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Palmer Kelly E, Hyer JM, Paredes AZ, Tsilimigras D, Meyer B, Newberry H, Pawlik TM. Provision of supportive spiritual care for hepatopancreatic cancer patients: an unmet need? HPB (Oxford) 2021; 23:1400-1409. [PMID: 33642211 DOI: 10.1016/j.hpb.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/16/2020] [Accepted: 02/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Among patients with a serious cancer diagnosis, like hepatopancreatic (HP) cancer, spiritual distress needs to be addressed, as these psychosocial-spiritual symptoms are often more burdensome than some physical symptoms. The objective of the current study was to characterize supportive spiritual care utilization among patients with HP cancers. METHODS Patients with HP cancer were identified from the electronic medical record at a large comprehensive cancer center; data on patients with breast/prostate cancer (non-HP) were collected for comparison. Associations between patient characteristics and receipt of supportive spiritual care were evaluated within the overall sample and end-of-life subsample. RESULTS Among 8,961 individuals (nHP=1,419, nnon-HP =7,542), 51.7% of HP patients utilized supportive spiritual care versus 19.8% of non-HP patients (p<0.001). Younger age and religious identity were associated with receiving spiritual care (p<0.001). HP patients had higher odds of receiving spiritual care versus non-HP patients (OR 2.41, 95%CI: 2.10, 2.78). Within the end-of-life subsample, HP patients more frequently received spiritual care to "accept their illness" (39.5% vs. 22.5%, p<0.001), while non-HP patients needed support to "define their purpose in life" (13.1% vs. 4.5%, p=0.001). DISCUSSION Supportive spiritual care was important to a large subset of HP patients and should be integrated into their care.
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Affiliation(s)
- Elizabeth Palmer Kelly
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Diamantis Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Bonnie Meyer
- The Ohio State University Wexner Medical Center Department of Chaplaincy and Clinical Pastoral Education, USA
| | - Hanci Newberry
- The Ohio State University Wexner Medical Center Department of Chaplaincy and Clinical Pastoral Education, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
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Chen JJ, Rawal B, Krishnan MS, Hertan LM, Shi DD, Roldan CS, Huynh MA, Spektor A, Balboni TA. Patterns of Specialty Palliative Care Utilization Among Patients Receiving Palliative Radiation Therapy. J Pain Symptom Manage 2021; 62:242-251. [PMID: 33383147 DOI: 10.1016/j.jpainsymman.2020.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/22/2022]
Abstract
CONTEXT Palliative radiation therapy (RT) is frequently used to ameliorate cancer-associated symptoms and improve quality of life. OBJECTIVES To examine how palliative care (PC) as a specialty is integrated at the time of RT consultation for patients with advanced cancer. METHODS We retrospectively reviewed 162 patients with metastatic cancer who received palliative RT at our institution (7/2017-2/2018). Fisher's exact test identified differences in incidence of receiving any specialty PC. Logistic regression analyses determined predictors of receiving PC. RESULTS Of the 74 patients (46%) who received any specialty PC, 24 (32%) initiated PC within four weeks of RT consultation. The most common reasons for specialty PC initiation were pain (64%) and goals of care/end-of-life care management (23%). Referrals to specialty PC were made by inpatient care teams (48.6%), medical oncologists (48.6%), radiation oncologists (1.4%), and self-referring patients (1.4%). Patients with pain at RT consultation had a higher incidence of receiving specialty PC (58.7% vs. 37.4%, P = 0.0097). There was a trend toward decreased PC among patients presenting with neurological symptoms (34.8% vs. 50%, P = 0.084). On multivariable analysis, receiving specialty PC significantly differed by race (non-white vs. white, odds ratio [OR] = 6.295 [95% CI 1.951-20.313], P = 0.002), cancer type (lung vs. other histology, OR = 0.174 [95% CI 0.071-0.426], P = 0.0006), and RT consultation setting (inpatient vs. outpatient, OR = 3.453 [95% CI 1.427-8.361], P = 0.006). CONCLUSION Fewer than half of patients receiving palliative RT utilized specialty PC. Initiatives are needed to increase PC, especially for patients with lung cancer and neurological symptoms, and to empower radiation oncologists to refer patients to specialty PC.
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Affiliation(s)
- Jie Jane Chen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Bhupendra Rawal
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Monica S Krishnan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Lauren M Hertan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Diana D Shi
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Claudia S Roldan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Mai Anh Huynh
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Alexander Spektor
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Tracy A Balboni
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.
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Abstract
OPINION STATEMENT Despite extensive research that has identified new risk factors, genetic mutations, and therapeutic options, pancreatic ductal adenocarcinoma continues to be a leading cause of cancer related death. Patients with pancreatic cancer, along with their clinicians, must balance realistic hope alongside a life-threatening diagnosis. As the search for treatments to reduce the morbidity and mortality continues, symptom management and quality of life remain the focus of our efforts. In addition to side effects of cancer-directed therapy, patients are at risk for malnutrition, pain, and fatigue. These factors are often overlooked in practice, so a multidisciplinary team is critical in optimizing the care of patients.
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Dengsø KE, Andersen EW, Thomsen T, Hansen CP, Christensen BM, Hillingsø J, Dalton SO. Increased psychological symptom burden in patients with pancreatic cancer: A population-based cohort study. Pancreatology 2020; 20:511-521. [PMID: 31973981 DOI: 10.1016/j.pan.2020.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVE To investigate the psychological symptom burden in patients with pancreatic cancer. METHODS We used Danish population-based registries to identify 10,793 pancreatic cancer patients and 109,238 age and gender matched cancer-free comparison persons between the years 2000-2016. The cohorts were followed up to five years for first prescription for antidepressants, anxiolytics or hypnotics as proxies for the psychological symptom burden of depression, anxiety or insomnia. Cumulated incidence proportions were analysed using the pseudo-value approach and hazards were estimated with Cox regression models adjusted for potential confounders. RESULTS The highest HR for first antidepressant use was seen in the first six months after diagnosis (HR 8.73 (95% CI: 7.57; 10.06)). Within the first two years the overall estimated cumulated probability of 12.9% (95% CI: 12%; 13.8%) in pancreatic cancer patients, and 4.6% (95% CI: 4.5%; 4.8%) in comparisons, and 20.4% and 31.4% patients received first prescription of anxiolytics or hypnotics, respectively. We found no difference in HRs of first antidepressant by gender, year of diagnosis, cohabitation, education or comorbidity in the patient cohort, however younger age (<59 years) was associated with depression. CONCLUSIONS Pancreatic cancer patients are at risk for first antidepressant, anxiolytic and hypnotic use up to five years after diagnosis. Patients younger than 59 years, newly diagnosed with advanced pancreatic cancer, and not treated with surgery were more likely to have first antidepressant use. The study calls for interventions to reduce the psychological burden in advanced pancreatic cancer patients which may improve quality of life and survival.
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Affiliation(s)
| | - Elisabeth Wreford Andersen
- Statistics and Data Analysis, Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark
| | - Thordis Thomsen
- Herlev Acute, Critical and Emergency Care Science Unit, Department of Anaesthesiology, Herlev and Gentofte Hospital, Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- Department of Surgery, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Bo Marcel Christensen
- Department of Surgery, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Jens Hillingsø
- Department of Surgery, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Unit of Survivorship, Danish Cancer Society & Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
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Agarwal R, Epstein AS. Palliative care and advance care planning for pancreas and other cancers. Chin Clin Oncol 2017; 6:32. [PMID: 28705009 PMCID: PMC6119222 DOI: 10.21037/cco.2017.06.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 05/27/2017] [Indexed: 12/25/2022]
Abstract
The principles of palliative care are fundamental to support and treat the physical, mental, and psychosocial health of patients living with pancreatic cancer. In addition to its proven advantages to help manage disease-related symptoms, improve accurate illness understanding, and enhance the quality of life and survival outcomes for patients with advanced disease, the inclusion of palliative care principles (whether by a specialist or by the primary oncology team) with standard oncologic care strengthens timely and quality advance care planning (ACP). The primary objective of this review article is to underscore the significant value of palliative care integration and ACP in oncology, including but not limited to care at the end of life, with a particular focus on its relevance to patients with advanced pancreatic cancer.
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Affiliation(s)
- Rajiv Agarwal
- Department of Medicine, Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Andrew S Epstein
- Gastrointestinal Oncology Service, Palliative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA.
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Janda M, Neale RE, Klein K, O'Connell DL, Gooden H, Goldstein D, Merrett ND, Wyld DK, Rowlands IJ, Beesley VL. Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 2017; 17:321-327. [PMID: 28153446 DOI: 10.1016/j.pan.2017.01.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND People with pancreatic cancer have high levels of anxiety and depression and reduced quality of life (QoL), but few studies have assessed these outcomes for patient-carer dyads. We therefore investigated these issues in an Australian population-based study. METHODS Patients with pancreatic cancer (n = 136) and many of their carers (n = 84) completed the Hospital Anxiety and Depression Scale (HADS) and Functional Assessment of Cancer Therapy QoL questionnaire at a median of three months after diagnosis. Overall QoL and well-being subscales (physical, social, emotional, functional) were compared with general population norms. Intraclass correlation coefficients were used to compare anxiety, depression and QoL scores of patients and their respective carers. RESULTS Fifteen percent of patients and 39% of carers had HADS scores indicative of anxiety and 15% of patients and 14% of carers of depression, respectively. Overall, 70% of patients and 58% of carers had QoL scores below the Queensland population average. Patients' anxiety, depression, overall QoL, social, emotional and functional wellbeing scores were significantly related to those scores in their carers. Among patients and carers, accessing psychological help was associated with elevated anxiety. Not receiving chemotherapy was associated with elevated depression among patients and younger age was associated with poorer outcomes in carers. CONCLUSIONS More carers had symptoms of anxiety than patients with pancreatic cancer, but symptoms of depression were similarly common in patients and carers. Further research is needed to assess whether interventions to reduce patients' distress could also improve QoL among carers, or whether carer-focussed interventions are required.
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Affiliation(s)
- Monika Janda
- Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kerenaftali Klein
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Helen Gooden
- Cancer Nursing Research Unit, University of Sydney, Sydney, Australia
| | - David Goldstein
- University of New South Wales, Sydney, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Neil D Merrett
- South Western Sydney Upper GI Surgical Unit, Bankstown Hospital, Sydney, Australia; Discipline of Surgery, University of Western Sydney, Sydney, Australia
| | - David K Wyld
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Ingrid J Rowlands
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Vanessa L Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
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