The role of a palliative care inpatient unit in disease management of cancer and HIV patients.

OBJECTIVES To monitor the success of an inpatient palliative care unit combining private and state patients, and accessible to patients with cancer and AIDS. DESIGN An observational study was conducted of patients admitted to the unit in the first 3 months following opening of the ward (1 March - 31 May 2006). METHODS Data were collected on all patients admitted to the ward to establish patient profiles, duration of stay and outcome of palliative care. RESULTS In the first 3 months 51 patients were admitted. Of these patients, 36 (70%) (1 readmission) had AIDS. All the AIDS patients had stage 4 disease and all but 3 were on antiretroviral (ARV) treatment. The death rate in the initial 3 months was 38% in the cancer group and 33% in the AIDS group. By the end of the 5th month the death rate was 37.5% in the cancer group, and 27% in the AIDS group. The remainder of the patients were discharged. The average duration of stay in the ward was 8.3 days. Among those who died, the average stay was 3.8 days for cancer patients and 8.3 days for AIDS patients. Among the patients who were discharged, the average duration of stay was 7 days for cancer patients and 8.5 days for AIDS patients. CONCLUSIONS The profile of terminally ill patients with cancer and AIDS was initially similar in terms of death rate. In the first 3 months 38% of cancer patients and 33% of AIDS patients died. In the following 2 months the death rate was 33% for cancer patients and 19% for AIDS patients. While the numbers of patients are small and only an indication of trend, the AIDS death rate seems to be dropping. This may be because ARV treatment is being introduced earlier, or because the role of palliative care in the treatment of AIDS patients is gaining recognition and introduction of this form of treatment is having a beneficial effect on outcome. In this hospital it is now accepted that AIDS patients developing symptoms on treatment will benefit from admission to a palliative care ward. This intervention may well improve the outcome in stage 4 AIDS. The duration of stay in the ward is longer for AIDS patients, and it appears that AIDS patients who survive will need a longer stay in the palliative care unit than cancer patients if outcome is to improve.