Clinical and health care setting of patients admitted at Pain Control Center Hospice of Solofra: A feasibility model of end-of-life care in the Avellino province of Italy

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Background: The Pain Control Center Hospice of Solofra (Italy) is managed with a mixed public / private, the first experience in the Campania region.We have evaluated the treatment procedures and the clinical outcome to make a comparison by between 123 evaluable patients in palliative care in 2015 and 232 evaluable patients in the biennium 2012-2014. Methods: The following characteristics: patient gender, mean hospitalization time, differentiation between cancer and non cancer patients, medical weapon use, venous access type, enteral and parenteral feeding, pain killer use,Karnofsky scale. Results: the average age is nearly overlapping being 70.5 yr vs 70.69 yr; average length of stay in hospice 24.33 days vs. 27.52 days; 79.67% had cancer vs 73.70%, while the non-cancer 20.32% vs 26.30%; 55.26% died in hospice vs 71.98%, while 44.7% were discharged home vs 24.56%; the performance status according to Karnofsky scale before admission to hospice 23.1% had index rating (%)- 50, 10.56 -40, 52.03%-30, 35.7%-20, 23.1%-10. 8.9% had ostomy vs 13.79%; 4.4% were carriers of PEG vs 6.3%; the central venous access already implanted at admission in 32.52% vs 26.72%; enteral feeding was administered in 23.7% vs 13.79% and parenteral feeding in 52.84% vs 46.98%; analgesic therapy with more opiates was already present on admission in 48.78% vs 40.94% with prevalence of trans TD formulations. Analgesic therapy was administered during the hospitalization in 66.66% vs 81.89%. 14.28% of cancer patients in 2015 have received morphine treatment vs 15.3%, 22.11% oxycodone / naloxone vs 19%, 58.16% trans-dermal fentanyl vs. 34%, 14.7% have supplements onset fentanyl, 2.4% with tapentadol vs na, 15.30% tramadol vs 9%, 4.2% codeine vs 15.3%. Conclusions: This report is a feasibility model of end of life-care in the Avellino province submitted to the public administrative control with the private organization supporting House Hospital Onlus. The present study shows gradual improvement of the knowledge of palliative care by the family doctors and the population of a territory with peculiar topography and induces public health authority to improve the care offered.

Analgesic treatment and pain killer use in patients enrolled at Pain Control Center Hospice of Solofra (Italy)

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Background: We have evaluated the treatment procedures and the clinical outcome in terms of pain control on 163 consecutive patients enrolled from December 2012 to April 2014 at “Pain Control Center” of the Hospice of Solofra. Methods: The following characteristics have been evaluated: patient gender, mean hospitalization time, differentiation between cancer and non cancer patients (pt.), tumour type, medical weapon use, venous access type, parenteral feeding, transfer in intensive care units, pain killer use. Results: Of the 163 patients (96 males and 67 females, mean age 63.31 years, range: 31-90 years, mean hospitalization time: 29.85 days) 126/163 pt (77.30%) had tumour diseases and 37/163 pt. (22.69%) non cancer diseases. Cancer pt. had lung (24.6%), colo-rectal (17.46%), breast (4.76%), bladder (5.55%), gastric (5.55%), prostate (3.17), hepatocellular (4.76%), pancreas (3.96%), head and neck (4.76%), kidney (3.17%) and other site tumours (19.67%). Patients with tracheostomy were 14/163 (8.58%), with gastrostomy 11/163 (6.74%), with uretero and colostomy 21/163 (12.88%) and with active mechanical ventilator 5/163 (3.06%). The central venous accesses were already present at the moment of the hospitalization in 61/163 pt. (37.42%); during the hospitalization the central venous access were made on 48/163 (29.44%). Seventy-six out of 163 pt. (46.62%) received either total or partial parenteral feeding while 26/163 pt. (15.95%) received enteral feeding. Analgesic therapy with opioids was administered at 131/163 pt. (80.36%) as it follows: morphin in 18.32%; oxycodon/naloxon in 23.63%; codein-paracetamol in 9.16% and transdermic or transmucosal Fentanyl in 48.85% of the pt. The most intensively treated pts. were those with tracheostomy followed by uretero and colostomy. Conclusions: The results of the present study confirm the underestimation of the parenteral feeding and analgesic requirements by pts. with chronic diseases. Another interesting result of the present report is the good clinical benefit achieved with the use of oxycodon/naloxon associated or not with other pain killers. These results are on line with the guidelines that suggest the use of oral slow release opioids.