Oncology and palliative care: the case for co-ordination

Patterns of Symptom Distress in Adults Receiving Treatment for Lung Cancer

Knowledge of the patterns of symptom distress in adults receiving treatment for lung cancer is an important first step in developing interventions that can potentially lessen symptom distress. The purposes of this secondary analysis were to describe the changes in patterns of symptom distress over time in adults receiving treatment for lung cancer, and to examine the relationship of selected demographic and clinical characteristics to symptom distress. Complete data were available for 117 patients. The patterns of symptom distress in adults receiving treatment for lung cancer varied between treatment groups and over time. Symptom distress scores were moderate to high on entry into the study, indicating that symptom management in newly diagnosed lung cancer patients is essential and should begin early in the course of illness. Moreover, clinical interventions should be tailored to the type of treatment. Various demographic and clinical variables were weak and inconsistent predictors of symptom distress, underscoring the importance of examining the role of psychosocial factors in mediating symptom distress.

Palliative care activity in a medical oncology unit: the implications for oncology training

There has been a nationwide reorganization of cancer services since publication of the Calman-Hine report, which encourages the integration of high-quality palliative care into all areas of cancer provision. Details of the daily clinical care activity for medical oncology inpatients are not collected routinely. A prospective survey of activity was carried out in a large teaching hospital, in order to ascertain the extent to which palliative care is exercised in a medical oncology unit, alongside other aspects of care provision. Almost a quarter (23%) of the admissions were for palliative care, either alone or in combination with another aspect of care. Palliative care activity accounted for 34% (169 bed-days) of daily activity, compared with 32% (163 bed-days) for the administration of chemotherapy. A high proportion of patients receive palliative care on medical oncology wards, consideration therefore needs to be given to the place of formal training in palliative medicine for oncology trainees.

Symptoms in adults with lung cancer. A systematic research review

Health care providers play a key role in providing adequate symptom management and promoting quality of life during chronic illness. Several studies have noted that adults with lung cancer experience more symptom distress than patients with other types of cancer. Therefore, symptom management in this group of patients is particularly important. An understanding of the research conducted in this area is important for further knowledge development and for potentially improving symptom management. This paper presents a systematic review of empirical studies examining symptoms in adults with lung cancer. The results of this systematic review revealed that although major strides have been made in understanding symptoms associated with lung cancer, further progress is needed to decrease the morbidity associated with uncontrolled symptoms. Theoretical, conceptual, and/or methodological issues identified through this review must be addressed in future research. In particular, the researcher should provide information about the theoretical or empirical framework guiding the study, give an explicit definition about the dimensions of the symptom experience being studied, report refusal rates and attrition, and use instruments that are reliable and valid.

Palliative care: past, present, and future perspectives

OBJECTIVES

To provide a review of the development and impact of palliative care; to discuss quality of lie as a framework for guiding clinical practice and research in palliative care; and to identify future trends that are likely to affect palliative care services.

DATA SOURCES

Research studies, review articles, and book chapters.

CONCLUSIONS

Palliative care is in the process of dynamic change. Advocates of palliative care are suggesting that cost-effective holistic care strategies should be available to patients and families throughout the illness trajectory, not just reserved for end of life care.

IMPLICATIONS FOR NURSING PRACTICE

Incorporation of palliative care principles across the cancer illness trajectory requires an attitude shift by all members of the multidisciplinary team.

Palliative medicine and the medical oncologist. Defining the purview of care

The fusion of palliative medicine and medical oncology, in practice and in education, can provide a better standard of patient care, reduce the risk of oncologist burnout, and increase the likelihood of patient family and physician satisfaction. There need be no gulf between these disciplines, and only together do they represent truly comprehensive cancer care. The realization of this fusion will require the participation of individual clinicians, program directors, and the policy makers for cancer centers, professional organizations, and the health care regulatory authorities. It is a logical next step in the evolution of medical oncology.

Quality assurance by specification and achievement of goals in palliative cancer treatment

As the goals of palliative cancer treatments have not always been clearly specified, this paper describes how frequently the goals of palliative cancer treatment can be specified according to a given definition and how frequently those specified goals can be achieved. The clinical problems of 171 cancer patients were discussed in the Interdisciplinary Oncologic Conference (IOC) of the Cancer Centre University of Ulm (CCUU) and recommendations concerning further diagnostic treatments and/or therapy were provided. These recommendations had been documented and analysed retrospectively. The goals were classified as either cure or palliation or further investigation. If the goal was palliation, it was investigated whether or not the goal was specified as either alleviation of existing problems or prevention of impending problems. The achievement of the specified goals was assessed. Palliation was the goal of treatment in 119 (71%) of the 168 evaluable recommendations. In 83 of the 119 cases (70%), immediate treatment was recommended. The goal was specified in 57 (69%) of the 83 recommendations and could be realized in 24 of 57 specified cases (42%). Patients in this group survived longer (p < 0.01) than patients in whom the goals could not be achieved. Impending problems could be prevented more often (p = 0.001) in 14 out of 18 cases, while existing problems could be alleviated in only 10 out of 34 cases. It is concluded that specification of the goals of palliation is necessary because it is impossible to decide if a goal of treatment could be achieved or not unless the goal of treatment has been defined (as existing/impending problem). The prevention of impending problems could be investigated in prospectively controlled clinical trials.

A proposed matrix for organisational changes to improve quality of life in oncology

Educational and institutional changes are needed to improve the care of dying patients. There are four phases to a cancer control programme, and each phase stresses prevention. The fourth phase of a cancer control programme is concerned with the prevention of suffering, through impeccable management of physical and psychosocial distress. In practice, cancer control is usually addressed primarily as a biological problem, with less emphasis placed on behavioural aspects and the alleviation of suffering. The principles of symptom control and the management of psychosocial issues have been defined by the palliative care movement. However, this body of knowledge tends to be cocooned within palliative care programmes and associated journals and textbooks. As exemplified by recent advances in cancer pain management, symptom control research is a promising area for development. However, the promise is not matched by priority assignment and idea implementation. This article offers proposals for specific changes in the structure of university and cancer programmes, and revision of legislative policies which will enhance the care of patients who depend upon our interest in the fourth phase of cancer control, the prevention and relief of suffering.