Emergency treatment of out-of-hospital palliative care patients with breakthrough pain in Germany

Breakthrough cancer pain is a symptom often reported by out-of-hospital palliative care patients in an advanced stage of cancer. Therefore, prehospital emergency physicians (EP) may be confronted with the acute care of breakthrough pain in palliative care patients in a home-care setting. Up to now, there is a lack of specialized out-of-hospital palliative care teams. There is also a lack of concepts for emergency care of palliative patients at the end of their lives given their specific symptoms. Over a 24 month period all emergency medical missions for patients with breakthrough cancer pain (four emergency medical systems) were retrospectively investigated. Only services for palliative care patients with cancerous diseases were included (diagnosis of breakthrough pain). The primary service diagnosis of breakthrough pain in palliative care patients occurred 17 times within the defined period (4.6% of all emergency medical missions for palliative patients during the defined time period). After emergency therapy 15 of these patients were admitted into hospital. In 10 cases no adequate relief by pain therapy was possible. A specialized palliative care team (PCT) was integrated into the out-of-hospital therapy 2 times by an EP. Concerning the emergency medical setting, breakthrough cancer pain in palliative care patients seems to be rare. However, such a situation can dramatically develop for patients and care-giving relatives. Therefore, an adequate and fast cancer pain therapy is necessary to allow the patient to stay at home after such an acute situation. The use of specialized outpatient PCT to support emergency situations motivated by palliative care patients should be encouraged. Basic principles of cancer pain therapy and palliative medical care (end-of-life care) should be integrated into emergency medical curricula to comply with the ethical principles of medical treatment at the end of life.