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                                                Table 1

                                   Patient Characteristics

 

 

Total Number of Patients                                              102 (100%)

Not coping at home                                                        49 (48%)

Documented Requests for Euthanasia                               none listed

Males : Females                                                            50 (49%) : 52 (51%)

Mean Age(SD) years                                                   72.3 (11.1) : 73.1 (13.2)

Range Age years                                                         (42.8-89.6 : 31.6-96.2)

Admission Diagnosis Malignant:                                    94 (92.2%)

Admission Diagnosis Non-Malignant                               8 (7.8%)

Overall Mean (SD) Days Survival                                   30 (60.9) range (<1-376)days

Median Days Survival Males:Females                                       6.5:18*

Digestive Cancer                                                            28 (27.5%) (19.1 – 37.2%)95% CI

Genitourinary Cancer                                                     16 (15.7%) (9.20 – 24.2%)

Lung Cancer                                                                   20 (19.6%) (12.4 – 28.6%)

Hematological Malignancies                                             7(6.80%) (2.80 – 13.6%)

Skin Cancer                                                                      6(5.90%) (2.20 – 12.4%)

Brain Cancer                                                                    5(4.90%) (1.60 – 11.1%)

Carcinoma Unknown Primary Site                                   5(4.90%) (1.60 – 11.1%)

Breast Cancer                                                                   4(3.90%) (1.10 – 9.70%)

Mesothelioma Pleura                                                        3 (2.90%) (0.60 – 8.40%)

Non Malignant Disease                                                     8 (7.80%) (3.50 – 14.9%)

Family Support                                                                          57 (55.9%)

Primary Carer                                                                            66 (64.7%)

Family Conflict                                                                         10 (9.80%)

Died Comfortably                                                                      65 (63.7%)

Patients with Diagnostic Interventions                                      41 (40.2%)

Patients with Therapeutic Interventions                                    68 (66.7%)

Patient survival <7days                                                              40 (39.2%)

Patient survival =14 days                                                           15 (14.7%)

Patient survival >14 days                                                           47 (46.1%)

 

* P<0.05 by Kruskal-Wallis test of difference of median survival between groups

 


Table 2

Documented Symptom Frequency on Admission in 102 Patients

and

Median Survival According to Symptoms

 

 

Symptoms on Admission

Prevalence y

N

95%CI

Median Survival Days

n

Pain 

-severe 

-moderate 

-no pain 

19 (18.6%)

64 (62.8%)

19 (18.6%)

11.6-27.6%

57.7-76.6%

11.6-27.6%

6.0

13.5

15.0

Mobility

-impaired*

-moderate

-good

83 (81.4%)

14 (13.7%)

5 (4.90%)

72.5-88.4%

7.70-21.9%

1.60-11.1%

10.0

20.5

16.0

Weakness/Asthenia

62 (60.8%)

50.6-70.3%

10.0

Loss of Appetite

43 (42.2%)

32.4-52.3%

8.0

Confusion

42 (41.2%)

31.5-51.4%

8.0

Nausea and/or Vomiting 

27 (26.5%)

18.2-36.1%

6.5

Dyspnea

24 (23.5%)

15.7-33.0%

5.0

Anxiety (19)/Depression(3)

22 (21.6%)

14.0-30.8%

17.0

Urinary/Fecal Incontinence^

12 (11.8%)

6.2-19.6%

11.0

Cough

11 (10.8%)

5.5-18.5%

15.0

Constipation

10 (9.80%)

4.8-17.3%

16.0

Melena

4 (3.90%)

1.1-9.7%

5.5

Hematemesis

3 (2.90%)

0.0-8.4%

7.0

Apnea

2 (1.90%)

0.0-6.9%

3.5

 

YSymptom prevalence at time of admission.

*Composed of patients that were completely immobile (14) and poorly ambulant (69)

- impaired mobility or immobility were defined as requiring nurse assistance in addition to 

the use ofwalking sticks, wheel chair - frames etc as compared tomobility 

[defined by an ECOG score of3 or 4]

symbol 94 \f "Symbol" \s 10^urinary (10) fecal (1) double (1)


Table 3

Diagnostic and Therapeutic Interventions in 102 Admissions

 

Interventionssymbol 116 \f "Symbol" \s 12t

N (%)

Patients

Median Survival

Days

N (%)

Deceased

Within 7 Days

Diagnosticsymbol 166 \f "Symbol" \s 12¦ (total 41 patients)

-Standard Diagnosticst

-ESAS

-Pain Numeric Scale

41 (40.2)

15 (14.7)

1(1)

26*

27*

5 (12.2)

1 (6.70)

Therapeutic¦¦(total 80 patients)

-Clinicalsymbol 166 \f "Symbol" \s 12¦symbol 166 \f "Symbol" \s 12¦interventions

0 (none)

= 1

> 1 (2-4)

overall

-Specialist Medical Consultationssymbol 89 \f "Symbol" \s 12Y

-Allied Health Interventionssymbol 209 \f "Symbol" \s 12Ń

-Psychosocial Interventionssymbol 94 \f "Symbol" \s 12^

37

40

25

65 (63.7)

5(4.90)

15 (14.7)

53 (51.9)

11

10.5

20*

          14

          17

21*

          17

17 (45.9)

19 (47.5)

6 (24.0)

26 (40.0)

1 (20.0)

4 (26.7)

14 (33.3)

 

 

 

 

 

*P<0.05 by Kruskal-Wallis test of the difference in median survival between groups.

symbol 116 \f "Symbol" \s 10tsymbol 166 \f "Symbol" \s 11symbol 166 \f "Symbol" \s 11symbol 166 \f "Symbol" \s 11 fluid therapy (49) oxygen therapy (38) antibiotics (35) blood transfusion (6) abdominal 

paracentesis (2) urinary catheters (4) anti tumor therapy (3) hypercalcemia–pamidronate

(2) manual disimpaction constipation (1) naso-gastric intubation (1)

Y consisting of: anaesthetic(2) neuro-surgical(1) oncological(1) psychiatric(1)

Ńphysical therapy (10) occupational therapy (5)

^ pastoral care(38) social work(9) other music therapy (6)

                                                      


Table 4

Symptoms on Admission and Risk of Death in

Terminally Ill Patients

 

 

Variable

Univariate

Hazard Ratio

Multivariate

Hazard Ratio

95% CI

Demographic and Social Characteristics:

Age

1.00

1.00

1.00-1.00

Males*^

1.20*

1.18

0.69-1.99

Primary Carer

1.16

1.25

0.73-2.15

Family Support*^

0.70

0.72

0.42-1.23

Symptoms and Signs on Admission:

Pain

1.27

1.52*

1.04-2.27

Dyspnea*^

1.98*

2.32*

1.33-4.00

Mobility*^

1.02

0.78*

0.60-0.99

Nausea and Vomiting

1.26

1.20

0.66-2.20

Weakness

1.03

1.21

0.71-2.06

Confusion

1.22

1.36

0.82-2.25

Loss of Appetite

1.28

1.12

0.65-1.94

Anxiety/Depression

0.97

0.95

0.83-1.09

Adjusted Charlson Score*^

1.11*

1.09*

1.01-1.17

Diagnostic and Therapeutic Interventions:

Diagnostic Interventions**^

0.37**

0.36**

0.22-0.58

Therapeutic Interventions

1.26

1.22

0.76-1.93

De Novo symptoms*^

0.75

0.74

0.48-1.14

Metastatic Disease *^2.050.800.20-3.80

 

This table presents the univariate and multivariate Cox proportional hazard ratios with its 95% confidence intervals for death for the regression model.Hazard ratios greater than 1 imply a higher risk of death and hence a shorter survival.

^ The Kruskal-Wallis test was used to compare median differences in survival between groups. For variables that were dichotomous patients with the characteristics were compared to those without it.Refer further to the appropriate tables for dichotomous outcome numbers.

Multivariate hazard ratios showed that patient survival was increased with diagnostic interventions (P<0.001), employing the ESAS symptom assessment schedule (P<0.05)

Levels of Significance: * P<.05** P<.001

 





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