Juan Luis Torres-Tenor, Andrea García-Leal, María Gómez Aguilera, Iván Martínez Redondo, Rocío Morales Santos, Eduardo Bruera, Alberto Alonso Babarro
{"title":"First Unscheduled Hospitalization in Pancreatic Cancer: A Point for Palliative Care Integration.","authors":"Juan Luis Torres-Tenor, Andrea García-Leal, María Gómez Aguilera, Iván Martínez Redondo, Rocío Morales Santos, Eduardo Bruera, Alberto Alonso Babarro","doi":"10.1016/j.jpainsymman.2026.10.009","DOIUrl":null,"url":null,"abstract":"<p><strong>Context: </strong>Pancreatic cancer is characterized by high symptom burden, rapid deterioration, and poor survival. Despite this complexity, specialist palliative care (SPC) is often integrated late or not at all. The first unscheduled hospitalization may represent a point for SPC assessment.</p><p><strong>Objectives: </strong>To characterize frequency, clinical features, and outcomes of the first unscheduled hospitalization in pancreatic adenocarcinoma, explore factors associated with subsequent survival, and describe the timing of SPC assessment.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of consecutive adults with pancreatic adenocarcinoma managed by medical oncology at three tertiary hospitals during 2022-2023, with follow-up through 2025. Overall survival (OS) from hospitalization was estimated with Kaplan-Meier methods; univariable Cox regression assessed associations with survival.</p><p><strong>Results: </strong>Among 125 patients, 105 (84%) experienced a first unscheduled hospitalization at a median of 4.1 months after diagnosis (IQR, 1.9-8.0). Median OS was 3.8 months (95% CI, 2.1-7.1); 21/104 (20%) died in hospital, and 62/80 (78%) were readmitted after discharge. ECOG performance status 2-4 (HR, 3.30), metastatic disease (HR, 3.05), liver metastases (HR, 2.58), and strong opioid use (HR, 2.10) were associated with shorter survival. Only 11 (10%) underwent SPC assessment before hospitalization; 31 (30%) were first assessed during hospitalization, 40 (38%) afterward, and 23 (22%) remained unassessed.</p><p><strong>Conclusion: </strong>A first unscheduled hospitalization occurred in most patients, marking limited survival, high in-hospital mortality, and frequent readmission. Most lacked prior SPC assessment. This event may serve as a pragmatic safety net for palliative care integration, complementing earlier needs- and prognosis-based referral strategies.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":4.0000,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jpainsymman.2026.10.009","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Context: Pancreatic cancer is characterized by high symptom burden, rapid deterioration, and poor survival. Despite this complexity, specialist palliative care (SPC) is often integrated late or not at all. The first unscheduled hospitalization may represent a point for SPC assessment.
Objectives: To characterize frequency, clinical features, and outcomes of the first unscheduled hospitalization in pancreatic adenocarcinoma, explore factors associated with subsequent survival, and describe the timing of SPC assessment.
Methods: We conducted a retrospective cohort study of consecutive adults with pancreatic adenocarcinoma managed by medical oncology at three tertiary hospitals during 2022-2023, with follow-up through 2025. Overall survival (OS) from hospitalization was estimated with Kaplan-Meier methods; univariable Cox regression assessed associations with survival.
Results: Among 125 patients, 105 (84%) experienced a first unscheduled hospitalization at a median of 4.1 months after diagnosis (IQR, 1.9-8.0). Median OS was 3.8 months (95% CI, 2.1-7.1); 21/104 (20%) died in hospital, and 62/80 (78%) were readmitted after discharge. ECOG performance status 2-4 (HR, 3.30), metastatic disease (HR, 3.05), liver metastases (HR, 2.58), and strong opioid use (HR, 2.10) were associated with shorter survival. Only 11 (10%) underwent SPC assessment before hospitalization; 31 (30%) were first assessed during hospitalization, 40 (38%) afterward, and 23 (22%) remained unassessed.
Conclusion: A first unscheduled hospitalization occurred in most patients, marking limited survival, high in-hospital mortality, and frequent readmission. Most lacked prior SPC assessment. This event may serve as a pragmatic safety net for palliative care integration, complementing earlier needs- and prognosis-based referral strategies.
期刊介绍：
The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.
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