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Terminally-ill patients' prognosis information preferences in an African setting: A qualitative descriptive study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Saletti P, Sanna P, Gabutti L, Ghielmini M. Choosing wisely in oncology: necessity and obstacles. ESMO Open 2018; 3:e000382. [PMID: 30018817 PMCID: PMC6045771 DOI: 10.1136/esmoopen-2018-000382] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 12/25/2022] Open
Abstract
In the last decades, the survival of many patients with cancer improved thanks to modern diagnostic methods and progresses in therapy. Still for several tumours, especially when diagnosed at an advanced stage, the benefits of treatment in terms of increased survival or quality of life are at best modest when not marginal, and should be weighed against the potential discomfort caused by medical procedures. As in other specialties, in oncology as well the dialogue between doctor and patient should be encouraged about the potential overuse of diagnostic procedures or treatments. Several oncological societies produced recommendations similar to those proposed by other medical disciplines adhering to the Choosing Wisely (CW) campaign. In this review, we describe what was reported in the medical literature concerning adequacy of screening, diagnostic, treatment and follow-up procedures and the potential impact on them of the CW. We only marginally touch on the more complex topic of treatment appropriateness, for which several evaluation methods have been developed (including the European Society for Medical Oncology-magnitude of clinical benefit scale). Finally, we review the possible obstacles for the development of CW in the oncological setting and focus on the strategies which could allow CW to evolve in the cancer field, so as to enhance the therapeutic relationship between medical professionals and patients and promote more appropriate management.
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Affiliation(s)
- Piercarlo Saletti
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - Piero Sanna
- Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Gabutti
- Internal Medicine Department, Ente Ospedaliero Cantonale (EOC), Choosing Wisely EOC, Bellinzona, Switzerland
| | - Michele Ghielmini
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Mallow C, Hayes M, Semaan R, Smith T, Hales R, Brower R, Yarmus L. Minimally invasive palliative interventions in advanced lung cancer. Expert Rev Respir Med 2018; 12:605-614. [PMID: 29883216 DOI: 10.1080/17476348.2018.1486709] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Lung cancer is the leading cause of cancer-related deaths in the United States. Nearly 85% of all lung cancers are diagnosed at a late stage, with an associated five-year survival rate of 4%. Malignant central airway obstruction and malignant pleural effusions occur in upwards of 30% of these patients. Many of these patients are in need of palliative interventions for symptom control and to help improve their quality of life. Areas covered: This review covers the treatment modalities of malignant central airway obstruction and malignant pleural effusion. PubMed was used to search for the most up to date and clinically relevant articles that guide current treatment strategies. This review focuses on rigid bronchoscopy and the tools used for the relief of central airway obstruction, as well as intra-pleural catheter use and pleurodesis for the management of malignant pleural effusions. Expert commentary: There are multiple treatment modalities that may be used to help alleviate the symptoms of malignant central airway obstruction and pleural effusion. The modality used depends on the urgency of the situation, and specific patient's goals. An open dialog to understand the patient's end of life goals is an important factor when choosing the appropriate treatment strategy.
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Affiliation(s)
| | - Margaret Hayes
- b Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Roy Semaan
- c University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
| | - Thomas Smith
- a Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Russell Hales
- a Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Roy Brower
- a Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Lonny Yarmus
- a Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Nwodoh CO, Okoronkwo IL, Nwaneri AC, Ndubuisi I, Ani GJ, Dyages EO. Terminally ill patients’ perception on healthcare providers’ communication of prognostic information: A qualitative study from Nigeria, West Africa. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1457232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Chijioke Oliver Nwodoh
- Faculty of Health Sciences & Technology, Nursing Sciences Department, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | - Ijeoma Lewechi Okoronkwo
- Faculty of Health Sciences & Technology, Nursing Sciences Department, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | - Ada Carol Nwaneri
- Faculty of Health Sciences & Technology, Nursing Sciences Department, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | - Ifeoma Ndubuisi
- Faculty of Health Sciences & Technology, Nursing Sciences Department, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | - Goodman John Ani
- Nursing Sciences Department, College of Medical Science, University of Maiduguri, Maiduguri, Borno State, Nigeria
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Usborne CM, Mullard AP. A review of systemic anticancer therapy in disease palliation. Br Med Bull 2018; 125:43-53. [PMID: 29190323 DOI: 10.1093/bmb/ldx045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/07/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Systemic anticancer therapy (SACT) is a collective term to describe the growing number of differing therapies used in malignancy to achieve palliation. Improving symptoms, quality of life (QOL) and where possible quantity of life are the goals of these treatments. SOURCES OF DATA A comprehensive literature review was undertaken using Medline, Embase and the Cochrane database. AREAS OF AGREEMENT The use of palliative SACT can lead to increases in symptom control, QOL and survival. The breadth of treatable cancers has increased along with the number of therapeutic options. AREAS OF CONTROVERSY The increasing use of SACT in the last weeks of life and the lack of consistency about the terms Supportive Care/Best Supportive Care in the trial setting. GROWING POINTS Integration between oncology and other palliative services leads to better outcomes. AREAS TIMELY FOR DEVELOPING RESEARCH Improved prognostication tools to elucidate which patients will benefit from SACT.
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Affiliation(s)
- C M Usborne
- North Wales Cancer Treatment Centre, Betsi Cadwaladr University Health Board, Ysbyty Glan Clwyd, Rhyl LL18 5UJ, UK
| | - A P Mullard
- North Wales Cancer Treatment Centre, Betsi Cadwaladr University Health Board, Ysbyty Glan Clwyd, Rhyl LL18 5UJ, UK
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Oostendorp LJM, Ottevanger PB, Donders ART, van de Wouw AJ, Schoenaker IJH, Smilde TJ, van der Graaf WTA, Stalmeier PFM. Decision aids for second-line palliative chemotherapy: a randomised phase II multicentre trial. BMC Med Inform Decis Mak 2017; 17:130. [PMID: 28859646 PMCID: PMC5580234 DOI: 10.1186/s12911-017-0529-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 08/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing recognition of the delicate balance between the modest benefits of palliative chemotherapy and the burden of treatment. Decision aids (DAs) can potentially help patients with advanced cancer with these difficult treatment decisions, but providing detailed information could have an adverse impact on patients' well-being. The objective of this randomised phase II study was to evaluate the safety and efficacy of DAs for patients with advanced cancer considering second-line chemotherapy. METHODS Patients with advanced breast or colorectal cancer considering second-line treatment were randomly assigned to usual care (control group) or usual care plus a DA (intervention group) in a 1:2 ratio. A nurse offered a DA with information on adverse events, tumour response and survival. Outcome measures included patient-reported well-being (primary outcome: anxiety) and quality of the decision-making process and the resulting choice. RESULTS Of 128 patients randomised, 45 were assigned to the control group and 83 to the intervention group. Median age was 62 years (range 32-81), 63% were female, and 73% had colorectal cancer. The large majority of patients preferred treatment with chemotherapy (87%) and subsequently commenced treatment with chemotherapy (86%). No adverse impact on patients' well-being was found and nurses reported that consultations in which the DAs were offered went well. Being offered the DA was associated with stronger treatment preferences (3.0 vs. 2.5; p=0.030) and increased subjective knowledge (6.7 vs. 6.3; p=0.022). Objective knowledge, risk perception and perceived involvement were comparable between the groups. CONCLUSIONS DAs containing detailed risk information on second-line palliative treatment could be delivered to patients with advanced cancer without having an adverse impact on patient well-being. Surprisingly, the DAs only marginally improved the quality of the decision-making process. The effectiveness of DAs for palliative treatment decisions needs further exploration. TRIAL REGISTRATION Netherlands Trial Registry (NTR): NTR1113 (registered on 2 November 2007).
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Affiliation(s)
| | | | | | - Agnes J van de Wouw
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
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Comoretto N, Larumbe A, Arantzamendi M, Centeno C. Palliative care consultants’ ethical concerns with advanced cancer patients participating in phase 1 clinical trials. A case study. PROGRESS IN PALLIATIVE CARE 2017. [DOI: 10.1080/09699260.2017.1364894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nunziata Comoretto
- ATLANTES Research Program, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Spain
| | - Ana Larumbe
- Palliative Medicine and Symptom Control Unit, University of Navarra School of Medicine, Pamplona, Spain
| | - Maria Arantzamendi
- ATLANTES Research Program, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Research Program, Institute for Culture and Society (ICS), University of Navarra, Pamplona, Spain
- Palliative Medicine and Symptom Control Unit, University of Navarra School of Medicine, Pamplona, Spain
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Routine assessment of performance status during palliative chemotherapy when approaching end-of-life. Eur J Oncol Nurs 2015; 21:266-71. [PMID: 26639897 DOI: 10.1016/j.ejon.2015.11.001] [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: 04/08/2015] [Accepted: 11/09/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Palliative chemotherapy treatment (PCT) offered late in the cancer disease trajectory may be problematic. It is not easy to accurately calculate whether the potential benefits will outweigh the side-effects. This study investigates whether routine use of the Performance Status in Palliative Chemotherapy questionnaire (PSPC) affects the proportions of patients receiving PCT during the last month of life, care utilization, and documentation routines. A secondary aim was to gather registered nurses' experiences of the PSPC in routine use. METHODS Eighty incurable patients with cancer who had used the PSPC before PCT were compared to 160 matched controls, using non-parametric tests. Nurses' reflections on the PSPC were collected and reviewed. RESULTS No significant differences were found between users and non-users of the PSPC in terms of proportions receiving PCT during the last month of life. Higher proportions of patients older than 74 years received PCT than in previous studies (40% versus 17%). Nurses considered the questionnaires to be a valuable complement to verbal information when trying to acquire an accurate picture of patients' performance status. CONCLUSION At this point in the development of the PSPC we did not find any significant decreases in the proportion of patients receiving PCT during the last month in life. However, as the nurses valued the PSPC, it can be used as a complementary tool in assessment of performance status until further research is conducted.
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Nakajima N, Kusumoto K, Onishi H, Ishida M. Does the Approach of Disclosing More Detailed Information of Cancer for the Terminally Ill Patients Improve the Quality of Communication Involving Patients, Families, and Medical Professionals? Am J Hosp Palliat Care 2014; 32:776-82. [DOI: 10.1177/1049909114548718] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Effective and faithful communication between patients and medical professionals could improve patients' quality of life and is an essential and fundamental factor in cancer treatment. The purpose of this study was to examine whether disclosing more detailed information about disease progression toterminally ill patients could improve the quality of communication. Methods: This was a before/after study of 91 consecutive terminal cancer patients. Based on the previous studies, we categorized cancer disclosure into 4 groups: A;“non-disclosure”, B;“disclosure of cancer diagnosis”, C;“disclosureof life-threatening disease”, and D;“disclosure of poor prognosis”. We disclosed more detailed information based on the SPIKES protocol and compared the scores of 3 communication items of Support Team Assessment Schedule (Japanese version) measured between at admission and one-week after this approach. Results: A, B, C and D groups included 8, 25, 40, and 18 cases, respectively. This approach to cancer disclosure was implemented in 37.5% of group A, 60% of group B, and 40% of group C. In group B, all 3 communications were significantly improved (2.40 ± 0.51 vs 1.53 ± 0.83, 1.93 ± 0.96 vs 1.00 ± 0.38, 2.13 ± 0.64 vs 1.13 ± 0.64; p = 0.0035, 0.0062, 0.0013). In group C, all 3 communications were significantly improved (1.25 ± 0.58 vs 0.81 ± 0.66, 1.13 ± 0.34 vs 0.69 ± 0.48, 1.31±0.60 vs 0.56 ± 0.63; p = 0.020, 0.0082, 0.0057). Conclusions: This study revealed that disclosing more detailed information of cancer for terminally ill cancer patients contributed to improving the quality of communication, irrespective of the stage of disclosure.
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Affiliation(s)
- Nobuhisa Nakajima
- Department of Palliative Care, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
| | | | - Hideki Onishi
- Department of Psycho-Oncology, Saitama Medical University, Hidaka, Japan
| | - Mayumi Ishida
- Department of Psycho-Oncology, Saitama Medical University, Hidaka, Japan
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Näppä U, Rasmussen BH, Axelsson B, Lindqvist O. Challenging situations when administering palliative chemotherapy - a nursing perspective. Eur J Oncol Nurs 2014; 18:591-7. [PMID: 24997518 DOI: 10.1016/j.ejon.2014.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/30/2014] [Accepted: 06/09/2014] [Indexed: 12/01/2022]
Abstract
UNLABELLED Palliative chemotherapy treatments (PCT) are becoming more common for patients with incurable cancer; a basic challenge is to optimize tumour response while minimizing side-effects and harm. As registered nurses most often administer PCT, they are most likely to be confronted with difficult situations during PCT administration. This study explores challenging situations experienced by nurses when administering PCT to patients with incurable cancer. METHODS Registered nurses experienced in administering PCT were asked in interviews to recall PCT situations they found challenging. Inspired by the narrative tradition, stories were elicited and analysed using a structural and thematic narrative analysis. RESULTS A total of twenty-eight stories were narrated by seventeen nurses. Twenty of these were dilemmas that could be sorted into three storylines containing one to three dilemmatic situations each. The six dilemmatic situations broadly related to three interwoven areas: the uncertainty of the outcome when giving potent drugs to vulnerable patients; the difficulty of resisting giving PCT to patients who want it; and insufficient communication between nurses and physician. CONCLUSION Nurses who administer PCT are engaged in a complex task that can give rise to a number of dilemmatic situations. The findings may be interpreted as meaning that at least some situations might be preventable if the knowledge and insight of all team members - nurses, physicians, patients, and relatives - are jointly communicated and taken into account when deciding whether or not to give PCT. Forming palliative care teams early in the PCT trajectory, could be beneficial for staff and patients.
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Affiliation(s)
- Ulla Näppä
- Department of Radiation Sciences, Unit of Clinical Research Centre - Östersund, Umeå University, S-901 87 Umeå, Sweden; Department of Nursing, Umeå University, S-901 87 Umeå, Sweden.
| | | | - Bertil Axelsson
- Department of Radiation Sciences, Unit of Clinical Research Centre - Östersund, Umeå University, S-901 87 Umeå, Sweden.
| | - Olav Lindqvist
- Department of Nursing, Umeå University, S-901 87 Umeå, Sweden; Department of Learning, Informatics, Management and Ethics/Medical Management Centre, Karolinska Institutet, S-171 77 Stockholm, Sweden.
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Haymart MR, Banerjee M, Yin H, Worden F, Griggs JJ. Marginal treatment benefit in anaplastic thyroid cancer. Cancer 2013; 119:3133-9. [PMID: 23839797 DOI: 10.1002/cncr.28187] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 04/22/2013] [Accepted: 04/25/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Because anaplastic thyroid cancer is a rare malignancy with a high mortality rate, the benefit of multimodality treatment was evaluated. METHODS Overall survival was determined in the 2742 patients captured by the National Cancer Database who were diagnosed with anaplastic thyroid cancer between 1998 and 2008. Kaplan-Meier analysis and then Cox proportional hazard regression was performed, controlling for patient characteristics and treatment. RESULTS Only older age (adjusted hazard ratio [AHR] for ≥ 85 years = 3.43, 95% confidence interval [CI] = 2.34-5.03; for 75-84 years, AHR = 2.85, 95% CI = 1.97-4.11; for 65-74 years, AHR = 2.20, 95% CI = 1.53-3.15; for 45-64 years, AHR = 2.08, 95% CI = 1.47-2.95) and omission of treatment were associated with greater mortality (omission of surgery: AHR = 1.79, 95% CI = 1.61-1.99; omission of radiation therapy: AHR = 1.56; 95% CI = 1.41-1.73; and omission of chemotherapy: AHR = 1.28, 95% CI = 1.15-1.43). In subgroup analysis of patients with American Joint Committee on Cancer stage IVA, IVB, and IVC anaplastic thyroid cancer, combination therapy with surgery, radiation, and chemotherapy was associated a difference in median survival of months. CONCLUSIONS Multimodality management of anaplastic thyroid cancer results in a marginal treatment benefit. The poor overall survival of all anaplastic thyroid cancer patients, regardless of treatment, emphasizes the need for informed patients whose preferences are incorporated into treatment decision-making.
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Affiliation(s)
- Megan R Haymart
- Department of Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan; Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
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Davis MP, Bruera E, Morganstern D. Early integration of palliative and supportive care in the cancer continuum: challenges and opportunities. Am Soc Clin Oncol Educ Book 2013:144-150. [PMID: 23714482 DOI: 10.14694/edbook_am.2013.33.144] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Palliative care has become synonymously associated with hospice care in the minds of patients and physicians. Supportive care is a more acceptable term and leads to earlier referral. Miscommunication and a "collusion of hope" centered on cancer treatment is detrimental to care at the end of life and results in complicated bereavement. Patients, despite being told prognosis, may not comprehend the news even if delivered in an empathetic manner. There are resource and policy barriers to palliative care. However, integration of palliative care early in the management of advanced cancer has demonstrated multiple benefits without reducing survival.
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Affiliation(s)
- Mellar P Davis
- From Cleveland Clinic Lerner School of Medicine, Case Western Reserve University, and Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH; The University of Texas MD Anderson Cancer Center, Houston, TX, Harvard Medical School and Breast Oncology Center, Dana Farber Cancer Institute, Boston, MA
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