Needs, symptoms, and outcome of patients with advanced head and neck cancer treated on a palliative care inpatient ward

Introduction: Knowledge about needs and problems of patients (pts) suffering from advanced cancer is increasing substantially within the last years in general, but little is known about the specific needs and symptoms as well as treatment and outcome of pts with advanced head and neck cancer (aHNC) when admitted to a palliative care inpatient ward.
Methods: A total of 97 pts (74% male, 26% female) with aHNC and a median age of 64 years (range, 35 – 90) were admitted to the palliative care inpatient ward at the University Medical Center Hamburg in 2011-2014. Most frequent primary tumor locations were oropharynx 19%, oral cavity 14%, hypopharynx 12%, multiple locations 12%. Distant metastases were present in 65%, 35% suffered from locally advanced disease.
Results: At admission 75% of pts presented with an ECOG performance status of 3 or 4. The most frequent moderate or severe symptoms were weakness in 87% of pts, tiredness 64%, anorexia 60%, pain 52%, exertion 49%, dyspnea 45%, anxiety 38%, and depression 36%. Needs of care were support in daily activities in 81%, organization of further care in 68%, and distressed relatives in 62%. Advance directives and health care proxies were present in only 26% and 28%, respectively. Tracheotomy had to be performed in 40% and in 58% nutrition was applied via a PEG tube.
During inpatient palliative care, 60% of pts received acute pain therapy, treatment of other symptoms 86%, physiotherapy 72%, social care 73%, psychological care 66%, music therapy 52%, pastoral care 48%. Additional palliative radiotherapy was applied to 7%, 16% received blood transfusions, and malignant effusions were drained in 6% of patients.
Median duration of inpatient palliative care was 9 days (range, 1 – 35). A total of 53% of pts died on the palliative care ward and received specialized end-of-life care. Only 18% could be discharged to home care while 29% were admitted to hospice or nursery homes.

Conclusion: In pts with aHNC weakness, tiredness, anorexia, and pain represent the most frequent symptoms. These pts seem to be referred to specialized palliative care rather late. Then they present with several needs of care and psychosocial support. Discharge to home care seems to be possible less frequent than in other tumor entities. These preliminary results will provide a basis to improve assessment and treatment in pts with aHNC.