A Month of Diagnostic Imaging Studies in an Acute Supportive/Palliative Care Unit

A Month of Diagnostic Imaging Studies in an Acute Supportive/Palliative Care Unit | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Month of Diagnostic Imaging Studies in an Acute Supportive/Palliative Care Unit Sebastiano Mercadante, Yasmine Grassi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3909739/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Oct, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted 8 You are reading this latest preprint version Abstract Aim: To assess the characteristics of patients who required imaging studies during admission to an acute supportive palliative care unit (ASPCU). Methods: A consecutive number of patients who performed imaging studies during ASPCU admission in a month period was assessed. Epidemiological data, ongoing anticancer treatment, cancer diagnosis, reasons for admission, referral, type of imaging study, were recorded. Indications, findings, consequent actions for treatment, prognosis and discharge were also collected. Results: Twenty-one of fifty-six patients admitted to ASPCU in the period taken into consideration underwent imaging studies. Pain and deterioration of the general condition were the most frequent indications for admission. Computed tomography (CT) was the most frequent imaging study performed. Indications for performing imaging studies depended on individual clinical needs. Findings suggested different clinical decisions, after a comprehensive oncological and palliative care assessment and family conference, the most frequent of which was to withdraw oncological treatments. The majority of patients underwent transition to palliative care and were discharged home or to hospice. Conclusion: Imaging studies were of paramount importance for clinical treatment and decision-making process in an intensive ASPCU. There is the need to explore the need and the possible outcomes of imaging studies, as well cost-effectiveness in any ASPCU. palliative care acute palliave care unit imaging. INTRODUCTION Inpatient palliative care units are lacking in most cancer hospitals ( 1 ), and even when palliative care units are present, they are predominantly based on a traditional hospice-like model for patients with short life expectancy. In comparison with existing data on traditional hospices, acute supportive/palliative care units (ASPCU) offers a whole range of palliative care interventions, from an early treatment of pain and symptoms, even at time diagnosis and during the oncological treatment, up to the advanced stage of disease, when they may favour the transition to best supportive care or palliative care only. Moreover, APCUs may indicate the best palliative care service that fits the clinical and social condition of patients ( 2 ). This crossroad has a fundamental role to avoid disproportionate treatments and to provide the best available care ( 3 , 4 ). Indeed, once the condition improves they can undergo chemotherapy again during the same admission ( 5 ), especially for patients living far from the hospital, Interestingly, in the last years oncologists refer patients who have never been treated before, but requiring supportive therapies while waiting for a precise histological diagnosis. This constituted an anticipated palliative or supportive care before the oncologic treatment, a sort of pre-emptive palliative care, rather than the better known early palliative care ( 6 ). Thus, palliative care may resemble the concept of prevention, that includes primary (information), secondary (early intervention), and tertiary actions (limiting and controlling the consequences of a disease). In the ASPCU patients are prevalently admitted with a large variety of indications, including toxicity, deterioration, pain, and other symptoms, or even to reassess patients’ conditions. Images of the abdomen, chest, and head are often used to assess disease progression and support patients' care plans. Other than providing useful information for next therapeuthic steps, image acquisition is essential to communicate effectively with patients and relatives and appropriately discuss prognosis and clinical decision on realistic intervention. Imaging studies are performed to explain some symptoms and provide the extension of disease directing the decision-making process, outlining or changing the direction of care towards the transition to the best supportive care, allowing the withdrawal of anticancer treatments. The aim of this study was to assess indications, findings, and decision-making process in an ASPCU. METHODS A sample of patients consecutively admitted to an ASPCU of a comprehensive cancer center was selected for a period of one month. Patients who required imaging studies were screened. Epidemiological data, ongoing anticancer treatment, cancer diagnosis, reasons for admission, referral, type of imaging study, were recorded. Indications, findings, consequent actions for treatment, prognosis and discharge were also collected. Patient’s consent was obtained, and local ethical committe approved the study. The study was performed in accordance with the Declaration of Helsinki. RESULTS Fifty-six patients were admitted to the ASPCU in the period taken into consideration. Twenty-one patients underwent imaging studies. Some of them required more imaging studies at the same time or after the first CT finding for different purposes or improving the information. Data recorded for each patient are listed in Table 1 . The most frequent indications for admission were uncontrolled pain and deterioration of the general condition. Most patients were admitted from home. Computed tomography (CT) was the most frequent imaging study performed. Indications for performing imaging studies were variable depending on individual clinical needs. Findings suggested different clinical decisions, after a comprehensive oncological and palliative care assessment and family conference, the most frequent of which was to withdraw oncological treatments. The majority of patients underwent transition to palliative care and were prevalently discharged home or to hospice, depending on their individual needs. Table 1 Characteristics of patients pt age sex admission diagnosis anticancer treatment reason admission referral imaging indications principal fiindings actions anticancer treatment discharge 1 53 F EM stomach ON deterioration home CT Restaging no progression oncological evaluation for BSC OFF Home PC 2* 36 M EM kidney ON pain other hospital CT Surgical evaluation intestinal perforation bowel rest PN OFF Hospice 2 36 M EM kidney ON pain other hospital RMN surgical evaluation perineum mass fistula surgical medications OFF Hospice 3 64 M EL lung OFF pain home CT restaging symptoms liver bone MTS Family Conference for BSC OFF Hospice 4 67 M TR pancreas ON GI symptoms oncology CT GI symptoms gastrectasia by duodenal obstruction medical treatment for MBO PN OFF Home PC 5 64 F EL breast ON CH toxicity deterioration home doppler limb pain Thrombosis anticoagulants OFF home PC 6 68 F EL lung naive Pain fewer home CT Pneumonia confirmed diagnosis antibilotics ON Home 7 75 F TR ovary on deterioration oncology CT Restaging Progression oncological evaluation for BSC OFF Home PC 8 75 M EM colon ON ascitis home US Ascitis limited ascitis for treatment no abdominal catether for continuous drainage OFF Home PC 9 60 F TR stomach ON deterioration oncology CT Restaging progression MBO bowel rest PN OFF Death 10 79 F EL breast ON pain home CT restaging-pain no progression oncological evaluation ON Home 11 66 M TR lung naive deterioration surgery CT restaging, respiratory disease progression pneumonia Antibiotics Oncological evaluation ON Home PC 12 78 F EL bladder ON pain restaging home CT Restaging no progression RT RT Home PC 13 40 M EL sarcoma ON pain home CT Pain Bone fracture planned surgery ON-SURGERY Home 14 75 M EM bowel ON deterioration ascitis home US Ascitis limited ascitis for treatment no abdominal catether for continuous drainage OFF Home PC 15 85 F EL lung naive deterioration, dyspnea home CT restaging, symptoms Progression increase diuretics OFF Home PC 16 67 M EL kidney naive pain home CT RMN Pain no new metastases oncological evaluation ON Home PC 17 64 F EL breast ON deterioration home doppler Thrombosis Thrombosis Anticoagulation ON Home 18 51 F EL stomach on deterioration home CT Restaging Progression oncological evaluation for BSC OFF Home PC 19 79 F EL lung naive deterioration home CT cognitive changes Progression oncological evaluation for BSC OFF Hospice 20* 59 f EL pancreas on sepsis home CT Restaging no progression CT change for toxicity ON Home 20 59 f EL pancreas on sepsis home RMN possible stenting biliary obstruction but no colestasis consultation: no need of stenting ON Home 21 75 EL lung off deterioration home CT Restaging no progression oncological evaluation ON Rehab EM = emercency admission, EL = election admission, TR = transfer CT = computed tomography, RMN, Magnetic resonance, US = ultrasound GI = gastrointestinal symptoms. CH = chemotherapy, RT = radiotherapy BSC = best supportive care, MBO = malignant bowel obstruction, PN = parenteral nutrition, PC = palliative care DISCUSSION This study addressed the frequency of imaging studies in an ASPCU. Imaging studies were performed in a high percentage of patients (45%). Findings offered relevant information for decision-making process. Patients had multiple indications for admission, prevalently uncontrolled pain and clinical deterioration. The demonstration of progression of disease by imaging studies allowed to discuss with oncologists, patients, and relatives, the need to discontinue any further anticancer treatment, privileging best supportive care. It was also useful to select the best setting of palliative care, either specialized home care or hospice, according to individual needs and the necessary level of care. Of interest, four patients did not ever have received any anticancer treament and were referred by oncological team for symptom control while performing a diagnosis. A recent study showed that in this ASPCU, about 14% of patients were admitted prior to receive any anticancer therapy, because they were waiting a diagnosis or developed rapid deterioration with high symptom burden ( 6 ). Indeed, information gathered from imaging studies was useful in a diagnostic perspective for a consequent therapeutic treatment, for example medical treatment of bowel obstruction, the use of antibiotics, anticoagulants, surgical consults, or the decision-making process to withdraw active treatments or planning further interventions. Some interventions, such as medical imaging, are necessary, to evaluate disease progression, to find causes of symptoms, and consequently alleviate them by specific interventions, introducing or changing therapy ( 7 , 8 ). ASPCU is a modern and advanced care setting that offers the whole range of palliative care interventions. Such intensive units may have a fundamental role in the pathway of cancer patients, representing a hospital hub for patients with advanced disease, either to resolve clinical problems or re-evaluate the disease to take the best decision. Existing palliative care networks, including only home care and hospice, often self-promoted as the only option to provide advice, facilitating the activation of palliative care pathways or eventually supporting the hospital admitting teams, are far from reality ( 9 ). Unfortunately, in literature there is lack of data regarding these aspects, likely due to the poor diffusion of ASPCU even in academic comprehensive cancer centers ( 1 ). Simple X-ray with limited resolution for providing specific interventions and supporting decisons, have been reported in hospice setting ( 10 – 14 ). In many territorial hospices, patients may need to be trasported to hospital. In conclusion, imaging studies are of paramount importance for clinical treatment, and to facilitate discussion on prognosis, and to prospect the best setting of care in an intensive ASPCU. There is the need to explore the need and the possible outcomes of imaging studies, as well cost-effectiveness in any ASPCU. Declarations Author contributions: SM conceptualised the study and collected the data. YG was involved in the data analysis. SM drafted the manuscript, with the support of YG. All authors contributed and agreed to the final manuscript. Conflict of interest statement None. Acknowledgments This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors References Hui D, De La Rosa A, Chen J, et al. (2020) State of palliative care services at US cancer centers: An updated national survey. Cancer. 126:2013-23 Mercadante S, Bruera E. (2023) Acute palliative care units: characteristics, activities and outcomes - scoping review. BMJ Support Palliat Care13:386-92 Mercadante S, Adile C, Caruselli A, Ferrera P, Costanzi A, Marchetti P, Casuccio A. (2016) The palliative-supportive care unit in a comprehensive cancer center as crossroad for patients' oncological pathway.PLoS One.11(6):e0157300. Jung FH, Kee SW, Kim YJ, et al. (2020) Clinical outcomes of operating an acute palliative Care unit at a comprehensive cancer center. JCO Oncol Pract 18:e1661-e1c71 Hui D, Elsayem A, Li Z, De La Cruz M, Palmer JL, Bruera E (2010) Antineoplastic therapy use in patients with advanced cancer admitted to an acute palliative care unit at a comprehensive cancer center: a simultaneous care model. Cancer 116:2036-43. Mercadante S, Grassi Y, Cascio AL, Restivo V, Casuccio A. Characteristics of Untreated Cancer Patients Admitted to an Acute Supportive/Palliative Care Unit..J Pain Symptom Manage. 2023;65:e677-e682. Spacey A, HeaslipV, Szczepura K. Understanding experiences of the radiography workforce delivering medical imaging as part of patients’ end of life care: An exploratory qualitative interview study. Radiography 2024;30:132-40. Grant PM, Cardin A, O’Connor N, Eastman P. Examining Clinical Utility of Imaging for Inpatient Palliative Care. Am J Hosp Palliat Med 2017; 34 632-6 Mercadante S. The need of a palliative care network. Support Care Cancer 2022;30:6381-3. Nemeth E, Cate W, Sharon C. Ultrasound scanning in a hospice setting–does it really alter patient pathways? BMJ Support Palliat Care. 2011;1(2):224. Beggan S, Rayment C, Ward J. Radiology imaging in the hospice setting. BMJ Support Palliat Care. 2012;2(suppl 1):a69-a70 Potter V, Gannon C. X-ray audit at princess alice hospice: is there a role for on-site x-ray imaging at hospices? BMJ Support Palliat Care. 2014;4(suppl 1):a91-92a. Belloni E, Tentoni S, Cella A, Cassinelli D, Berte R, Scagnelli P P. Radiological exams on end-stage oncologic patients before hospice admission. Radiol Med 2017;222(10):792e7. Massa I, Balzi W, Altini M, Berte R, Bosco M, Cassinelli D, et al. The challenge of sustainability in healthcare systems: frequency and cost of diagnostic procedures in end-of-life cancer patients. Support Care Cancer 2018;26:2201e8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Oct, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 30 Jun, 2024 Reviews received at journal 30 Jun, 2024 Reviewers agreed at journal 08 Jun, 2024 Reviewers agreed at journal 13 May, 2024 Reviewers invited by journal 14 Mar, 2024 Editor assigned by journal 09 Mar, 2024 Submission checks completed at journal 01 Feb, 2024 First submitted to journal 30 Jan, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3909739","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":270390799,"identity":"902903ad-15fd-4512-b3a9-c9e59d420045","order_by":0,"name":"Sebastiano Mercadante","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYBACNv4GBmYGBgsZBvYGINfAgrAWfokDIC0SPAw8B0BaJAhrkWxIgGqRSADxidBicOD4w8cFFRI8/JLPr274USDBwN/enYBfy+EeY+MZZyR4JGfnlN3sATpM4szZDQRsOcMmzdsmwWNwOyftBg9Qi4FELiEt6c9/8/6T4LG/eSbt5h9itAC9b8bM2wC0RYL92G2ibOGXOGMsPeOYBI/EmRy22zIGIAYBv7Dxtz/8XFBjI8fffvzZzTd/QIxe/FqQAI8BmCRWOQiwPyBF9SgYBaNgFIwgAABzJUN4G2oM9QAAAABJRU5ErkJggg==","orcid":"","institution":"La Maddalena Cancer Center","correspondingAuthor":true,"prefix":"","firstName":"Sebastiano","middleName":"","lastName":"Mercadante","suffix":""},{"id":270390800,"identity":"5eb06080-1e06-457d-a2f9-63f6b53ba942","order_by":1,"name":"Yasmine Grassi","email":"","orcid":"","institution":"La Maddalena Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Yasmine","middleName":"","lastName":"Grassi","suffix":""}],"badges":[],"createdAt":"2024-01-30 06:48:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3909739/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3909739/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00520-024-08948-8","type":"published","date":"2024-10-22T15:58:20+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67682006,"identity":"27cf1afb-af3d-4135-926b-96ba07ee4ceb","added_by":"auto","created_at":"2024-10-28 16:12:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":450970,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3909739/v1/2ddf2b5a-1c51-4f77-a695-a60c28fb6aa9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eA Month of Diagnostic Imaging Studies in an Acute Supportive/Palliative Care Unit\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eInpatient palliative care units are lacking in most cancer hospitals (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), and even when palliative care units are present, they are predominantly based on a traditional hospice-like model for patients with short life expectancy. In comparison with existing data on traditional hospices, acute supportive/palliative care units (ASPCU) offers a whole range of palliative care interventions, from an early treatment of pain and symptoms, even at time diagnosis and during the oncological treatment, up to the advanced stage of disease, when they may favour the transition to best supportive care or palliative care only. Moreover, APCUs may indicate the best palliative care service that fits the clinical and social condition of patients (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis crossroad has a fundamental role to avoid disproportionate treatments and to provide the best available care (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Indeed, once the condition improves they can undergo chemotherapy again during the same admission (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), especially for patients living far from the hospital, Interestingly, in the last years oncologists refer patients who have never been treated before, but requiring supportive therapies while waiting for a precise histological diagnosis. This constituted an anticipated palliative or supportive care before the oncologic treatment, a sort of pre-emptive palliative care, rather than the better known early palliative care (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Thus, palliative care may resemble the concept of prevention, that includes primary (information), secondary (early intervention), and tertiary actions (limiting and controlling the consequences of a disease).\u003c/p\u003e \u003cp\u003eIn the ASPCU patients are prevalently admitted with a large variety of indications, including toxicity, deterioration, pain, and other symptoms, or even to reassess patients\u0026rsquo; conditions. Images of the abdomen, chest, and head are often used to assess disease progression and support patients' care plans. Other than providing useful information for next therapeuthic steps, image acquisition is essential to communicate effectively with patients and relatives and appropriately discuss prognosis and clinical decision on realistic intervention.\u003c/p\u003e \u003cp\u003eImaging studies are performed to explain some symptoms and provide the extension of disease directing the decision-making process, outlining or changing the direction of care towards the transition to the best supportive care, allowing the withdrawal of anticancer treatments. The aim of this study was to assess indications, findings, and decision-making process in an ASPCU.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eA sample of patients consecutively admitted to an ASPCU of a comprehensive cancer center was selected for a period of one month. Patients who required imaging studies were screened. Epidemiological data, ongoing anticancer treatment, cancer diagnosis, reasons for admission, referral, type of imaging study, were recorded. Indications, findings, consequent actions for treatment, prognosis and discharge were also collected. Patient\u0026rsquo;s consent was obtained, and local ethical committe approved the study. The study was performed in accordance with the Declaration of Helsinki.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eFifty-six patients were admitted to the ASPCU in the period taken into consideration. Twenty-one patients underwent imaging studies. Some of them required more imaging studies at the same time or after the first CT finding for different purposes or improving the information. Data recorded for each patient are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The most frequent indications for admission were uncontrolled pain and deterioration of the general condition. Most patients were admitted from home. Computed tomography (CT) was the most frequent imaging study performed. Indications for performing imaging studies were variable depending on individual clinical needs. Findings suggested different clinical decisions, after a comprehensive oncological and palliative care assessment and family conference, the most frequent of which was to withdraw oncological treatments. 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fiindings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eactions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eanticancer treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003edischarge\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003edeterioration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRestaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eno progression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eoncological evaluation for BSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome PC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ekidney\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003epain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eother hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSurgical evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eintestinal perforation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ebowel rest PN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHospice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ekidney\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003epain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eother hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRMN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003esurgical evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eperineum mass\u003c/p\u003e \u003cp\u003efistula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003esurgical medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHospice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003elung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003epain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003erestaging symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eliver bone MTS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eFamily Conference for BSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHospice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epancreas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGI symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eoncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGI symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003egastrectasia by duodenal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003emedical treatment for MBO PN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome PC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ebreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCH toxicity deterioration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003edoppler\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003elimb pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eanticoagulants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003ehome PC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003elung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003enaive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003cp\u003efewer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003econfirmed diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eantibilotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eovary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003edeterioration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eoncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRestaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eProgression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eoncological evaluation for BSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome PC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecolon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eascitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAscitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003elimited ascitis for treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eno abdominal catether for continuous drainage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome PC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003edeterioration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eoncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRestaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eprogression MBO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003ebowel rest PN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ebreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003epain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003erestaging-pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eno progression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eoncological evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003elung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003enaive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003edeterioration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003erestaging, respiratory disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eprogression pneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAntibiotics\u003c/p\u003e \u003cp\u003eOncological evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome PC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ebladder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003epain restaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRestaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eno progression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome PC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esarcoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003epain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eBone fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eplanned surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eON-SURGERY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ebowel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003edeterioration ascitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAscitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003elimited ascitis for treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eno abdominal catether for continuous drainage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome PC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003elung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003enaive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003edeterioration, dyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003erestaging, symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eProgression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eincrease diuretics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome PC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ekidney\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003enaive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003epain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT RMN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eno new metastases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eoncological evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome PC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ebreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003edeterioration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003edoppler\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eThrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eThrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAnticoagulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003estomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003edeterioration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRestaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eProgression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eoncological evaluation for BSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome PC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003elung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003enaive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003edeterioration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ecognitive changes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eProgression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eoncological evaluation for BSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eOFF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHospice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epancreas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRestaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eno progression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eCT change for toxicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epancreas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRMN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003epossible stenting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003ebiliary obstruction but no colestasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003econsultation: no need of stenting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003elung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eoff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003edeterioration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ehome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRestaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eno progression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eoncological evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eRehab\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003eEM\u0026thinsp;=\u0026thinsp;emercency admission, EL\u0026thinsp;=\u0026thinsp;election admission, TR\u0026thinsp;=\u0026thinsp;transfer\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003eCT\u0026thinsp;=\u0026thinsp;computed tomography, RMN, Magnetic resonance, US\u0026thinsp;=\u0026thinsp;ultrasound\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003eGI\u0026thinsp;=\u0026thinsp;gastrointestinal symptoms. CH\u0026thinsp;=\u0026thinsp;chemotherapy, RT\u0026thinsp;=\u0026thinsp;radiotherapy\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003eBSC\u0026thinsp;=\u0026thinsp;best supportive care, MBO\u0026thinsp;=\u0026thinsp;malignant bowel obstruction, PN\u0026thinsp;=\u0026thinsp;parenteral nutrition, PC\u0026thinsp;=\u0026thinsp;palliative care\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study addressed the frequency of imaging studies in an ASPCU. Imaging studies were performed in a high percentage of patients (45%). Findings offered relevant information for decision-making process. Patients had multiple indications for admission, prevalently uncontrolled pain and clinical deterioration. The demonstration of progression of disease by imaging studies allowed to discuss with oncologists, patients, and relatives, the need to discontinue any further anticancer treatment, privileging best supportive care. It was also useful to select the best setting of palliative care, either specialized home care or hospice, according to individual needs and the necessary level of care. Of interest, four patients did not ever have received any anticancer treament and were referred by oncological team for symptom control while performing a diagnosis. A recent study showed that in this ASPCU, about 14% of patients were admitted prior to receive any anticancer therapy, because they were waiting a diagnosis or developed rapid deterioration with high symptom burden (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIndeed, information gathered from imaging studies was useful in a diagnostic perspective for a consequent therapeutic treatment, for example medical treatment of bowel obstruction, the use of antibiotics, anticoagulants, surgical consults, or the decision-making process to withdraw active treatments or planning further interventions.\u003c/p\u003e \u003cp\u003eSome interventions, such as medical imaging, are necessary, to evaluate disease progression, to find causes of symptoms, and consequently alleviate them by specific interventions, introducing or changing therapy (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). ASPCU is a modern and advanced care setting that offers the whole range of palliative care interventions. Such intensive units may have a fundamental role in the pathway of cancer patients, representing a hospital hub for patients with advanced disease, either to resolve clinical problems or re-evaluate the disease to take the best decision. Existing palliative care networks, including only home care and hospice, often self-promoted as the only option to provide advice, facilitating the activation of palliative care pathways or eventually supporting the hospital admitting teams, are far from reality (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Unfortunately, in literature there is lack of data regarding these aspects, likely due to the poor diffusion of ASPCU even in academic comprehensive cancer centers (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Simple X-ray with limited resolution for providing specific interventions and supporting decisons, have been reported in hospice setting (\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In many territorial hospices, patients may need to be trasported to hospital.\u003c/p\u003e \u003cp\u003eIn conclusion, imaging studies are of paramount importance for clinical treatment, and to facilitate discussion on prognosis, and to prospect the best setting of care in an intensive ASPCU. There is the need to explore the need and the possible outcomes of imaging studies, as well cost-effectiveness in any ASPCU.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSM conceptualised the study and collected the data. YG was involved in the data analysis. SM drafted the manuscript, with the support of YG. All authors contributed and agreed to the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHui D, De La Rosa A, Chen J, et al. (2020) State of palliative care services at US cancer centers: An updated national survey. Cancer. 126:2013-23\u003c/li\u003e\n\u003cli\u003eMercadante S, Bruera E. (2023) Acute palliative care units: characteristics, activities and outcomes - scoping review. BMJ Support Palliat Care13:386-92\u003c/li\u003e\n\u003cli\u003eMercadante S, Adile C, Caruselli A, Ferrera P, Costanzi A, Marchetti P, Casuccio A. (2016) The palliative-supportive care unit in a comprehensive cancer center as crossroad for patients\u0026apos; oncological pathway.PLoS One.11(6):e0157300.\u003c/li\u003e\n\u003cli\u003eJung FH, Kee SW, Kim YJ, et al. (2020) Clinical outcomes of operating an acute palliative Care unit at a comprehensive cancer center. JCO Oncol Pract 18:e1661-e1c71\u003c/li\u003e\n\u003cli\u003eHui D, Elsayem A, Li Z, De La Cruz M, Palmer JL, Bruera E (2010) Antineoplastic therapy use in patients with advanced cancer admitted to an acute palliative care unit at a comprehensive cancer center: a simultaneous care model. Cancer 116:2036-43.\u003c/li\u003e\n\u003cli\u003eMercadante S, Grassi Y, Cascio AL, Restivo V, Casuccio A. Characteristics of Untreated Cancer Patients Admitted to an Acute Supportive/Palliative Care Unit..J Pain Symptom Manage. 2023;65:e677-e682.\u003c/li\u003e\n\u003cli\u003eSpacey A, HeaslipV, Szczepura K. Understanding experiences of the radiography workforce delivering medical imaging as part of patients\u0026rsquo; end of life care: An exploratory qualitative interview study. Radiography 2024;30:132-40.\u003c/li\u003e\n\u003cli\u003eGrant PM, Cardin A, O\u0026rsquo;Connor N, Eastman P. Examining Clinical Utility of Imaging for Inpatient Palliative Care. Am J Hosp Palliat Med 2017; 34 632-6\u003c/li\u003e\n\u003cli\u003eMercadante S. The need of a palliative care network. Support Care Cancer 2022;30:6381-3.\u003c/li\u003e\n\u003cli\u003eNemeth E, Cate W, Sharon C. Ultrasound scanning in a hospice setting\u0026ndash;does it really alter patient pathways? BMJ Support Palliat Care. 2011;1(2):224.\u003c/li\u003e\n\u003cli\u003eBeggan S, Rayment C, Ward J. Radiology imaging in the hospice setting. BMJ Support Palliat Care. 2012;2(suppl 1):a69-a70\u003c/li\u003e\n\u003cli\u003ePotter V, Gannon C. X-ray audit at princess alice hospice: is there a role for on-site x-ray imaging at hospices? BMJ Support Palliat Care. 2014;4(suppl 1):a91-92a.\u003c/li\u003e\n\u003cli\u003eBelloni E, Tentoni S, Cella A, Cassinelli D, Berte R, Scagnelli P P. Radiological exams on end-stage oncologic patients before hospice admission. Radiol Med 2017;222(10):792e7.\u003c/li\u003e\n\u003cli\u003eMassa I, Balzi W, Altini M, Berte R, Bosco M, Cassinelli D, et al. The challenge of sustainability in healthcare systems: frequency and cost of diagnostic procedures in end-of-life cancer patients. Support Care Cancer 2018;26:2201e8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"palliative care, acute palliave care unit, imaging. ","lastPublishedDoi":"10.21203/rs.3.rs-3909739/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3909739/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e To assess the characteristics of patients who required imaging studies during admission to an acute supportive palliative care unit (ASPCU).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A consecutive number of patients who performed imaging studies during ASPCU admission in a month period was assessed. Epidemiological data, ongoing anticancer treatment, cancer diagnosis, reasons for admission, referral, type of imaging study, were recorded. Indications, findings, consequent actions for treatment, prognosis and discharge were also collected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Twenty-one of fifty-six patients admitted to ASPCU in the period taken into consideration underwent imaging studies. Pain and deterioration of the general condition were the most frequent indications for admission. Computed tomography (CT) was the most frequent imaging study performed. Indications for performing imaging studies depended on individual clinical needs. Findings suggested different clinical decisions, after a comprehensive oncological and palliative care assessment and family conference, the most frequent of which was to withdraw oncological treatments. The majority of patients underwent transition to palliative care and were discharged home or to hospice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Imaging studies were of paramount importance for clinical treatment and decision-making process in an intensive ASPCU. There is the need to explore the need and the possible outcomes of imaging studies, as well cost-effectiveness in any ASPCU.\u003c/p\u003e","manuscriptTitle":"A Month of Diagnostic Imaging Studies in an Acute Supportive/Palliative Care Unit","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-02 17:37:43","doi":"10.21203/rs.3.rs-3909739/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-01T00:46:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-30T08:39:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"41412010399750457633073489315365571335","date":"2024-06-09T02:08:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"301887665782996364751865798975277234265","date":"2024-05-13T08:35:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-15T00:13:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-09T14:14:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-01T06:05:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2024-01-30T06:44:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"6d9388c3-4db8-4694-a7e2-b45b92dde53d","owner":[],"postedDate":"February 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T16:05:56+00:00","versionOfRecord":{"articleIdentity":"rs-3909739","link":"https://doi.org/10.1007/s00520-024-08948-8","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2024-10-22 15:58:20","publishedOnDateReadable":"October 22nd, 2024"},"versionCreatedAt":"2024-02-02 17:37:43","video":"","vorDoi":"10.1007/s00520-024-08948-8","vorDoiUrl":"https://doi.org/10.1007/s00520-024-08948-8","workflowStages":[]},"version":"v1","identity":"rs-3909739","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3909739","identity":"rs-3909739","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}