Patterns and Determinants of Terminal Hospital Admissions in Advanced Cancer

Abstract

Background: Avoidable end-of-life hospital admissions remain common in oncology and often signal suboptimal palliative support. We aimed to characterize the clinical features and disease factors associated with terminal admissions at a tertiary care hospital.

Methods: We performed a retrospective cohort study of all adults with advanced solid or hematological malignancy who were managed by the palliative care service and died in hospital between 1 January 2022 and 31 March 2024. Demographics, primary cancer site and stage, admission diagnosis, and length of stay (LOS) were obtained from electronic records. Descriptive statistics summarized frequencies whereas χ² tests and adjusted residuals explored associations between malignancy type and admission reason.

Results: 586 patients with cancer met inclusion criteria (52.2 % male; mean age 66.8 ± 15.8 years). Stage IV solid tumors predominated (79.5 %). The leading primary cancers were gastrointestinal (51.2 %), breast (10.1 %), and genitourinary (8.5 %). Principal causes of terminal admission were performance status deterioration (28.8 %), gastrointestinal (GI) symptoms (21.0 %: vomiting 36 %, malignant bowel obstruction 23 %), respiratory complications (16.6 %: pneumonia 86 %), altered consciousness (13.3 %), and other causes including pain and sepsis. GI symptoms as the cause of admission was strongly linked to GI cancers (p < 0.001), while respiratory symptoms were more common in lung cancers (p = 0.005). Mean LOS was 21.64 ± 15; 6.7% of patients died within 48 h and 21.3% remained hospitalized ≥30 days.

Conclusions: Terminal admissions were driven largely by abrupt functional decline, uncontrolled GI disturbances, and pneumonia. Associations between the type of cancer and the cause of admission were prevalent. These findings offer data driven guidance for improving outpatient and home based palliative care in patients with advanced cancer.