Symptoms and prognoses of patients with end-stage fungating breast cancer in palliative care units: the multicentre, prospective, observational EASED study

Abstract

Abstract Purpose: We investigated the symptoms and prognoses of patients with fungating breast cancer in the palliative care unit setting. Methods: This study was a sub-group analysis of a multicentre, prospective, observational study. Patients admitted to 23 palliative care units in Japan between January and December 2017 were enrolled. Data of patients with breast cancer were extracted. Wecompared demographic characteristics, symptoms, and prognoses by breast cancer skin lesion status. The primary outcome was overall survival. Secondary outcomes included Palliative Prognostic Index (PPI) score, details about skin lesions, and symptom burden. Results:Of 1,896 patients, 131 (6.9%) had breast cancer. In this cohort, 44 (33.6%) patients had skin lesions. Most skin lesions (88%) were on the backand chest. Some skin lesions were associated with skin redness, erosion, necrosis, or fistula. Symptoms included bleeding, exudate, odour, and pain. Twenty-eight patients (63.6%) needed dressing changes and 14 (31.8%) patients experienced bleeding. None died due to bleeding. In the skin lesion group, 32 (72.8%) patients had used opioids equivalent to 38 mg of oral morphine daily, compared to 25 mg in 57 (65.5%) in the non-skin lesion group (p = 0.26). Median PPI scores at hospital admission were 4.5 versus 6.5 (p = 0.08). Median survival was 23 versus 21 days (p = 0.48). Conclusion: Patients with skin lesions had a distinct symptom burden and tended to use a higher dose of opioids. The effect of skin lesions on survival was unclear.