Utilidad del Palliative Performance Scale v2 para la estimación de supervivencia en enfermos con cáncer avanzado

Burden and quality of life in caregivers of cancer patients at the beginning of palliative care. CUIDPALCOSTASOL Study

OBJECTIVES

To describe the quality of life and caregiver burden of family caregivers of cancer patients at the beginning of palliative care.

METHOD

Cross-sectional descriptive study in the CUIDPACOSTASOL cohort of family caregivers of palliative phase cancer patients, included between February 2017 and December 2019 from health centres of the Costa del Sol and Malaga-Valle del Guadalhorce Primary Care District, and Cudeca Foundation. Sociodemographic data on caregivers and patients, specific questionnaires related to family caregiver burden as well as satisfaction (Zarit and FAMCARE), quality of life (SF-36) and nursing diagnoses (NANDA), and patient characteristics (PPI, PPSv2) were collected.

RESULTS

174 family caregivers were included, 86.8% were women with a mean age of 57 years. 60.6% perceived their health as good, and the mean score on the Zarit scale was 13.0. The most repeated nursing diagnosis (NANDA) was «Risk for caregiver role strain» (41.8%). The quality-of-life dimensions with the highest scores were «Physical function» (80.5), and «Physical role» (67.2). Of the people receiving care, 62.6% were men with a mean age of 73 years and required care for an average of 19 h per day. The mean score on the Palliative Performance Scale, PPSv2, was 44.9%, and 3.9% on the PPI Palliative Prognostic Index.

CONCLUSIONS

Family caregivers in this study had moderate burden, high risk for caregiver role strain, and acceptable perceived health and quality of life. This is probably because they were at the beginning of palliative care.

Burden and quality of life in caregivers of cancer patients at the beginning of palliative care. CUIDPALCOSTASOL Study

OBJECTIVES

To describe the quality of life and caregiver burden of family caregivers of cancer patients at the beginning of palliative care.

METHOD

Cross-sectional descriptive study in the CUIDPACOSTASOL cohort of family caregivers of palliative phase cancer patients, included between February 2017 and December 2019 from health centres of the Costa del Sol and Malaga-Valle del Guadalhorce Primary Care District, and Cudeca Foundation. Sociodemographic data on caregivers and patients, specific questionnaires related to family caregiver burden as well as satisfaction (Zarit and FAMCARE), quality of life (SF-36) and nursing diagnoses (NANDA), and patient characteristics (PPI, PPSv2) were collected.

RESULTS

174 family caregivers were included, 86.8% were women with a mean age of 57 years. 60.6% perceived their health as good, and the mean score on the Zarit scale was 13.0. The most repeated nursing diagnosis (NANDA) was «Risk for caregiver role strain» (41.8%). The quality-of-life dimensions with the highest scores were «Physical function» (80.5), and «Physical role» (67.2). Of the people receiving care, 62.6% were men with a mean age of 73 years and required care for an average of 19 hours per day. The mean score on the Palliative Performance Scale, PPSv2, was 44.9%, and 3.9% on the PPI Palliative Prognostic Index.

CONCLUSIONS

Family caregivers in this study had moderate burden, high risk for caregiver role strain, and acceptable perceived health and quality of life. This is probably because they were at the beginning of palliative care.

Frailty, Complexity, and Priorities in the Use of Advanced Palliative Care Resources in Nursing Homes

Background and objectives: This study aimed to determine the frailty, prognosis, complexity, and palliative care complexity of nursing home residents with palliative care needs and define the characteristics of the cases eligible for receiving advanced palliative care according to the resources available at each nursing home. Materials and Methods: In this multi-centre, descriptive, and cross-sectional study, trained nurses from eight nursing homes in southern Spain selected 149 residents with palliative care needs. The following instruments were used: the Frail-VIG index, the case complexity index (CCI), the Diagnostic Instrument of Complexity in Palliative Care (IDC-Pal), the palliative prognosis index, the Barthel index (dependency), Pfeiffer's test (cognitive impairment), and the Charlson comorbidity index. A consensus was reached on the complexity criteria of the Diagnostic Instrument of Complexity in Palliative Care that could be addressed in the nursing home (no priority) and those that required a one-off (priority 2) or full (priority 1) intervention of advanced palliative care resources. Non-parametric tests were used to compare non-priority patients and patients with some kind of priority. Results: A high percentage of residents presented frailty (80.6%), clinical complexity (80.5%), and palliative care complexity (65.8%). A lower percentage of residents had a poor prognosis (10.1%) and an extremely poor prognosis (2%). Twelve priority 1 and 14 priority 2 elements were identified as not matching the palliative care complexity elements that had been previously identified. Of the studied cases, 20.1% had priority 1 status and 38.3% had priority 2 status. Residents with some kind of priority had greater levels of dependency (p < 0.001), cognitive impairment (p < 0.001), and poorer prognoses (p < 0.001). Priority 1 patients exhibited higher rates of refractory delirium (p = 0.003), skin ulcers (p = 0.041), and dyspnoea (p = 0.020). Conclusions: The results indicate that there are high levels of frailty, clinical complexity, and palliative care complexity in nursing homes. The resources available at each nursing home must be considered to determine when advanced palliative care resources are required.

Estimating the short-term prognosis to adjust the transfer of patients with terminal cancer to medium-stay palliative care units

BACKGROUND AND OBJECTIVES

Clinical management for terminal patients should consider various aspects, particularly the patient's functional assessment, which correlates well with the short-term prognosis. The prognosis could improve if the presence of symptoms strongly associated with a poorer progression were included. The study's main objective was to assess whether the prognosis according to the Palliative Performance Scale (PPS) improved with the presence/absence of pain-dyspnoea-delirium symptoms. The secondary objective was to determine caregiver satisfaction with the transfer to medium-stay palliative care units (MSPCUs), which are prepared for medium stays of approximately one month.

PATIENTS AND METHOD

We conducted a prospective, observational, multicentre (regional) study that analysed survival in MSPCUs according to the PPS dichotomized to>20% and≤20%. We estimated the mean survival functions using the Kaplan-Meier method and compared them according to the Cox proportional hazards ratios (HR). Caregiver satisfaction was studied using an anonymous self-administered Likert questionnaire.

RESULTS

The study included 130 patients. The PPS≤20% and PPS>20% subgroups had a median survival of 6 (3-13) days and 21 (11-42) days, respectively, with an unadjusted mortality HR 3.1-fold greater in the PPS≤20% subgroup. The HR did not change when adjusted for the symptoms. Eighty-three percent of the caregivers found the transfer beneficial, and 40% observed better patient care.

CONCLUSIONS

For patients transferred from general hospitals to MSPCUs, PPS scores≤20% were associated with survival shorter than one week, with a 3-fold higher mortality HR than patients with PPS scores>20%, without the analysis adjusted for the presence of pain-dyspnoea-delirium providing greater prognostic accuracy. The caregivers found benefits mainly in the convenience of the facilities and distance.