51
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Meillon-Garcia LA, Demichelis-Gómez R. Access to Therapy for Acute Myeloid Leukemia in the Developing World: Barriers and Solutions. Curr Oncol Rep 2020; 22:125. [PMID: 33025161 PMCID: PMC7538168 DOI: 10.1007/s11912-020-00987-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Acute myeloid leukemia (AML) is a costly disease, and its impact is greater in developing countries (DC). We will review the current concept of what are DC, compare the differences in the epidemiology and economic burden of this disease between developed and DC, and finally, analyze the barriers and possible solutions that DC should implement to achieve better results. RECENT FINDINGS DC is a frequently misunderstood name. The way we use to measure human development is changing, and multidimension metrics better define what are DC. With this in mind, we show the differences in the AML epidemiology and the impact of economic burden in DC. We analyze the barriers to access therapy from a clinician point of view, to show that most DC shared similar challenges but with a diverse healthcare structure. Finally, we provide several possible solutions for a more integrated and timely treatment that allows better results not only in terms of survival but with a better quality of life. The economic burden of AML treatment in DC is high, and the results are poor. It is crucial to face this challenge and propose new treatment approaches to achieve better results.
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Affiliation(s)
| | - Roberta Demichelis-Gómez
- Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Subirán, SSA, Ciudad De Mexico, Mexico
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52
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Chen YC, Loh EW, Huang TW. Humanity behind the intention of primary caregiver to choose withdrawing life-sustaining treatment for terminating patients. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30329-3. [PMID: 32561315 DOI: 10.1016/j.pec.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Mechanical ventilation, a measure of life-sustaining treatment (LST), may not be helpful and can be devastating for patients with terminal illness. We explored the effects of demographic characteristics, attitude, subjective norms, and perceived behavioral control on the behavioral intentions of primary caregivers to withdraw LST of long-term ventilator-dependent patients. METHODS Primary caregivers of ventilator-dependent patients in the respiratory care units of six hospitals participated in the study. A cross-sectional design including the domains of attitude, subjective norms, perceived behavioral control, and behavioral intention was adopted. RESULTS Valid data for 99 participants were analyzed using logistic regression. Religious belief, a spousal relationship with the patient, item 5 in subjective norms, and item 5 in perceived behavioral control positively influenced the intention to withdraw patient LST. CONCLUSIONS Religious beliefs, a spousal relationship, perceived behavioral control (confidence in relieving patient suffering), and the opportunity of current favorable subjective norms are major determinants of the intention to withdraw patients' LST. PRACTICE IMPLICATIONS Shared decision-making with the kin and primary caregivers of long-term ventilator-dependent patients at the end of life is crucial.
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Affiliation(s)
- Ya-Chin Chen
- Department of Nursing, Yuanlin Christian Hospital, Changhua, Taiwan.
| | - El-Wui Loh
- Center for Evidence-Based Health Care, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, Zhonghe District, New Taipei City, Taiwan; Shared Decision Making Resource Center, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
| | - Tsai-Wei Huang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
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53
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Gray TF, Temel JS, El-Jawahri A. Illness and prognostic understanding in patients with hematologic malignancies. Blood Rev 2020; 45:100692. [PMID: 32284227 DOI: 10.1016/j.blre.2020.100692] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/04/2020] [Accepted: 04/02/2020] [Indexed: 12/25/2022]
Abstract
It is critical for patients with hematologic malignancies to have an accurate understanding of their illness and prognosis to make informed treatment decisions. Illness and prognostic understanding have primarily been studied in patients with solid tumors, however, data in patients with hematologic malignancies are rapidly growing. Patients with hematologic malignancies often face a unique and unpredictable illness trajectory with the possibility of cure persisting even in relapsed and refractory settings. These patients often require intensive therapies such as high-dose chemotherapy, hematopoietic stem cell transplantation (HCT), or CAR T-cell therapy, which carry with them significant risk of morbidity, mortality, and prognostic uncertainty. In this review article, we first described the current literature on illness and prognostic understanding in patients with hematologic malignancies including 1) patients' varying desire for prognostic information; (2) patients' prognostic misperceptions, (3) the association between patients' prognostic understanding and their psychological outcomes; and (4) barriers to prognostic understanding. Next, we examined insights gained from the literature about illness and prognostic understanding in patients with solid tumors to guide our understanding of the research gaps in hematologic malignancies. Future studies are needed to better delineate the longitudinal relationship between prognostic understanding, psychological distress, and coping in patients with hematologic malignancies. Strategies such as communicating effectively about prognosis, cultivating adaptive coping in the face of a terminal prognosis, and integrating specialty palliative care for patients with hematologic malignancies have the potential to improve patients' prognostic understanding and their quality of life and care.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jennifer S Temel
- Massachusetts General Hospital Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Areej El-Jawahri
- Massachusetts General Hospital Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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54
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El-Jawahri A, Nelson AM, Gray TF, Lee SJ, LeBlanc TW. Palliative and End-of-Life Care for Patients With Hematologic Malignancies. J Clin Oncol 2020; 38:944-953. [PMID: 32023164 PMCID: PMC8462532 DOI: 10.1200/jco.18.02386] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 12/18/2022] Open
Abstract
Hematologic malignancies are a heterogeneous group of diseases with unique illness trajectories, treatment paradigms, and potential for curability, which affect patients' palliative and end-of-life care needs. Patients with hematologic malignancies endure immense physical and psychological symptoms because of both their illness and often intensive treatments that result in significant toxicities and adverse effects. Compared with patients with solid tumors, those with hematologic malignancies also experience high rates of hospitalizations, intensive care unit admissions, and in-hospital deaths and low rates of referral to hospice as well as shorter hospice length of stay. In addition, patients with hematologic malignancies harbor substantial misperceptions about treatment risks and benefits and frequently overestimate their prognosis. Even survivors of hematologic malignancies struggle with late effects, post-treatment complications, and post-traumatic stress symptoms that can significantly diminish their quality of life. Despite these substantial unmet needs, specialty palliative care services are infrequently consulted for the care of patients with hematologic malignancies. Several illness-specific, cultural, and system-based barriers to palliative care integration and optimal end-of-life care exist in this population. However, recent evidence has demonstrated the feasibility, acceptability, and efficacy of integrating palliative care to improve the quality of life and care of patients with hematologic malignancies and their caregivers. More research is needed to develop and test population-specific palliative and supportive care interventions to ensure generalizability and to define a sustainable clinical delivery model. Future work also should focus on identifying moderators and mediators of the effect of integrated palliative care models on patient-reported outcomes and on developing less resource-intensive integrated care models to address the diverse needs of this population.
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Affiliation(s)
- Areej El-Jawahri
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ashley M. Nelson
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Tamryn F. Gray
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
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55
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Richardson DR, Crossnohere NL, Seo J, Estey E, O'Donoghue B, Smith BD, Bridges JFP. Age at Diagnosis and Patient Preferences for Treatment Outcomes in AML: A Discrete Choice Experiment to Explore Meaningful Benefits. Cancer Epidemiol Biomarkers Prev 2020; 29:942-948. [PMID: 32132149 DOI: 10.1158/1055-9965.epi-19-1277] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/17/2019] [Accepted: 02/25/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The recent expansion of treatment options in acute myeloid leukemia (AML) has necessitated a greater understanding of patient preferences for treatment benefits, about which little is known. METHODS We sought to quantify and assess heterogeneity of the preferences of AML patients for treatment outcomes. An AML-specific discrete choice experiment (DCE) was developed involving multiple stakeholders. Attributes included in the DCE were event-free survival (EFS), complete remission (CR), time in the hospital, short-term side effects, and long-term side effects. Continuously coded conditional, stratified, and latent-class logistic regressions were used to model preferences of 294 patients with AML. RESULTS Most patients were white (89.4%) and in remission (95.0%). A 10% improvement in the chance of CR was the most meaningful offered benefit (P < 0.001). Patients were willing to trade up to 22 months of EFS or endure 8.7 months in the hospital or a two-step increase in long-term side effects to gain a 10% increase in chance of CR. Patients diagnosed at 60 years or older (21.6%) more strongly preferred to avoid short-term side effects (P = 0.03). Latent class analysis showed significant differences of preferences across gender and insurance status. CONCLUSIONS In this national sample of mostly AML survivors, patients preferred treatments that maximized chance at remission; however, significant preference heterogeneity for outcomes was identified. Age and gender may affect patients' preferences. IMPACT Survivor preferences for outcomes can inform patient-focused drug development and shared decision-making. Further studies are necessary to investigate the use of DCEs to guide treatment for individual patients.
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Affiliation(s)
- Daniel R Richardson
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. .,The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jaein Seo
- Patient-Centered Research, Evidera, Rockville, Maryland
| | - Elihu Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington
| | | | - B Douglas Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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56
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Gatta B, LeBlanc TW. Palliative care in hematologic malignancies: a multidisciplinary approach. Expert Rev Hematol 2020; 13:223-231. [PMID: 32066301 DOI: 10.1080/17474086.2020.1728248] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Palliative care is specialized health care focused on improving the quality of life amid serious illness. Patients with hematologic malignancies have significant needs that could be addressed by a multidisciplinary palliative care team, but the integration of palliative care into hematology is far behind that of solid tumor oncology.Areas covered: This article considers what is known about the palliative care needs of hematologic malignancy patients, shows how the multidisciplinary palliative care team could improve their care, and explores how barriers to this relationship might be overcome. The evidence to support this review comes from review of recent, relevant papers known to the authors as well as PubMed searches of additional relevant articles over the past 3 years.Expert opinion: Further cultivating this relationship requires us to thoughtfully integrate the multidisciplinary palliative care team to respond to each patient's specific disease and needs, and do so at the ideal time, to maximize benefits.
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Affiliation(s)
- Brittany Gatta
- Department of Medicine, Division of General Internal Medicine, Duke Center for Palliative Care, Duke University, Durham, NC, USA
| | - Thomas W LeBlanc
- Duke Cancer Institute, Duke University, Durham, NC, USA.,Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Stegmann ME, Geerse OP, Tange D, Richel C, Brom L, Engelen V, Duijts SFA. Experiences and needs of patients with incurable cancer regarding advance care planning: results from a national cross-sectional survey. Support Care Cancer 2020; 28:4211-4217. [PMID: 31900610 DOI: 10.1007/s00520-019-05285-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/23/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Patients faced with incurable cancer may experience a lack of support from their physician throughout and after treatment. Studies on the needs and experiences of these patients are scarce. In this study, we explored the needs and experiences of patients diagnosed with incurable cancer regarding the conversation, in which they were told that their cancer was incurable, the care received after this conversation, and their preferences regarding end-of-life conversations. METHODS Data were cross-sectionally collected through a national online survey in the Netherlands (September 2018). Descriptive statistics and correlation coefficients were reported and subgroups were compared. RESULTS Six hundred fifty-four patients (mean age 60 years; 58% women) completed the survey. Patients were primarily diagnosed with breast cancer (22%) or a hematological malignancy (21%). Patients reported a strong need for emotional support during the conversation, in which they were told their cancer was incurable (mean score 8.3; scale 1-10). Their experienced satisfaction with received emotional support was mediocre (mean score 6.4; scale 1-10). Of those patients who felt like they did not receive any additional care (37%) after the diagnosis, the majority expressed a clear need for this kind of care (59%). Mostly, support pertained to psychosocial issues. Regarding conversations about the end of life, most patients (62%) expressed a need to discuss this topic, and preferred their healthcare provider to initiate this conversation. CONCLUSION Care for patients with incurable cancer can be further improved by tailoring conversations to specific needs and timely providing appropriate supportive care services.
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Affiliation(s)
- Mariken E Stegmann
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, FA 21, 9713 AV, Groningen, The Netherlands.
| | - Olaf P Geerse
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, FA 21, 9713 AV, Groningen, The Netherlands
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dorien Tange
- Dutch Federation of Cancer Patients Organisations (Nederlandse Federatie van Kankerpatiëntorganisaties, NFK), Utrecht, The Netherlands
| | - Carol Richel
- Dutch Breast Cancer Association (Borstkankervereniging Nederland, BVN), Utrecht, The Netherlands
| | - Linda Brom
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Vivian Engelen
- Dutch Federation of Cancer Patients Organisations (Nederlandse Federatie van Kankerpatiëntorganisaties, NFK), Utrecht, The Netherlands
| | - Saskia F A Duijts
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, FA 21, 9713 AV, Groningen, The Netherlands
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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58
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Loh KP, Xu H, Back A, Duberstein PR, Gupta Mohile S, Epstein R, McHugh C, Klepin HD, Abel G, Lee SJ, El-Jawahri A, LeBlanc TW. Patient-hematologist discordance in perceived chance of cure in hematologic malignancies: A multicenter study. Cancer 2019; 126:1306-1314. [PMID: 31809566 DOI: 10.1002/cncr.32656] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/29/2019] [Accepted: 11/07/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Ensuring that patients with hematologic malignancies have an accurate understanding of their likelihood of cure is important for informed decision making. In a multicenter, longitudinal study, the authors examined discordance in patients' perception of their chance of cure versus that of their hematologists, whether patient-hematologist discordance changed after a consultation with a hematologist, and factors associated with persistent discordance. METHODS Before and after consultation with a hematologist, patients were asked about their perceived chance of cure (options were <10%, 10%-19%, and up to 90%-100% in 10% increments, and "do not wish to answer"). Hematologists were asked the same question after consultation. Discordance was defined as a difference in response by 2 levels. The McNemar test was used to compare changes in patient-hematologist prognostic discordance from before to after consultation. A generalized linear mixed model was used to examine associations between factors and postconsultation discordance, adjusting for clustering at the hematologist level. RESULTS A total of 209 patients and 46 hematologists from 4 sites were included in the current study. Before consultation, approximately 61% of dyads were discordant, which improved to 50% after consultation (P < .01). On multivariate analysis, lower educational level (<college vs postgraduate: odds ratio [OR], 2.24; 95% CI, 1.02-4.92), higher social support-affection subscale score (1-unit change in score: OR, 1.15; 95% CI, 1.00-1.32), and discordance before consultation (OR, 6.17; 95% CI, 2.99-12.72) were found to be significantly associated with discordance after consultation. CONCLUSIONS Patient-hematologist concordance in prognostic understanding appears to improve after a hematology consultation, but approximately one-half of patients' views of their prognoses were found to remain discordant with those of their hematologists. Interventions are needed to improve prognostic understanding among patients with hematologic malignancies.
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Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Huiwen Xu
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Anthony Back
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Paul R Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Supriya Gupta Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Ronald Epstein
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Palliative Care Program, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Colin McHugh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York
| | - Heidi D Klepin
- Section on Hematology and Oncology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Gregory Abel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Areej El-Jawahri
- Department of Hematology-Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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59
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Dionne-Odom JN, Currie ER, Johnston EE, Rosenberg AR. Supporting Family Caregivers of Adult and Pediatric Persons with Leukemia. Semin Oncol Nurs 2019; 35:150954. [DOI: 10.1016/j.soncn.2019.150954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
OBJECTIVE To describe the interdisciplinary management of acute leukemias across the continuum of care. DATA SOURCE Literature review and experiential knowledge. CONCLUSION Acute leukemia, including acute myelogenous leukemia, acute promyelocytic leukemia, and acute lymphoblastic leukemia, represent a heterogeneous group of hematologic malignancies with complex diagnostic requirements that drive risk-adapted treatment selection. Involvement of clinicians from a variety of specialties and disciplines is required to ensure safe and effective treatment, mitigate adverse events, and maintain or improve quality of life. Patient-centered communication, shared decision-making, and interdisciplinary communication are integral to patient outcomes. IMPLICATIONS FOR NURSING PRACTICE Oncology clinicians play a primary role in coordinating the interdisciplinary team and navigating the patient and caregiver experience across the acute leukemia continuum.
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Affiliation(s)
- Sandra Kurtin
- The University of Arizona Cancer Center, Tucson, AZ.
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61
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Webb JA, LeBlanc TW, El-Jawahri AR. Integration of Palliative Care into Acute Myeloid Leukemia Care. Semin Oncol Nurs 2019; 35:150959. [PMID: 31767262 DOI: 10.1016/j.soncn.2019.150959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide an overview of the past, present, and future of the integration of palliative care services for patients with hematologic malignancies, such as acute myeloid leukemia (AML). DATA SOURCES Published literature as indexed in Medline, relevant guideline documents, textbooks, and clinical experience. CONCLUSION Patients with acute leukemias have substantial palliative care needs that often go unmet with standard oncology care. Evidence shows that the early integration of specialist palliative care into standard oncology care improves patient-centered outcomes among those with advanced solid tumors. Emerging evidence supports similar benefits among hospitalized patients with hematologic malignancies undergoing stem cell transplantation, and additional trials are underway to further test palliative care interventions in patients with AML. IMPLICATIONS FOR NURSING PRACTICE By better understanding the palliative care needs of patients with AML and the evidence of integration with standard oncologic care, patients with leukemias may be more likely to receive early integrated palliative care.
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Affiliation(s)
- Jason A Webb
- Duke Palliative Care, Duke University and Health System, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.
| | - Thomas W LeBlanc
- Department of Medicine, Duke University School of Medicine, Durham, NC; Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Durham, NC
| | - Areej R El-Jawahri
- Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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62
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Booth A, Bell T, Halhol S, Pan S, Welch V, Merinopoulou E, Lambrelli D, Cox A. Using Social Media to Uncover Treatment Experiences and Decisions in Patients With Acute Myeloid Leukemia or Myelodysplastic Syndrome Who Are Ineligible for Intensive Chemotherapy: Patient-Centric Qualitative Data Analysis. J Med Internet Res 2019; 21:e14285. [PMID: 31755871 PMCID: PMC6898885 DOI: 10.2196/14285] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/01/2019] [Accepted: 08/23/2019] [Indexed: 12/14/2022] Open
Abstract
Background Until recently, treatment options were limited for patients with acute myeloid leukemia and myelodysplastic syndrome (AML and MDS) who are ineligible for intensive chemotherapy. Owing to the condition’s rapid progression, it is difficult to identify what is most important to patients when making treatment decisions. Patients’ needs can be better addressed by gaining a deeper understanding of their perspectives, which is valuable in the decision-making process. The Food and Drug Administration recently encouraged the use of social media as a tool to gain insight on patients’ perspectives regarding symptoms experienced and the impacts of their disease. Objective This study aimed to use disease-specific social media posts by patients with AML or MDS who are ineligible for intensive chemotherapy and their caregivers to capture factors they feel are most important, and to provide current evidence to inform and characterize these perspectives. Methods Posts by patients with AML or MDS and their caregivers were extracted from publicly available discussions on 3 large AML- or MDS–specific sites. These posts were manually reviewed to only include patients who are ineligible for intensive chemotherapy. A total of 1443 posts from 220 AML patients/caregivers and 2733 posts from 127 MDS patients/caregivers met the study inclusion criteria. A qualitative data analysis (QDA) of a sample of 85 patients’/caregivers’ posts was conducted to identify themes, and a targeted QDA of posts from 79 users focused on treatment decision discussions. Posts were manually reviewed, and relevant text segments were coded and grouped into categories and overall themes. Results Eighty-six percent (73/85) of users in the overall QDA had relevant information about the key objectives. The most commonly discussed treatment experience theme was the humanistic burden of AML or MDS in terms of emotional/physical impact and impact on family (86%, 63/73 of users), followed by treatment decisions (56%, 41/73) and unmet needs (50%, 37/73). In the QDA of treatment decisions, 60 posts from 45 users contained relevant information. Patients commonly reported the desire to reach specific milestones, including birthdays and weddings. They wished for a better quality of life over quantity of life, did not want the risk of suffering from side effects, and expressed a clear preference to be at home rather than in a hospital or care home. Conclusions This study was a novel application of disease-specific social media. It highlighted experiences in the current treatment of AML and MDS, including information gaps, patient/caregiver uncertainty, and the importance of understanding patients’/caregivers’ goals and opinions. A clear finding from this research was the importance of reaching certain personal life goals and being at home with family and friends. The analysis showed that patients/caregivers face additional challenges, including humanistic impacts and a lack of information regarding treatment options.
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63
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Abstract
OBJECTIVES Shared decision-making (SDM) is the gold standard approach to cancer treatment decision-making in the 21st century, but it is frequently misunderstood, and many clinicians do not know how to operationalize the SDM framework in their busy practices. Here we review the principles behind SDM, discuss unique aspects of acute myeloid leukemia (AML) that complicate the decision-making process, and provide one recommended framework for how to implement SDM into practice. DATA SOURCES Published literature and clinical experiences. CONCLUSION AML poses unique challenges to treatment decision-making. These challenges can be effectively addressed by following the SDM framework in practice. IMPLICATIONS FOR NURSING PRACTICE Nurses can play an important role in the AML treatment decision-making process. Being on the front lines of care, working most directly with patients and families, nurses are best positioned to assess understanding after treatment discussions take place, detect emotional distress, and provide empathic support as part of the SDM process.
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Affiliation(s)
- Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Durham, NC.
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64
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Albrecht TA, Bryant AL. Psychological and Financial Distress Management in Adults With Acute Leukemia. Semin Oncol Nurs 2019; 35:150952. [PMID: 31753705 DOI: 10.1016/j.soncn.2019.150952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To review and summarize psychological and financial distress in adults with acute leukemia and provide evidence-based methods that nurses can apply to alleviate distress experienced by patients. DATA SOURCES Oncology and palliative care literature published over the past decade. CONCLUSION Current evidence supports the efficacy of psychosocial interventions to improve psychological well-being and reduce distress for adults undergoing treatment for leukemia. IMPLICATIONS FOR NURSING PRACTICE Nurses play a critical role, not only in identifying patients who are experiencing impaired psychological well-being and high levels of distress, but also in providing prompt support to these patients.
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Affiliation(s)
| | - Ashley Leak Bryant
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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65
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Hemato-oncology and palliative care teams: is it time for an integrated approach to patient care? Curr Opin Support Palliat Care 2019; 12:530-537. [PMID: 30379755 DOI: 10.1097/spc.0000000000000385] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Integrated palliative care for those with advanced solid tumors yields significant benefits in patient and caregiver outcomes. However, most palliative care clinical trials have excluded patients with hematologic malignancies. There is growing interest in whether integrated palliative care may yield similar benefits in hematologic malignancy patients and caregivers, but there has been little direct evidence of benefit in this population. This review summarizes new data on palliative care issues in hematologic malignancies, published in the preceding 12 months. RECENT FINDINGS Most newly published evidence on this topic from the last year is descriptive of unmet needs, poor end-of-life care outcomes or unique differences and issues posed by hematologic malignancies as compared to solid tumors. A few articles describe models of collaborative care in hematologic malignancies, and just one describes the impact of an integrated palliative care intervention on patient and caregiver outcomes. Several studies point to transfusions as a unique and problematic barrier to high-quality end-of-life care in hematologic malignancies. SUMMARY Recent evidence confirms that hematologic malignancy patients have unique and often unmet palliative care needs, and also have worse end-of-life outcomes. More work is needed to develop and test integrated palliative care interventions in this population.
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LeBlanc TW, Baile WF, Eggly S, Bylund CL, Kurtin S, Khurana M, Najdi R, Blaedel J, Wolf JL, Fonseca R. Review of the patient-centered communication landscape in multiple myeloma and other hematologic malignancies. PATIENT EDUCATION AND COUNSELING 2019; 102:1602-1612. [PMID: 31076236 DOI: 10.1016/j.pec.2019.04.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/25/2019] [Accepted: 04/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To identify factors limiting and facilitating patient-centered communication (PCC) in the United States hematology-oncology setting, with a focus on multiple myeloma (MM), given the limited attention to PCC and rapid pace of change that has taken place in this setting. METHODS A literature search was performed from 2007 to 2017 to identify published articles and congress abstracts related to clinician-patient communication and treatment decision-making in oncology. Search results were evaluated by year of publication and disease area. A thematic assessment was performed to identify factors limiting and promoting PCC for patients with MM and other hematologic malignancies. RESULTS Of the 6673 publications initially retrieved, 18 exclusively reported findings in patients with hematologic malignancies and were included in this review. We identified three critical, but modifiable, barriers to PCC in the hematologic malignancy setting, including insufficient information exchange, treatment goal misalignment, and discordant role preferences in treatment decision-making. Factors that enhanced interaction quality included educational programs for clinicians and patients. CONCLUSIONS Patients with MM and other hematologic malignancies experience a distinct set of challenges that may affect PCC. PRACTICE IMPLICATIONS Clinicians have the opportunity to improve patient care by proactively addressing the identified barriers and implementing strategies demonstrated to improve PCC.
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Affiliation(s)
- Thomas W LeBlanc
- Duke Cancer Institute, Durham, NC, USA; Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Walter F Baile
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan Eggly
- Wayne State University Department of Oncology/Karmanos Cancer Institute, Detroit, MI, USA
| | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA; College of Medicine, University of Florida, Gainesville, FL, USA
| | - Sandra Kurtin
- University of Arizona and Arizona Cancer Center, Tucson, AZ, USA
| | | | | | | | - Jeffrey L Wolf
- Department of Medicine, Division of Hematology & Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Rafael Fonseca
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
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Stiefel F, Bourquin C. Moving toward the next generation of communication training in oncology: The relevance of findings from qualitative research. Eur J Cancer Care (Engl) 2019; 28:e13149. [PMID: 31429157 DOI: 10.1111/ecc.13149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/01/2019] [Accepted: 08/01/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The critics and recommendations for communication training in oncology call for new ideas, which may contribute to designing the next generation of training. The aim of this work was to search the literature on communication in oncology for empirically grounded observations that might be useful for the development of training approaches. METHODS The approach consists of identifying findings that might serve as cues for the design of the next generation of training. The literature search strategy allowed the inclusion of 68 articles. RESULTS Findings of the articles showed that multiple factors shape clinical communication: the functions and effects of information provision, the relational and interactional aspects of communication, its patient- and context-related dimensions, and the intrapsychic and context-related barriers hampering the patient encounter that clinicians are facing. CONCLUSION A way to reach all oncologists and to provide training centred on the singular needs of participants is a shift in the focus of training from communication tasks or communication-related situations to the clinician. PRACTICE IMPLICATIONS Training should focus on the competencies and qualities to be developed by clinicians, such as being flexible, able to adapt to the singular patient, sensitive to interactional aspects of communication, which influence the clinical encounter.
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Affiliation(s)
- Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
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LeBlanc TW, Erba HP. Shifting paradigms in the treatment of older adults with AML. Semin Hematol 2019; 56:110-117. [DOI: 10.1053/j.seminhematol.2019.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/22/2019] [Indexed: 12/31/2022]
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Mamolo CM, Cappelleri JC, Hoang CJ, Kim R, Hadfield A, Middleton C, Rider A, Walter RB. A real-world, cross-sectional, community survey of symptoms and health-related quality of life of adults with acute myeloid leukemia. Future Oncol 2019; 15:1895-1909. [PMID: 30912462 DOI: 10.2217/fon-2018-0842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We used Adelphi Real World Disease-Specific Programme data to characterize adults with newly diagnosed or relapsed/refractory de novo acute myeloid leukemia (AML). Materials & methods: Community-practice hematologists/oncologists completed patient record forms for their regular AML patients. Patients were invited to complete patient self-completion forms including 3-Level EuroQol 5-Dimensions (EQ-5D-3L) and Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu) questionnaires. Results: Physicians provided patient record forms for 389 patients (339 newly diagnosed, 50 relapsed/refractory); 68 patients completed patient self-completion forms. Mean EQ-5D visual-analog scale and index and FACT-General scores were significantly lower than US population norms (p < 0.0001); health-related quality of life (HRQoL) scores were generally lower than 11 other cancers. Conclusion: HRQoL impairment is grave in AML. Efforts are needed to improve HRQoL in affected patients.
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Affiliation(s)
| | | | | | - Ruth Kim
- Pfizer Inc, New York, NY 10017, USA
| | | | | | - Alex Rider
- Adelphi Real World, Cheshire, SK10 5JB, UK
| | - Roland B Walter
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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Gualano MR, Bert F, Passi S, Stillo M, Brescia V, Scaioli G, Thomas R, Voglino G, Minniti D, Boraso F, Siliquini R. Could shared decision making affect staying in hospital? A cross-sectional pilot study. BMC Health Serv Res 2019; 19:174. [PMID: 30885180 PMCID: PMC6423869 DOI: 10.1186/s12913-019-4002-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/11/2019] [Indexed: 01/09/2023] Open
Abstract
Background Shared Decision Making (SDM) is an approach where clinicians and patients share the best available evidence to make decision and where patients opinions are considered. This approach provides benefits for patients, clinicians and health care system. The aim of the present study is to investigate the patients’ perception of their participation in treatment choices and to identify the possible influences of variables in decision aids and therapeutic choices. Furthermore the present study evaluates the impact of SDM on the length of hospital stay and the health expenditure in Piemonte, an Italian region. Methods A cross-sectional study was performed in 2016. The patients were selected after hospitalization to clinical and surgical units at the Rivoli and Susa Hospital. Data were collected through the questionnaire and the Hospital Discharge Registers. STROBE guidelines for observational studies were used. A descriptive analysis was conducted. Frequencies and percentages of the categorical variables were reported. Statistical analyses were performed using t-test, chi-square test and Mann-Whitney test. Results The final sample was made of 174 subjects. More than half of the sample reported a SDM approach. Female gender (p = 0.027) and lower age (p = 0.047) are associated with an increased possibility to report SDM. Receiving “good” or “excellent” information, having their own request fulfilled and their opinions took into account by healthcare professionals, were all found to be predictors for an approach recognized as SDM (p ≤ 0.05). The perception that healthcare professionals spent a proper amount of time with the patients and used an understendable language are factors increase the chance of a “shared” decision process (p ≤ 0.05). The patients trust in the information given by the healthcare professional is not affecting their perception about the decision making process (P = 0.195). No significant difference where recorded in length of stay and hospital expenditure. Conclusions The data show the role played by different dimension of the patients-clinician relationship and that the strongest determinant of a perceived shared decision making approach are healthcare professional-depending.
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Affiliation(s)
- M R Gualano
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - F Bert
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.,AOU Città della Salute e della Scienza, Torino, Italy
| | - S Passi
- Local Health Unit, ASL TO 3, Piedmont, Italy
| | - M Stillo
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - V Brescia
- Department of Management, University of Torino, Torino, Italy
| | - G Scaioli
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - R Thomas
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - G Voglino
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.
| | - D Minniti
- Local Health Unit, ASL TO 3, Piedmont, Italy
| | - F Boraso
- Local Health Unit, ASL TO 3, Piedmont, Italy
| | - R Siliquini
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.,AOU Città della Salute e della Scienza, Torino, Italy
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Geerse OP, Stegmann ME, Kerstjens HAM, Hiltermann TJN, Bakitas M, Zimmermann C, Deal AM, Brandenbarg D, Berger MY, Berendsen AJ. Effects of Shared Decision Making on Distress and Health Care Utilization Among Patients With Lung Cancer: A Systematic Review. J Pain Symptom Manage 2018; 56:975-987.e5. [PMID: 30145213 DOI: 10.1016/j.jpainsymman.2018.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 12/25/2022]
Abstract
CONTEXT Lung cancer is associated with significant distress, poor quality of life, and a median prognosis of less than one year. Benefits of shared decision making (SDM) have been described for multiple diseases, either by the use of decisions aids or as part of supportive care interventions. OBJECTIVES The objective of this study was to summarize the effects of interventions facilitating SDM on distress and health care utilization among patients with lung cancer. METHODS We performed a systematic literature search in the CINAHL, Cochrane, EMBASE, MEDLINE, and PsychINFO databases. Studies were eligible when conducted in a population of patients with lung cancer, evaluated the effects of an intervention that facilitated SDM, and measured distress and/or health care utilization as outcomes. RESULTS A total of 12 studies, detailed in 13 publications, were included: nine randomized trials and three retrospective cohort studies. All studies reported on a supportive care intervention facilitating SDM as part of their intervention. Eight studies described effects on distress, and eight studies measured effects on health care utilization. No effect was found in studies measuring generic distress. Positive effects, in favor of the intervention groups, were observed in studies using anxiety-specific measures (n = 1) or depression-specific measures (n = 3). Evidence for reductions in health care utilization was found in five studies. CONCLUSION Although not supported by all studies, our findings suggest that facilitating SDM in the context of lung cancer may lead to improved emotional outcomes and less aggressive therapies. Future studies, explicitly studying the effects of SDM by using decision aids, are needed to better elucidate potential benefits.
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Affiliation(s)
- Olaf P Geerse
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Mariken E Stegmann
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thijo Jeroen N Hiltermann
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Allison M Deal
- Department of Biostatistics and Clinical Data Management Core, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daan Brandenbarg
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette J Berendsen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Understanding patients' values and priorities in selecting cancer treatments: Developing a therapy preference scale. J Geriatr Oncol 2018; 10:677-679. [PMID: 30501985 DOI: 10.1016/j.jgo.2018.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 11/23/2022]
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73
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Early Palliative Care for Patients with Hematologic Malignancies: Is It Really so Difficult to Achieve? Curr Hematol Malig Rep 2018. [PMID: 28639084 DOI: 10.1007/s11899-017-0392-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Evidence points to many benefits of "early palliative care," the provision of specialist palliative care services upstream from the end of life, to improve patients' quality of life while living with a serious illness. Yet most trials of early palliative care have not included patients with hematologic malignancies. Unfortunately, patients with hematologic malignancies are also known to have substantial illness burden, poor quality of life, and aggressive care at the end of life, including a greater likelihood of dying in the hospital, receiving chemotherapy at the end of life, and low hospice utilization, compared to patients with solid tumors. Given these unmet needs, one must wonder, why is palliative care so underutilized in this population? In this article, we discuss barriers to palliative care integration in hematology, highlight several reports of successful integration, and suggest specific indications for involving palliative care in the management of hematologic malignancy patients.
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Kayastha N, Wolf SP, Locke SC, Samsa GP, El-Jawahri A, LeBlanc TW. The impact of remission status on patients' experiences with acute myeloid leukemia (AML): an exploratory analysis of longitudinal patient-reported outcomes data. Support Care Cancer 2018; 26:1437-1445. [PMID: 29151174 PMCID: PMC5921898 DOI: 10.1007/s00520-017-3973-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Shared decision-making in acute myeloid leukemia (AML) requires understanding patients' longitudinal experiences of illness, but little is known about the impact of remission status on patient-reported outcomes (PROs). We aimed to explore the association between remission status and PROs 6-12 months following induction chemotherapy. METHODS Forty-two patients completed three validated instruments characterizing symptom burden (Patient Care Monitor v2.0), distress (NCCN Distress Thermometer), and QOL (FACT-Leu), as part of a longitudinal observational study. We used regression models to explore the relationship between remission status and PROs, and explore differences by initial disease type (de novo versus secondary/relapsed AML). RESULTS Those with secondary or relapsed AML at study onset had marked impairments in all measures compared to de novo AML patients. After 6 months, their mean distress score was 4.8 (> 4.0 warrants intervention), they reported a mean of 14.1 moderate/severe symptoms and had a mean QOL score of 113.6, compared to 1.0, 1.7, and 155.2, respectively, for those with de novo AML (p < .0001). Similarly, patients in relapse had a mean distress score of 5.3, a mean of 12.8 moderate/severe symptoms, and a mean QOL score of 113.4, compared to 1.8, 5.7, and 143.8, respectively, among those in remission (p < .005). These patterns persisted after adjusting for baseline differences (p < .0001). CONCLUSION Remission is associated with markedly better patient well-being in AML. Patients with secondary or relapsed AML face more severe symptom burden, distress, and QOL issues after induction. Interventions are needed to improve AML patients' experiences of illness.
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Affiliation(s)
- Neha Kayastha
- Duke University School of Medicine, Box: DUMC 2927, Durham, NC, 27703, USA
| | - Steven P Wolf
- Duke Cancer Institute, Box: DUMC 2715, Durham, NC, 27710, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102 Hock Plaza Box 2721, Durham, NC, 27710, USA
| | - Susan C Locke
- Duke Cancer Institute, Box: DUMC 2715, Durham, NC, 27710, USA
| | - Gregory P Samsa
- Duke Cancer Institute, Box: DUMC 2715, Durham, NC, 27710, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102 Hock Plaza Box 2721, Durham, NC, 27710, USA
| | - Areej El-Jawahri
- Department of Hematology and Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
| | - Thomas W LeBlanc
- Duke University School of Medicine, Box: DUMC 2927, Durham, NC, 27703, USA.
- Duke Cancer Institute, Box: DUMC 2715, Durham, NC, 27710, USA.
- Duke University School of Medicine, Box 2715, DUMC, Durham, NC, 27710, USA.
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Yang CFJ, Aibel K, Meyerhoff R, Wang F, Harpole D, Abernethy AP, LeBlanc TW. Actigraphy assessment of sleep quality among patients with acute myeloid leukaemia during induction chemotherapy. BMJ Support Palliat Care 2018; 8:274-277. [DOI: 10.1136/bmjspcare-2018-001509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/03/2022]
Abstract
ObjectivesPatients receiving induction chemotherapy for acute myeloid leukaemia (AML) anecdotally describe poor sleep, but sleep disturbances have not been well-characterised in this population. We aimed to test the feasibility of measuring sleep quality in AML inpatients using a wearable actigraphy device.MethodsUsing the Actigraph GT3X ‘watch’, we assessed the total sleep time, sleep onset latency, wake after sleep onset, number of awakenings after sleep onset and sleep efficiency for inpatients with AML receiving induction chemotherapy. We assessed patient self-reported sleep quality using the Pittsburgh Sleep Quality Index (PSQI).ResultsOf the 12 patients enrolled, 11 completed all actigraphy and PSQI assessments, demonstrating feasibility. Patients wore the Actigraph device for a mean (SD) of 15.92 (8.3) days, and actigraphy measures suggested poor sleep. Patients had a median average awakening length of 6.92 min, a median number of awakenings after sleep onset of 4 and a median sleep onset latency of 10.8 min. Actual median sleep efficiency (0.91) was high, suggesting that patients’ poor sleep was not due to insomnia but perhaps due to interruptions, such as administration of medications, lab draws and vital sign measurements.ConclusionsCollection of sleep quality data among inpatients with AML via a wearable actigraphy device is feasible. AML inpatients appear to have poor sleep quality and quantity, suggesting that sleep issues represent an area of unmet supportive care needs in AML. Further research in this areas is needed to inform the development of interventions to improve sleep duration and quality in hospitalised patients with AML.
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Horinuki F, Noguchi-Watanabe M, Takai Y, Yamahana R, Ohno N, Okada S, Mori SI, Yamamoto-Mitani N. The Experience of Persons With Hematological Malignancy When Communicating With Health Care Professionals. QUALITATIVE HEALTH RESEARCH 2018; 28:479-490. [PMID: 29103363 DOI: 10.1177/1049732317739839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study aimed to elucidate the experiences of Japanese persons with hematological malignancy (PHMs) in communicating with health care professionals (HCPs), from diagnosis to the end of life, as recalled by their families. We interviewed 14 bereaved families and analyzed the data using the basic techniques of grounded theory. We found that PHMs lived to the fullest possible when they experienced ownership of their illness process despite their disease. The ownership was made possible by active communication from HCPs: first, acknowledging the PHM's way of life, including reaching out from the HCPs and appreciating sincerely PHMs' hopes and will; and second, paving the way ahead, including giving prospects and offering choices. The study underlines that rather than just providing information about the disease, HCPs need to actively ask about and show respect for the PHM's way of life. Only after achieving this can HCPs communicate possible future pathways with PHMs.
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Affiliation(s)
| | | | - Yukari Takai
- 2 Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | | | | | - Sadamu Okada
- 3 St. Luke's International Hospital, Tokyo, Japan
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Lowe JR, Yu Y, Wolf S, Samsa G, LeBlanc TW. A Cohort Study of Patient-Reported Outcomes and Healthcare Utilization in Acute Myeloid Leukemia Patients Receiving Active Cancer Therapy in the Last Six Months of Life. J Palliat Med 2018; 21:592-597. [PMID: 29341836 DOI: 10.1089/jpm.2017.0463] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Evidence about the unique palliative care needs of patients with acute myeloid leukemia (AML) is limited. Improving the care of these patients will require a better understanding of their unmet needs, including symptom burden at the end of life, and patterns of healthcare utilization. OBJECTIVE To describe AML patients' experiences in the last six months of life regarding symptom burden, blood product utilization, and use of palliative care services. METHODS Exploratory analysis of prospectively collected patient-reported outcomes and healthcare utilization data during the last six months of life among 33 AML patients who died during a longitudinal observational study. RESULTS Symptom burden, quality of life (QOL), and psychological distress worsened with proximity to death. Of the 26 patients with utilization data, most (n = 24; 92.4%) were hospitalized in the last month of life, with 26.9% (n = 7) dying in the intensive care unit. Patients required a median of 16 red blood cell transfusions in the last six months of life, and those with a high transfusion burden in the last month of life had a higher rate of in-hospital death (blood transfusions: p < 0.01; platelet transfusions: p = 0.03). Only six patients enrolled in hospice (23.1%). DISCUSSION Patients with AML have marked symptoms and QOL impairments that escalate in the final six months of life. Patients entering the healthcare system for active cancer treatment are likely to continue disease-oriented care until death. High rates of hospitalization and blood product transfusion are a direct barrier to transitioning to hospice care.
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Affiliation(s)
- Jared R Lowe
- 1 Department of Medicine, Duke University School of Medicine , Durham, North Carolina
| | - Yinxi Yu
- 2 Department of Biostatistics and Bioinformatics, Duke University School of Medicine , Durham, North Carolina
| | - Steven Wolf
- 2 Department of Biostatistics and Bioinformatics, Duke University School of Medicine , Durham, North Carolina
| | - Greg Samsa
- 2 Department of Biostatistics and Bioinformatics, Duke University School of Medicine , Durham, North Carolina
| | - Thomas W LeBlanc
- 3 Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine , Durham, North Carolina
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