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Mercadante S, Bruera E. That's right: palliative care is not simple. BMJ Support Palliat Care 2023:spcare-2023-004584. [PMID: 37770102 DOI: 10.1136/spcare-2023-004584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Affiliation(s)
| | - Eduardo Bruera
- Palliative Care & Rehabilitation Medicine, UT M D Anderson Cancer Center, Houston, Texas, USA
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Shiraishi R, Kizawa Y, Mori M, Maeda I, Hatano Y, Ishiki H, Miura T, Yokomichi N, Kodama M, Inoue K, Otomo S, Yamaguchi T, Hamano J. Comparison of Symptom Severity and Progression in Advanced Cancer Patients Among Different Care Settings: A Secondary Analysis. Palliat Med Rep 2023; 4:139-149. [PMID: 37360680 PMCID: PMC10288302 DOI: 10.1089/pmr.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Background Most people in Japan wish to spend their final days at home, but the majority fail to do so; earlier studies indicated a more pronounced worsening of symptoms if treated at home. Objectives This study compared the prevalence of symptom worsening and explored associated factors between patients with advanced cancer receiving palliative care in palliative care units (PCUs) and at home. Design We conducted a secondary analysis of two multicenter, prospective cohort studies involving patients with advanced cancer receiving palliative care in PCUs or at home. Setting/Subjects One study was conducted at 23 PCUs (January to December 2017) and the other on 45 palliative home care services (July to December 2017) in Japan. Measurements Symptom changes were categorized as stable, improved, or worse. Results Of the 2998 registered patients, 2877 were analyzed. Among them, 1890 patients received palliative care in PCUs, and 987 at home. Patients receiving palliative care at home were more likely to have worsening of pain (17.1% vs. 3.8%; p < 0.001) and drowsiness (32.6% vs. 22.2%; p < 0.001) than those in PCUs. By multivariate logistic regression analysis, palliative care at home was significantly associated with worsening of the Palliative Prognostic Index dyspnea subscale in the unadjusted model (odds ratio, 1.42 [95% confidence interval, 1.08-1.88]; p = 0.014) but not for any symptoms in the adjusted model. Conclusions After adjusting for patient background, the prevalence of symptom worsening was not different between patients with advanced cancer receiving palliative care at home and in PCUs.
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Affiliation(s)
- Ryuto Shiraishi
- Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
| | - Yoshiyuki Kizawa
- Division of Clinical Medicine, Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Keiko Inoue
- Medical Corporation Aisei-kai, Hirakata, Japan
| | | | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Sousa BR, Dias Moreira T, Pires P. Palliative Care in a Specialized Palliative Cancer Care Unit in Portugal: A Complex Reality. Cureus 2023; 15:e37930. [PMID: 37220447 PMCID: PMC10200128 DOI: 10.7759/cureus.37930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction The goal of palliative care (PC) is to improve the quality of life of patients and their families through the involvement of a multidisciplinary team. PC improves symptom control and end-of-life care. Despite the fact that the benefits of PC have long been acknowledged, Portugal's demands are currently unmet. The majority of patients have been identified as having a high level of complexity and are referred for symptom management and end-of-life care. Study aim The study aimed to analyze the sociodemographic, disease and hospitalization characteristics of the patients admitted to a specialized PC unit. Materials and methods We conducted a retrospective, single-center study of palliative care patients admitted to a Portuguese oncology institute's acute palliative care unit during a three-month period. Patients' information such as social demographics, clinical data, patient and family member's psychological, social, nutritional and spiritual counseling and knowledge on diagnosis and therapy objectives were collected from physician's records and analyzed using SPSS Statistics for Windows, Version 23.0 (IBM SPSS Statistics for Windows). Results A total of 41 patients were included, with a mean age of 66.4 years. Spouses were the primary caregivers. There was no indication for targeted therapy in any of the patients. Prior to hospitalization, 58.5% did not receive follow-up by PC. The most frequently reported symptoms were pain (75.6%), tiredness (68.3%), anorexia (61%) and emotional distress (58.5%). Patients were referred to counseling for psychological (43.3%), spiritual (19.5%), nutritional (58.5%) and social services (34.1%). During hospitalization, 75% of patients died; out of which, 70.9% were not previously followed up on by the PC team. Conclusion PC patients are complex, with multiple clinical-psychological-social-spiritual issues, and their management in non-PC wards can be challenging. Since the use of a multidisciplinary approach can improve patients' and families' quality of life, it is critical to train, expand and integrate the PC teams into the existing teams, allowing patients a better quality of life until they pass.
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Affiliation(s)
- Beatriz R Sousa
- Internal Medicine, Centro Hospitalar Universitário de Lisboa Central, Lisbon, PRT
| | - Teresa Dias Moreira
- Palliative Care, Instituto Português de Oncologia do Porto Francisco Gentil, Oporto, PRT
| | - Pedro Pires
- Internal Medicine, Centro Hospitalar Universitário de Lisboa Central, Lisbon, PRT
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Coym A, Ullrich A, Hackspiel LK, Ahrenholz M, Bokemeyer C, Oechsle K. Systematic symptom and problem assessment at admission to the palliative care ward - perspectives and prognostic impacts. BMC Palliat Care 2020; 19:75. [PMID: 32466759 PMCID: PMC7257199 DOI: 10.1186/s12904-020-00576-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 05/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Symptom assessment is essential in palliative care, but holds challenges concerning implementation and relevance. This study aims to evaluate patients' main symptoms and problems at admission to a specialist inpatient palliative care (SIPC) ward using physician proxy- and patient self-assessment, and aims to identify their prognostic impact as well as the agreement between both assessments. METHODS Within 12 h after admission, palliative care specialists completed the Symptom and Problem Checklist of the German Hospice and Palliative Care Evaluation (HOPE-SP-CL). Patients either used the new version of the minimal documentation system for patients in palliative care (MIDOS) or the Integrated Palliative Care Outcome Scale (IPOS) plus the Distress Thermometer (DT). RESULTS Between 01.01.2016-30.09.2018, 1206 patients were included (HOPE-SP-CL 98%; MIDOS 21%, IPOS 34%, DT 27%) whereof 59% died on the ward. Proxy-assessment showed a mean HOPE-SP-CL Total Score of 24.6 ± 5.9 of 45. Most frequent symptoms/problems of at least moderate intensity were weakness (95%), needs of assistance with activities of daily living (88%), overburdening of family caregivers (83%), and tiredness (75%). Factor analysis identified four symptom clusters (SCs): (1) Deteriorated Physical Condition/Decompensation of Home Care, (2) Emotional Problems, (3) Gastrointestinal Symptoms and (4) Other Symptoms. Self-assessment showed a mean MIDOS Total Score of 11.3 ± 5.3 of 30, a mean IPOS Total Score of 32.0 ± 9.0 of 68, and a mean distress of 6.6 ± 2.5 of 10. Agreement of self- and proxy-assessment was moderate for pain (ƙ = 0.438) and dyspnea (ƙ = 0.503), fair for other physical (ƙ = 0.297 to 0.394) and poor for psychological symptoms (ƙ = 0.101 to 0.202). Multivariate regression analyses for single symptoms and SCs revealed that predictors for dying on the SIPC ward included impaired ECOG performance status, moderate/severe dyspnea, appetite loss, tiredness, disorientation/confusion, and the SC Deteriorated Physical Condition/Decompensation of Home Care. CONCLUSION Admissions to a SIPC ward are mainly caused by problems impairing mobility and autonomy. Results demonstrate that implementation of self- and reliability of proxy- and self-assessment is challenging, especially concerning non-physical symptoms/problems. We identified, specific symptoms and problems that might provide information needed for treatment discussions regarding the medical prognosis.
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Affiliation(s)
- Anja Coym
- Department of Oncology, Hematology and BMT, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Anneke Ullrich
- Department of Oncology, Hematology and BMT, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Lisa Kathrin Hackspiel
- Department of Oncology, Hematology and BMT, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Mareike Ahrenholz
- Department of Oncology, Hematology and BMT, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and BMT, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology and BMT, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Factors Influencing Clinical and Setting Pathways After Discharge From an Acute Palliative/Supportive Care Unit. Am J Clin Oncol 2019; 42:265-269. [PMID: 30601145 DOI: 10.1097/coc.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to assess the factors which influence the care pathway after discharge from an acute palliative supportive care unit (APSCU). METHODS Patients' demographics, indications for admission, kind of admission, the presence of a caregiver, awareness of prognosis, data on anticancer treatments in the last 30 days, ongoing treatment (on/off or uncertain), the previous care setting, analgesic consumption, and duration of admission were recorded. The Edmonton Symptom Assessment Scale (ESAS) at admission and at time of discharge (or the day before death), CAGE (cut down, annoy, guilt, eye-opener), and the Memorial Delirium Assessment Scale (MDAS), were used. At time of discharge, the subsequent referral to other care settings (death, home, home care, hospice, oncology), and the pathway of oncologic treatment were reconsidered (on/off, uncertain). RESULTS A total of 314 consecutive cancer patients admitted to the APSCU were surveyed. Factors independently associated with on-therapy were the lack of a caregiver, home discharge, and short hospital admission, in comparison with off-treatment, and less admission for other symptoms, shorter hospital admission, discharge at home, and better well-being, when compared with "uncertain." Similarly, many factors were associated with discharge setting, but the only factor independently associated with discharge home was being "on-therapy." CONCLUSIONS The finding of this study is consistent with an appropriate selection of patients after being discharged by an APSCU, that works as a bridge between active treatments and supportive/palliative care, according the concept of early and simultaneous care.
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Laursen L, Schønau MN, Bergenholtz HM, Siemsen M, Christensen M, Missel M. Table in the corner: a qualitative study of life situation and perspectives of the everyday lives of oesophageal cancer patients in palliative care. BMC Palliat Care 2019; 18:60. [PMID: 31331302 PMCID: PMC6647132 DOI: 10.1186/s12904-019-0445-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Incurable oesophageal cancer patients are often affected by existential distress and deterioration of quality of life. Knowledge about the life situation of this patient group is important to provide relevant palliative care and support. The purpose of this study is to illuminate the ways in which incurable oesophageal cancer disrupts the patients' lives and how the patients experience and adapt to life with the disease. METHODS Seventeen patients receiving palliative care for oesophageal cancer were interviewed 1-23 months after diagnosis. The epistemological approach was inspired by phenomenology and hermeneutics, and the method of data collection, analysis and interpretation consisted of individual qualitative interviews and meaning condensation, inspired by Kvale and Brinkmann. RESULTS The study reveals how patients with incurable oesophageal cancer experience metaphorically to end up at a "table in the corner". The patients experience loss of dignity, identity and community. The study illuminated how illness and symptoms impact and control daily life and social relations, described under these subheadings: "sense of isolation"; "being in a zombie-like state"; "one day at a time"; and "at sea". Patients feel alone with the threat to their lives and everyday existence; they feel isolated due to the inhibiting symptoms of their illness, anxiety, worry and daily losses and challenges. CONCLUSIONS The patients' lives are turned upside down, and they experience loss of health, function and familiar, daily habits. The prominent issues for the patients are loneliness and lack of continuity. As far as their normal everyday lives, social networks and the health system are concerned, patients feel they have been banished to a "table in the corner". These patients have a particular need for healthcare professionals who are dedicated to identifying what can be done to support the patients in their everyday lives, preserve dignity and provide additional palliative care.
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Affiliation(s)
- Louise Laursen
- Department of Palliative Care, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mai Nanna Schønau
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Roskilde University, Roskilde, Denmark
| | - Heidi Maria Bergenholtz
- Medical and Surgical Department, Holbaek Sygehus, Denmark & The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense, Denmark
| | - Mette Siemsen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Merete Christensen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
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