Early data on symptoms and outcomes for COVID-19 patients

21st April 2020

Hospital palliative care is an essential part of the COVID-19 response but data are lacking. A team of clinicians based at the Cicely Saunders Institute have published early data on characteristics, symptom management and outcomes for 101 patients referred for palliative care.

The team identified symptom burden, management, response to treatment, and outcomes for a case series of 101 in-patients with confirmed COVID-19 referred to hospital palliative care between 4 March and 26 March 2020.

The patients were in two large acute NHS Hospital Trusts in London, UK. The two trusts comprise four hospitals and include a Highly Communicable Infectious Disease Unit. They serve populations with among the highest prevalence of COVID-19 in the UK.

Clinician-researchers gathered the data from medical and nursing case notes. 64 of the patients were male, 37 female. The most common co-morbidity was hypertension. The most common symptom was breathlessness. Agitation was also common with psychological distress caused by rapid deterioration and isolation from family.

Fifty-eight patients were prescribed a subcutaneous infusion. Frequently used medicines were opioids. Infusions were assessed as at least partially effective for 40/58 patients, while 13 patients died before review. At 30 March 2020, 75 patients had died, 13 had been discharged back to team, home or hospice, and 13 continued to receive inpatient palliative care.

The team has no information about the palliative care needs of other inpatients with COVID-19. There were few referrals from Intensive Care Units. Around 50% of patients with COVID-19 who are admitted to ICUs subsequently die and they are likely to have high palliative needs.

Palliative care is an essential component to the COVID-19 response, and teams must rapidly adapt with new ways of working. Breathlessness and agitation are common but respond well to opioids and benzodiazepines. Availability of subcutaneous infusion pumps is essential. An international minimum dataset for palliative care would accelerate finding answers to new questions as the COVID-19 pandemic develops.

Summary

In this first case series of 101 patients with COVID-19 referred to palliative care, input was brief; most patients died in <3 days. The most common symptoms were breathlessness and agitation, controlled in most cases using relatively small doses of opioid and benzodiazepine, delivered by subcutaneous infusion. To meet the rapidly growing need for palliative care, services must adapt. Training and guidance for non-specialists will help ensure symptoms are addressed promptly.

Lovell N, Maddocks M, Etkind SN, Taylor K, Carey I, Vora V, Marsh L, Higginson IJ, Prentice W, Edmonds P, Sleeman KE. Characteristics, symptom management and outcomes of 101 patients with COVID-19 referred for hospital palliative care. Journal of Pain & Symptom Management. In press 21 April 2020

DOI: https://doi.org/10.1016/j.jpainsymman.2020.04.015