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Moon CC, Mah K, Pope A, Swami N, Hannon B, Lau J, Mak E, Al-Awamer A, Banerjee S, Dawson LA, Husain A, Rodin G, Le LW, Zimmermann C. Family physicians' involvement in palliative cancer care. Cancer Med 2023; 12:6213-6224. [PMID: 36263836 PMCID: PMC10028020 DOI: 10.1002/cam4.5371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family physicians' (FPs) long-term relationships with their oncology patients position them ideally to provide primary palliative care, yet their involvement is variable. We examined perceptions of FP involvement among outpatients receiving palliative care at a cancer center and identified factors associated with this involvement. METHODS Patients with advanced cancer attending an oncology palliative care clinic (OPCC) completed a 25-item survey. Eligible patients had seen an FP within 5 years. Binary multivariable logistic regression analyses were conducted to identify factors associated with (1) having seen an FP for palliative care within 6 months, and (2) having a scheduled/planned FP appointment. RESULTS Of 258 patients, 35.2% (89/253) had seen an FP for palliative care within the preceding 6 months, and 51.2% (130/254) had a scheduled/planned FP appointment. Shorter travel time to FP (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.48-0.93, p = 0.02), the FP having a 24-h support service (OR = 1.96, 95% CI = 1.02-3.76, p = 0.04), and a positive perception of FP's care (OR = 1.05, 95% CI = 1.01-1.09, p = 0.01) were associated with having seen the FP for palliative care. English as a first language (OR = 2.90, 95% CI = 1.04-8.11, p = 0.04) and greater ease contacting FP after hours (OR = 1.33, 95% CI = 1.08-1.64, p = 0.008) were positively associated, and female sex of patient (OR = 0.51, 95% CI = 0.30-0.87, p = 0.01) and travel time to FP (OR = 0.66, 95% CI = 0.47-0.93, p = 0.02) negatively associated with having a scheduled/planned FP appointment. Number of OPCC visits was not associated with either outcome. CONCLUSION Most patients had not seen an FP for palliative care. Accessibility, availability, and equity are important factors to consider when planning interventions to encourage and facilitate access to FPs for palliative care.
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Affiliation(s)
- Christine C Moon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Kenneth Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ashley Pope
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nadia Swami
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ernie Mak
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Subrata Banerjee
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura A Dawson
- Department of Radiation Oncology, University of Toronto, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Amna Husain
- Temmy Latner Centre for Palliative Care Lunenfeld Tanenbaum Research Institute, Sinai Health Division of Palliative Care, University of Toronto, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Cannon ST, Gabbard J, Walsh RC, Statler TM, Browne JD, Marterre B. Concordant palliative care delivery in advanced head and neck cancer. Am J Otolaryngol 2023; 44:103675. [PMID: 36302326 PMCID: PMC9743959 DOI: 10.1016/j.amjoto.2022.103675] [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: 09/02/2022] [Accepted: 10/16/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the palliative care consultation practices in an academic head and neck surgery practice. METHODS This is a retrospective review of a palliative care database and the health record for all palliative care consultations of patients suffering from advanced stage head and neck cancer within a 21-month period. RESULTS Ten head and neck cancer patients received palliative care consults while on the otolaryngology service. One consultation occurred preoperatively; nine occurred postoperatively, on a median of hospital day 9. At the time of referral, seven patients were in the ICU and three were on a surgical floor. Code status de-escalation occurred in six patients and psycho-socio-spiritual suffering was supported in all consultations. Nine patients died within six months, with a median post-consultation survival of 35 days. Of these, two died in an ICU, five were discharged to hospice, one to a SNF, and one to a LTACH. CONCLUSION Palliative care consultation in this advanced head and neck cancer cohort was commonly late, however, significant suffering was mitigated following most consults. Palliative care specialists are experts at eliciting patient values, determining acceptable tradeoffs and suffering limitations by employing a shared decision-making process that ends with a patient-centered value-congruent treatment recommendation. Oftentimes, this embraces curative-intent or palliative surgery, along with contingency plans for unacceptable value-incongruent postoperative outcomes. Enhanced awareness of the benefits of embracing concordant palliative care in advanced head and neck cancer patients may help overcome the significant barriers to involving palliative care experts earlier.
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Affiliation(s)
- Sydney T. Cannon
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America
| | - Jennifer Gabbard
- Department of Internal Medicine, Section on Palliative Care, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America
| | - Rebecca C. Walsh
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America
| | - Tiffany M. Statler
- Department of Internal Medicine, Section on Palliative Care, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America
| | - J. Dale Browne
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America,Corresponding author at: 1 Medical Center Blvd, Winston-Salem, NC 27157, United States of America. (J.D. Browne)
| | - Buddy Marterre
- Department of Internal Medicine, Section on Palliative Care, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America,Department of General Surgery, Wake Forest School of Medicine and Atrium Health-Wake Forest Baptist, Winston-Salem, NC, United States of America
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Dorr MC, Sewnaik A, Berzenji D, van Hof KS, Grevelink T, Baatenburg de Jong RJ, Offerman MPJ. Learnings From Longitudinal Patient-Reported and Clinical Outcomes in Palliative Head and Neck Cancer Care. Otolaryngol Head Neck Surg 2022:1945998221127203. [PMID: 36166301 DOI: 10.1177/01945998221127203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Patients with palliative head and neck cancer experience many symptoms in a short period of time. Longitudinal data on patient-reported outcomes in this phase are lacking. The aim of this study is to use structurally obtained patient-reported outcome data combined with clinical patient data and obtain insight in patient-reported outcomes, survival, circumstances of death, and interventions and treatment during the palliative phase in order to improve the quality of end-of-life care and patient-centered counseling. STUDY DESIGN Longitudinal observational cohort study. SETTING Tertiary cancer center. METHOD Quality of life was prospectively collected using the European Organization for Research and Treatment of Cancer QLQ-C15-PAL. Tumor- and patient-specific data were retrospectively collected. Descriptive statistics, linear mixed models, and regression analyses were performed. RESULTS A significant deterioration was found in global health status, physical functioning, fatigue, dyspnea, appetite loss, and constipation over time. However, emotional functioning improved. Median survival was 5.1 months, and only a low percentage of in-hospital death was observed (7.8%). Higher global health status at intake was associated with prolonged survival. CONCLUSION Structural measurement of patient-reported outcome together with clinical outcomes provides unique insight, which enables improvement of patient-centered counseling and care.
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Affiliation(s)
- Maarten C Dorr
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Diako Berzenji
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kira S van Hof
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tim Grevelink
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marinella P J Offerman
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Mayland CR, Ho QM, Doughty HC, Rogers SN, Peddinti P, Chada P, Mason S, Cooper M, Dey P. The palliative care needs and experiences of people with advanced head and neck cancer: A scoping review. Palliat Med 2021; 35:27-44. [PMID: 33084497 PMCID: PMC7797618 DOI: 10.1177/0269216320963892] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The palliative care needs of people with advanced head and neck cancer pose unique complexities due to the impact the illness has on eating, speaking, appearance and breathing. Examining these needs would help provide guidance about developing relevant models of care and identify gaps in research knowledge. AIM To identify and map out the palliative care needs and experiences for people with advanced head and neck cancer. DESIGN A scoping literature review following the methods described by the Joanna Briggs Institute. DATA SOURCES An electronic search of the literature was undertaken in MEDLINE (Ovid), EMBASE and CINAHL covering the years January 1996 to January 2019. RESULTS People with advanced head and neck cancer often had palliative care needs but there was variability in the timing and access to relevant services. A high prevalence of interventions, for example hospital admissions were needed even during the last month of life. This was not necessarily negated with early engagement of palliative care. Dissonance between patients and family carers about information needs and decision-making was an additional complexity. Studies tended to be descriptive in nature, and often involved a single centre. CONCLUSION This scoping review demonstrates the complexity of care for people with advanced head and neck cancer and the issues related to the current healthcare systems. Focus on appropriate referral criteria, increased integration and coordination of care and robust evaluation of specific care components seems key. Linkage between research and service design delivery across teams, disciplines and care settings seems pertinent.
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Affiliation(s)
- Catriona R Mayland
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Palliative Care Institute, University of Liverpool, Liverpool, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Qiaoling Marilyn Ho
- Palliative Care Institute, University of Liverpool, Liverpool, UK
- Nanyang Technology University, Singapore
| | - Hannah C Doughty
- Palliative Care Institute, University of Liverpool, Liverpool, UK
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Simon N Rogers
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Prithvi Peddinti
- University of Liverpool Medical School, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Praytush Chada
- University of Liverpool Medical School, Liverpool, UK
- Luton and Dunstable University Hospital, Luton, UK
| | - Stephen Mason
- Palliative Care Institute, University of Liverpool, Liverpool, UK
| | - Matthew Cooper
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paola Dey
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
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Mitchell G, Aubin M, Senior H, Johnson C, Fallon-Ferguson J, Williams B, Monterosso L, Rhee JJ, McVey P, Grant M, Nwachukwu H, Yates P. General practice nurses and physicians and end of life: a systematic review of models of care. BMJ Support Palliat Care 2020:bmjspcare-2019-002114. [PMID: 32718955 DOI: 10.1136/bmjspcare-2019-002114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/28/2020] [Accepted: 06/02/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide palliative care (PC) or end-of-life care (EoLC) as the population ages. In order to maximise the impact of GPs and GPNs, the impact of different models of care that have been developed to support their practice of EoLC needs to be understood. OBJECTIVE To examine published models of EoLC that incorporate or support GP and GPN practice, and their impact on patients, families and the health system. METHOD Systematic literature review. Data included papers (2000 to 2017) sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. RESULTS From 6209 journal articles, 13 papers reported models of care supporting the GP and GPN's role in EoLC or PC practice. Services and guidelines for clinical issues have mixed impact on improving symptoms, but improved adherence to clinical guidelines. National Frameworks facilitated patients being able to die in their preferred place. A single specialist PC-GP case conference reduced hospitalisations, better maintained functional capacity and improved quality of life parameters in both patients with cancer and without cancer. No studies examined models of care aimed at supporting GPNs. CONCLUSIONS Primary care practitioners have a natural role to play in EoLC, and most patient and health system outcomes are substantially improved with their involvement. Successful integrative models need to be tested, particularly in non-malignant diseases. Such models need to be explored further. More work is required on the role of GPNs and how to support them in this role.
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Affiliation(s)
- Geoffrey Mitchell
- Primary Care Clinical Unit, University of Queensland, Herston, Queensland, Australia
| | - Michèle Aubin
- Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec City, Quebec, Canada
| | - Hugh Senior
- Primary Care Clinical Unit, University of Queensland, Herston, Queensland, Australia
- College of Health, Massey University, Auckland, New Zealand
| | - Claire Johnson
- Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Julia Fallon-Ferguson
- Primary Care Collaborative Cancer Clinical Trials Group, The University of Melbourne, Melbourne, Victoria, Australia
- General Practice, University of Western Australia, Perth, Western Australia, Australia
| | - Briony Williams
- Primary Care Collaborative Cancer Clinical Trials Group, The University of Melbourne, Melbourne, Victoria, Australia
- General Practice, University of Western Australia, Perth, Western Australia, Australia
| | - Leanne Monterosso
- School of Nursing, Notre Dame University, Perth, Western Australia, Australia
- School of Nursing, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Joel J Rhee
- General Practice Unit, University of Wollongong, Wollongong, New South Wales, Australia
| | - Peta McVey
- Susan Wakil School of Nursing, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Grant
- School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Harriet Nwachukwu
- Primary Care Clinical Unit, University of Queensland, Herston, Queensland, Australia
| | - Patsy Yates
- Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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McCammon SD. Concurrent palliative care in the surgical management of head and neck cancer. J Surg Oncol 2019; 120:78-84. [DOI: 10.1002/jso.25452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Susan D. McCammon
- Department of Otolaryngology, Department of Internal Medicine, Division of Gerontology, Geriatrics and Palliative CareThe University of AlabamaBirmingham Alabama
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Mitchell GK, Senior HE, Johnson CE, Fallon-Ferguson J, Williams B, Monterosso L, Rhee JJ, McVey P, Grant MP, Aubin M, Nwachukwu HTG, Yates PM. Systematic review of general practice end-of-life symptom control. BMJ Support Palliat Care 2018; 8:411-420. [DOI: 10.1136/bmjspcare-2017-001374] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 11/04/2022]
Abstract
BackgroundEnd of life care (EoLC) is a fundamental role of general practice, which will become more important as the population ages. It is essential that general practice’s role and performance of at the end of life is understood in order to maximise the skills of the entire workforce.ObjectiveTo provide a comprehensive description of the role and performance of general practitioners (GPs) and general practice nurses (GPNs) in EoLC symptom control.MethodSystematic literature review of papers from 2000 to 2017 were sought from Medline, PsycINFO, Embase, Joanna Briggs Institute and Cochrane databases.ResultsFrom 6209 journal articles, 46 papers reported GP performance in symptom management. There was no reference to the performance of GPNs in any paper identified. Most GPs expressed confidence in identifying EoLC symptoms. However, they reported lack of confidence in providing EoLC at the beginning of their careers, and improvements with time in practice. They perceived emotional support as being the most important aspect of EoLC that they provide, but there were barriers to its provision. GPs felt most comfortable treating pain, and least confident with dyspnoea and depression. Observed pain management was sometimes not optimal. More formal training, particularly in the use of opioids was considered important to improve management of both pain and dyspnoea.ConclusionsIt is essential that GPs receive regular education and training, and exposure to EoLC from an early stage in their careers to ensure skill and confidence. Research into the role of GPNs in symptom control needs to occur.
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End-of-life care for head and neck cancer patients: a population-based study. Support Care Cancer 2016; 25:1529-1536. [PMID: 28039504 DOI: 10.1007/s00520-016-3555-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Head and neck cancers (HNCs) usually present a poor prognosis and cause high morbidity rates. Recent surveys have demonstrated that HNC incidence rates are still on the increase in many countries. Our study objective was to assess the end-of-life care for patients with HNCs in Taiwan. METHODS Data was retrieved from Taiwan's National Health Insurance Research Database, where we identified patients who had been diagnosed with HNCs from January 1997 to December 2010. Each patient's annual trend of opioid use and hospice care needs, along with the distribution of place of death in the study cohort, were all analyzed. RESULTS A total of 98,211 HNC patients diagnosed between 1997 and 2010 were eligible for this study. The majority of HNC patients died in hospital. Patients who were male, lived in capital area, had a higher income, had received palliative hospice care, and had been prescribed opioids tended to choose to die at home or in hospice wards. Both opioid prescription and hospice care have increased during the past 10 years; however, the rate of palliative hospice care remained below 50%. CONCLUSIONS Our results demonstrate that greater efforts are needed to implement palliative care for HNC patients in Taiwan.
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Shinozaki T, Ebihara M, Iwase S, Yamaguchi T, Hirakawa H, Shimbashi W, Kamijo T, Okamoto M, Beppu T, Ohori J, Matsuura K, Suzuki M, Nishino H, Sato Y, Ishiki H. Quality of life and functional status of terminally ill head and neck cancer patients: a nation-wide, prospective observational study at tertiary cancer centers in Japan. Jpn J Clin Oncol 2016; 47:47-53. [PMID: 27677662 DOI: 10.1093/jjco/hyw138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/27/2016] [Accepted: 08/30/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about quality of life and functional status of patients with terminally ill head and neck cancers. METHODS We conducted a multicenter, prospective, observational study to examine quality of life and functional status in terminally ill head and neck cancer patients. RESULTS Of the 100 patients meeting inclusion criteria, 72 were observed until death. There was no significant difference in the quality of life score between baseline and Week 3. Forty patients (54.9%) could speak and 22 patients (30.5%) could have oral intake upon study entry. Fifty-three patients (74.6%) received enteral nutrition. Twenty-six patients (36.6%) required dressing changes for fungating tumors. The route of nutritional intake (nasogastric tube vs. percutaneous gastric tube) might be predictive for the duration of hospital stay (64 vs. 21 days, P = 0.0372). CONCLUSION There was no significant relationship between quality of life and functional status seen in this study. Feeding tube type could have the most impact on quality of life.
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Affiliation(s)
- Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa
| | | | - Satoru Iwase
- Department of Palliative Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai
| | - Hitoshi Hirakawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya
| | - Wataru Shimbashi
- Department of Head and Neck Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo
| | - Tomoyuki Kamijo
- Department of Head and Neck Surgery, Shizuoka Cancer Center, Nagaizumicho
| | - Makito Okamoto
- Department of Otolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara
| | - Takeshi Beppu
- Department of Head and Neck Surgery, Saitama Cancer Center, Saitama
| | - Junichiro Ohori
- Department of Otolaryngology, Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori
| | - Motoyuki Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - Hiroshi Nishino
- Department of Otolaryngology, Head and Neck Surgery, Jichi Medical University, Shimotsuke
| | - Yuichiro Sato
- Department of Head and Neck Surgery, Niigata Cancer Center, Niigata, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, The Institute of Medical Science, The University of Tokyo, Tokyo
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Shuman AG, Fins JJ, Prince ME. Improving end-of-life care for head and neck cancer patients. Expert Rev Anticancer Ther 2012; 12:335-43. [PMID: 22369325 DOI: 10.1586/era.12.6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite improvements in the treatment of head and neck cancer, many patients still succumb to their disease. A litany of medical, psychosocial and ethical challenges arise in managing the end-of-life experiences within this patient population. In this article, we attempt to review existing data about the end-of-life experiences of this cohort, extrapolate relevant data from other cancer patients, and suggest the most promising avenues for additional research and practice improvement for terminal head and neck cancer patients. Clinical decision-making for patients dying of head and neck cancer requires proactive consideration of quality of life, functionality, symptom control and other patient-centered objectives, and frequently benefits from palliative care team involvement. Additional research aimed toward optimizing the end of life experience of head and neck cancer patients and their families is greatly needed.
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Affiliation(s)
- Andrew G Shuman
- Division of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
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Shuman AG, Yang Y, Taylor JMG, Prince ME. End-of-life care among head and neck cancer patients. Otolaryngol Head Neck Surg 2011; 144:733-9. [PMID: 21493350 DOI: 10.1177/0194599810397603] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study is designed to (1) determine the perceived quality of care received by patients with head and neck cancer at the end of their lives, in order to (2) better anticipate and improve upon the experiences of future patients. STUDY DESIGN Cross-sectional survey. SETTING Single-institution, academic tertiary care medical center. SUBJECTS AND METHODS A validated survey instrument, the Family Assessment of Treatment at the End of life (FATE), was administered to families of patients who died of head and neck cancer (n = 58). The primary outcome was the overall FATE score. Independent variables included clinical characteristics, treatments received, and the care provided at the time of death. RESULTS Overall FATE scores and the domains assessing management of symptoms and care at the time of death did not vary by disease status (logoregional vs distant metastasis) at the end of life (P = .989). The location of death in the home or in hospice (vs hospital) significantly improves scores in all 3 categories (P = .023). Involvement of a palliative care team improved the care at the time of death (P < .001), and palliative treatments (radiation and/or chemotherapy) improved scores in managing symptoms and care at the time of death (P = .011, P = .017). CONCLUSION The FATE survey is a useful measure of the end-of-life experience of head and neck cancer patients. Palliative treatments of head and neck cancer, death outside of the hospital, and palliative care team involvement all improve the end-of-life experience in this population.
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Affiliation(s)
- Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.
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Ledeboer QCP, van der Schroeff MP, Pruyn JFA, de Boer MF, Baatenburg de Jong RJ, van der Velden LA. Survival of patients with palliative head and neck cancer. Head Neck 2010; 33:1021-6. [DOI: 10.1002/hed.21572] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/18/2010] [Accepted: 07/09/2010] [Indexed: 11/07/2022] Open
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Dietl B, Marienhagen J, Schaefer C, Pohl F, Murthum T, Kölbl O. Überleben mit hämatogen metastasierten HNO-Tumoren. HNO 2007; 55:785-6, 788-91. [PMID: 17333044 DOI: 10.1007/s00106-006-1522-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
QUESTIONS The objective of this retrospective analysis was to investigate parameters with a potential impact on survival in a collective of 114 patients with distant metastatic disease after head and neck cancer. PATIENTS AND METHODS The primary endpoint was the survival with distant metastatic disease, the secondary endpoint was overall survival. Primary therapy, local recurrence, second neoplasms, palliative chemotherapy (CHT) and radiotherapy (RT), as well as Karnofsky performance status (KPS) at the time of diagnosis of the metastases were analyzed as potential impact parameters using the log-rank test with subsequent Cox regression analysis. RESULTS Palliative CHT (P=0.0020) and KPS (P=0.0011) had a significant positive impact on the median survival probability with metastases (8.2 months) using the log-rank test, KPS at the time of diagnosis of metastases remained as an independent prognostic parameter in the Cox regression (P=0.0013). Primary therapy, local tumor control and KPS had a significant positive influence on the median overall survival probability (18.5 months) univariately (P=0.0139, P=0.0106, P= 0.0096) and multivariately (P=0.0123, and P=0.0063, P=0.0197, respectively). CONCLUSIONS KPS at the time of diagnosis of metastases is an independent prognostic parameter for both endpoints. Lacking evidence for life prolongation, palliative therapies should therefore first and foremost focus on the stabilization of the KPS.
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Affiliation(s)
- B Dietl
- Klinik für Strahlentherapie, Universität Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg.
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