1
|
Johnston EE, Rosenberg AR. Palliative Care in Adolescents and Young Adults With Cancer. J Clin Oncol 2024; 42:755-763. [PMID: 37862672 DOI: 10.1200/jco.23.00709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 08/25/2023] [Indexed: 10/22/2023] Open
Abstract
Palliative care (PC) aims to improve quality of life (QOL) for patients with serious illness and their families by recognizing and alleviating the physical, emotional, social, existential, and spiritual suffering of patients and their communities. Because adolescents and young adults (AYAs, age 15-39 years) with cancer commonly report distress across all these domains and because that distress translates to their QOL during and after their cancers, PC is particularly relevant for this population. Here, we review the evidence for PC among AYAs with cancer, including its rationale, gaps, opportunities, and implications for care delivery. For example, nearly 90% of AYAs with cancer report distressing symptoms during their treatment, those who survive report ongoing unmet psychosocial and physical health needs, and those who die from their cancers are highly likely to receive medically intense care that is discordant with their goals and values. AYA communication and decision making can be challenging because of ethical and developmental considerations regarding the patient's autonomy and competing priorities of patients and caregivers. PC interventions (including primary PC delivered by oncologists, routine PC subspecialty care, symptom tracking, advance care planning, and psychosocial programs promoting AYA resilience) are all associated with improved patient-centered outcomes. However, PC is inconsistently integrated into AYA oncology care, and access to PC programs is not equitable; marginalized groups continue to experience poorer outcomes. Ongoing and future research and clinical initiatives must continue to bridge these gaps. Improving the QOL of AYAs with cancer is a shared goal of the larger clinical oncology community, and including PC in AYA cancer care delivery can help attain that goal.
Collapse
Affiliation(s)
- Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| |
Collapse
|
2
|
Drake EK, Weeks LE, van Manen M, Shin HD, Wong H, Taylor D, McKibbon S, Curran J. The Delivery of Palliative and End-of-Life Care to Adolescents and Young Adults Living with Cancer: A Scoping Review. J Adolesc Young Adult Oncol 2023; 12:611-624. [PMID: 37155194 DOI: 10.1089/jayao.2023.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The primary purpose of this scoping review was to provide an overview of the existing evidence on the delivery of palliative and end-of-life care to adolescents and young adults (AYAs) living with cancer, by identifying knowledge gaps and discussing the key characteristics and types of evidence in this field. This study employed a JBI scoping review design. CINAHL (EBSCO), Embase (Elsevier), MEDLINE (Ovid), APA PsycINFO (EBSCO), and Web of Science (Science Citation Index Expanded and Social Sciences Citation Index; Clarivate Analytics) databases were searched along with grey literature sources to February 2022 for related studies on the delivery of palliative and end-of-life care to AYAs. No search restrictions were applied. Two independent reviewers screened titles, abstracts, and full-text articles for eligibility, and they extracted data from studies that met the inclusion criteria. A total of 29,394 records were identified through our search strategy and 51 studies met the inclusion criteria of the study. The studies were published between 2004 and 2022, with the majority from North America (65%). The included studies involved patient, healthcare provider, caregiver, and public stakeholders. Their primary foci were often on end-of-life outcomes (41%) and/or advance care planning/end-of-life priorities and decision-making (35%). This review identified several evidence gaps within the field, including a focus primarily on patients who have died. Findings highlight the need for more collaborative research with AYAs on their experiences with palliative and end-of-life care, as well as their involvement as patient partners in research.
Collapse
Affiliation(s)
- Emily K Drake
- Faculty of Health, Dalhousie University, Halifax, Canada
- IWK Health, Halifax, Canada
- School of Nursing, Dalhousie University, Halifax, Canada
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A Joanna Briggs Institute Centre of Excellence, Halifax, Canada
| | - Lori E Weeks
- Faculty of Health, Dalhousie University, Halifax, Canada
- School of Nursing, Dalhousie University, Halifax, Canada
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A Joanna Briggs Institute Centre of Excellence, Halifax, Canada
- Nova Scotia Health, Halifax, Canada
| | - Michael van Manen
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Canada
| | - Hwayeon Danielle Shin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Centre for Complex Care Interventions, Centre for Addiction and Mental Health, Toronto, Canada
| | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, Canada
| | - Dani Taylor
- Patient Partner, St. John's, Canada
- Young Adult Cancer Canada, St. John's, Canada
| | - Shelley McKibbon
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A Joanna Briggs Institute Centre of Excellence, Halifax, Canada
- W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, Canada
| | - Janet Curran
- Faculty of Health, Dalhousie University, Halifax, Canada
- IWK Health, Halifax, Canada
- School of Nursing, Dalhousie University, Halifax, Canada
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A Joanna Briggs Institute Centre of Excellence, Halifax, Canada
| |
Collapse
|
3
|
Abdelaal M, Avery J, Chow R, Saleem N, Fazelzad R, Mosher P, Hannon B, Zimmermann C, Al-Awamer A. Palliative care for adolescents and young adults with advanced illness: A scoping review. Palliat Med 2023; 37:88-107. [PMID: 36352490 PMCID: PMC9841827 DOI: 10.1177/02692163221136160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Age-related complex medical conditions have been commonly reported among adolescents and young adults with advanced life-limiting illness. There is increasing interest in exploring their palliative care needs and end-of-life experiences. AIM This scoping review aimed to explore the available literature about providing palliative and end-of-life care to adolescents and young adults with advanced life-limiting illnesses. DESIGN Scoping review. This review was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/SPTD7). DATA SOURCES Electronic databases (MEDLINEALL, Embase, Emcare, Cochrane Central Register of Controlled Trial CENTRAL, Scopus, PsycINFO, Cochrane Database of Systematic Reviews), Google Scholar and reference lists were searched up to October 2021. We included studies reporting on adolescents and/or young adults with advanced life-limiting illnesses. There were no limitations concerning location, type of illness or study design. RESULTS We identified 51 studies published between 2002 and 2021. Most studies were published in the United States (n = 34, 67%), and nine studies (18%) reported exclusively on patients with non-malignant illnesses. Two thirds of the identified studies were case reports and retrospective chart reviews (n = 33). Three main topics were identified: Physical symptom burden (n = 26, 51%), Psychological and social needs (n = 33, 65%), and end-of-life care (n = 30, 59%). Twenty-six studies (51%) were focused only on one topic, and the age range used to identify adolescents and young adults varied based on the study location. CONCLUSION The findings of this review shed light on the different palliative care experiences and knowledge gaps related to adolescents and young adults as an underserved and vulnerable patient population. Further research needs to be dedicated toward palliative care programs tailored for adolescents and young adults.
Collapse
Affiliation(s)
- Mohamed Abdelaal
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jonathan Avery
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Ronald Chow
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nasreen Saleem
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rouhi Fazelzad
- UHN Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Pamela Mosher
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Child and Adolescent Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Pierron C, Levy M, Mattioni V, Poncelet G, Le Bourgeois F. Perceptible Signs of End of Life in Pediatric Intensive Care Patients. J Palliat Med 2022; 25:1829-1834. [PMID: 36137014 DOI: 10.1089/jpm.2021.0582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: How children die in pediatric intensive care units (PICUs) has been poorly described, and support for parents during this traumatic experience could be improved. Better information on perceptible signs of the end of life (EOL) in children may help mitigate the trauma. Objective: To describe the most common perceptible EOL signs in PICU patients. Methods: A prospective study in a PICU. Health care providers observed 28 children expected to die and noted the perceptible signs. Results: The most common perceptible signs were desaturation and bradycardia. Twenty-seven patients had at least one change in physical appearance. Gasping was noted in 12 patients. Conclusion: Perceptible signs of the EOL were different from those reported in children dying in other units or in adults. Sharing information about signs of EOL with parents may prepare them and enable them to better support their child.
Collapse
Affiliation(s)
- Charlotte Pierron
- Neonatal and Pediatric Intensive Care Unit, Hospital Center of Luxembourg-KannerKlinik, Luxembourg, Luxembourg
| | - Michaël Levy
- Pediatric Intensive Care Unit, Robert-Debré University Hospital, Paris, France
| | - Violaine Mattioni
- Medical Oncology Department, Saint Louis University Hospital, Paris, France
| | - Géraldine Poncelet
- Pediatric Intensive Care Unit, Robert-Debré University Hospital, Paris, France
| | - Fleur Le Bourgeois
- Pediatric Intensive Care Unit, Robert-Debré University Hospital, Paris, France
| |
Collapse
|
5
|
Odejide OO, Fisher L, Kushi LH, Chao CR, Vega B, Rodrigues G, Josephs I, Brock KE, Buchanan S, Casperson M, Cooper RM, Fasciano KM, Kolevska T, Lakin JR, Lefebvre A, Schwartz CM, Shalman DM, Wall CB, Wiener L, Altschuler A, Mack JW. Patient, Family, and Clinician Perspectives on Location of Death for Adolescents and Young Adults With Cancer. JCO Oncol Pract 2022; 18:e1621-e1629. [PMID: 35981281 PMCID: PMC9810128 DOI: 10.1200/op.22.00143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/24/2022] [Accepted: 07/11/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Adolescents and young adults (AYAs) with cancer have high rates of hospital deaths. It is not clear if this reflects their preferences or barriers to dying at home. METHODS Between December 2018 and January 2021, we conducted in-depth interviews with AYAs (age 12-39 years) with stage IV or recurrent cancer, family caregivers including bereaved caregivers, and clinicians of AYAs with cancer. Patients were asked about their priorities for care including location of death, caregivers were asked what was most important in the care of their AYA family member, and clinicians were asked to reflect on priorities identified through caring for AYAs. Directed content analysis was applied to interview data, and themes regarding location of death were developed. RESULTS Eighty individuals (23 AYAs, 28 caregivers, and 29 clinicians) participated in interviews. Most AYAs and caregivers preferred a home death. However, some AYAs and caregivers opted for a hospital death to alleviate caregiver burden or protect siblings from the perceived trauma of witnessing a home death. Lack of adequate services to manage intractable symptoms at home and insufficient caregiver support led some AYAs/caregivers to opt for hospital death despite a preference for home death. Participants acknowledged the value of hospice while also pointing out its limitations in attaining a home death. CONCLUSION Although most AYAs prefer to die at home, this preference is not always achieved. Robust home-based services for effective symptom management and caregiver support are needed to close the gap between preferred and actual location of death for AYAs.
Collapse
Affiliation(s)
- Oreofe O. Odejide
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Lauren Fisher
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Chun R. Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Brenda Vega
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Gilda Rodrigues
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | | | - Katharine E. Brock
- Division of Pediatric Oncology, Emory University, Atlanta, GA
- Division of Palliative Care, Emory University, Atlanta, GA
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
| | - Susan Buchanan
- Agios Pharmaceuticals, Cambridge, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Robert M. Cooper
- Pediatric Oncology, Kaiser Permanente Southern California, Pasadena, CA
| | - Karen M. Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Tatjana Kolevska
- Division of Medical Oncology, Kaiser Permanente Northern California, Oakland, CA
| | - Joshua R. Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Anna Lefebvre
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Corey M. Schwartz
- Division of Medical Oncology, Kaiser Permanente Northern California, Oakland, CA
| | - Dov M. Shalman
- Palliative Care, Kaiser Permanente Southern California, Pasadena, CA
| | - Catherine B. Wall
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Lori Wiener
- Psychosocial Support and Research Program, National Cancer Institute, Bethesda, MD
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jennifer W. Mack
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
6
|
Steineck A, Bradford MC, O'Daffer A, Fladeboe KM, O'Donnell MB, Scott S, Yi-Frazier JP, Rosenberg AR. Quality of Life in Adolescents and Young Adults: The Role of Symptom Burden. J Pain Symptom Manage 2022; 64:244-253.e2. [PMID: 35649460 PMCID: PMC9378571 DOI: 10.1016/j.jpainsymman.2022.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Adolescents and young adults (AYAs) with cancer report worse health-related quality of life (HRQOL) than other age groups. Symptom burden is a modifiable predictor of HRQOL. OBJECTIVES The objective of this study was to identify which symptoms are most burdensome to AYAs with advanced cancer. METHODS In this observational study, English-speaking individuals aged 12-25 years undergoing treatment for advanced cancer completed assessments of symptom burden (Memorial Symptom Assessment Scale) and HRQOL (Pediatric Quality of Life Inventory Generic Form and Cancer Module; minimal clinically important difference 4.4). We dichotomized participants as having low (<7) or high (≥7) symptom prevalence. Mixed regression models estimated HRQOL differences between groups. For individual symptoms, unadjusted mixed models estimated HRQOL reductions. RESULTS N = 58 AYAs completed baseline surveys. The median age was 17 years (IQR 15-19), 58% were male, 59% identified as white, and 44% were diagnosed with leukemia/lymphoma. High symptom prevalence was associated with a mean generic HRQOL 7 points lower (95% CI: -11, -3; P < 0.01) and cancer-specific HRQOL score 12 points lower (95% CI: -17, -7; P < 0.01) than low symptom prevalence. The most prevalent symptoms were fatigue (71%), pain (58%), and difficulty sleeping (58%). Fatigue (-8), difficulty concentrating (-7), and mouth sores (-6) were associated with the greatest generic HRQOL score reductions. Dysphagia (-12), difficulty concentrating (-12), and sadness (-11) were associated with the greatest cancer-specific HRQOL score reductions. CONCLUSION The symptom experience among AYAs with advanced cancer is unique. Separate evaluation of AYA's symptoms may optimize management and improve HRQOL.
Collapse
Affiliation(s)
- Angela Steineck
- Seattle Children's Hospital (A.S.), Cancer and Blood Disorders Center, Seattle, Washington, USA; Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington School of Medicine (A.S.), Department of Pediatrics, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA; MACC Fund Center for Cancer and Blood Disorders (A.S.), Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Miranda C Bradford
- Core for Biostatistics (M.C.B.), Epidemiology, and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Alison O'Daffer
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA
| | - Kaitlyn M Fladeboe
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA
| | - Maeve B O'Donnell
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA
| | - Samantha Scott
- Department of Psychology (S.S.), University of Denver, Denver, Colorado, USA
| | - Joyce P Yi-Frazier
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA
| | - Abby R Rosenberg
- Seattle Children's Hospital (A.S.), Cancer and Blood Disorders Center, Seattle, Washington, USA; Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington School of Medicine (A.S.), Department of Pediatrics, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA.
| |
Collapse
|
7
|
Abstract
Purpose of Review To present new findings in order to aid in the provision of high-quality symptom management and psychosocial care for adolescents and young adults with advanced cancer at the end of life. Recent Findings Behavioral health providers support patients by teaching them symptom control skills, building legacies, and making meaning of their lives. Integration of cultural values is essential for comprehensive assessment and decision-making. Effective management of physiological symptoms and psychological distress begins with accurate communication about prognosis and goals of care that focus on patient preferences and priorities. Oncology teams promote quality of life and the successful management of fatigue, pain, decreased mobility, poor appetite, and dyspnea with the early inclusion of palliative care. Summary While provision of end-of-life care in a young person with cancer presents challenges, multidisciplinary teams can effectively accompany patients in this journey by prioritizing patient and family preferences to promote quality of life.
Collapse
|
8
|
Adolescent and young adult brain tumors: current topics and review. Int J Clin Oncol 2022; 27:457-464. [PMID: 35064353 PMCID: PMC8782686 DOI: 10.1007/s10147-021-02084-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/10/2021] [Indexed: 11/05/2022]
Abstract
The management of brain tumors developed in adolescents and young adults (AYAs) is challenging because of their histological heterogeneity and low incidence. The brain tumor and its treatment interventions can negatively affect neurological, neurocognitive, and endocrinological function, and dramatically affect the circumstances of AYA patients progressing to further education, employment, and marriage. Specific support is thus necessary to maintain the quality of life (QOL) of AYA brain tumor patients. AYA patients and survivors require active intervention and support for returning to school or work, progressing to further education, finding employment, and preserving fertility. Recent cancer genome profiling revealed that AYA gliomas include pediatric- and adult-type genetic alteration. Insights into the biology underlying the distribution of tumors in AYAs may influence the development of prospective trials. A more individualized view of brain tumors may influence stratification of patients' in future clinical studies as well as selection for molecular targeted therapy. Here I review strategies for achieving a better outcome to decrease late effects and improve QOL.
Collapse
|
9
|
Katz NT, Le BH, Berger I, Lewin J, Thompson K, Pitt H, Philip J. A Descriptive Cohort Study of Adolescent and Young Adult Decedents Known to an Australian Comprehensive Cancer Center. J Adolesc Young Adult Oncol 2021; 11:535-539. [PMID: 34874784 DOI: 10.1089/jayao.2021.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In Australia, cancer is the second leading cause of death in adolescents and young adults (AYA). In an audit of 76 AYA decedents known to a comprehensive cancer center, most were male (63%), and most had a parent as primary carer (78%). Median age at diagnosis was 21 years (range: 15-27). Median time from diagnosis to first palliative care consultation was 9 months, and from first palliative care review to death, 4 months. Location of death was hospital (41%), home (24%), and palliative care unit (16%). Eleven (65%) of 17 patients who wished to die at home achieved this.
Collapse
Affiliation(s)
- Naomi T Katz
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Center, Palliative Care Service, Alfred Health, Victorian Pediatric Palliative Care Program, Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Brian H Le
- Parkville Integrated Palliative Care Service, Victorian Comprehensive Cancer Center, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Ilana Berger
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer, Melbourne, Australia
| | - Jeremy Lewin
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer, Department of Medical Oncology, Peter MacCallum Cancer Center, Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Kate Thompson
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer, Department of Social Work, The University of Melbourne, Melbourne, Australia
| | - Holly Pitt
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Jennifer Philip
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Center, Palliative Care Service, St. Vincent's Hospital, Department of Medicine, University of Melbourne, Melbourne, Australia
| |
Collapse
|
10
|
Podda MG, Schiavello E, Clerici CA, Luksch R, Terenziani M, Ferrari A, Casanova M, Spreafico F, Meazza C, Biassoni V, Chiaravalli S, Puma N, Bergamaschi L, Gattuso G, Sironi G, Nigro O, Massimino M. Children and adolescent solid tumours and high-intensity end-of-life care: what can be done to reduce acute care admissions? BMJ Support Palliat Care 2021:bmjspcare-2021-003031. [PMID: 34493535 DOI: 10.1136/bmjspcare-2021-003031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/17/2021] [Indexed: 11/03/2022]
Abstract
Despite improvements in survival, cancer remains the leading cause of non-accidental death in children and adolescents, who risk receiving high-intensity end-of-life (HI-EOL) care. OBJECTIVE To analyse treatments for relapses (particularly in the last weeks of life), assess their impact on the EOL, identify patients most likely to receive HI-EOL care and examine whether palliative care services can contain the intensity of EOL care. METHODS This retrospective study involved patients treated at the paediatric oncology unit of the Istituto Nazionale Tumori in Milan who died between 2018 and 2020. The primary outcome was HI-EOL care, defined as: ≥1 session of intravenous chemotherapy <14 days before death; ≥1 hospitalisation in intensive care in the last 30 days of life and ≥1 emergency room admission in the last 30 days of life. RESULTS The study concerned 68 patients, and 17 had HI-EOL care. Patients given specific in-hospital treatments in the last 14 days of their life more frequently died in hospital. Those given aggressive EOL care were less likely to die at home or in the hospice. Patients with central nervous system (CNS) tumours were more likely to have treatments requiring hospitalisation, and to receive HI-EOL care. CONCLUSION These results underscore the importance of considering specific treatments at the EOL with caution. Treatments should be administered at home whenever possible.The early activation of palliative care, especially for fragile and complicated patients like those with CNS cancers, could help families cope with the many problems they face.
Collapse
Affiliation(s)
- Marta Giorgia Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Carlo Alfredo Clerici
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| |
Collapse
|
11
|
"When Will I Feel Normal?": Disorienting Grief Responses Among Young Adults With Advanced Cancer. Cancer Nurs 2021; 45:E355-E363. [PMID: 34183519 DOI: 10.1097/ncc.0000000000000977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The diagnosis of an advanced cancer during young adulthood frequently entails the loss of confidence in physical function, as well as the certainty of achieving future social, vocational, and existential aspirations. These losses leave young adults with tenuous holds on facets of their life that foster hope and meaning. OBJECTIVE The aim of this study was to explore the unique physical and psychosocial-spiritual losses and patterns of grief responses among young adults living with advanced cancer. INTERVENTIONS/METHODS Theoretical sampling led to the recruitment of 13 young adults, ages 23 to 38 years, diagnosed with stage III or IV cancer. Participants completed 1 semistructured interview, a timeline of pivotal moments throughout their illness, and a sociodemographic survey. Glaser's grounded theory methods informed the study design and analysis. RESULTS Young adults displayed patterns of disorienting grief, which left them bereft of almost all familiar facets of their pretrauma lives and identities. Disorienting physical and psychosocial-spiritual losses presented in the following subcategories: disorientation to all aspects of former life, lost identity, and isolation. CONCLUSIONS Findings from this study reveal a novel framework from which to interpret grief experiences among young adults living with advanced cancer. IMPLICATIONS FOR NURSING PRACTICE The implementation of grief assessments and interventions during pivotal stages in young adults' cancer treatment and recovery may ameliorate psychological distress and normalize perceptions of life disruptions. Nursing education before treatment initiation and termination can reduce young adults' fears surrounding unfamiliar symptoms and prepare them for the physical and emotional uncertainties that often accompany remission or end-of-life.
Collapse
|
12
|
Kassam A, Gupta A, Rapoport A, Srikanthan A, Sutradhar R, Luo J, Widger K, Wolfe J, Earle C, Gupta S. Impact of Palliative Care Involvement on End-of-Life Care Patterns Among Adolescents and Young Adults With Cancer: A Population-Based Cohort Study. J Clin Oncol 2021; 39:2506-2515. [PMID: 34097441 DOI: 10.1200/jco.20.03698] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Evidence suggests that adolescents and young adults (AYAs) with cancer (defined as age 15-39 years) receive high-intensity (HI) medical care at the end-of-life (EOL). Previous population-level studies are limited and lack information on the impact of palliative care (PC) provision. We evaluated prevalence and predictors of HI-EOL care in AYAs with cancer in Ontario, Canada. A secondary aim was to evaluate the impact of PC physicians on the intensity of EOL care in AYAs. METHODS A retrospective decedent cohort of AYAs with cancer who died between 2000 and 2017 in Ontario, Canada, was assembled using a provincial registry and linked to population-based health care data. On the basis of previous studies, the primary composite measure HI-EOL care included any of the following: intravenous chemotherapy < 14 days from death, more than one emergency department visit, and more than one hospitalization or intensive care unit admission < 30 days from death. Secondary measures included the most invasive (MI) EOL care (eg, mechanical ventilation < 14 days from death) and PC physician involvement. We determined predictors of outcomes using appropriate regression models. RESULTS Of 7,122 AYAs, 43.8% experienced HI-EOL care. PC physician involvement (odds ratio [OR], 0.57; 95% CI, 0.51 to 0.63) and older age at death (OR, 0.60; 95% CI, 0.48 to 0.74) were associated with a lower risk of HI-EOL care. AYAs with hematologic malignancies were at highest risk for HI and MI-EOL care. PC physician involvement substantially reduced the odds of mechanical ventilation at EOL (OR, 0.36; 95% CI, 0.30 to 0.43). CONCLUSION A large proportion of AYAs with cancer experience HI-EOL care. Our study provides strong evidence that PC physician involvement can help mitigate the risk of HI and MI-EOL care in AYAs with cancer.
Collapse
Affiliation(s)
- Alisha Kassam
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics and Division of Palliative Care, Southlake Regional Health Centre, Newmarket, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abha Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Adam Rapoport
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, ON, Canada.,Emily's House Children's Hospice, Toronto, ON, Canada
| | - Amirrtha Srikanthan
- Department of Medical Oncology, The Ottawa Hospital, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Toronto, ON, Canada
| | - Rinku Sutradhar
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Jin Luo
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Kimberley Widger
- Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Craig Earle
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
13
|
Blais S, Cohen-Gogo S, Gouache E, Guerrini-Rousseau L, Brethon B, Rahal I, Petit A, Raimondo G, Pellegrino B, Orbach D. End-of-life care in children and adolescents with cancer: perspectives from a French pediatric oncology care network. TUMORI JOURNAL 2021; 108:223-229. [PMID: 33940999 DOI: 10.1177/03008916211013384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In developed countries, cancer remains the leading cause of pediatric death from illness after the neonatal period. OBJECTIVE To describe the end-of-life care characteristics of children and adolescents with solid tumors (ST) or hematologic malignancies (HM) who died from tumor progression in the Île-de-France area. METHODS This is a regional, multicentric, retrospective review of medical files of all children and adolescents with cancer who died over a 1-year period. Extensive data from the last 3 months of life were collected. RESULTS A total of 99 eligible patients died at a median age of 9.8 years (range, 0.3-24 years). The most frequent terminal symptoms were pain (n = 86), fatigue (n = 84), dyspnea (n = 49), and anorexia (n = 41). Median number of medications per patient was 8 (range, 3-18). Patients required administration of opioids (n = 91), oxygen (n = 36), and/or sedation (n = 61). Decision for palliative care was present in all medical records and do-not-resuscitate orders in 90/99 cases. Symptom prevalence was comparable between children and adolescents with ST and HM. A wish regarding the place of death had been expressed for 64 patients and could be respected in 42 cases. Death occurred in hospital for 75 patients. CONCLUSIONS This study represents a large and informative cohort illustrating current pediatric palliative care approaches in pediatric oncology. End-of-life remains an active period of care requiring coordination of multiple care teams.
Collapse
Affiliation(s)
- Sophie Blais
- Pediatric Department, Poissy Hospital, Poissy, France
| | - Sarah Cohen-Gogo
- Division of Hematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Elodie Gouache
- Department of Pediatric Hematology, Trousseau Hospital (AP-HP), Sorbonne University, Paris, France
| | - Lea Guerrini-Rousseau
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Paris-Saclay University, Villejuif, France
| | - Benoit Brethon
- Pediatric Hematology Department, Robert Debré Hospital (AP-HP), Paris, France.,RIFHOP, Île-de-France Regional Network of Pediatric Hematology-Oncology, Paris, France
| | - Ilhem Rahal
- Adolescents and Young Adults Hematology Department, Saint-Louis Hospital (AP-HP), Paris, France
| | - Arnaud Petit
- Department of Pediatric Hematology, Trousseau Hospital (AP-HP), Sorbonne University, Paris, France
| | - Graziella Raimondo
- Department of Pediatric Hematology and Oncology, Hôpital d'Enfants Margency, Margency, France.,PALIPED, Regional Pediatric Palliative Care Resource Team of Île-de-France, Paris, France
| | - Beatrice Pellegrino
- Pediatric Department, Poissy Hospital, Poissy, France.,RIFHOP, Île-de-France Regional Network of Pediatric Hematology-Oncology, Paris, France.,PALIPED, Regional Pediatric Palliative Care Resource Team of Île-de-France, Paris, France
| | - Daniel Orbach
- RIFHOP, Île-de-France Regional Network of Pediatric Hematology-Oncology, Paris, France.,SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| |
Collapse
|
14
|
Olesen AMR, Missel M, Boisen KA. The Needs and Care Experiences of Adolescents and Young Adults Treated for Cancer in Adult Surgery Clinics: A Qualitative Study. J Adolesc Young Adult Oncol 2021; 11:48-55. [PMID: 33844956 DOI: 10.1089/jayao.2021.0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescents and young adults (AYAs) with cancer hospitalized in adult surgery clinics are an overlooked group of patients. They are a minority hospitalized among elderly surgical patients, and the surroundings and care are designed with older patients in mind. A growing body of research focuses on AYAs' experiences of cancer care. However, studies exploring care experiences in terms of in-patient surgery treatment are still needed. Hence, the purpose of the study was to explore the needs and care experiences of AYAs, 15-29 years of age, treated for cancer in adult surgery clinics. Methods: This qualitative study was based on semistructured interviews with 15 AYAs with cancer from seven surgery clinics at Rigshospitalet, Copenhagen University Hospital, Denmark. Data were analyzed and interpreted using inductive content analysis. The Danish Data Protection Agency approved the study (project no.: 05617). Results: Three themes were identified: (1) being the black sheep - experiences of being young in an adult environment, (2) the significant nurse - experiences of the essential relationship between AYAs and the nurses, and (3) the wounded body - experiences of how the physically changed body affects the mind. Conclusions: Our findings showed that the psychosocial needs of AYAs with cancer hospitalized in adult surgery clinics were not being adequately met. Initiatives are needed to improve the psychological and social well-being of this vulnerable patient group, while hospitalized for treatment in surgery clinics.
Collapse
Affiliation(s)
- Anne Marie Roholm Olesen
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten A Boisen
- Department of Pediatrics and Adolescent Medicine, Center of Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
15
|
Alleviating Terminal Pediatric Cancer Pain. CHILDREN-BASEL 2021; 8:children8030239. [PMID: 33808534 PMCID: PMC8003275 DOI: 10.3390/children8030239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Abstract
Terminal cancer pain remains one of the most distressing aspects of pediatric oncology practice. Opioids are the cornerstone of cancer pain management at end-of-life and fortunately, most pain at end-of-life can be managed successfully. This article presents a practical step-by-step approach to alleviating pediatric terminal cancer pain, which can be delivered across settings.
Collapse
|
16
|
Supporting the Needs of Adolescents and Young Adults: Integrated Palliative Care and Psychiatry Clinic for Adolescents and Young Adults with Cancer. Cancers (Basel) 2021; 13:cancers13040770. [PMID: 33673202 PMCID: PMC7918814 DOI: 10.3390/cancers13040770] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Adolescents and young adults (AYAs) with cancer experience a high level of distress and have unique unmet palliative and supportive care needs. There is limited knowledge about the symptom burden, quality of life, and type of care that AYA patients receive. In 2017, a dedicated AYA-specialized palliative care clinic was established at Princess Margaret Cancer Centre in Canada, with a collaborative approach between palliative care and psychiatry. This study aims to describe the demographics and symptoms burden of AYA cancer patients who attended the integrated palliative care and psychiatry clinic, measure the impact of the clinic on AYAs’ symptom control, and examine their end-of-life outcomes. Abstract Clinical guidelines aimed at cancer care for adolescents and young adults (AYAs) encourage early integration of palliative care, yet there are scarce data to support these recommendations. We conducted a retrospective chart review of AYA patients, aged 15 to 39 years, who were referred to the Integrated AYA Palliative Care and Psychiatry Clinic (IAPCPC) at the Princess Margaret Cancer Centre between May 2017 and November 2019 (n = 69). Demographic data, symptom prevalence, change in symptom scores between baseline consultation and first follow-up, and intensity of end-of-life care were collected from the patients’ medical charts, analyzed, and reported. Of the 69 patients, 59% were female, and sarcoma was the most common cancer. A majority of patients had at least one symptom scored as moderate to severe; tiredness, pain, and sleep problems were the highest scored symptoms. More than one-third used medical cannabis to manage their symptoms. Symptom scores improved in 61% after the first clinic visit. Out of the 69 patients, 50 (72.5%) had died by October 2020, with a median time between the initial clinic referral and death of 5 months (range 1–32). Three patients (6%) received chemotherapy, and eight (16%) were admitted to an intensive care unit during the last month of life. In conclusion, AYAs with advanced cancer have a high burden of palliative and psychosocial symptoms. Creating a specialized AYA palliative care clinic integrated with psychiatry showed promising results in improving symptom scores and end-of-life planning.
Collapse
|
17
|
Upshaw NC, Roche A, Gleditsch K, Connelly E, Wasilewski-Masker K, Brock KE. Palliative care considerations and practices for adolescents and young adults with cancer. Pediatr Blood Cancer 2021; 68:e28781. [PMID: 33089627 DOI: 10.1002/pbc.28781] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022]
Abstract
The definition of adolescents and young adults (AYAs) in oncology varies with upper limits up to age 39. Younger AYAs, ages 12-24 years, are often cared for within pediatrics. In caring for AYAs with cancer, there are unique considerations that become even more important to recognize, acknowledge, and address in AYAs with life-threatening cancer receiving palliative care. This review highlights important factors such as psychosocial development, cultural considerations, and support structure, which should be considered when providing palliative care to AYAs with cancer during the various stages of care: introduction of palliative care; symptom management; advanced care planning (ACP); end-of-life (EOL) care; and bereavement.
Collapse
Affiliation(s)
- Naadira C Upshaw
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Anna Roche
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Katrina Gleditsch
- Division of Hospice and Palliative Medicine, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina
| | - Erin Connelly
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Katharine E Brock
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia.,Division of Pediatric Palliative Care, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
18
|
Younger E, Husson O, Asare B, Benson C, Judson I, Miah A, Zaidi S, Dunlop A, Al-Muderis O, van Houdt WJ, Jones RL, van der Graaf WTA. Metastatic Soft Tissue Sarcomas in Adolescents and Young Adults: A Specialist Center Experience. J Adolesc Young Adult Oncol 2020; 9:628-638. [PMID: 32379517 PMCID: PMC7757586 DOI: 10.1089/jayao.2020.0010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: Soft tissue sarcomas (STS) account for 8% of all cancers in adolescents and young adults (AYAs). Metastatic STS contribute significantly to disease-related mortality in this age group; however, data are limited due to under-representation in clinical trials. Methods: AYAs aged 18-39 years, diagnosed with metastatic STS between 1990 and 2012, were identified from The Royal Marsden Hospital database. Outcomes of interest were clinical characteristics, treatment patterns, overall survival (OS), and prognostic factors. Results: Overall, 455 patients were included. Median age at diagnosis of metastatic STS was 33 years (interquartile range [IQR] 27-37 years). The most common histological subtypes were leiomyosarcoma (n = 68, 15%), synovial sarcoma (n = 68, 15%), Ewing sarcoma (n = 44, 10%), and rhabdomyosarcoma (n = 35, 8%). Treatments included systemic therapy (n = 395, 87%; median 2 lines [IQR 1-3]; clinical trial n = 93, 22%), radiotherapy (n = 297, 66%), and metastasectomy (n = 191, 43%). Median duration between last chemotherapy regimen and death was 4.6 months (IQR 2-10). Median OS was 19.2 months (95% confidence interval [CI] 15.8-22.2); 5-year OS was 16%. Of common subtypes, patients with rhabdomyosarcoma had the worst OS (8.8 months; 95% CI 7.9-11.4). Adverse prognostic factors included male gender, synchronous metastases, bone or liver metastases, first-line polychemotherapy, and no metastasectomy. Conclusions: Outcomes were variable; patients with supposed chemosensitive subtypes had particularly poor survival. The diverse behavior of STS in AYAs highlights the need for subtype-specific clinical trials.
Collapse
Affiliation(s)
- Eugenie Younger
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Olga Husson
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Bernice Asare
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Charlotte Benson
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ian Judson
- Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Aisha Miah
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Shane Zaidi
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison Dunlop
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Omar Al-Muderis
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Winan J van Houdt
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Winette T A van der Graaf
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| |
Collapse
|
19
|
Sansom-Daly UM, Wakefield CE, Patterson P, Cohn RJ, Rosenberg AR, Wiener L, Fardell JE. End-of-Life Communication Needs for Adolescents and Young Adults with Cancer: Recommendations for Research and Practice. J Adolesc Young Adult Oncol 2019; 9:157-165. [PMID: 31660768 DOI: 10.1089/jayao.2019.0084] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A growing evidence base highlights the negative impact of poor psychosocial care at end-of-life. Adolescents and young adults (AYAs) 15-39 years of age with cancer face unique medical and psychosocial challenges that make them especially vulnerable when treatment is not successful. Although the importance of age-appropriate medical and psychosocial care is internationally recognized for AYAs across the cancer trajectory, there is little guidance on best-practice care and communication practices with AYAs as they approach the end-of-life. We conducted a narrative review and found evidence points to the potential benefits of introducing palliative care teams early in the care trajectory. Research undertaken to date emphasizes the importance of exploring AYAs' preferences around end-of-life issues in a repeated, consistent manner, and highlighted that AYAs may have strong preferences on a range of issues such as being able to stay in their own home, being comfortable and free from pain, and expressing their wishes to loved ones. We highlight a number of best-practice recommendations to guide clinicians around the critical elements of when, who, what, and how end-of-life conversations may be best facilitated with AYAs. Gaps in the evidence base remain, including research focusing on better understanding barriers and facilitators to timely, age-appropriate end-of-life communication for AYAs with different diagnoses, where discordance between AYA-parent preferences exists, and when AYAs die at home versus in hospital. We have proposed a new model to support clinicians and researchers to better conceptualize how interacting individual, familial, and sociocultural factors impact end-of-life communication with AYAs in clinical settings.
Collapse
Affiliation(s)
- Ursula M Sansom-Daly
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Pandora Patterson
- Department of Research, Evaluation & Social Policy, CanTeen Australia, Sydney, Australia.,Cancer Nursing Research Unit, University of Sydney, Sydney, Australia
| | - Richard J Cohn
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Abby R Rosenberg
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Cancer and Blood Disorders Center and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, Washington
| | - Lori Wiener
- National Institutes of Health, Bethesda, Maryland
| | - Joanna E Fardell
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| |
Collapse
|
20
|
Revon-Rivière G, Pauly V, Baumstarck K, Bernard C, André N, Gentet JC, Seyler C, Fond G, Orleans V, Michel G, Auquier P, Boyer L. High-intensity end-of-life care among children, adolescents, and young adults with cancer who die in the hospital: A population-based study from the French national hospital database. Cancer 2019; 125:2300-2308. [PMID: 30913309 DOI: 10.1002/cncr.32035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/17/2018] [Accepted: 01/25/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Efforts to improve the quality of end-of-life (EOL) care depend on better knowledge of the care that children, adolescents, and young adults with cancer receive, including high-intensity EOL (HI-EOL) care. The objective was to assess the rates of HI-EOL care in this population and to determine patient- and hospital-related predictors of HI-EOL from the French national hospital database. METHODS This was a population-based, retrospective study of a cohort of patients aged 0 to 25 years at the time of death who died at hospital as a result of cancer in France between 2014 and 2016. The primary outcome was HI-EOL care, defined as the occurrence of ≥1 chemotherapy session <14 days from death, receiving care in an intensive care unit ≥1 time, >1 emergency room admission, and >1 hospitalization in an acute care unit in the last 30 days of life. RESULTS The study included 1899 individuals from 345 hospitals; 61.4% experienced HI-EOL care. HI-EOL was increased with social disadvantage (adjusted odds ratio [AOR], 1.30; 95% confidence interval [CI], 1.03-1.65; P = .028), hematological malignancies (AOR, 2.09; 95% CI, 1.57-2.77; P < .001), complex chronic conditions (AOR, 1.60; 95% CI, 1.23-2.09; P = .001) and care delivered in a specialty center (AOR, 1.70; 95% CI, 1.22-2.36; P = .001). HI-EOL was reduced in cases of palliative care (AOR, 0.31; 95% CI, 0.24-0.41; P < .001). CONCLUSION A majority of children, adolescents, and young adults experience HI-EOL care. Several features (eg, social disadvantage, cancer diagnosis, complex chronic conditions, and specialty center care) were associated with HI-EOL care. These findings should now be discussed with patients, families, and professionals to define the optimal EOL.
Collapse
Affiliation(s)
- Gabriel Revon-Rivière
- Department of Pediatric Hematology and Oncology, La Timone Children's Hospital, APHM, Marseille, France
- Fédération des Équipes Ressources Régionales de Soins Palliatifs Pédiatriques
| | - Vanessa Pauly
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- Department of Medical Information, APHM, Marseille, France
| | - Karine Baumstarck
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Cecile Bernard
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Nicolas André
- Department of Pediatric Hematology and Oncology, La Timone Children's Hospital, APHM, Marseille, France
| | - Jean-Claude Gentet
- Department of Pediatric Hematology and Oncology, La Timone Children's Hospital, APHM, Marseille, France
| | | | - Guillaume Fond
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- Department of Medical Information, APHM, Marseille, France
| | | | - Gérard Michel
- Department of Pediatric Hematology and Oncology, La Timone Children's Hospital, APHM, Marseille, France
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Pascal Auquier
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Laurent Boyer
- Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- Department of Medical Information, APHM, Marseille, France
| |
Collapse
|
21
|
Abstract
Purpose of Review Over the past two decades, advances have been made in understanding the pathophysiology of cancer-associated weight loss, termed “cachexia.” To date, there is no proven effective intervention to completely reverse cachexia and there are no approved drug therapies to treat it. This paper will review relevant literature in relation to communicating with adolescents and young adults about cancer-associated weight loss. Recent Findings Adolescents and young adults (AYAs) who have cancer are a unique group of patients due to their stage of development and maturity. Summary This article outlines issues specific to this patient cohort that need to be considered to better understand the impact of cachexia and explore pertinent matters when communicating with AYAs in relation to cachexia.
Collapse
|
22
|
Palliative Care in Adolescents and Young Adults With Cancer-Why Do Adolescents Need Special Attention? Cancer J 2018; 24:336-341. [PMID: 30480579 DOI: 10.1097/ppo.0000000000000341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Meeting shortfalls in the provision of care to adolescents and young adults with cancer has focused largely on improving outcomes and psychosocial support. A significant percentage of adolescents and young adults with cancer will die of disease because of initial poor prognosis conditions or disease relapse. In adults, progress has been made in the concept of an integrated cancer/palliative care service. In pediatric oncology, the application of this philosophy of care has lagged behind somewhat. In the case of adolescents, particularly those with advanced cancer, the palliative care needs, in a broader sense than only end-of-life care, are often not adequately met, irrespective of whether treatment is delivered in a pediatric or adult cancer service. There are a number of age-specific aspects to palliative and supportive care for adolescents. Complex interactions between clinicians, parents, and patients potentially limit the young person's ability to influence care planning. The wide variation in real or perceived competency at this age, the developmental challenges in relation to behavior, communication, and coping strategy all require particular professional expertise that is not always available.
Collapse
|
23
|
Mori M, Sasahara T, Morita T, Aoyama M, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Achievement of a good death among young adult patients with cancer: analyses of combined data from three nationwide surveys among bereaved family members. Support Care Cancer 2018; 27:1519-1527. [PMID: 30446856 DOI: 10.1007/s00520-018-4539-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Although little improvement has been made in the survival rate among young cancer patients over recent decades, whether they have achieved a good death has never been systematically explored. We aimed to clarify whether young cancer patients (aged 20-39 years) have achieved a good death, and compare their achievement with that of middle-aged patients (aged 40-64 years). METHODS We analyzed combined data of three nationwide, cross-sectional surveys of families of cancer patients who died at inpatient hospices in Japan (2007-2014). We measured 10 core items of the Good Death Inventory (GDI) short-version on a 7-point scale, and calculated rates of "agree/absolutely agree" and the mean scores. RESULTS We analyzed 245 and 5140 responses of families of young and middle-aged patients, respectively. Less than 60% of families of young patients reported "agree/absolutely agree" regarding 9 items, which included "feeling that one's life was completed" in 44 (18%; 95% confidence interval (CI) = 14-23%), "being independent in daily life" in 48 (20%; 95% CI = 15-25%), and "being free from physical distress" in 103 (42%; 95% CI = 36-48%) young patients. Young patients were significantly less likely to feel "one's life was completed" (mean = 3.3 (standard deviation = 2.0) vs. 3.8 (1.9), respectively; effect size (ES) = 0.29; adjusted p value = 0.000) and "not being a burden to others" (3.1 (1.5) vs. 3.5 (1.6), respectively; ES = 0.24; adjusted p value = 0.010) than the middle-aged. CONCLUSIONS Overall, young cancer patients did not achieve a good death. Future efforts are needed to improve the quality of palliative care for young patients, focusing on psychosocial/spiritual suffering.
Collapse
Affiliation(s)
- Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, 3453 Mikataharacho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan.
| | - Tomoyo Sasahara
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, 3453 Mikataharacho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Amakubo 1-3-1, Tsukuba City, Ibaraki, 305-8558, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| |
Collapse
|
24
|
Devlin SM, Murphy JD, Yeung HN. A Retrospective Analysis of Pain Burden in Hospitalized Young Adult Cancer Patients Compared with Their Older Adult Counterpart. J Palliat Med 2018; 22:307-309. [PMID: 30383470 DOI: 10.1089/jpm.2018.0212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
CONTEXT Research shows an increased symptom burden in young adult (YA) cancer patients compared with their older adult counterpart. OBJECTIVES The purpose of this study was to identify differences in clinical characteristics and related outcomes between YA and older adult cancer patients admitted for cancer-related pain. MATERIALS AND METHODS We retrospectively identified 190 hospitalized patients in a single academic center with admissions for cancer-related pain. Patients were grouped into either "young adult" (18-39) or "older adult" (>40) cohorts. We compared differences in patient characteristics and pain regimens. RESULTS Median oral morphine equivalent per 24 hours was higher in the YA group (194 mg vs. 70 mg, p = 0.010). Younger patients received patient-controlled analgesia (PCA) more frequently (p = 0.023). The number of palliative care consults and adjuvants prescribed did not differ between groups (p > 0.05), although YAs more frequently had an inpatient pain anesthesia consult (p = 0.047). CONCLUSION Findings show increased opioid requirements and PCA use in YAs being treated for malignancy compared with their older adult counterpart.
Collapse
Affiliation(s)
- Shannon M Devlin
- 1 Department of Internal Medicine, University of California San Diego , La Jolla, California
| | - James D Murphy
- 2 Department of Radiation Medicine and Applied Sciences, University of California San Diego , La Jolla, California
| | - Heidi N Yeung
- 3 Division of Palliative Medicine and Hematology/Oncology, Department of Internal Medicine, University of California San Diego , La Jolla, California
| |
Collapse
|
25
|
|
26
|
Abstract
Background Total pain is a concept that approaches pain holistically: physically, psychologically, socially, and spiritually. Any individual may experience pain in each domain at a different level. This is the case report of an adolescent who suffered from total pain and how his healthcare team and peers helped to relieve it. Case presentation A 15-years-old Thai male was diagnosed with recurrent T-cell lymphoma and readmitted to hospital. He was admitted to an adult ward and suffered from pain due to his disease and from the fear of being alienated. As a result, he had an existential crisis. His parents felt unsure whether they or the patient should make the medical decisions and advance care plan. Conclusions This case report emphasises the importance of total pain assessment in the relief of total pain in an adolescent whose needs are different from both children and adults. It also highlights the role of medical decision-making in adolescents and the importance of the social support of peers in the alleviation of pain.
Collapse
|
27
|
Beerbower E, Winters D, Kondrat D. Bio-psycho-social-spiritual needs of adolescents and young adults with life-threatening illnesses: Implications for social work practice. SOCIAL WORK IN HEALTH CARE 2018; 57:250-266. [PMID: 29377778 DOI: 10.1080/00981389.2018.1430091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper explores the biopsychosocial and spiritual needs of adolescents and young adults (AYA) with life-threatening or terminal illnesses. AYA are situated between childhood and adulthood (ages 15-25) and have distinct biopsychosocial and spiritual needs unique to their developmental stage. Having a life-threatening or terminal illness directly challenges normal AYA developmental tasks and identity formation. AYA experience more troubling physical symptoms during the dying process compared to other age groups, which leads to significant psychological distress and an increased need for pharmacological treatments. In general, AYA desire to be fully informed and involved in the health care decision-making process, leading to ethical dilemmas when the AYA is a minor and their wishes differ from the wishes of their legal guardian(s). Social workers are especially well-equipped to serve this population due to aligning professional standards and ability to advocate for holistic care within interdisciplinary teams. Additional research is needed to tailor holistic interventions to meet the needs of this population.
Collapse
Affiliation(s)
- Emily Beerbower
- a Indiana University School of Social Work , Indianapolis , IN , USA
| | - Drew Winters
- a Indiana University School of Social Work , Indianapolis , IN , USA
| | - David Kondrat
- a Indiana University School of Social Work , Indianapolis , IN , USA
| |
Collapse
|
28
|
Abstract
PURPOSE OF REVIEW Pediatric palliative oncology (PPO) is an emerging field that integrates the principles of palliative care early into the illness trajectory of children with cancer. PPO providers work with interdisciplinary clinicians to provide optimal medical and psychosocial care to children with cancer and their families. Ongoing advances in the field of pediatric oncology, including new treatment options for progressive cancers, necessitate the early integration of palliative care tenets including holistic care, high-quality communication, and assessment and management of refractory symptoms. RECENT FINDINGS Research in this emerging field has expanded dramatically over the past several years. This review will focus on advancements within several key areas of the field, specifically regarding investigation of the communication needs and preferences of patients and families, exploration of educational initiatives and interventions to teach PPO principles to clinicians, study of patient-reported and parent-reported tools to better assess and manage refractory symptoms, and development of novel models to integrate palliative care within pediatric oncology. SUMMARY Research findings in the field of PPO, concurrent with advances in the treatment of pediatric cancer, may help improve survival and quality of life for children with cancer.
Collapse
|
29
|
Fletcher S, Hughes R, Pickstock S, Auret K. Advance Care Planning Discussions with Adolescent and Young Adult Cancer Patients Admitted to a Community Palliative Care Service: A Retrospective Case-Note Audit. J Adolesc Young Adult Oncol 2018; 7:112-119. [DOI: 10.1089/jayao.2017.0032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Sophie Fletcher
- Silver Chain Hospice Community Service, Perth, Western Australia
| | - Rachel Hughes
- Youth Cancer Services, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Sarah Pickstock
- Silver Chain Hospice Community Service, Perth, Western Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia (Albany), University of Western Australia, Albany, Western Australia
| |
Collapse
|
30
|
Treatment intensity and symptom burden in hospitalized adolescent and young adult hematopoietic cell transplant recipients at the end of life. Bone Marrow Transplant 2017; 53:84-90. [PMID: 29131155 DOI: 10.1038/bmt.2017.187] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/22/2017] [Accepted: 07/13/2017] [Indexed: 11/09/2022]
Abstract
Adolescent and young adult (AYA) oncology patients experience many physical and psychological symptoms at the end of life (EOL); however, data on these experiences for AYA patients who have undergone hematopoietic cell transplantation (HCT) remains sparse. We sought to investigate the characteristics of AYA patients aged 15-25 years who received allogeneic HCT and subsequently died while inpatient at our institution between the years 2008 and 2014. A standardized data extraction tool was used to collect information about patient demographics, treatment and symptoms. We found that during this time frame, 34 AYA patients had received HCT and died while inpatient at our institution, 23 (68%) of whom died because of treatment-related complications. Compared with non-HCT AYA oncology patients (n=35), patients who received HCT (n=34) were more likely to have died in the intensive care unit (71% vs 23%, P<0 .0001) and to have received mechanical ventilation (68% vs 17%, P<0.0001) or hemodialysis (53% vs 0%, P<0.0001) in the last 30 days of life. These findings demonstrate that AYA patients who receive allogeneic HCT receive intensive EOL treatment, suggesting that these patients may benefit from early integration of expert interdisciplinary services to prospectively assess and manage distressing symptoms.
Collapse
|
31
|
Sison J, Tran H, Margol A, Tiwari N, Garcia KM, Cotter J, Kiehna E, Olch AJ, Wong K. Palliative Care Options for a Young Adult Patient with a Diffuse Intrinsic Pontine Glioma. Cureus 2017; 9:e1580. [PMID: 29057192 PMCID: PMC5647135 DOI: 10.7759/cureus.1580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Diffuse intrinsic pontine gliomas (DIPGs) are rare but devastating brain tumors that occur primarily in children. These gliomas have poor prognoses and present options focus on palliation of symptoms and prolongation of life. Here, we present a case of a 16-year-old female diagnosed with a DIPG whose age group has been mostly left out of discussions regarding psychosocial support options. This report is meant to start a conversation about the different support options available at our institution that have shown promising results in the literature for palliative care applications. These options can include camps for patients with brain tumors, psychological counseling, the Ronald McDonald House, and other psychosocial programs. Many of these programs can be tailored to meet the specific needs of adolescent and young adult (AYA) patients and will hopefully be integrated into a comprehensive palliative care regimen in future studies.
Collapse
Affiliation(s)
| | - Hung Tran
- Children's Center for Cancer and Blood Diseases, Children's Hospital of Los Angeles
| | - Ashley Margol
- Children's Center for Cancer and Blood Diseases, Children's Hospital of Los Angeles
| | - Nishant Tiwari
- Pathology and Laboratory Medicine, Children's Hospital of Los Angeles
| | - Karla M Garcia
- Clinical Social Work, Children's Hospital of Los Angeles
| | - Jennifer Cotter
- Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, Ca
| | - Erin Kiehna
- Department of Neurosurgery, Children's Hospital of Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, Ca
| | - Arthur J Olch
- Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Kenneth Wong
- Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| |
Collapse
|
32
|
Snaman JM, Kaye EC, Lu JJ, Sykes A, Baker JN. Palliative Care Involvement Is Associated with Less Intensive End-of-Life Care in Adolescent and Young Adult Oncology Patients. J Palliat Med 2017; 20:509-516. [DOI: 10.1089/jpm.2016.0451] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jennifer M. Snaman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erica C. Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jessie J. Lu
- Department of Anthropology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - April Sykes
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| |
Collapse
|
33
|
Fin de vie en services pédiatriques hospitaliers spécialisés : étude nationale. Arch Pediatr 2017; 24:231-240. [DOI: 10.1016/j.arcped.2017.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/23/2022]
|
34
|
Ngwenya N, Kenten C, Jones L, Gibson F, Pearce S, Flatley M, Hough R, Stirling LC, Taylor RM, Wong G, Whelan J. Experiences and Preferences for End-of-Life Care for Young Adults with Cancer and Their Informal Carers: A Narrative Synthesis. J Adolesc Young Adult Oncol 2017; 6:200-212. [PMID: 28075655 PMCID: PMC5467142 DOI: 10.1089/jayao.2016.0055] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To review the qualitative literature on experiences of and preferences for end-of-life care of people with cancer aged 16–40 years (young adults) and their informal carers. A systematic review using narrative synthesis of qualitative studies using the 2006 UK Economic and Social Research Council research methods program guidance. Seven electronic bibliographic databases, two clinical trials databases, and three relevant theses databases were searched from January 2004 to October 2015. Eighteen articles were included from twelve countries. The selected studies included at least 5% of their patient sample within the age range 16–40 years. The studies were heterogeneous in their aims, focus, and sample, but described different aspects of end-of-life care for people with cancer. Positive experiences included facilitating adaptive coping and receiving palliative home care, while negative experiences were loss of “self” and nonfacilitative services and environment. Preferences included a family-centered approach to care, honest conversations about end of life, and facilitating normality. There is little evidence focused on the end-of-life needs of young adults. Analysis of reports including some young adults does not explore experience or preferences by age; therefore, it is difficult to identify age-specific issues clearly. From this review, we suggest that supportive interventions and education are needed to facilitate open and honest communication at an appropriate level with young people. Future research should focus on age-specific evidence about the end-of-life experiences and preferences for young adults with cancer and their informal carers.
Collapse
Affiliation(s)
- Nothando Ngwenya
- 1 Cancer Clinical Trials Unit, University College Hospital , London, United Kingdom
| | - Charlotte Kenten
- 1 Cancer Clinical Trials Unit, University College Hospital , London, United Kingdom
| | - Louise Jones
- 2 Division of Psychiatry, Palliative Care Research Department, University College London , London, United Kingdom
| | - Faith Gibson
- 3 Centre for Outcomes and Experiences Research in Children's Health, Great Ormond Street Hospital for Children NHS Foundation Trust , London, United Kingdom .,4 School of Health Sciences, University of Surrey , London, United Kingdom
| | - Susie Pearce
- 5 Department of Oncology, University College Hospital , London, United Kingdom
| | | | - Rachael Hough
- 7 Children and Young Peoples Cancer Service, University College Hospital , London, United Kingdom
| | - L Caroline Stirling
- 8 Camden, Islington ELiPSe and UCLH & HCA Palliative Care Service, Central and North West London NHS Trust , London, United Kingdom
| | - Rachel M Taylor
- 5 Department of Oncology, University College Hospital , London, United Kingdom
| | - Geoff Wong
- 9 Nuffield Department of Primary Care Health Sciences, University of Oxford , Oxford, United Kingdom
| | - Jeremy Whelan
- 5 Department of Oncology, University College Hospital , London, United Kingdom
| |
Collapse
|
35
|
Hughes RE, Holland LR, Zanino D, Link E, Michael N, Thompson KE. Prevalence and Intensity of Pain and Other Physical and Psychological Symptoms in Adolescents and Young Adults Diagnosed with Cancer on Referral to a Palliative Care Service. J Adolesc Young Adult Oncol 2016; 4:70-5. [PMID: 26812554 DOI: 10.1089/jayao.2014.0015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE While adolescent and young adult (AYA) oncology is recognized as a distinct specialty, there remains a paucity of literature documenting symptomatology in this cohort. This study aimed to identify the prevalence, severity, and mechanism of pain and other symptoms in AYA patients referred to a palliative care service in a specialist Australian cancer center. METHODS A retrospective design analyzed the case file data of 33 eligible AYA patients aged 15-25 years old at diagnosis and two randomly selected control groups of patients >25 years old: unmatched and matched for diagnosis and sex. All cases were referred to the palliative care service between July 2009 and June 2012. Descriptive statistics, analysis of Edmonton Symptom Assessment Scale (ESAS) and Edmonton Classification System of Cancer Pain (ECS-CP) data, and non-parametric tests were performed. RESULTS The most common malignancies among the AYA patients were sarcoma and hematological cancers. All AYA patients reported pain syndrome on the ECS-CP compared with 85% of the matched controls (p=0.018). An age group effect was found for mechanisms of pain (p=0.035). A trend toward more neuropathic pain among AYA cases was also found (59% vs. 39%). The most common ESAS symptoms in AYAs were pain (91%), diminished well-being (76%), fatigue (75%), and decreased appetite (67%). CONCLUSION AYA cancer patients appear to experience a unique symptom profile with high symptom prevalence and complexity. Further research is warranted to identify determinants and inform integration of supportive and palliative care services for this unique patient cohort.
Collapse
Affiliation(s)
- Rachel E Hughes
- 1 ONTrac at Peter Mac, Victorian Adolescent and Young Adult Oncology Service, Peter MacCallum Cancer Centre , East Melbourne, Victoria, Australia
| | - Lucy R Holland
- 1 ONTrac at Peter Mac, Victorian Adolescent and Young Adult Oncology Service, Peter MacCallum Cancer Centre , East Melbourne, Victoria, Australia
| | - Diana Zanino
- 2 Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre , East Melbourne, Victoria, Australia
| | - Emma Link
- 2 Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre , East Melbourne, Victoria, Australia
| | | | - Kate E Thompson
- 1 ONTrac at Peter Mac, Victorian Adolescent and Young Adult Oncology Service, Peter MacCallum Cancer Centre , East Melbourne, Victoria, Australia
| |
Collapse
|
36
|
Keim-Malpass J, Adelstein K, Kavalieratos D. Legacy Making Through Illness Blogs: Online Spaces for Young Adults Approaching the End-of-Life. J Adolesc Young Adult Oncol 2016; 4:209-12. [PMID: 26697270 DOI: 10.1089/jayao.2015.0003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Little is known about young adults with cancer at the end-of-life, but life review and legacy making may be important modalities to process the emotions associated with anticipatory grief. The study analyzed the illness blogs of five young women (aged 25-39 years) at the end-of-life using a narrative approach. Key elements of legacy making and grief processing were explored. The women had varying experiences before their death, but uniform posthumous occurrences with the use of the blog for a space of grief for loved ones. The use of online blogs among adolescents and young adults with advanced cancer is an area of needed further study.
Collapse
Affiliation(s)
- Jessica Keim-Malpass
- Department of Acute and Specialty Care, University of Virginia School of Nursing , Charlottesville, Virginia
| | - Katharine Adelstein
- Department of Acute and Specialty Care, University of Virginia School of Nursing , Charlottesville, Virginia
| | - Dio Kavalieratos
- Department of Medicine, University of Pittsburgh School of Medicine , Division of General Internal Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
37
|
Donovan KA, Knight D, Quinn GP. Palliative Care in Adolescents and Young Adults With Cancer. Cancer Control 2016; 22:475-9. [PMID: 26678974 DOI: 10.1177/107327481502200413] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cancer survival rates for adolescents and young adults (AYA) have not improved over time relative to children or adults older than 39 years of age. Palliative care is specialized medical care focused on the control of symptoms and relief of suffering with the goal of improving quality of life for the patient and his or her family. To date, the integration of palliative care in AYA patients with cancer remains suboptimal. METHODS We explore the role of palliative care in the continuum of clinical care for AYA patients with cancer. RESULTS Clinical practice guidelines highlight the need for integrating palliative care for all patients with cancer, including the AYA population. Despite this, a paucity of evidence exists regarding the use of palliative care with AYA patients with cancer. Graduate clinical education represents an opportunity to promote the full inclusion and early integration of palliative care in the care of AYA patients with cancer. Advance care planning is one area where some agreement exists on the unique needs of AYA patients and their families. CONCLUSIONS In general, palliative care is seen as being synonymous with end-of-life care for patients with cancer. However, the emerging trend toward standardizing oncology care to meet the unique medical, psychosocial, and supportive care needs of AYA patients with cancer and their families represents an opportunity for health care professionals to collaborate early with palliative care specialists to control symptoms and relieve suffering in this vulnerable population.
Collapse
|
38
|
Ethische Aspekte der Ernährungstherapie bei Kindern mit Demenzerkrankungen. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3432-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Olsson M, Jarfelt M, Pergert P, Enskär K. Experiences of teenagers and young adults treated for cancer in Sweden. Eur J Oncol Nurs 2015; 19:575-81. [DOI: 10.1016/j.ejon.2015.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 02/13/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
|
40
|
Mack JW, Chen LH, Cannavale K, Sattayapiwat O, Cooper RM, Chao CR. End-of-Life Care Intensity Among Adolescent and Young Adult Patients With Cancer in Kaiser Permanente Southern California. JAMA Oncol 2015; 1:592-600. [PMID: 26181778 PMCID: PMC4620733 DOI: 10.1001/jamaoncol.2015.1953] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Cancer is the leading disease-related cause of death among adolescents and young adults (AYAs), but little is known about the care that AYA patients with cancer receive at the end of life (EOL). OBJECTIVE To evaluate the intensity of EOL care among AYA patients with cancer. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of Kaiser Permanente Southern California (KSPC) cancer registry data and electronic health records for 663 AYA patients with either stage I to III cancer and evidence of cancer recurrence or stage IV cancer at diagnosis. All patients were treated within KSPC, an integrated health care delivery system, and died between 2001 and 2010 before age 40 years (age range at time of death, 15-39 years). MAIN OUTCOMES AND MEASURES (1) Chemotherapy use in the last 14 days of life; (2) intensive care unit (ICU) care in the last 30 days of life; (3) more than 1 emergency department (ED) visit in the last 30 days of life; (4) hospitalization in the last 30 days of life; and (5) a composite measure of medically intensive EOL care including any of the aforementioned measures. RESULTS Eleven percent of patients (72 of 663) received chemotherapy within 14 days of death. In the last 30 days of life, 22% of patients (144 of 663) were admitted to the ICU; 22% (147 of 663) had more than 1 ED visit; and 62% (413 of 663) were hospitalized. Overall, 68% of patients (449 of 663) received at least 1 medically intensive EOL care measure. CONCLUSIONS AND RELEVANCE Most AYA patients received at least 1 form of medically intensive EOL care. These findings suggest the need to better understand EOL care preferences and decision making in this young population.
Collapse
Affiliation(s)
- Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts2Division of Population Sciences' Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lie H Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | | | - Robert M Cooper
- Department of Pediatric Oncology, Kaiser Permanente Southern California, Pasadena
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| |
Collapse
|
41
|
Zhukovsky DS, Rozmus CL, Robert RS, Bruera E, Wells RJ, Chisholm GB, Allo JA, Cohen MZ. Symptom profiles in children with advanced cancer: Patient, family caregiver, and oncologist ratings. Cancer 2015. [PMID: 26218240 DOI: 10.1002/cncr.29597] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Systematic symptom assessment is not routinely performed in pediatric oncology. The objectives of the current study were to characterize the symptoms of pediatric oncology outpatients and evaluate agreement between patient and proxy reports and the association between children's ratings and oncologists' treatment recommendations. METHODS Two versions of the pediatric Memorial Symptom Assessment Scale (pMSAS) were translated into Spanish. An age-appropriate and language-appropriate pMSAS was administered independently before visits to the oncologist to patients and family caregivers (caregivers) and after visits to consenting oncologists. Statistical analysis included Spearman correlation coefficients and weighted kappa values. RESULTS English and Spanish results were similar and were combined. A total of 60 children and their caregivers completed the pMSAS. The children had a median age of 10 years (range, 7-18 years); approximately 62% were male and 33% were Spanish-speaking. Fourteen oncologists completed the pMSAS for 25 patients. Nine patients (15%) had no symptoms and 38 patients (63%) reported ≥2 symptoms. The most common symptoms were fatigue (12 patients; 40%) and itch (9 patients; 30%) for the younger children and pain (15 patients; 50%) and lack of energy (13 patients; 45%) among the older children. Total and subscale score agreement varied by proxy type and subscale, ranging from fair to good for most comparisons. Agreement for individual symptoms between the patient and proxy ranged from a kappa of -0.30 (95% confidence interval, -0.43 to -0.01) to 0.91 (95% confidence interval, 0.75 to 1.00). Three of 51 symptomatic patients (6%) had treatment recommendations documented in the electronic health record. CONCLUSIONS Symptoms are common and cross several functional domains. Proxy and child reports are often not congruent, possibly explaining apparent undertreatment among this group of patients.
Collapse
Affiliation(s)
- Donna S Zhukovsky
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cathy L Rozmus
- School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Rhonda S Robert
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert J Wells
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gary B Chisholm
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Julio A Allo
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marlene Z Cohen
- College of Nursing, The University of Nebraska Medical Center, Omaha, Nebraska
| |
Collapse
|
42
|
Kohlschütter A, Riga C, Crespo D, Torres JM, Penchaszadeh V, Schulz A. Reprint of "Ethical issues with artificial nutrition of children with degenerative brain diseases". Biochim Biophys Acta Mol Basis Dis 2015; 1852:2312-5. [PMID: 26071856 DOI: 10.1016/j.bbadis.2015.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/07/2015] [Accepted: 03/09/2015] [Indexed: 11/16/2022]
Abstract
This report highlights viewpoints of the authors and comments from the auditory at a workshop, held during the 14th international Congress on neuronal ceroid lipofuscinoses (NCL) in Córdoba, Argentina, on ethical aspects of artificial nutrition in children with degenerative brain diseases. The discussion centers on what constitutes the best interest of a patient whose personality was immature before the onset of the disease, who has become demented during its course and is unable to communicate his/her own positions and desires. There is wide consensus that in a child with advanced disease who cannot be fed naturally, decisions to withhold nutrition or to institute or stop artificial nutrition, should only be made by parents (or their representatives) who are adequately prepared on an intellectual and emotional level. We try to show that such decisions are highly individual but can be made in a rationally and emotionally acceptable way after a careful and prolonged dialogue between families and professionals. A checklist summarizes important considerations. This article is part of a Special Issue entitled: "Current Research on the Neuronal Ceroid Lipofuscinoses (Batten Disease)".
Collapse
Affiliation(s)
- Alfried Kohlschütter
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Carolina Riga
- Service of Gastroenterology and Nutrition, Children's Hospital La Santísima Trinidad, Córdoba, Argentina.
| | - Dolores Crespo
- Service of Gastroenterology and Nutrition, Children's Hospital La Santísima Trinidad, Córdoba, Argentina.
| | | | | | - Angela Schulz
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
43
|
Kohlschütter A, Riga C, Crespo D, Torres JM, Penchaszadeh V, Schulz A. Ethical issues with artificial nutrition of children with degenerative brain diseases. Biochim Biophys Acta Mol Basis Dis 2015; 1852:1253-6. [PMID: 25795594 DOI: 10.1016/j.bbadis.2015.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/07/2015] [Accepted: 03/09/2015] [Indexed: 11/18/2022]
Abstract
This report highlights viewpoints of the authors and comments from the auditory at a workshop, held during the 14th international Congress on neuronal ceroid lipofuscinoses (NCL) in Córdoba, Argentina, on ethical aspects of artificial nutrition in children with degenerative brain diseases. The discussion centers on what constitutes the best interest of a patient whose personality was immature before the onset of the disease, who has become demented during its course and is unable to communicate his/her own positions and desires. There is wide consensus that in a child with advanced disease who cannot be fed naturally, decisions to withhold nutrition or to institute or stop artificial nutrition, should only be made by parents (or their representatives) who are adequately prepared on an intellectual and emotional level. We try to show that such decisions are highly individual but can be made in a rationally and emotionally acceptable way after a careful and prolonged dialogue between families and professionals. A checklist summarizes important considerations. This article is part of a Special Issue entitled: "Current Research on the Neuronal Ceroid Lipofuscinoses (Batten Disease)".
Collapse
Affiliation(s)
- Alfried Kohlschütter
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Carolina Riga
- Service of Gastroenterology and Nutrition, Children's Hospital La Santísima Trinidad, Córdoba, Argentina.
| | - Dolores Crespo
- Service of Gastroenterology and Nutrition, Children's Hospital La Santísima Trinidad, Córdoba, Argentina.
| | | | | | - Angela Schulz
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
44
|
Quinn GP, Gonçalves V, Sehovic I, Bowman ML, Reed DR. Quality of life in adolescent and young adult cancer patients: a systematic review of the literature. PATIENT-RELATED OUTCOME MEASURES 2015; 6:19-51. [PMID: 25733941 PMCID: PMC4337625 DOI: 10.2147/prom.s51658] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction Adolescent and young adult (AYA) cancer survivors experience many unique challenges and quality of life (QoL) effects that persist beyond cancer diagnosis and treatment. Due to continuous improvements in technology and cancer treatments resulting in improved survival rates, the identification of late effects, survivorship issues, and QoL is moving to the forefront of cancer research. The goal of this systematic review was to identify key psychosocial factors impacting QoL in AYA oncology populations. Methods A systematic review of the literature was conducted using combinations of these phrases or keywords: “adolescent and young adult or AYA” AND “health outcomes OR quality of life OR psychology” AND “neoplasm OR cancer OR oncology”. A total of 35 articles were included in this review. Studies were classified into two categories: AYA perceptions and stakeholder perceptions. Results AYA cancer survivors were more likely to have “worse” or impaired QoL compared with the general population, regardless of other demographic factors. AYAs described both positive and negatives experiences with their medical care, the educational information received, and the supportive care services. Although health care professionals were likely to underestimate or misjudge the health preferences and support needs of AYAs, these perceptions varied across disciplines and levels of experience. Conclusion The literature is lacking in sufficient evidence-based interventions to improve QoL in AYA cancer populations. Further, the tools to adequately measure QoL in this population are also unsatisfactory. The literature, however, consistently shows agreement regarding the unique needs of this population, indicating a trend toward health care standardization within age ranges or life stages. We suggest the need for AYA-specific programs in health care institutions that comprise a multidisciplinary team that addresses all the unique medical and QoL needs of AYAs.
Collapse
Affiliation(s)
- Gwendolyn P Quinn
- H Lee Moffitt Cancer Center and Research Institute, Department of Health Outcomes and Behavior, Tampa, FL, USA ; Morsani College of Medicine, University of South Florida, Tampa, FL, USA ; H Lee Moffitt Cancer Center and Research Institute, Adolescent Young Adult Oncology Program, Tampa, FL, USA
| | - Vânia Gonçalves
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Ivana Sehovic
- H Lee Moffitt Cancer Center and Research Institute, Department of Health Outcomes and Behavior, Tampa, FL, USA ; H Lee Moffitt Cancer Center and Research Institute, Adolescent Young Adult Oncology Program, Tampa, FL, USA
| | - Meghan L Bowman
- H Lee Moffitt Cancer Center and Research Institute, Department of Health Outcomes and Behavior, Tampa, FL, USA ; H Lee Moffitt Cancer Center and Research Institute, Adolescent Young Adult Oncology Program, Tampa, FL, USA
| | - Damon R Reed
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA ; H Lee Moffitt Cancer Center and Research Institute, Adolescent Young Adult Oncology Program, Tampa, FL, USA ; H Lee Moffitt Cancer Center and Research Institute, Department of Sarcoma, Tampa, FL, USA
| |
Collapse
|
45
|
Vallero SG, Lijoi S, Bertin D, Pittana LS, Bellini S, Rossi F, Peretta P, Basso ME, Fagioli F. End-of-life care in pediatric neuro-oncology. Pediatr Blood Cancer 2014; 61:2004-11. [PMID: 25131215 DOI: 10.1002/pbc.25160] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/30/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND The management of children with cancer during the end-of-life (EOL) period is often difficult and requires skilled medical professionals. Patients with tumors of the central nervous system (CNS) with relapse or disease progression might have additional needs because of the presence of unique issues, such as neurological impairment and altered consciousness. Very few reports specifically concerning the EOL period in pediatric neuro-oncology are available. PROCEDURE Among all patients followed at our center during the EOL, we retrospectively analyzed data from 39 children and adolescents with brain tumors, in order to point out on their peculiar needs. RESULTS Patients were followed-up for a median time of 20.1 months. Eighty-two percent were receiving only palliative therapy before death. Almost half the patients (44%) died at home, while 56% died in a hospital. Palliative sedation with midazolam was performed in 58% of cases; morphine was administered in 51.6% of cases. No patient had uncontrolled pain. CONCLUSIONS The EOL in children with advanced CNS cancer is a period of active medical care. Patients may develop complex neurological symptoms and often require long hospitalization. We organized a network-based collaboration among the reference pediatric oncology center, other pediatric hospitals and domiciliary care personnel, with the aim to ameliorate the quality of care during the EOL period. In our cohort, palliative sedation was widely used while no patients died with uncontrolled pain. A precise process of data collection and a better sharing of knowledge are necessary in order to improve the management of such patients.
Collapse
Affiliation(s)
- Stefano Gabriele Vallero
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division. A.O. Città della Salute e della Scienza - Ospedale Infantile "Regina Margherita", Turin, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
|
47
|
Clark JK, Fasciano K. Young adult palliative care: challenges and opportunities. Am J Hosp Palliat Care 2013; 32:101-11. [PMID: 24198063 DOI: 10.1177/1049909113510394] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Young adulthood is a time of immense growth and possibilities. As a result, it is also a time when serious illness can have profound effects. This review examines the current data pertinent to young adult palliative care and discusses the challenges and opportunities where palliative medicine can enhance the care provided to this growing and vulnerable population. From the data, 2 primary themes emerged (1) ongoing young adult development not only generates unique biologic disease burdens and clinical treatment options but also requires frequent assessment and promotion and (2) binary health care systems often leave young adults without access to developmentally appropriate health care. Given its interdisciplinary approach, palliative care is uniquely poised to address the challenges known to caring for the seriously ill young adult.
Collapse
Affiliation(s)
- Jennifer K Clark
- Departments of Internal Medicine and Pediatrics, University of Oklahoma, School of Community Medicine-Tulsa, OU Center for Palliative Care, Tulsa, OK, USA
| | - Karen Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
48
|
Venkatasalu MR, Arthur A, Seymour J. Talking about end-of-life care: the perspectives of older South Asians living in East London. J Res Nurs 2013. [DOI: 10.1177/1744987113490712] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The National End-of-life Care Strategy for England identifies that a lack of open discussion about death and dying can be a barrier to achieving good quality end-of-life care. South Asians constitute the single largest ethnic minority group in the United Kingdom, yet little is known about their attitudes and expectations towards the discussion of death and dying. In this study, set in East London, five focus groups and 29 in-depth, semi-structured interviews were conducted with a total of 55 older adults aged between 52 and 78 years. Participants from six South Asian ethnic groups were recruited from 11 local community organisations. A constructivist grounded theory approach was used to analyse the data. Findings revealed two key themes which capture the perspectives of older South Asian study participants towards end-of-life care discussions. The theme ‘avoidance as a cultural norm’ relates to the relative absence of discussions around death and dying experienced by participants. Participants neither expected to have discussions about their own death and dying within their family, nor to assume any involvement in decision-making. The second theme ‘avoidance as protection’ relates to beliefs and experiences about the delegation of decision-making to family members. Future research should explore the perspectives of second-generation adult children towards end-of-life care discussions.
Collapse
Affiliation(s)
| | - Antony Arthur
- Professor in Nursing Science, School of Nursing Sciences, University of East Anglia, UK
| | - Jane Seymour
- Sue Ryder Care Professor of Palliative and End of Life Studies, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, UK
| |
Collapse
|
49
|
Arland LC, Hendricks-Ferguson VL, Pearson J, Foreman NK, Madden JR. Development of an in-home standardized end-of-life treatment program for pediatric patients dying of brain tumors. J SPEC PEDIATR NURS 2013; 18:144-57. [PMID: 23560586 DOI: 10.1111/jspn.12024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 11/12/2012] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate an end-of-life (EOL) program related to specific outcomes (i.e., number of hospitalizations and place of death) for children with brain tumors. DESIGN AND METHODS From 1990 to 2005, a retrospective chart review was performed related to specified outcomes for 166 children with admission for pediatric brain tumors. RESULTS Patients who received the EOL program were hospitalized less often (n = 114; chi-square = 5.001 with df = 1, p <.05) than patients who did not receive the program. PRACTICE IMPLICATIONS An EOL program may improve symptom management and decrease required hospital admissions for children with brain tumors.
Collapse
Affiliation(s)
- Lesley C Arland
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | | | | |
Collapse
|
50
|
Abstract
Adolescents and young adults (AYAs) with cancer represent a unique and challenging group of patients with distinct developmental and psychosocial needs that may be unrecognized or unmet during their cancer experience. Palliative care refers to the total care of a patient, regardless of his or her disease status, and aims to improve quality of life by controlling symptoms and alleviating physical, social, psychological, and spiritual suffering. Integrating palliative care into standard oncology practice for AYAs is therefore valuable, if not imperative, in improving their overall cancer experience. In this review, we aimed to describe the scope, benefits, and challenges of palliative care for AYA oncology patients. We provide a broad impression of the existing literature describing or investigating palliative care in this population. Put together, the evidence suggests that palliative care is not only needed, but can also be critically beneficial to patients, families, and health care professionals alike. As we increase public and professional awareness of the needs and applications of palliative care for AYA patients with cancer, we will ultimately enable better psychosocial outcomes of the AYA patients and their larger communities.
Collapse
Affiliation(s)
- Abby R Rosenberg
- Division of Pediatric Hematology/ Oncology, Seattle Children's Hospital, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.,Department of Pediatrics, University of Washington, Seattle, WA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care/Division of Pediatric Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine/Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA.,Department of Pediatrics, Harvard University School of Medicine, Boston, MA, USA
| |
Collapse
|