A159: Scope for an acute oncology service in a Scottish district general hospital
1Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK,2Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK,3Borders General Hospital, NHS Borders, Melrose, UK
Improving survival rates, more complex cancer therapies and frailer patients have rendered the management of cancer patients harder for non-specialists. Acute oncology services (AOS), aiming to provide 24-hour access to specialist advice, have been shown to improve patient experience and reduce length of inpatient stay (LOS). The focus of AOS has been on new diagnosis and management of treatment complications. The present study aimed to inform service provision in a district general hospital (DGH) by investigating the circumstances, management and outcomes of cancer patients where the disease itself precipitated admission.
A record was available of all cancer patients admitted to a Scottish DGH for cancer-related symptoms over a 3-month period. All but 5 of these patient records were retrospectively reviewed. Data were analysed using Graphpad software.
63 patients were included. 51% were female; median age was 70 (range 30-80) years. The most common reasons for admission were pain (33%), breathlessness (29%), nausea/vomiting (27%) and fatigue (21%), with symptoms/signs being experienced overall a median of 4.0 (range 0.0-35.0) days pre-admission. Mean LOS was 9.8 days and time from admission to initiating management of the presenting symptom/sign was 6 hours. 10%, 27% and 47% of patients were referred to a cancer nurse specialist (CNS), oncologist and palliative care team respectively, with the mean length of time to review by these respective services being 3.3, 2.7 and 4.2 days. 76% died within 6 months of admission.
These results suggest approximately 1 patient per day will be admitted with complications of cancer, many of whom will have reported these symptoms to primary care in the week preceding admission. An AOS, integrating primary care, oncologists, CNSs and palliative care specialists would benefit cancer patients by (i) optimizing community care, potentially reducing hospital admissions and (ii) focusing inpatient management to reduce LOS.