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Hsiao WH, Wang CL, Lee LC, Chien SP, Hsu CC, Chu WM. Exploring Risk Factors of Unexpected Death, Using Palliative Care Outcomes Collaboration (PCOC) Measures, among Terminal Patients Receiving Palliative Care in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13294. [PMID: 36293875 PMCID: PMC9602686 DOI: 10.3390/ijerph192013294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Palliative care has the ability to relieve both physical discomfort and psychological distress in terminally ill patients. However, unexpected death may still occur in palliative care settings. This study aimed to utilize Palliative Care Outcomes Collaboration (PCOC) data to better determine any associated factors which may surround unexpected death in palliative care settings. Data were extracted from the PCOC database by the palliative care team within Taichung Veterans General Hospital (TCVGH). Data of deceased patients were extracted during the period from January 2021 to December 2021 from multiple palliative care settings. The deaths of patients whose last recorded palliative phase was 1-3 were defined as unexpected. A total of 280 deceased patients were included, with mean age at death being 67.73, 61% being male, and 83.2% cancer patients. We discovered that shortness of breath, as assessed by the Symptom Assessment Scale (SAS), decreased risk of unexpected death (OR: 0.91, 95% CI: 0.84-0.98), while impending death discharge (OR: 3.93, 95% CI: 1.20-12.94) and a higher Australia-modified Karnofsky performance status (AKPS) score (OR: 1.15, 95% CI: 1.10-1.21) were associated with unexpected death. Thus, medical staff must inform the family of patients early on regarding any risk factors surrounding unexpected death to help everyone involved be prepared in advance.
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Affiliation(s)
- Wen-Hsuan Hsiao
- Department of Medical Education, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chun-Li Wang
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Lung-Chun Lee
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 407, Taiwan
| | - Szu-Pei Chien
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Public Health, China Medical University, Taichung 404, Taiwan
| | - Chin-Chu Hsu
- Department of Nursing, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Education and Innovation Center for Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
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Hansen MB, Nylandsted LR, Petersen MA, Adsersen M, Rojas-Concha L, Groenvold M. Patient-reported symptoms and problems at admission to specialized palliative care improved survival prediction in 30,969 cancer patients: A nationwide register-based study. Palliat Med 2020; 34:795-805. [PMID: 32186244 DOI: 10.1177/0269216320908488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Large, nationally representative studies of the association between quality of life and survival time in cancer patients in specialized palliative care are missing. AIM The aim of this study was to investigate whether symptoms/problems at admission to specialized palliative care were associated with survival and if the symptoms/problems may improve prediction of death within 1 week and 1 month, respectively. SETTING/PARTICIPANTS All cancer patients who had filled in the EORTC QLQ-C15-PAL at admission to specialized palliative care in Denmark in 2010-2017 were included through the Danish Palliative Care Database. Cox regression was used to identify clinical variables (gender, age, type of contact (inpatient vs outpatient), and cancer site) and symptoms/problems significantly associated with survival. To test whether symptoms/problems improved survival predictions, the overall accuracy (area under the receiver operating characteristic curve) for different prediction models was compared. The validity of the prediction models was tested with data on 5,508 patients admitted to palliative care in 2018. RESULTS The study included 30,969 patients with an average age of 68.9 years; 50% were women. Gender, age, type of contact, cancer site, and most symptoms/problems were significantly associated with survival time. The predictive value of symptoms/problems was trivial except for physical function, which clearly improved the overall accuracy for 1-week and 1-month predictions of death when added to models including only clinical variables. CONCLUSION Most symptoms/problems were significantly associated with survival and mainly physical function improved predictions of death. Interestingly, the predictive value of physical function was the same as all clinical variables combined (in hospice) or even higher (in palliative care teams).
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Affiliation(s)
- Maiken B Hansen
- The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Ross Nylandsted
- The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten A Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mathilde Adsersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Leslye Rojas-Concha
- The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mogens Groenvold
- The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Abstract
Introduction Calcium has several physiological functions and when it registers abnormal serum levels those functions may be impacted with potentially severe consequences. There is much research on hypercalcemia in cancer patients, but there are no recent studies on the prevalence of hypocalcemia in those patients. However, there has been an evolution in oncology, namely, new drugs that may directly or indirectly result in hypocalcemia. The primary aim was to explore the association of hypocalcemia with the diverse types of cancer. The secondary aim was to study the influence that hypocalcemia might have on survival. Methods Review of the records of patients ≥18 years old, with total calcium <2.0 mmol/L measured in 2013 in a cancer center. Results Eight hundred twenty-nine patients were included. Four hundred thirty-nine (53%) were male. The median age was 63 years. The most frequent cancer diagnoses were hematological 196 (24%) and colorectal 111 (13%). Six hundred thirty-eight patients had measured serum albumin, with a median of 25.5 g/L (14-47). When corrected for albumin level, calcium was in the normal range in 210 (33%) cases. The median survival of patients with corrected calcium lower than normal was 479 days (95% confidence interval [CI]: 309-649) and that of patients with normal corrected calcium was 62 days (95% CI: 33-91), P < .001. In a multivariate analysis, age, primary cancer, and albumin were significantly associated with survival. Conclusion Hypocalcemia is associated with several types of cancer. A low calcium level is not by itself a factor of a poor prognosis since other factors seem to be more important.
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Internal medicine and palliative care: Science and humanism. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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5
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Galindo Ocaña J, Aguilera González C. Internal medicine and palliative care: Science and humanism. Rev Clin Esp 2019; 219:324-326. [PMID: 31128855 DOI: 10.1016/j.rce.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- J Galindo Ocaña
- Medicina Interna, UHD/ESCP, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - C Aguilera González
- Unidad de Hospitalización Domiciliaria/Equipo de Soporte de Cuidados Paliativos, Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España
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Kuroda N, Hiramatsu H, Mori M, Tanaka T. Mechanical Thrombectomy for Trousseau Syndrome in a Terminally Ill Cancer Patient. J Pain Symptom Manage 2019; 57:688-694. [PMID: 30576713 DOI: 10.1016/j.jpainsymman.2018.12.327] [Citation(s) in RCA: 5] [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: 10/16/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
Trousseau syndrome was first described by Armand Trousseau in 1865 and is characterized by hypercoagulation resulting from malignant tumors. This complication can markedly impact quality of life (QOL). This is the first report of a terminally ill patient who developed large-vessel occlusion stroke from Trousseau syndrome and underwent mechanical thrombectomy. A 75-year-old woman presented with Stage IV ovarian cancer. Goals of care were transitioned to palliative care. The patient was hospitalized with vertebral compression fracture and suddenly developed right hemiparesis and total aphasia during admission. Magnetic resonance imaging and angiography showed occlusion of Segment 1 of the left middle cerebral artery. We administered tissue-plasminogen activator, but symptoms remained unimproved. We performed mechanical thrombectomy based on medical indications and with the consent of her family. Thrombectomy improved symptoms dramatically. She was able to walk and talk with her family at discharge. She eventually died of respiratory failure on postoperative Day 98, but QOL remained high for those 98 days. Mechanical thrombectomy has the potential to markedly improve QOL in terminally ill patients with large-vessel occlusion associated with Trousseau syndrome.
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Affiliation(s)
- Naoto Kuroda
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
| | - Hisaya Hiramatsu
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tokutaro Tanaka
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Kaleva-Kerola J, Huhtala H, Helminen M, Pylkkänen L, Holli K. Evaluation of frequency of Clinical Symptoms and Signs within Six Months Prior to Death in Patients with Advanced Solid Cancers. J Palliat Care 2018. [DOI: 10.1177/082585971202800103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This retrospective study documented the frequency of the clinical symptoms and signs that increase in advanced cancer patients as they move toward death in order to create a sum score and correlate it with survival. Of 572 adult patients who were treated in four selected hospitals and who died in 1998 and 1999, data at six, three, and one month(s) prior to death was available for 257. The results showed that the number of symptoms and certain clinical findings accelerated toward death, increasing the sum score. Younger patients obtained higher sum scores at one month prior to death than did elderly ones (p=0.014); this suggests that elderly patients die at a point where they show less worsening in their clinical condition than do younger patients. The score was independent of cancer type or gender. The results of this analysis provide data for further development of a clinical tool to predict long-term survival in palliative care settings.
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Affiliation(s)
- Jaana Kaleva-Kerola
- J Kaleva-Kerola (corresponding author): Department of Oncology, West Bothnia Central Hospital, Kauppakatu 25, FI-94100 Kemi, Finland
| | - Heini Huhtala
- H Huhtala: Tampere School of Public Health, University of Tampere, Tampere, Finland
| | - Mika Helminen
- M Helminen: Tampere School of Public Health, University of Tampere, and Science Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Liisa Pylkkänen
- L Pylkkänen: Department of Oncology, University of Turku, Turku, and Medical School, University of Tampere, Tampere, Finland
| | - Kaija Holli
- K Holli: Medical School, University of Tampere, Tampere, Finland
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Wiegert EVM, Padilha PDC, Peres WAF. Performance of Patient-Generated Subjective Global Assessment (PG-SGA) in Patients With Advanced Cancer in Palliative Care. Nutr Clin Pract 2017; 32:675-681. [DOI: 10.1177/0884533617725071] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Patricia de Carvalho Padilha
- Department of Nutrition and Dietetics, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Wilza Arantes Ferreira Peres
- Department of Nutrition and Dietetics, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Jho HJ, Suh SY, Yoon SJ, Lee SS, Ahn HY, Yamaguchi T, Mori M, Maeda I, Baba M, Morita T. Prospective Validation of the Objective Prognostic Score for Advanced Cancer Patients in Diverse Palliative Settings. J Pain Symptom Manage 2016; 52:420-7. [PMID: 27387346 DOI: 10.1016/j.jpainsymman.2016.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/16/2016] [Accepted: 03/07/2016] [Indexed: 11/17/2022]
Abstract
CONTEXT Prognostication is an essential part of palliative care to aid decision making and negotiate goals of care. The Objective Prognostic Score (OPS) is an easy-to-use prognosticating tool to predict survival among far-advanced cancer patients in palliative care units (PCUs) in Korea. OBJECTIVES This study aimed to prospectively validate the OPS for advanced cancer patients in the palliative care teams (PCTs), PCUs, and home-based palliative care (HPC) in Japan. METHODS This was a substudy of a multicenter prospective cohort study that was conducted to validate and compare prognostic tools among advanced cancer patients in Japan. Participants' survival was calculated according to OPS 3 as a cutoff for predicting survival of less than three weeks. Overall accuracy and area under the receiver operator characteristic curves of OPS 3 were calculated for PCT, PCU, and HPC, respectively. RESULTS A total of 1146 cases (PCTs 441, PCUs 519, and HPCs 186 cases) were included in final analyses. The overall accuracy of OPS 3 for predicting three-week survival ranged from 0.70 to 0.78 across diverse palliative care settings. The c-statistics ranged from 0.742 to 0.808 across three settings. Participants in the PCT showed the highest overall accuracy and c-statistics for OPS. CONCLUSION The OPS can be used for prognostication among advanced cancer patients in PCT, PCU, and HPC settings.
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Affiliation(s)
- Hyun Jung Jho
- Palliative Care Clinic, Hospital, National Cancer Center, Goyang, South Korea
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea; Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea.
| | - Seok-Joon Yoon
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, South Korea
| | | | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Mori
- Department of Palliative Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mika Baba
- Department of Palliative Care, Saito Yukoukai Hospital, Osaka, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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10
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Overall survival of cancer patients with serum lactate dehydrogenase greater than 1000 IU/L. Tumour Biol 2016; 37:14083-14088. [PMID: 27511116 PMCID: PMC5097084 DOI: 10.1007/s13277-016-5228-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/15/2016] [Indexed: 12/22/2022] Open
Abstract
High level of serum lactate dehydrogenase (LDH) is a well-known poor prognostic factor in patients with malignancies. However, there was no data on overall survival (OS) in cancer patients with serum LDH level > 1000 IU/L, and the prognostic value of the changes in LDH over time for OS had not been reported. Clinical data of 311 cancer patients with metastatic disease with serum LDH >1000 IU/L (four times upper limit of normal) admitted consecutively to a single center were reviewed in this retrospective study. LDH level ranged from 1002 to 8235 U/L with a mean of 1689 U/L. The median OS was 1.7 months (95 % CI: 1.4–2.0). About half of patients (n = 163, 52 %) died within 2 months with the median OS of 0.5 months (95 % CI: 0.3–0.7). Only 173 patients were indicated for salvage treatment. Fifty-one patients’ serum LDH level decreased to normal at 2 months following chemotherapy; OS was significantly longer in these patients (22.6 months, 95 % CI: 10.9–34.3, p < 0.001) compared to those with persistently abnormal serum LDH at 2 months (4.0 months, 95 % CI: 3.4–4.6). The independent factors that increased the death risk were ECOG performance status 3–4 (HR: 2.05, 95 % CI: 1.42–2.97, p < 0.001), supportive care only (HR: 2.91, 95 % CI: 2.06–4.10, p < 0.001), and persistently abnormal serum LDH at 2 months (HR: 2.72, 95 % CI: 1.67–4.42, p < 0.001). In conclusion, serum LDH level > 1000 IU/L predicted a terminal stage in metastatic cancer patients. OS was significantly prolonged in patients indicated for effective palliative treatment and LDH level decreased to normal at 2 months.
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Elsayem AF, Bruera E, Valentine AD, Warneke CL, Yeung SCJ, Page VD, Wood GL, Silvestre J, Holmes HM, Brock PA, Todd KH. Delirium frequency among advanced cancer patients presenting to an emergency department: A prospective, randomized, observational study. Cancer 2016; 122:2918-24. [DOI: 10.1002/cncr.30133] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/27/2016] [Accepted: 03/29/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Ahmed F. Elsayem
- Department of Emergency Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Eduardo Bruera
- Department of Palliative; Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Alan D. Valentine
- Department of Psychiatry; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Carla L. Warneke
- Department of Biostatistics; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Sai-Ching J. Yeung
- Department of Emergency Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Valda D. Page
- Department of Emergency Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Geri L. Wood
- The University of Texas Health Science Center at the Houston School of Nursing; Houston Texas
| | - Julio Silvestre
- Department of Emergency Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Holly M. Holmes
- Division of Geriatric and Palliative Medicine; The University of Texas Health Science Center at Houston; Houston Texas
| | - Patricia A. Brock
- Department of Emergency Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Knox H. Todd
- Department of Emergency Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
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12
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Tan T, Cheang F. A single-center retrospective analysis of interventions provided to geriatric inpatients receiving end-of-life care. PROGRESS IN PALLIATIVE CARE 2016. [DOI: 10.1080/09699260.2016.1188521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Prognostic Model for Predicting Survival in Patients with Disease Recurrence Following Radical Cystectomy. Eur Urol Focus 2015; 1:75-81. [DOI: 10.1016/j.euf.2014.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 11/21/2022]
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Chen YT, Ho CT, Hsu HS, Huang PT, Lin CY, Liu CS, Li TC, Lin CC, Lin WY. Objective palliative prognostic score among patients with advanced cancer. J Pain Symptom Manage 2015; 49:690-6. [PMID: 25261639 DOI: 10.1016/j.jpainsymman.2014.08.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 08/19/2014] [Accepted: 08/21/2014] [Indexed: 11/26/2022]
Abstract
CONTEXT The accurate prediction of survival is one of the key factors in the decision-making process for patients with advanced illnesses. OBJECTIVES This study aimed to develop a short-term prognostic prediction method that included such objective factors as medical history, vital signs, and blood tests for use with patients with advanced cancer. METHODS Medical records gathered at the admission of patients with advanced cancer to the hospice palliative care unit at a tertiary hospital in Taiwan were reviewed retrospectively. The records included demographics, history of cancer treatments, performance status, vital signs, and biological parameters, Multivariate logistic regression analyses and receiver operating characteristic curves were used for model development. RESULTS The Objective Palliative Prognostic Score was determined by using six objective predictors identified by multivariate logistic regression analysis. The predictors include heart rate >120/min, white blood cells >11,000/mm(3), platelets <130,000/mm(3), serum creatinine level >1.3 mg/dL, serum potassium level >5 mg/dL, and no history of chemotherapy. The area under the receiver operating characteristic curve used to predict seven-day survival was 82.0% (95% confidence interval 75.2%-88.8%). If any three predictors of the six were reached, death within seven days was predicted with 68.8% sensitivity, 86.0% specificity, 55.9% positive predictive value, and 91.4% negative predictive value. CONCLUSION The Objective Palliative Prognostic Score consists of six objective predictors for the estimation of seven-day survival among patients with advanced cancer and showed a relatively high accuracy, specificity, and negative predictive value. Objective signs, such as vital signs and blood test results, may help clinicians make decisions at the end of life.
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Affiliation(s)
- Yen-Ting Chen
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; Hospice Palliative Medicine Unit, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Te Ho
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; Hospice Palliative Medicine Unit, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Hua-Shai Hsu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; Hospice Palliative Medicine Unit, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Po-Tsung Huang
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; Hospice Palliative Medicine Unit, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Yu Lin
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan; Institute of Health Care Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Institute of Health Care Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; Hospice Palliative Medicine Unit, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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15
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Apostol CC, Waldfogel JM, Pfoh ER, List D, Billing LS, Nesbit SA, Dy SM. Association of goals of care meetings for hospitalized cancer patients at risk for critical care with patient outcomes. Palliat Med 2015; 29:386-90. [PMID: 25527528 PMCID: PMC4695974 DOI: 10.1177/0269216314560800] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Caring for cancer patients with advanced and refractory disease requires communication about care preferences, particularly when patients become ill enough to be at risk for critical care interventions potentially inconsistent with their preferences. AIM To describe the use of goals of care discussions in patients with advanced/refractory cancer at risk for critical care interventions and evaluate associations between these discussions and outcomes. DESIGN Cohort study describing patients/families' perceptions of goals of care meetings and comparing health care utilization outcomes of patients who did and did not have discussions. SETTING/PARTICIPANTS Inpatient units of an academic cancer center. Included patients had metastatic solid tumors or relapsed/refractory lymphoma or leukemia and were at risk for critical care, defined as requiring supplemental oxygen and/or cardiac monitor. RESULTS Of 86 patients enrolled, 34 (39%) had a reported goals of care discussion (study group). Patients/families reported their needs and goals were addressed moderately to quite a bit during the meetings. Patients in the study group were less likely to receive critical care (0% vs 22%, p = 0.003) and more likely to be discharged to hospice (48% vs 30%, p = 0.04) than the control group. Only one patient in the study group died during the index hospitalization (on comfort care) (3%) compared with 9(17%) in the control group (p = 0.08). CONCLUSION Goals of care meetings for advanced/refractory cancer inpatients at risk for critical care interventions can address patient and family goals and needs and improve health care utilization. These meetings should be part of routine care for these patients.
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Affiliation(s)
- Colleen C Apostol
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (SKCCC), Baltimore, MD, USA
| | | | - Elizabeth R Pfoh
- Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Donald List
- Department of Social Work, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (SKCCC), Baltimore, MD, USA
| | - Lynn S Billing
- Harry J. Duffey Family Pain and Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (SKCCC), Baltimore, MD, USA
| | - Suzanne A Nesbit
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sydney Morss Dy
- Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Harry J. Duffey Family Pain and Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (SKCCC), Baltimore, MD, USA
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Coulter SL, Melvin T, Carden JP, Mathis RS. Hospice Care in a Commercial Preferred Provider Organization Population in Tennessee. Am J Hosp Palliat Care 2015; 32:168-72. [DOI: 10.1177/1049909113511689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study was undertaken to examine two aspects of care at the end of life. First, we wanted to see whether the cost savings demonstrated repeatedly in the US Medicare hospice population would also be observed in a commercial population in Tennessee. They were. The second primary interest we had was whether there were certain medical services that seemed to presage death. We found four categories of services that profoundly increase in number as the end of life is approached: primary care, hospital-based specialist, non-hospital based specialist, and oncologist services. It is hoped that these findings could lead to a simple predictive model based on readily available claims data to help identify candidates for Hospice Care earlier.
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Affiliation(s)
- Steven L. Coulter
- BlueCross BlueShield of Tennessee Health Institute, Chattanooga, TN, USA
| | | | - J. Payne Carden
- BlueCross BlueShield of Tennessee Health Institute, Chattanooga, TN, USA
| | - Rick S. Mathis
- BlueCross BlueShield of Tennessee Health Institute, Chattanooga, TN, USA
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Bogaardt H, Veerbeek L, Kelly K, van der Heide A, van Zuylen L, Speyer R. Swallowing problems at the end of the palliative phase: incidence and severity in 164 unsedated patients. Dysphagia 2014; 30:145-51. [PMID: 25533181 DOI: 10.1007/s00455-014-9590-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/04/2014] [Indexed: 11/25/2022]
Abstract
Swallowing problems are reported to be a common finding in patients who receive palliative care. In existing literature, the incidence of swallowing problems is mostly described in small numbers of patients at the start of the palliative phase. As we hypothesized that the incidence of dysphagia might increase as the palliative phase progresses, this study describes the incidence of swallowing problems and related problems in 164 unsedated patients at the end of the palliative phase, defined by the last 72 h before their death. To determine the incidence of swallowing problems and related problems, questionnaires were completed bereaved by relatives and nursing staff. Our data shows that in the palliative phase the incidence of swallowing problems can be as high as 79 %. A significant correlation was found between swallowing problems and reduced psycho-social quality of life as assessed by nursing staff (ρ = -.284). Overall the nursing staff rated the incidence and severity of swallowing problems (and related problems like frequent coughing, loss of appetite, and problems with oral secretions) lower than the relatives. This study suggests that incidence of swallowing problems at the end of the palliative phase is high and that these difficulties may not only result in discomfort for patients, but also can raise concern for caregivers. More information and education on management of swallowing problems in palliative settings might be needed for both relatives and nursing staff. However, the data also suggest that any intervention should be proportional to the level of distress caused by the intervention.
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Affiliation(s)
- Hans Bogaardt
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 2141, Australia,
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18
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Kim ES, Lee JK, Kim MH, Noh HM, Jin YH. Validation of the prognosis in palliative care study predictor models in terminal cancer patients. Korean J Fam Med 2014; 35:283-94. [PMID: 25426276 PMCID: PMC4242906 DOI: 10.4082/kjfm.2014.35.6.283] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/07/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Prognosis in Palliative Care Study (PiPS) predictor models were developed in 2011 to estimate the survival of terminal cancer patients in the United Kingdom. The aim of this study was to validate the PiPS model for terminal cancer patients in Korea, and evaluate its value in clinical practice. METHODS This study included 202 advanced cancer patients who were admitted to the cancer hospital's palliative care ward from November 2011 to February 2013. On admission, physicians recorded the PiPS-A, PiPS-B, and doctor's survival estimates in inpatients. RESULTS The median survival across PiPS-A categories was 9, 28, and 33 days, and the median survival across PiPS-B was 9.5, 27, and 43 days. The median actual survival was 25 days; overall accuracy between the PiPS-A, PiPS-B, doctor's estimates of survival, and actual survival was 52.0%, 49.5%, and 46.5%, respectively. The PiPS-A and PiPS-B groups for survival in 'days' showed a sensitivity of 48.4% and 64.1%, and specificity of 87.7%, and 77.5%, respectively. The PiPS-A and PiPS-B groups for survival in 'weeks' showed a sensitivity of 59.2%, and 44.7%, and specificity of 61.6%, and 64.7%, respectively. The PiPS-A and PiPS-B 'months' group showed a sensitivity of 37.1% and 37.1%, and specificity of 74.9% and 78.4%, respectively. The 'weeks' and 'months' groups showed significantly prolonged survival rates than 'days' group did in both PiPS-A and PiPS-B, by the Kaplan-Meier method. CONCLUSION The PiPS predictor models effectively predicted the survival ≥14 days in terminal cancer patients, and were superior to doctor's estimates.
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Affiliation(s)
- Eun-Shin Kim
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Kwon Lee
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Hyun Kim
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye-Mi Noh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yeong-Hyeon Jin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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19
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Sachlova M, Majek O, Tucek S. Prognostic value of scores based on malnutrition or systemic inflammatory response in patients with metastatic or recurrent gastric cancer. Nutr Cancer 2014; 66:1362-70. [PMID: 25356861 DOI: 10.1080/01635581.2014.956261] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cancer patients are frequently affected by malnutrition and weight loss, which affects their prognosis, length of hospital stay, health care costs, quality of life and survival. Our aim was to assess the prognostic value of different scores based on malnutrition or systemic inflammatory response in 91 metastatic or recurrent gastric cancer patients considered for palliative chemotherapy at the Masaryk Memorial Cancer Institute. We investigated their overall survival according to the following measures: Onodera's Prognostic Nutritional Index (OPNI), Glasgow Prognostic Score (GPS), nutritional risk indicator (NRI), Cancer Cachexia Study Group (CCSG), as previously defined, and a simple preadmission weight loss. The OPNI, GPS, and CCSG provided very significant prognostic values for survival (log-rank test P value < 0.001). For example, the median survival for patients with GPS 0 was 12.3 mo [95% confidence interval (CI): 7.7-16.7], whereas the median survival for patients with GPS 2 was only 2.9 mo (95% CI: 1.9-4.8). A significantly worse survival of malnourished patients was also suggested by a multivariate model. The values of GPS, OPNI, and CCSG represent useful tools for the evaluation of patients' prognosis and should be part of a routine evaluation of patients to provide a timely nutrition support.
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Affiliation(s)
- Milana Sachlova
- a Department of Gastroenterology , Masaryk Memorial Cancer Institute , Brno , Czech Republic
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20
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Kluth LA, Xylinas E, Kent M, Hagiwara M, Kikuchi E, Ikeda M, Matsumoto K, Dalpiaz O, Zigeuner R, Aziz A, Fritsche HM, Deliere A, Raman JD, Bensalah K, Al-Matar B, Gakis G, Novara G, Klatte T, Remzi M, Comploj E, Pycha A, Rouprêt M, Tagawa ST, Chun FKH, Scherr DS, Vickers AJ, Shariat SF. Predictors of survival in patients with disease recurrence after radical nephroureterectomy. BJU Int 2014; 113:911-7. [DOI: 10.1111/bju.12369] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Luis A. Kluth
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
- Department of Urology; University Medical-Center Hamburg-Eppendorf; Hamburg Germany
| | - Evanguelos Xylinas
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
- Department of Urology; Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes University; Paris France
| | - Matthew Kent
- Department of Epidemiology and Biostatistics; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Masayuki Hagiwara
- Department of Urology; Keio University School of Medicine; Shinjuku-ku Tokyo Japan
| | - Eiji Kikuchi
- Department of Urology; Keio University School of Medicine; Shinjuku-ku Tokyo Japan
| | - Masaomi Ikeda
- Department of Urology; Kitasato University School of Medicine; Minami-ku Sagamihara Kanagawa Japan
| | - Kazumasa Matsumoto
- Department of Urology; Kitasato University School of Medicine; Minami-ku Sagamihara Kanagawa Japan
| | - Orietta Dalpiaz
- Department of Urology; Medical University of Graz; Graz Austria
| | | | - Atiqullah Aziz
- Department of Urology; Caritas St. Josef Medical Centre; University of Regensburg; Regensburg Germany
| | - Hans-Martin Fritsche
- Department of Urology; Caritas St. Josef Medical Centre; University of Regensburg; Regensburg Germany
| | - Amanda Deliere
- Division of Urology; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Jay D. Raman
- Division of Urology; Penn State Milton S. Hershey Medical Center; Hershey PA USA
| | - Karim Bensalah
- Department of Urology; Centre Hospitalier Universitaire de Rennes; Rennes France
| | - Bikheet Al-Matar
- Department of Urology; University Medical Hospital of Tuebingen; Tuebingen Germany
| | - Georgios Gakis
- Department of Urology; University Medical Hospital of Tuebingen; Tuebingen Germany
| | - Giacomo Novara
- Department of Surgical, Oncological and Gastroenterologic Sciences; Urology Clinic; University of Padua; Padua Italy
| | - Tobias Klatte
- Department of Urology; Medical University of Vienna; Vienna Austria
| | - Mesut Remzi
- Department of Urology; Landesklinikum Korneuburg; Korneuburg Austria
| | - Evi Comploj
- Department of Urology; General Hospital of Bolzano; Bolzano Italy
| | - Armin Pycha
- Department of Urology; General Hospital of Bolzano; Bolzano Italy
| | - Morgan Rouprêt
- Academic Department of Urology of la Pitié-Salpétrière; Assistance Publique-Hôpitaux de Paris; University Paris VI, Faculté de médecine Pierre et Marie Curie; Paris France
| | - Scott T. Tagawa
- Division of Medical Oncology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
| | - Felix K.-H. Chun
- Department of Urology; University Medical-Center Hamburg-Eppendorf; Hamburg Germany
| | - Douglas S. Scherr
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
| | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Shahrokh F. Shariat
- Department of Urology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
- Division of Medical Oncology; Weill Cornell Medical College; New York Presbyterian Hospital; New York NY USA
- Department of Urology; Medical University of Vienna; Vienna Austria
- Department of Urology; UT Southwestern; Dallas TX USA
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Zhang K, Lai Y, Axelrod R, Campling B, Hyslop T, Civan J, Solomides C, Myers RE, Lu B, Bar Ad V, Li B, Ye Z, Yang H. Modeling the overall survival of patients with advanced-stage non-small cell lung cancer using data of routine laboratory tests. Int J Cancer 2014; 136:382-91. [PMID: 24866905 DOI: 10.1002/ijc.28995] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/15/2014] [Indexed: 02/02/2023]
Abstract
Cancer patients undergo routine clinical monitoring with an array of blood tests that may carry long-term prognostic information. We aimed to develop a new prognostic model predicting survival for patients with advanced non-small cell lung cancer (NSCLC), based on laboratory tests commonly performed in clinical practice. A cohort of 1,161 stage IIIB or IV NSCLC patients was divided into training (n = 773) and testing (n = 388) cohorts. We analyzed the associations of 32 commonly tested laboratory variables with patient survival in the training cohort. We developed a model based on those significant laboratory variables, together with important clinical variables. The model was then evaluated in the testing cohort. Five variables, including albumin, total protein, alkaline phosphatase, blood urea nitrogen and international normalized ratio, were significantly associated with patient survival after stepwise selection. A model incorporating these variables classified patients into low-, medium- and high-risk groups with median survival of 16.9, 7.2 and 2.1 months, respectively (p < 0.0001). Compared with low-risk group, patients in the medium- and high-risk groups had a significantly higher risk of death at 1 year, with hazard ratio (HR) of 1.95 (95% CI 1.62-2.36) and 5.22 (4.30-6.34), respectively. These results were validated in the testing cohort. Overall, we developed a prognostic model relying entirely on readily available variables, with similar predictive power to those which depend on more specialized and expensive molecular assays. Further study is necessary to validate and further refine this model, and compare its performance to models based on more specialized and expensive testing.
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Affiliation(s)
- Kejin Zhang
- Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; College of Life Sciences, Northwest University, Xi'an, China
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Habermehl D, Brecht IC, Debus J, Combs SE. Palliative radiation therapy in patients with metastasized pancreatic cancer - description of a rare patient group. Eur J Med Res 2014; 19:24. [PMID: 24887532 PMCID: PMC4046029 DOI: 10.1186/2047-783x-19-24] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 04/29/2014] [Indexed: 12/25/2022] Open
Abstract
Background Pancreatic cancer (PAC) patients experience a high rate of locoregional recurrences and distant metastasis finally leading to their demise even after curatively-intended multidisciplinary treatment approaches including surgery, chemotherapy and radiotherapy. However, clinical reports on bone and brain metastases in PAC patients are extremely rare and thus timing and dose description are not well defined. Our work therefore summarizes a mono-institutional experience on the use of radiotherapy (RT) for PAC patients with metastatic disease with the aim of identifying overall survival and treatment response in this rarely reported patient group. Method Forty-four PAC patients with 66 metastatic lesions were treated with palliative radiotherapy (RT). Thirty-three patients (48 lesions), 7 patients (11 lesions) and 5 patients (7 lesions) with bone, liver and brain metastases analyzed respectively were analyzed; one patient had both bone and cerebral metastases and was treated for the lesions, thus including him in both subgroups. Indications for RT were pain, neurological impairment, risk of pathological fracture or imminent danger for development of any of these conditions in case of tumor progression. Median age was 64 years (range 38 to 78 years) and there were 27 male (61%) and 17 (39%) female patients. Analyses of overall survival (OS) and local control were performed. OS was calculated from the first day of RT. Results Median overall survival (mOS) of all patients after start of RT was 4.2 months. Survival rates after 1, 3 and 6 months were 79.3%, 55.3% and 30.3% respectively. Patients presenting with bone metastasis had a mOS of 3.1 months and after 1, 3 and 6 months, survival rates were 75.3%, 46.5% and 19.9% respectively. Symptomatic response to therapy was recorded in 85% of all evaluated patients with bone metastasis. Patients undergoing radiosurgery because of liver metastasis were locally controlled in all but one patient after a median follow-up of 8.3 months. Conclusion Overall survival of all patients with metastatic disease was considerably worse. A major goal for the future must be the selection of an appropriate RT treatment in terms of duration and technique for these PAC patients.
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Affiliation(s)
- Daniel Habermehl
- Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Strasse 22, 81675 Munich, Germany.
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23
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Delirium in adult patients receiving palliative care: A systematic review of the literature. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rpsmen.2013.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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24
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Development and validation of a prognostic scale for hospitalized patients with terminally ill cancer in China. Support Care Cancer 2013; 22:145-52. [DOI: 10.1007/s00520-013-1970-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
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Sánchez-Román S, Beltrán Zavala C, Lara Solares A, Chiquete E. Delirium in adult patients receiving palliative care: a systematic review of the literature. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2013; 7:48-58. [PMID: 23911280 DOI: 10.1016/j.rpsm.2013.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/23/2013] [Accepted: 05/14/2013] [Indexed: 11/25/2022]
Abstract
Delirium in palliative care patients is common and its diagnosis and treatment is a major challenge. Our objective was to perform a literature analysis in two phases on the recent scientific evidence (2007-2012) on the diagnosis and treatment of delirium in adults receiving palliative care. In phase 1 (descriptive studies and narrative reviews) 133 relevant articles were identified: 73 addressed the issue of delirium secondarily, and 60 articles as the main topic. However, only 4 prospective observational studies in which delirium was central were identified. Of 135 articles analysed in phase 2 (clinical trials or descriptive studies on treatment of delirium in palliative care patients), only 3 were about prevention or treatment: 2 retrospective studies and one clinical trial on multicomponent prevention in cancer patients. Much of the recent literature is related to reviews on studies conducted more than a decade ago and on patients different to those receiving palliative care. In conclusion, recent scientific evidence on delirium in palliative care is limited and suboptimal. Prospective studies are urgently needed that focus specifically on this highly vulnerable population.
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Affiliation(s)
- Sofía Sánchez-Román
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Cristina Beltrán Zavala
- Clínica del Dolor y Cuidados Paliativos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Argelia Lara Solares
- Clínica del Dolor y Cuidados Paliativos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Erwin Chiquete
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
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Bergstraesser E, Hain RD, Pereira JL. The development of an instrument that can identify children with palliative care needs: the Paediatric Palliative Screening Scale (PaPaS Scale): a qualitative study approach. BMC Palliat Care 2013; 12:20. [PMID: 23657092 PMCID: PMC3663726 DOI: 10.1186/1472-684x-12-20] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 05/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of paediatric palliative care and referral to specialised teams still occurs late in the illness trajectory of children with life-limiting diseases. The aim of this ongoing multipart study was to develop a screening instrument for paediatricians that would improve the timely identification of children who could benefit from a palliative care approach. METHODS We used a qualitative study approach with semi-structured interviews (Part 1) and a focus group discussion (Part 2) to define the domains and items of the screening instrument. Seven international paediatric palliative care experts from the UK, France, USA, and Canada took part in face-to-face interviews, and eleven paediatric health professionals from the University Children's Hospital, Zurich, participated in a subsequent focus group discussion. RESULTS This preliminary phase of development and validation of the instrument revealed five domains relevant to identifying children with life-limiting diseases, who could benefit from palliative care: 1) trajectory of disease and impact on daily activities of the child; 2) expected outcome of disease-directed treatment and burden of treatment; 3) symptom and problem burden; 4) preferences of patient, parents or healthcare professional; and 5) estimated life expectancy. Where palliative care seems to be necessary, it would be introduced in a stepwise or graduated manner. CONCLUSIONS This study is a preliminary report of the development of an instrument to facilitate timely introduction of palliative care in the illness trajectory of a severely ill child. The instrument demonstrated early validity and was evaluated as being a valuable approach towards effective paediatric palliative care.
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Affiliation(s)
- Eva Bergstraesser
- Department of Palliative Care and Oncology, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
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Al-Zahrani AS, El-Kashif AT, Mohammad AA, Elsamany S, Alsirafy SA. Prediction of In-Hospital Mortality of Patients With Advanced Cancer Using the Chuang Prognostic Score. Am J Hosp Palliat Care 2012; 30:707-11. [DOI: 10.1177/1049909112467362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The prediction of in-hospital mortality may help in improving end-of-life care for patients dying of cancer. The Chuang Prognostic Score (CPS) was developed to predict survival of terminally ill patients with cancer. The CPS was assessed in 61 hospitalized adult patients with advanced cancer. Using a CPS cutoff point of ≥6, in-hospital mortality was predicted with 71% positive predictive value, 91% negative predictive value, 75% sensitivity, 89% specificity, and 85% overall accuracy. The patients were divided according to the CPS score into 3 groups (Group 1: CPS < 3.5, Group 2: CPS ≥ 3.5-<6, and Group 3: CPS ≥ 6) with a median survival of not reached, 118 days, and 16 days, respectively ( P < .001). The CPS may be useful in predicting in-hospital mortality of hospitalized patients with advanced cancer.
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Affiliation(s)
| | - Amr T. El-Kashif
- Oncology Center, King Abdullah Medical City–Holy Capital, Makkah, Saudi Arabia
| | | | - Shereef Elsamany
- Oncology Center, King Abdullah Medical City–Holy Capital, Makkah, Saudi Arabia
| | - Samy A. Alsirafy
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
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28
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Alshemmari S, Ezzat H, Samir Z, Refaat S, Alsirafy SA. The palliative prognostic index for the prediction of survival and in-hospital mortality of patients with advanced cancer in Kuwait. J Palliat Med 2012; 15:200-4. [PMID: 22283372 DOI: 10.1089/jpm.2011.0253] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Prognostic scoring systems are increasingly used in cancer care. One of these systems is the Palliative Prognostic Index (PPI) which is based on clinical findings. Few studies validated the PPI in different settings. Our aim was to test the predictive value of the PPI in an acute cancer care setting. METHODS Prospective study that included patients with advanced cancer admitted to a tertiary cancer center in Kuwait. Patients were divided according to the PPI score into three groups: A (PPI≤3), B (PPI>3- ≤6), and C (>6). RESULTS The study included 91 hospitalized patients. At the time of PPI assessment, the plan of treatment was best supportive care only in 70 (77%) patients. The majority (80%) of included patients died in-hospital. The in-hospital mortality rate for patients with a PPI>6 was significantly higher than those with ≤6 (93% versus 56%, p<0.001). Using a cutoff point of PPI>6, in-hospital mortality was predicted with a 73% sensitivity, 78% specificity, 93% positive predictive value, and 41% negative predictive value. The median survival was 61 days (95% confidence interval [CI]: 25.8-96.2) for group A, 20 days (95% CI: 4.5-35.5) for group B, and 6 days (95% CI: 4-8) for group C. The difference in survival was highly significant (p<0.001). CONCLUSION The results suggest that the PPI may be helpful for oncologists in predicting survival and in-hospital mortality of patients with advanced cancer in the acute care setting.
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Feliu J, Jiménez-Gordo AM, Madero R, Rodríguez-Aizcorbe JR, Espinosa E, Castro J, Acedo JD, Martínez B, Alonso-Babarro A, Molina R, Cámara JC, García-Paredes ML, González-Barón M. Development and validation of a prognostic nomogram for terminally ill cancer patients. J Natl Cancer Inst 2011; 103:1613-20. [PMID: 21972226 DOI: 10.1093/jnci/djr388] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Determining life expectancy in terminally ill cancer patients is a difficult task. We aimed to develop and validate a nomogram to predict the length of survival in patients with terminal disease. METHODS From February 1, 2003, to December 31, 2005, 406 consecutive terminally ill patients were entered into the study. We analyzed 38 features prognostic of life expectancy among terminally ill patients by multivariable Cox regression and identified the most accurate and parsimonious model by backward variable elimination according to the Akaike information criterion. Five clinical and laboratory variables were built into a nomogram to estimate the probability of patient survival at 15, 30, and 60 days. We validated and calibrated the nomogram with an external validation cohort of 474 patients who were treated from June 1, 2006, through December 31, 2007. RESULTS The median overall survival was 29.1 days for the training set and 18.3 days for the validation set. Eastern Cooperative Oncology Group performance status, lactate dehydrogenase levels, lymphocyte levels, albumin levels, and time from initial diagnosis to diagnosis of terminal disease were retained in the multivariable Cox proportional hazards model as independent prognostic factors of survival and formed the basis of the nomogram. The nomogram had high predictive performance, with a bootstrapped corrected concordance index of 0.70, and it showed good calibration. External independent validation revealed 68% predictive accuracy. CONCLUSIONS We developed a highly accurate tool that uses basic clinical and analytical information to predict the probability of survival at 15, 30, and 60 days in terminally ill cancer patients. This tool can help physicians making decisions on clinical care at the end of life.
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Affiliation(s)
- Jaime Feliu
- Department of Medical Oncology, University Hospital La Paz, Paseo de la Castellana, Madrid 261-28046, Spain.
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Selby D, Chakraborty A, Lilien T, Stacey E, Zhang L, Myers J. Clinician accuracy when estimating survival duration: the role of the patient's performance status and time-based prognostic categories. J Pain Symptom Manage 2011; 42:578-88. [PMID: 21565461 DOI: 10.1016/j.jpainsymman.2011.01.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 01/20/2011] [Accepted: 01/25/2011] [Indexed: 10/18/2022]
Abstract
CONTEXT Although shown to be an independent predictor of actual survival (AS) duration, previous reports have identified significant inaccuracy in clinician estimates of survival (CES). OBJECTIVES This study aimed to both examine demographic and clinical factors potentially impacting CES accuracy and explore possible strategies for improvement in a patient population with advanced incurable disease. METHODS At the time of initial assessment by a specialist palliative care team, CES for each patient was chosen from one of the following time-based categories: <24 hours, one to seven days, one to four weeks, one to three months, three to six months, three to 12 months, or >12 months. Survival estimates were then classified as an accurate (AS=CES), overestimate (AS<CES), or underestimate (AS>CES). Demographic data were analyzed using descriptive statistics, and both univariate and stepwise multivariate logistic regression analyses were used to identify any associated demographic and/or clinical factors significantly impacting accuracy. RESULTS Within the total study population of 1835, both CES and AS data were available for 1622 patients among whom mean and median survival was 26.5 and 88 days, respectively. The remaining 213 patients (12% of the total population) remained alive at the time of analysis. Of the total study population, CES was accurate for 34% of patients and an overestimate for 51% of patients. CES of <24 hours and one to seven days were significantly more likely to be accurate than any other prognostic category (P<0.0001). Additionally, a CES of either one to four weeks or >12 months was significantly more likely to be accurate than CES of one to three months, three to six months, and six to 12 months (P<0.0001). Finally, multivariate analyses indicated CES to be significantly more likely to be accurate for males (P=0.0407) and for patients with baseline Palliative Performance Scale (PPS) ratings of either "30 and less" (P<0.0001) or "70 and greater" (P<0.0001). CONCLUSION In a patient population referred for specialist palliative care consultation with diverse diagnoses and a wide range of CES, time-based categorization of survival estimates along with PPS and possibly gender could be used to inform the CES process for individual patients. Intentionally incorporating these objective elements into what has historically been the subjective process of CES may lead to improvements in accuracy.
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Affiliation(s)
- Debbie Selby
- Palliative Care Consult Team, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Osthus A, Aarstad A, Olofsson J, Aarstad H. Health-Related Quality of Life Scores in long-term head and neck cancer survivors predict subsequent survival: a prospective cohort study. Clin Otolaryngol 2011; 36:361-8. [DOI: 10.1111/j.1749-4486.2011.02342.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sutradhar R, Barbera L, Seow H, Howell D, Husain A, Dudgeon D. Multistate analysis of interval-censored longitudinal data: application to a cohort study on performance status among patients diagnosed with cancer. Am J Epidemiol 2011; 173:468-75. [PMID: 21193535 DOI: 10.1093/aje/kwq384] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In observational studies on cancer patients, progression of performance status over time can be described by using a multistate model in which state-to-state transitions represent changes in a patient's health condition. Although a patient experiences transitions in continuous time, assessments on the patient are often made at irregularly spaced time points. In this paper, the authors formulate a Markov 4-state model for examining longitudinal data on performance status collected under intermittent observation. The cohort consisted of 11,342 patients diagnosed with cancer in Ontario, Canada, from 2007 to 2009. The authors extend the model to estimate the predicted probability of reaching the absorbing state, death, over various time intervals. The authors also illustrate what happens to the estimated transition intensities if the true observational scheme is overlooked. Methods for multistate analysis should be used by epidemiologists, since they prove particularly useful for examining the complexities of disease processes.
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Affiliation(s)
- Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
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Barbera L, Seow H, Howell D, Sutradhar R, Earle C, Liu Y, Stitt A, Husain A, Sussman J, Dudgeon D. Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer 2010; 116:5767-76. [PMID: 21136579 DOI: 10.1002/cncr.25681] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 08/13/2010] [Accepted: 08/31/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND For ambulatory cancer patients, Ontario has standardized symptom and performance status assessment population-wide, using the Edmonton Symptom Assessment System (ESAS) and Palliative Performance Scale (PPS). In a broad cross-section of cancer outpatients, the authors describe the ESAS and PPS scores and their relation to patient characteristics. METHODS This is a descriptive study using administrative healthcare data. RESULTS The cohort included 45,118 and 23,802 patients' first ESAS and PPS, respectively. Fatigue was most prevalent (75%), and nausea least prevalent (25%) in the cohort. More than half of patients reported pain or shortness of breath; about half of those reported moderate to severe scores. Seventy-eight percent had stable performance status scores. On multivariate analysis, worse ESAS outcomes were consistently seen for women, those with comorbidity, and those with shorter survivals from assessment. Lung cancer patients had the worst burden of symptoms. CONCLUSIONS This is the first study to report ESAS and PPS scores in a large, geographically based cohort with a full scope of cancer diagnoses, including patients seen earlier in the cancer trajectory (ie, treated for cure). In this ambulatory cancer population, the high prevalence of numerous symptoms parallels those reported in palliative populations and represents a target for improved clinical care. Differences in outcomes for subgroups require further investigation. This research sets the groundwork for future research on patient and provider outcomes using linked administrative healthcare data.
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Affiliation(s)
- Lisa Barbera
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Fraser S, Brady RR, Graham C, Paterson-Brown S, Gibb AP. Methicillin-resistant Staphylococcus aureus in surgical patients: identification of high-risk populations for the development of targeted screening programmes. Ann R Coll Surg Engl 2010; 92:311-5. [PMID: 20385046 DOI: 10.1308/003588410x12628812459698] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA)-related hospital-acquired infection (HAI) in surgical patients is associated with high morbidity, mortality and financial cost. The identification and characterisation of populations of patients who are at high risk of developing MRSA infection or colonisation could inform the design of more effective strategies to prevent HAIs and reduce transmission of MRSA. PATIENTS AND METHODS An analysis of historical discharge data for the whole of 2005 (7145 surgical in-patients) was performed, for all patients admitted to general surgery at the Royal Infirmary of Edinburgh. Analysis specifically focused on MRSA laboratory data and coding data for patient demographics, medical co-morbidities, and progress of in-patient stay. RESULTS A total of 134 (1.88%) individual patients with colonisation or infection by MRSA were identified from indicated laboratory testing. Univariate analysis identified a significant association of concurrent MRSA-positive status with patients aged over 60 years (P < 0.01), a duration of inpatient stay > 7 days (P < 0.01), presence of a malignant neoplasm (P < 0.01), circulatory disease (P < 0.01), respiratory disease (P < 0.01), central nervous system disease (P < 0.01), renal failure (P < 0.01), and concurrent admission to ITU/HDU (P < 0.01). Multivariate analysis suggested MRSA colonisation or infection was strongest in those with co-morbid malignancy (P < 0.0001) or admission to ITU/HDU (P < 0.0001). CONCLUSIONS This large observational study has identified cancer patients as a UK surgical patient subpopulation which is at significantly higher risk of colonisation by MRSA. These data could inform the development of focused hospital in-patient screening protocols and provide a means to stratify patient risk.
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Affiliation(s)
- Stephanie Fraser
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Bainbridge D, Brazil K, Krueger P, Ploeg J, Taniguchi A. A proposed systems approach to the evaluation of integrated palliative care. BMC Palliat Care 2010; 9:8. [PMID: 20459734 PMCID: PMC2876145 DOI: 10.1186/1472-684x-9-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 05/10/2010] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is increasing global interest in regional palliative care networks (PCN) to integrate care, creating systems that are more cost-effective and responsive in multi-agency settings. Networks are particularly relevant where different professional skill sets are required to serve the broad spectrum of end-of-life needs. We propose a comprehensive framework for evaluating PCNs, focusing on the nature and extent of inter-professional collaboration, community readiness, and client-centred care. METHODS In the absence of an overarching structure for examining PCNs, a framework was developed based on previous models of health system evaluation, explicit theory, and the research literature relevant to PCN functioning. This research evidence was used to substantiate the choice of model factors. RESULTS The proposed framework takes a systems approach with system structure, process of care, and patient outcomes levels of consideration. Each factor represented makes an independent contribution to the description and assessment of the network. CONCLUSIONS Realizing palliative patients' needs for complex packages of treatment and social support, in a seamless, cost-effective manner, are major drivers of the impetus for network-integrated care. The framework proposed is a first step to guide evaluation to inform the development of appropriate strategies to further promote collaboration within the PCN and, ultimately, optimal palliative care that meets patients' needs and expectations.
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Affiliation(s)
- Daryl Bainbridge
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Juravinski Cancer Centre, 699 Concession St, Rm 4-203, Hamilton, ON L8V 5C2 Canada.
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Bibliography. PROGRESS IN PALLIATIVE CARE 2009. [DOI: 10.1179/096992609x12455871937224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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