# Comprehensive Palliative Care in Patients with Lung Cancer Admitted to an Acute Palliative Care Unit

## TL;DR

Lung cancer patients in palliative care units experience significant symptom relief and often transition to more appropriate care settings.

## Contribution

The study demonstrates the effectiveness of acute palliative care units in managing symptoms and guiding care decisions for lung cancer patients.

## Key findings

- Lung cancer patients showed significant symptom improvement after acute palliative care.
- Breathlessness remained more severe in lung cancer patients compared to others.
- Many patients transitioned to palliative-focused care after treatment.

## Abstract

People with advanced lung cancer often experience severe symptoms, especially breathlessness and pain, and may be admitted to hospital when problems become difficult to manage. Specialized acute palliative care units can provide intensive symptom control and help patients and clinicians make clearer decisions about whether cancer treatments should continue or be stopped. In this study, we examined lung cancer patients admitted to an acute palliative care unit and compared them with a similar group of patients with other cancers. We measured symptoms at admission and at discharge and recorded where patients went next (home, home palliative care, hospice, or another hospital unit) and whether anticancer treatment was continued. Symptoms improved substantially by discharge, although breathlessness remained more prominent in lung cancer. Many patients were discharged with a shift towards palliative-focused care. These findings support the role of acute palliative care units in improving symptom relief and guiding appropriate care pathways.

Background/Objectives: The primary objective of this study was to assess the symptom profile and changes observed at discharge of lung cancer (LC) patients following comprehensive palliative care. The secondary objective was to evaluate potential differences between LCr patients and those with other cancer (OC) diagnoses. Methods: A consecutive sample of LC patients admitted to the acute palliative care unit (APCU) was prospectively assessed and compared with a random sample of patients with OC. All patients underwent comprehensive palliative care treatment. Demographic data, Karnofsky, referral sources, recent oncological treatments, and patient status at admission and discharge (on-treatment, off-treatment, or uncertain) were collected. At admission (T0) and at the time of discharge (TX), symptom burden was assessed using the Edmonton Symptom Assessment Scale (ESAS). Lastly, there was subsequent referral to next care settings (discharge home, home palliative care, hospice, other units). Results: A total of 159 patients with LC were compared with a similar sample of OC. In all patients a significant decrease in the number of “on therapy” patients were reported at discharge, and concomitantly the number of “off-therapy” patients increased (p < 0.0005) in comparison with the data recorded at admission. Dyspnea intensity was higher in group LC at T0 and TX (p < 0.0005), as well as pain intensity, which was significant at TX (p < 0.0005). A statistical difference in MDAS was also observed at TX (p = 0.034). LC patients had a lower overall survival (p = 0.034). Conclusions: Comprehensive palliative care in APCU provided relevant changes in symptom burden, with the potential to prevent inappropriate admissions to other hospital units and to reduce costs associated with non-specialist interventions.