ABSTRACT
A substantial proportion of cancer patients presenting to an emergency center (EC) or clinic with acute dyspnea survives fewer than 2 weeks. If these patients could be identified at the time of admission, physicians and patients would have additional information on which to base decisions to continue therapy to extend life or to refocus treatment efforts on palliation and/or hospice care alone. The purpose of this study was to identify risk factors for imminent death (survival
Subject(s)
Dyspnea/complications , Neoplasms/complications , Neoplasms/mortality , Acute Disease , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Models, Theoretical , Multivariate Analysis , Prognosis , Retrospective Studies , Risk Factors , Time FactorsABSTRACT
BACKGROUND: Dyspnea is the fourth most common symptom of patients who present to the emergency department (ED) at The University of Texas M. D. Anderson Cancer Center and may, in some patients with advanced cancer, represent a clinical marker for the terminal phase of their disease. This retrospective study describes the clinical characteristics of these patients, the resource utilization associated with the management of dyspnea, and the survival of patients with this symptom. METHODS: The authors randomly selected 122 of 1068 patients presenting with dyspnea for a retrospective analysis. The median age of the patients was 58 years (range, 23-90 years) and 53% were female. Underlying malignancies were breast cancer (30%), lung cancer (37%), and other cancers (34%). Approximately 94% of the patients had received prior cancer treatment and the majority (69%) had uncontrolled, progressive disease. RESULTS: The most common treatments administered in the ED were oxygen (31%), beta-2 agonists (14%), antibiotics (12%), and narcotics (11%). Approximately 60% of patients were admitted to the hospital from the ED for further treatment of dyspnea and the underlying malignancy, and the median length of stay was 9 days. The median overall survival after the ED visit for dyspnea was 12 weeks. Specific diagnoses were associated with different median survival rates: lung cancer patients: 4 weeks; breast cancer patients: 22 weeks (P = 0.0073, vs. lung cancer); and other cancer diagnoses: 27 weeks (P = 0.0027, vs. lung cancer). CONCLUSIONS: Lung cancer patients presenting to the ED with dyspnea have much shorter survival than patients with other malignancies. For some patients, the presence of dyspnea requiring emergency treatment may indicate a phase in their illness in which resources should be shifted from acute intervention with hospitalization to palliative and supportive care measures.
Subject(s)
Dyspnea/etiology , Neoplasms/complications , Adrenergic beta-Agonists/therapeutic use , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Breast Neoplasms/complications , Breast Neoplasms/therapy , Disease Progression , Dyspnea/therapy , Emergency Service, Hospital/statistics & numerical data , Female , Health Resources/statistics & numerical data , Hospitalization , Humans , Length of Stay , Lung Neoplasms/complications , Lung Neoplasms/therapy , Male , Managed Care Programs , Middle Aged , Narcotics/therapeutic use , Neoplasms/therapy , Oxygen Inhalation Therapy , Palliative Care , Retrospective Studies , Survival Rate , Terminally IllABSTRACT
Septic shock is currently the most common cause of death in noncoronary intensive care units in the United States. The pathogenesis of sepsis involves a variety of cytokine and noncytokine mediators, which, when activated, can result in a self-perpetuating cascade. This systemic response to infection is a frequent cause of multi-organ system failure and death. Treatment has traditionally focused on antibiotic therapy, but this has not significantly changed patient outcomes. Steroids have been shown to be of little or no value and studies evaluating monoclonal antibodies that target the mediators of the sepsis cascade have not produced promising results.
