A Study of the Incidence and Management of Admissions for Cancer-related Symptoms in a District General Hospital: the Potential Role of an Acute Oncology Service.

Objective: The non-specialist management of cancer patients is becoming increasingly complex. Acute oncology services (AOS), aiming to provide rapid access to specialist advice, have been shown to improve patient experience and reduce length of inpatient stay. The present study aimed to inform service provision in a district general hospital (DGH) by investigating cancer patients, not on active anti-cancer treatment, where the disease itself precipitated admission. This is a vulnerable group who are potentially disenfranchised of focused oncological input due to having less robust care pathways established to date.

Methods: A record was available of all cancer patients, not on active anti-cancer treatment, admitted to a Scottish DGH over a 3 month period. All but five of these patient records were retrospectively reviewed.

Results: The study group (n=63) comprised 31 males and 32 females; median age was 70 years (range 30-90). The most common reasons for admission were pain (33%), breathlessness (29%) and nausea/vomiting (27%). Symptoms/signs were experienced a median of 4.0 days (range 0.1-35.0) before admission. The median length of stay was 6 days (range 0-39). Ten, 27 and 46% of patients were referred to a cancer nurse specialist, oncologist and palliative care team, respectively. Seventy-six per cent died within 6 months of admission.

Conclusions: About one patient/day was admitted with cancer complications, many of whom will have contacted primary care in the week preceding admission. An AOS, integrating primary and secondary care, would benefit cancer patients by (i) optimising community care, potentially reducing hospital admissions and (ii) increasing inpatient specialist input to reduce length of inpatient stay. Implementation of an AOS would probably have a significant impact on both cancer patients at an individual level and service provision at a regional and national level.