, it is important to recognise that not all patients wish to die at home and other options should be made available. 127 Identifying characteristics of patients diagnosed with lung cancer during emergency admission to hospital L.D. Calvert *, S. Chatterji, I. Allingham. Peterborough City Hospital NHS Foundation Trust, UK Introduction: Despite national cancer awareness campaigns and initiatives such as rapid access clinics, a high number of new lung cancer diagnoses are made during emergency admission to hospital. Identifying features common to this group of patients may be useful in targeting future interventions. Method: Retrospective case-note review of emergency admissions with a new diagnosis of lung cancer (excluding mesothelioma) January-June 2013. Patient demographics, diagnostic pathways, stage, performance status, survival and previous hospital contact were noted.
Pleural effusion Haemoptysis SCVO Chest pain SOB, weight loss, deterioration Hyponatraemia Persisting pneumonia Brain metastases Bone/spinal metastases Incidental
5 3 1 7 1 2 7 7 3
Stage 3b N=5
1 1 1 1 1
Stage 3a N=5
Stage 1 N=5
1 2 1
1
5
128 The impact of the Acute Oncology Service (AOS) on emergency admissions of lung cancer patients to a West Midlands hospital K. Herring *, S. Mansukhani, J. Thompson. Dept. Oncology, Heartlands Hospital, Birmingham, UK Introduction: Lung cancer continues to generate the highest number of cancer emergency bed days per year. The AOS focuses on the prompt management of patients admitted because of symptoms caused by cancer, or its treatment. Identifying those in-patients with problems directly related to their cancer, or treatment, is key to improving patient services, minimising length of hospital stay (LOS) and avoiding delays in ongoing cancer management. Method: The 50 most recent lung cancer patients reviewed by the AOS were identified. Relevant data was extracted from computerised patient records and outcomes compared to data collected prior to initiation of the AOS. Results: The median age of patients was 66 years. 36% of patients were referred through Oncology triage, 50% attended A&E, the remainder were referred by GP’s. 16% of admissions were the result of medical/surgical problems unrelated to their cancers. Of those admissions related to cancer, 28% were due to complications of treatment, 20% were due to disease progression and 36% were