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Koroukian SM, Douglas SL, Vu L, Fein HL, Gairola R, Warner DF, Schiltz NK, Cullen J, Owusu C, Sajatovic M, Rose J. Aggressive end-of-life care across gradients of cognitive impairment in nursing home patients with metastatic cancer. J Am Geriatr Soc 2023; 71:3546-3553. [PMID: 37515440 PMCID: PMC10907987 DOI: 10.1111/jgs.18526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/13/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Studies examining end-of-life (EOL) care in older cancer patients are scarce, and prior studies have not accounted for gradients of cognitive impairment (COG-I). We examine EOL care patterns across COG-I gradients, hypothesizing that greater COG-I severity is associated with lower odds of receiving aggressive EOL care. METHODS Using data from the linked Surveillance Epidemiology and End Results (SEER) -Medicare -Minimum Data Set (MDS) 3.0, we identified patients with nursing facility stays (NFS) and who died with metastatic cancer from 2013 to 2017. Markers of aggressive EOL care were: cancer-directed treatment, intensive care unit admission, >1 emergency department visit, or >1 hospitalization in the last 30 days of life, hospice enrollment in the last 3 days of life, and in-hospital death. In addition to descriptive analysis, we conducted multivariable logistic regression analysis to evaluate the independent association between COG-I severity and receipt of aggressive EOL care. RESULTS Of the 40,833 patients in our study population, 49.2% were cognitively intact; 24.4% had mild COG-I; 19.7% had moderate COG-I; and 6.7% had severe COG-I. The percent of patients who received aggressive EOL care was 62.6% and 74.2% among those who were cognitively intact and those with severe COG-I, respectively. Compared with cognitively intact patients, those with severe COG-I had 86% higher odds of receiving any type of aggressive EOL care (adjusted odds ratio (aOR): 1.86 (95% confidence interval: 1.70-2.04)), which were primarily associated with higher odds of in-hospital death. The odds of in-hospital death associated with severe COG-I were higher among those with short- than with long-term stays (aOR:2.58 (2.35-2.84) and aOR:1.40 (1.17-1.67), respectively). CONCLUSIONS Contrary to our hypothesis, aggressive EOL care in older metastatic cancer patients with NFS was highest among those suffering severe COG-I. These findings can inform the development of interventions to help reduce aggressive EOL care in this patient population.
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Affiliation(s)
- Siran M. Koroukian
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH
- Case Comprehensive Cancer Center, Case Western Reserve
University School of Medicine, Cleveland, OH
| | - Sara L. Douglas
- Case Comprehensive Cancer Center, Case Western Reserve
University School of Medicine, Cleveland, OH
- Frances Payne Bolton School of Nursing, Case Western
Reserve University, Cleveland, OH
| | - Long Vu
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH
| | - Hannah L. Fein
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH
| | - Richa Gairola
- Department of Epidemiology, School of Public Health, Brown
University, Providence, RI; she was at Case Western Reserve University at the time
this study was conducted
| | - David F. Warner
- Department of Sociology, University of Alabama at
Birmingham, Birmingham, AL
- Center for Family & Demographic Research, Bowling Green
State University, Bowling Green, OH
| | - Nicholas K. Schiltz
- Frances Payne Bolton School of Nursing, Case Western
Reserve University, Cleveland, OH
| | - Jennifer Cullen
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH
- Case Comprehensive Cancer Center, Case Western Reserve
University School of Medicine, Cleveland, OH
| | - Cynthia Owusu
- Case Comprehensive Cancer Center, Case Western Reserve
University School of Medicine, Cleveland, OH
- Department of Internal Medicine, University Hospitals
Cleveland Medical Center, Cleveland, OH
| | - Martha Sajatovic
- Department of Neurology, University Hospitals Cleveland
Medical Center, Cleveland, OH
| | - Johnie Rose
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH
- Case Comprehensive Cancer Center, Case Western Reserve
University School of Medicine, Cleveland, OH
- Center for Community Health Integration, School of
Medicine, Case Western Reserve University, Cleveland, OH
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Filteau C, Simeone A, Ravot C, Dayde D, Falandry C. Cultural and Ethical Barriers to Cancer Treatment in Nursing Homes and Educational Strategies: A Scoping Review. Cancers (Basel) 2021; 13:3514. [PMID: 34298728 PMCID: PMC8305927 DOI: 10.3390/cancers13143514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 01/15/2023] Open
Abstract
(1) Background: The aging of the population, the increase in the incidence of cancer with age, and effective chronic oncological treatments all lead to an increased prevalence of cancer in nursing homes. The aim of the present study was to map the cultural and ethical barriers associated with the treatment of cancer and educational strategies in this setting. (2) Methods: A systematic scoping review was conducted until April 2021 in MEDLINE, Embase, and CINAHL. All articles assessing continuum of care, paramedical education, and continuing education in the context of older cancer patients in nursing homes were reviewed. (3) Results: A total of 666 articles were analyzed, of which 65 studies were included. Many factors interfering with the decision to investigate and treat, leading to late- or unstaged disease, palliative-oriented care instead of curative, and a higher risk of unjustified transfers to acute care settings, were identified. The educational strategies explored in this context were generally based on training programs. (4) Conclusions: These results will allow the co-construction of educational tools intended to develop knowledge and skills to improve diagnostic and therapeutic decision-making, the consistency of care, and, ultimately, the quality of life of older cancer patients in nursing homes.
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Affiliation(s)
- Cynthia Filteau
- Service de Gériatrie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (C.R.); (C.F.)
- Département de Gériatrie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC H1T 2M4, Canada
| | - Arnaud Simeone
- Université Lumière-Groupe de Recherche en Psychologie Sociale (UR GRePS) Institut de Psychologie, 69676 Bron, France;
| | - Christine Ravot
- Service de Gériatrie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (C.R.); (C.F.)
| | - David Dayde
- Plateforme de Recherche de l’Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France;
| | - Claire Falandry
- Service de Gériatrie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (C.R.); (C.F.)
- Laboratoire CarMeN, INSERM, INRAE, Université Claude Bernard Lyon-1, 69600 Oullins, France
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3
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Panagiotou OA, Keeney T, Ogarek JA, Wulff-Burchfield E, Olszewski AJ, Bélanger E. Prevalence of functional limitations and their associations with systemic cancer therapy among older adults in nursing homes with advanced non-small cell lung cancer. J Geriatr Oncol 2021; 12:765-770. [PMID: 33610505 PMCID: PMC8184570 DOI: 10.1016/j.jgo.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To determine the relationship of self-care task disabilities with the use of systemic cancer therapies for advanced non-small cell lung cancer (NSCLC) in nursing home patients. MATERIALS AND METHODS Using the Surveillance, Epidemiology, and End Results-Medicare database linked with Minimum Data Set assessments, we identified nursing home residents with advanced NSCLC from 2011 to 2015. We considered disability in activities of daily living (ADL) including dressing, personal hygiene, toilet use, locomotion on unit, transfer, bed mobility, and eating. We estimated the association between ADL disabilities and receipt of systemic cancer therapies within 3 months of diagnosis. RESULTS Of the 3174 patients, 2702 (85.2%) experienced disability in one or more ADLs and 64.7% had disability in 5-7 ADLs. A total of 415 (13.1%) patients received systemic therapy. There was a strong association between disability in each ADL and receipt of therapy including dressing (OR, 0.52 [95% CI, 0.42-0.65]), toileting (odds ratio, OR, 0.52 [95% confidence interval, CI, 0.42-0.65]), personal hygiene (OR, 0.48 [95% CI, 0.39-0.59]), transfers (OR, 0.51 [95% CI, 0.41-0.64]), bed mobility (OR, 0.55 [95% CI, 0.44-0.69]), locomotion (OR, 0.57 [95% CI, 0.46-0.71]), or eating (OR, 0.45 [95% CI, 0.31-0.67]). Compared to patients having no ADL disability, patients were less likely to receive chemotherapy if they had disability in 1-2 ADLs (OR, 0.95 [95% CI, 0.66-1.37]), 3-4 ADLs (OR, 0.81 [95% CI, 0.56-1.15]), or 5-7 ADLs (OR, 0.43 [95% CI, 0.33-0.56]). CONCLUSIONS Systemic cancer therapy is not commonly used in this population and is strongly predicted by disability in self-care tasks.
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Affiliation(s)
- Orestis A Panagiotou
- Department of Health Services, Policy and Practice, Brown University School of Public Health, RI, United States of America; Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, United States of America; Center for Evidence Synthesis in Health, Brown University School of Public Health, RI, United States of America; Providence VA Medical Center, Providence, RI, United States of America.
| | - Tamra Keeney
- Department of Health Services, Policy and Practice, Brown University School of Public Health, RI, United States of America; Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, United States of America; Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jessica A Ogarek
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, United States of America
| | - Elizabeth Wulff-Burchfield
- Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Adam J Olszewski
- Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Emmanuelle Bélanger
- Department of Health Services, Policy and Practice, Brown University School of Public Health, RI, United States of America; Center for Gerontology and Healthcare Research, Brown University School of Public Health, RI, United States of America
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Jesdale BM, Mack DS, Forrester SN, Lapane KL. Cancer Pain in Relation to Metropolitan Area Segregation and Nursing Home Racial and Ethnic Composition. J Am Med Dir Assoc 2020; 21:1302-1308.e7. [PMID: 32224259 PMCID: PMC8098520 DOI: 10.1016/j.jamda.2020.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To estimate pain reporting among residents with cancer in relation to metropolitan area segregation and NH racial and ethnic composition. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS 383,757 newly admitted black (B), Hispanic (H), or white (W) residents with cancer in 12,096 US NHs (2011-2013). METHODS Using the Minimum Data Set 3.0, pain in past 5 days was determined by self-report or use of pain management. The Theil entropy index, a measure of metropolitan area segregation, was categorized [high (up to 0.20), very high (0.20-0.30), or extreme (0.30-0.53)]. RESULTS Pain prevalence decreased across segregation level (black: high = 77%, very high = 75%, extreme = 72%; Hispanic: high = 79%, very high = 77%, extreme = 70%; white: high = 80%, very high = 77%, extreme = 74%). In extremely segregated areas, all residents were less likely to have recorded pain [adjusted prevalence ratios: blacks, 4.6% less likely, 95% confidence interval (CI) 3.1%-6.1%; Hispanics, 6.9% less likely, 95% CI 4.2%-9.6%; whites, 7.4% less likely, 95% CI 6.5%-8.2%] than in the least segregated areas. At all segregation levels, pain was recorded more frequently for residents (black or white) in predominantly white (>80%) NHs than in mostly black (>50%) NHs or residents (Hispanic or white) in predominantly white NHs than mostly Hispanic (>50%) NHs. CONCLUSIONS AND IMPLICATIONS We observed decreased pain recording in metropolitan areas with greater racial and ethnic segregation. This may occur through the inequitable distribution of resources between NHs, resident-provider empathy, provider implicit bias, resident trust, and other factors.
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Affiliation(s)
- Bill M Jesdale
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.
| | - Deborah S Mack
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Sarah N Forrester
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Kate L Lapane
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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5
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Blytt KM, Selbæk G, Drageset J, Natvig GK, Husebo BS. Comorbid Dementia and Cancer in Residents of Nursing Homes: Secondary Analyses of a Cross-Sectional Study. Cancer Nurs 2019; 41:E13-E20. [PMID: 28146014 PMCID: PMC5839697 DOI: 10.1097/ncc.0000000000000478] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Life expectancy is increasing continuously, which increases the likelihood of developing dementia or cancer. Both dementia and cancer are serious conditions that give manifold symptoms. The interaction of these conditions is however complex and less explored. OBJECTIVES The aim of this study was to identify the prevalence of cancer and differences regarding neuropsychiatric symptoms (NPS) and medication among nursing home (NH) patients with and without dementia and cancer. METHODS This is a cross-sectional study of Norwegian NH patients (N = 1825). Participants were categorized according to degree of dementia (Clinical Dementia Rating > 1) and cancer diagnoses. Differences in NPS and other symptoms, as well as the use of medication, were explored. RESULTS Eighty-four percent of NH patients had dementia, and 5.5% had comorbid dementia and cancer. Patients with comorbid dementia and cancer received significantly more analgesics compared with patients without cancer but with dementia (P < .05). Compared with patients without dementia but with cancer, patients with comorbid dementia and cancer had significantly more NPS, including sleep disturbances and agitation. CONCLUSIONS Patients with comorbid dementia and cancer receive more analgesics than patients with dementia but still display more agitation and sleep disturbances than patients with cancer and patients with neither dementia nor cancer, suggesting that symptoms may not be treated adequately. IMPLICATIONS FOR PRACTICE The results indicate a considerable strain for patients with comorbid dementia and cancer and highlight essential challenges for the clinician who is responsible for treatment and care. Nurses should pay attention to agitation and sleep disturbances among patients with comorbid dementia and cancer.
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Affiliation(s)
- Kjersti Marie Blytt
- Author Affiliations: Department of Global Public Health and Primary Care (Ms Blytt and Drs Drageset, Natvig, and Husebo) and Centre for Elderly and Nursing Home Medicine (Ms Blytt and Dr Husebo), University of Bergen; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen (Ms Blytt); Faculty of Medicine, University of Oslo; Ageing and Health, Norwegian Centre for Research, Education and Service Development, Vestfold Hospital Trust, Tonsberg; and Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, Ottestad (Dr Selbæk); Faculty for Health and Social Sciences, Bergen University College (Dr Drageset); and the Municipality of Bergen (Dr Husebo), Norway
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6
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Liuu E, Guyot N, Valero S, Jamet A, Ouazzani HE, Bouchaert P, Tourani JM, Migeot V, Paccalin M. Prevalence of cancer and management in elderly nursing home residents. A descriptive study in 45 French nursing homes. Eur J Cancer Care (Engl) 2018; 28:e12957. [PMID: 30370946 DOI: 10.1111/ecc.12957] [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: 03/21/2018] [Revised: 09/11/2018] [Accepted: 09/28/2018] [Indexed: 11/30/2022]
Abstract
This study aimed to determine cancer prevalence occurring after the age of 75 in 45 French nursing homes (NH), as well as residents' characteristics and parameters associated with cancer-specific management. Descriptive retrospective study including 214 residents (mean age, 89.7 years) with cancer diagnosed after age 75. The studied parameters were sociodemographic, functional, nutritional and cognitive data; comorbidity assessment; date of tumoral diagnosis; cancer type; tumoral stage; treatment plan; multidisciplinary staff decision and oncologic follow-up. Our results showed that cancer prevalence in NH was 8.4 ± 1.1%, diagnosed before admission in 63% of cases. The most common tumoral sites were skin (26%), digestive tract and breast (18% for both); 12% had metastasis. Cognitive impairment was the most common comorbidity (42%), and 44% of the residents were highly dependent. Multivariate analysis showed that therapeutic decisions were associated with age. Older patients had less staging exploration (odd ratios [ORs], 0.90, 95% confidence interval [CI], 0.85-0.97) and underwent less cancer-specific treatment (ORs, 0.92; 95%CI, 0.86-0.99). Oncologic follow-up was more frequent in younger patients (ORs, 0.90; 95%CI, 0.81-0.99) and those with recent diagnosis (ORs, 0.37; 95%CI, 0.23-0.61). This study identified factors associated with substandard neoplastic management in elderly NH residents. It highlights needs for information, education and training in cancer detection to improve cancer consideration and care in NH.
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Affiliation(s)
- Evelyne Liuu
- Department of Geriatrics, Poitiers University Hospital, Poitiers, France.,INSERM, CIC-P 1402, Poitiers University Hospital, University of Poitiers, Poitiers, France
| | - Nicolas Guyot
- Department of Geriatrics, Saintes Hospital, Saintes, France
| | - Simon Valero
- Department of Geriatrics, Poitiers University Hospital, Poitiers, France
| | - Amelie Jamet
- Department of Geriatrics, Poitiers University Hospital, Poitiers, France
| | - Houria El Ouazzani
- Department of Analytical Chemistry, Pharmaceutics and Epidemiology, University of Poitiers, Poitiers, France
| | - Patrick Bouchaert
- Department of Medical Oncology, Poitiers University Hospital, Poitiers, France
| | - Jean-Marc Tourani
- Department of Medical Oncology, Poitiers University Hospital, Poitiers, France
| | - Virginie Migeot
- Department of Analytical Chemistry, Pharmaceutics and Epidemiology, University of Poitiers, Poitiers, France
| | - Marc Paccalin
- Department of Geriatrics, Poitiers University Hospital, Poitiers, France.,INSERM, CIC-P 1402, Poitiers University Hospital, University of Poitiers, Poitiers, France
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7
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Mack DS, Hunnicutt JN, Jesdale BM, Lapane KL. Non-Hispanic Black-White disparities in pain and pain management among newly admitted nursing home residents with cancer. J Pain Res 2018; 11:753-761. [PMID: 29695927 PMCID: PMC5905487 DOI: 10.2147/jpr.s158128] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Racial disparities in pain management persist across health care settings and likely extend into nursing homes. No recent studies have evaluated racial disparities in pain management among residents with cancer in nursing homes at time of admission. Methods Using a cross-sectional study design, we compared reported pain and pain management between non-Hispanic White and non-Hispanic Black newly admitted nursing home residents with cancer (n=342,920) using the de-identified Minimum Data Set version 3.0. Pain management strategies included the use of scheduled analgesics, pro re nata analgesics, and non-pharmacological methods. Presence of pain was based on self-report when residents were able, and staff report when unable. Robust Poisson models provided estimates of adjusted prevalence ratios (aPR) and 95% CIs for reported pain and pain management strategies. Results Among nursing home residents with cancer, ~60% reported pain with non-Hispanic Blacks less likely to have both self-reported pain (aPR [Black versus White]: 0.98, 95% CI: 0.97–0.99) and staff-reported pain (aPR: 0.89, 95% CI: 0.86–0.93) documentation compared with Non-Hispanic Whites. While most residents received some pharmacologic pain management, Blacks were less likely to receive any compared with Whites (Blacks: 66.6%, Whites: 71.1%; aPR: 0.98, 95% CI: 0.97–0.99), consistent with differences in receipt of non-pharmacologic treatments (Blacks: 25.8%, Whites: 34.0%; aPR: 0.98, 95 CI%: 0.96–0.99). Conclusion Less pain was reported for Black compared with White nursing home residents and White residents subsequently received more frequent pain management at admission. The extent to which unequal reporting and management of pain persists in nursing homes should be further explored.
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Affiliation(s)
- Deborah S Mack
- Department of Quantitative Health Sciences, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jacob N Hunnicutt
- Department of Quantitative Health Sciences, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bill M Jesdale
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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8
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Drageset J, Eide GE, Hauge S. Symptoms of depression, sadness and sense of coherence (coping) among cognitively intact older people with cancer living in nursing homes-a mixed-methods study. PeerJ 2016; 4:e2096. [PMID: 27330859 PMCID: PMC4906642 DOI: 10.7717/peerj.2096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/09/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Symptoms of depression are often reported among patients with a cancer diagnosis. Strong sense of coherence (SOC) is shown to be associated with less depression in the general older population and among nursing homes (NH) residents in particular. Knowledge about mixed-methods perspectives that examine symptoms of depression and SOC among cognitively intact NH residents with cancer is scarce. AIM To investigate symptoms of depression and SOC among NH residents who are cognitively intact and have cancer. METHODS We used a quantitatively driven mixed-methods design with sequential supplementary qualitative components. We facilitated the collection of quantitative survey data of 60 NH residents (≥ 65 years) with cancer using the Geriatric Depression Scale (GDS) and SOC scale. The supplementary psychosocial component comprised qualitative research interviews about experiences related to depression with nine respondents from the same cohort. RESULTS In fully adjusted multiple regression analysis of the sociodemographic variables, the GDS was significantly correlated with SOC (P < 0.001). The experience of sadness was identified by the following theme: sadness. Coping with the experience of symptoms of depression was dominated by coping with sadness. CONCLUSION More than half the NH residents reported symptoms of depression, and the SOC was associated with reduced symptoms. A mixed-methods design contributed to nuanced and detailed information about the meaning of depression, and the supplementary component informs and supports the core component. To improve the situation of NH residents with cancer, more attention should be paid to the residents' experience of symptoms of depression and their SOC.
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Affiliation(s)
- Jorunn Drageset
- Faculity of Health and Social Science, Bergen University College, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Centre for Clinical Research, Western Norway Health Region Authority, Bergen, Norway
| | - Solveig Hauge
- Faculty of Health and Social Studies and Centre for Caring Research–Southern Norway, Unversity College of Southeast, Porsgrunn, Norway
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9
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Drageset J, Eide GE, Ranhoff AH. Better health-related quality of life (mental component summary), having a higher level of education, and being less than 75 years of age are predictors of hospital admission among cognitively intact nursing home residents: a 5-year follow-up study. Patient Prefer Adherence 2016; 10:275-82. [PMID: 27022249 PMCID: PMC4788368 DOI: 10.2147/ppa.s92135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To study whether health-related quality of life (HRQOL), activities of daily living (ADL), and anxiety and depression symptoms affect the risk of hospital admission and potential interactions with having a cancer diagnosis. METHODS This study was a prospective observational study with 5-year follow-up and analyzed the follow-up data on hospital admissions until 2010 using baseline data from 227 cognitively intact nursing home (NH) residents (60 of whom had cancer) in 2004-2005. Data on HRQOL were collected by using the Short Form-36 Health Survey, divided into physical component summary (PCS) and mental component summary (MCS), and symptoms of anxiety and depression were collected by using the Hospital Anxiety and Depression Scale (HADS). ADL were obtained from registered observation and sociodemographic variables, diagnoses, and hospital admissions from the NH records. Personal identification numbers were linked to the record systems of the hospitals, thereby registering all hospital admissions. We analyzed the time elapsing between inclusion and the first hospital admission. RESULTS Residents with higher HRQOL (MCS) had significantly more hospital admissions after adjustment for age, sex, marital status, education, and comorbidity. HRQOL (PCS), ADL, depression, and anxiety symptoms were not associated with hospital admissions. Cancer increased the risk after adjustment for all other risk factors but did not increase the effects of MCS, PCS, ADL, or depression or anxiety symptoms. Having a higher level of education and being less than 75 years of age were associated with hospitalization. The residents diagnosed with cancer had the most days in hospital related to diseases of the respiratory system and cancer, and diseases of the circulatory and respiratory systems were more frequent among the residents without a cancer diagnosis. CONCLUSION Better self-reported HRQOL (MCS) was associated with hospital admissions, whereas self-reported HRQOL (PCS), ADL, and depression and anxiety symptoms were not. Cancer increased the risk but not the effects of MCS, PCS, ADL, or depression or anxiety symptoms. Having a higher level of education and being less than 75 years of age were also associated with hospitalization.
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Affiliation(s)
- Jorunn Drageset
- Department of Nursing, Faculty for Health and Social Science, Bergen University College, Bergen, Norway
- Department of Public Health and Primary Care, University of Bergen, Bergen, Norway
- Correspondence: Jorunn Drageset, Department of Nursing, Faculty for Health and Social Science, Bergen University College, Inndalsveien 28, N-5063 Bergen Norway, Tel +47 55 585 589, Fax +47 55 585 556, Email
| | - Geir Egil Eide
- Centre for Clinical Research, Western Norway Health Region Authority, Bergen, Norway
- Research Group for Lifestyle Epidemiology, Department of Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anette Hylen Ranhoff
- Kavli Research Centre for Ageing and Dementia, Haraldsplass Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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10
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Drageset J, Eide GE, Dysvik E, Furnes B, Hauge S. Loneliness, loss, and social support among cognitively intact older people with cancer, living in nursing homes--a mixed-methods study. Clin Interv Aging 2015; 10:1529-36. [PMID: 26451093 PMCID: PMC4590337 DOI: 10.2147/cia.s88404] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Loneliness is a significant psychosocial effect following a cancer diagnosis and may prevent people from engaging in social activities, thus creating difficulties in interpersonal relationships. This study investigated loneliness and social support among cognitively intact nursing home residents with cancer by using a quantitatively driven mixed-methods design with sequential supplementary qualitative components. METHODS The quantitative component consisted of face-to-face interviews of 60 nursing home residents (≥65 years) using the one-item Loneliness Scale and the Social Provisions Scale. The supplementary psychosocial component consisted of qualitative research interviews about experiences related to loneliness with nine respondents. RESULTS The quantitative results indicated that reassurance of worth was associated with loneliness. The experience of loneliness was identified by the following: loneliness that was dominated by a feeling of inner pain, feeling of loss, and feeling small. Loneliness was alleviated by the following: being engaged in activities, being in contact with other people, and occupying oneself. CONCLUSION Enhancing the lives of nursing home residents with cancer requires attending to the residents' experience of loneliness and social relationships in a targeted and individualized manner. This might require screening all nursing home residents for early detection of loneliness. Revealing factors that may contribute to or reduce loneliness improves the ability to enhance people's lives.
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Affiliation(s)
- Jorunn Drageset
- Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Elin Dysvik
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Bodil Furnes
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Solveig Hauge
- Faculty of Health and Social Studies and Centre for Caring Research – Southern Norway, Telemark University College, Porsgrunn, Norway
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Drageset J, Corbett A, Selbaek G, Husebo BS. Cancer-related pain and symptoms among nursing home residents: a systematic review. J Pain Symptom Manage 2014; 48:699-710.e1. [PMID: 24703946 DOI: 10.1016/j.jpainsymman.2013.12.238] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/14/2013] [Accepted: 12/19/2013] [Indexed: 11/28/2022]
Abstract
CONTEXT Many older nursing home (NH) residents with cancer experience pain and distressing symptoms. Although some develop cancer during their time in the institution, an increasing number are admitted during their final stages of their lives. Numerous studies have evaluated various treatment approaches, but how pain and symptoms are assessed and managed in people with cancer with and without dementia is unclear. OBJECTIVES The objective of this review was to summarize the evidence on cancer-related symptoms among NH residents with and without dementia. METHODS We systematically searched the PubMed (1946-2012), Embase (1974-2012), CINAHL (1981-2012), AgeLine, and Cochrane Library (1998-2012) databases using the search terms neoplasms, cancer, tumor, and nursing home. The inclusion criteria were studies including NH residents with a diagnosis of cancer and outcome measures including pain and cancer-related symptoms. RESULTS We identified 11 studies (cross-sectional, longitudinal, clinical trial, and qualitative studies). Ten studies investigated the prevalence and treatment of cancer-related symptoms such as vomiting, nausea, urinary tract infections, and depression. Studies clearly report a high prevalence of pain and reduced prescribing and treatment, regardless of the cognitive status. Only one small study included people with cancer and a diagnosis of dementia. Studies of new cancer diagnoses in NHs could not be identified. CONCLUSION This review clearly reports a high prevalence of pain and reduced drug prescribing and treatment among NH residents with cancer. This issue appears to be most critical among people with severe dementia, emphasizing the need for better guidance and evidence on pain assessment for these individuals.
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Affiliation(s)
- Jorunn Drageset
- Faculty for Health and Social Science, Bergen University College, Bergen, Norway; Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.
| | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom
| | - Geir Selbaek
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Akershus University Hospital, Lørenskog, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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Anxiety and depression and mortality among cognitively intact nursing home residents with and without a cancer diagnosis: a 5-year follow-up study. Cancer Nurs 2014; 36:E68-74. [PMID: 23051868 DOI: 10.1097/ncc.0b013e31826fcb11] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Studies are lacking on how anxiety and depression symptoms influence mortality among cognitively intact older people in nursing homes (NHs) with a diagnosis of cancer versus those without cancer. OBJECTIVE We hypothesized that anxiety or depression was associated with survival and has greater effects on survival for residents with cancer than for those without cancer. METHODS A cohort of 227 cognitively intact (Clinical Dementia Rating scale score ≤0.5) older residents (60 with cancer and 167 without) from 30 NHs were followed from 2004-2005 to 2010. Data were collected using face-to-face interviews. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale subscales. Sociodemographic variables and medical diagnoses were obtained from the records. RESULTS The overall survival after 5 years was 17% for residents with cancer and 22% for residents without cancer. Depression and comorbidity were associated with significantly worse survival independent of a cancer diagnosis. Residents with cancer and symptoms of anxiety (subscores at least 8) had worse survival than those without anxiety symptoms (P = .02), but this was not found among the noncancer group. CONCLUSIONS Independent of a cancer diagnosis, depression symptoms and comorbidity were associated with mortality among cognitive intact NH residents. Having symptoms of anxiety predicted shorter survival among residents with a cancer diagnosis. IMPLICATIONS FOR PRACTICE Nurses should pay attention to depression symptoms among NH residents with and without a cancer diagnosis. Giving attention to residents with cancer and anxiety symptoms is especially important.
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Monroe TB, Carter MA, Feldt KS, Dietrich MS, Cowan RL. Pain and hospice care in nursing home residents with dementia and terminal cancer. Geriatr Gerontol Int 2013; 13:1018-25. [PMID: 23506621 PMCID: PMC4850827 DOI: 10.1111/ggi.12049] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 11/29/2022]
Abstract
AIM One condition associated with severe end-of-life pain that can lead to a poor quality of death is cancer. Cancer pain in people with dementia is of particular concern because of communication problems that occur with worsening disease. The aim of the current pilot study was to examine the association between hospice enrolment, dementia severity and pain among nursing home residents who died from advanced cancer. METHODS Between-groups cross-sectional chart audits of 55 nursing home residents with dementia who died from cancer were carried out. RESULTS A total of 45% of residents were in hospice at the end-of-life. Residents in hospice were more likely to receive an opioid (80% vs 43%, P = 0.005); but less likely to show severe cognitive impairment (20% vs 50%, P = 0.050). Enrolment in hospice was associated with an increased likelihood of receiving an opioid after controlling for level of cognitive impairment (OR = 3.9, 95% CI = 1.1-14.0, P = 0.037). Lower levels of cognitive functioning were associated with a decreased likelihood of receiving an opioid after controlling for enrolment in hospice (OR = 0.3, 95% CI = 0.1-0.8, P = 0.030). Notably, 40% of nursing home residents with dementia who died from cancer did not receive any opioid during this time. CONCLUSIONS Preliminary results suggest that hospice enrolment might be influenced by the facility or region of this particular country. Hospice enrolment predicts more opioid pain treatment in residents with dementia and terminal cancer; however, no resident with very severe dementia and terminal cancer was placed in hospice care. Severely cognitively impaired nursing home residents requiring opioids are at great risk of suffering from untreated advanced cancer pain. New methods are urgently required to improve end-of-life palliative care for nursing home residents with terminal cancer and severe dementia.
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Affiliation(s)
| | - Michael A Carter
- College of Nursing, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Karen S Feldt
- College of Nursing, Seattle University, Seattle, Washington, USA
| | - Mary S Dietrich
- Schools of Nursing & Medicine, Vanderbilt University, Nashville
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Cancer in nursing homes: characteristics and health-related quality of life among cognitively intact residents with and without cancer. Cancer Nurs 2012; 35:295-301. [PMID: 21946900 DOI: 10.1097/ncc.0b013e31822e7cb8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies are lacking on how cancer influences physical, mental, and social functioning beyond comorbidity among older people without cognitive impairment in nursing homes (NHs). OBJECTIVE The objective was to study the sociodemographic characteristics and health-related quality of life (HRQOL) among NH residents with and without a cancer diagnosis, adjusting for comorbidity. METHODS This was a cross-sectional observation study: 30 NHs; 227 residents 65 to 102 years old: 60 with cancer and 167 without, at least 6 months' residence. All had Clinical Dementia Rating of 0.5 or less and could converse. Health-related quality of life was measured using the 36-item Short-Form Health Survey in face-to-face interviews. Sociodemographic variables and medical diagnoses were obtained from records. Possible differences in HRQOL, controlled for age, gender, marital status, education, length of stay, and comorbidity, were examined by multiple linear regression analyses. RESULTS The most common cancer diagnoses were breast cancer among women (20%) and prostate cancer among men (12%). More residents with cancer were married (P = .007), reported more bodily pain (P = .17) and scored lower on all other HRQOL subscales, except for role-emotional. General health was worse than that of the residents without cancer (P = .04) after adjusting for sociodemographic variables but not for comorbidity (P = .06). CONCLUSION Cognitively intact NH residents with cancer reported more pain and worse general health but better role limitation related to emotional problems compared with residents without cancer. The difference in general health was partly due to comorbidity. IMPLICATIONS FOR PRACTICE Nurses should pay attention to HRQOL among NH residents with cancer and especially observe and ensure pain treatment.
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Long-term care residents with cancer and their health care providers reflect on hope. Can J Aging 2012; 31:285-93. [PMID: 22827865 DOI: 10.1017/s0714980812000219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study examined hope in long-term care residents with cancer from the perspectives of both residents and health care providers (HCPs). Clinical data established that the prevalence of a cancer diagnosis in the study facility (15%) was similar to other estimates in the literature. Eight experienced HCPs were interviewed. Ten residents with a cancer diagnosis were interviewed, and they completed the Herth Hope Index (HHI). Dimensions of hope and contextual factors that shape hope emerged as themes for both HCPs and residents, but reflected their different perspectives. HCPs identified hope as integral to care. HHI scores were high, indicating residents were generally hopeful. The study findings suggest that for the small but complex subgroup of long-term care (LTC) residents who have a diagnosis of cancer, hope is not lost, but rather it is relevant, nuanced, and possible to attain.
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Abstract
This article describes the range of cancer patients in longterm care and provides a framework for clinical decision making. The benefits and burdens of providing standard therapy to a vulnerable population are discussed. To give more specific guidelines for advocates of treatment, skeptics, and others, the authors present best estimates of the current burden of cancer in the long-term care population and current screening guidelines that apply to the elderly under long-term care. Experience-based suggestions are offered for oncologists and clinicians involved in long-term care to help them respond to patient and family concerns about limitations of cancer care.
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Affiliation(s)
- Beatriz Korc-Grodzicki
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Hjaltadóttir I, Hallberg IR, Ekwall AK, Nyberg P. Health status and functional profile at admission of nursing home residents in Iceland over 11-year period. Int J Older People Nurs 2011; 7:177-87. [DOI: 10.1111/j.1748-3743.2011.00287.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Clement JP, Bradley CJ, Lin C. Organizational characteristics and cancer care for nursing home residents. Health Serv Res 2009; 44:1983-2003. [PMID: 19780848 DOI: 10.1111/j.1475-6773.2009.01024.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We evaluate whether organization, market, policy, and resident characteristics are related to cancer care processes and outcomes for dually eligible residents of Michigan nursing homes who entered facilities without a cancer diagnosis but subsequently developed the disease. DATA SOURCES/STUDY DESIGN/DATA COLLECTION: Using data from the Michigan Tumor Registry (1997-2000), Medicare claims, Medicaid cost reports, and the Area Resource File, we estimate logistic regression models of diagnosis at or during the month of death and receipt of pain medication during the month of or month after diagnosis. PRINCIPAL FINDINGS Approximately 25 percent of the residents were diagnosed at or near death. Only 61 percent of residents diagnosed with late or unstaged cancer received pain medication during the diagnosis month or the following month. Residents in nursing homes with lower staffing and in counties with fewer hospital beds were more likely to be diagnosed at death. After the Balanced Budget Act (BBA), residents were more likely to be diagnosed at death. CONCLUSIONS Nursing home characteristics and community resources are significantly related to the cancer care residents receive. The BBA was associated with an increased likelihood of later diagnosis of cancer.
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Affiliation(s)
- Jan P Clement
- Department of Health Administration, Virginia Commonwealth University, 1008 Clay Street, Richmond, VA 23298-0203, USA
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Duncan JG, Bott MJ, Thompson SA, Gajewski BJ. Symptom occurrence and associated clinical factors in nursing home residents with cancer. Res Nurs Health 2009; 32:453-64. [DOI: 10.1002/nur.20331] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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An update on advance directives in the medical record: findings from 1186 consecutive patients with unresectable exocrine pancreas cancer. J Gastrointest Cancer 2009; 39:100-3. [PMID: 19127451 DOI: 10.1007/s12029-008-9041-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 12/10/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Terri Schiavo case and other recent events underscore the importance of advance directives. Yet, in the past, only a small subgroup has utilized them. This study from a large tertiary medical center was undertaken to assess current rates of advance directives among patients with incurable pancreas cancer. METHODS/RESULTS The medical records of 1,186 consecutive patients with unresectable pancreas cancer were reviewed over a 4-year span. Only 174 patients (15%) had an advance directive in the medical record. Older age and having cancer therapy at our institution were associated with a greater likelihood of having an advance directive with odds ratios (95% confidence intervals) of 8.26 (2.81, 24.93) and 2.86 (2.03, 4.02), respectively, in multivariate analyses. Importantly, 42 patients (24%) had a different person designated as their healthcare agent in their advanced directive than what appeared in the medical record as the "contact person." CONCLUSION These findings underscore the ongoing need to discuss advance directives with patients with incurable malignancies and to clarify patients' wishes when seemingly contradictory information appears in other parts of the medical record.
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Abstract
Nursing home residents living with cancer have unacceptably high percentages of unrelieved pain and other symptoms. However, residents with cancer have received relatively little attention in the literature to date. This article provides an overview of previous symptom research for residents with cancer, explores clinical and organizational factors that impede effective symptom management, and proposes an agenda for future research and clinical practice. Residents with cancer have numerous symptoms that tend to be different from the symptoms of other nursing home residents. Symptom management for residents with cancer is often complicated by cognitive impairment, declining physical functioning, and comorbid illnesses. Barriers to symptom management include underuse of analgesics and hospice, nursing home staffing patterns, and lack of resources. Additional research is necessary to provide a more comprehensive understanding of residents with cancer, explore how organizational factors affect the care of residents with cancer, and evaluate interventions for effective symptom assessment and management. Collaboration of oncology nurses with clinicians and researchers in nursing home settings is needed to improve care for residents with cancer.
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Geriatric assessment and care for older cancer inpatients admitted in acute care for elders unit. Crit Rev Oncol Hematol 2008; 68:165-71. [DOI: 10.1016/j.critrevonc.2008.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 04/02/2008] [Accepted: 04/09/2008] [Indexed: 12/27/2022] Open
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Rodin MB. Cancer Patients Admitted to Nursing Homes: What Do We Know? J Am Med Dir Assoc 2008; 9:149-56. [DOI: 10.1016/j.jamda.2007.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 11/28/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022]
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O'Brien MB, Johnston GM, Gao J, Dewar R. End-of-life care for nursing home residents dying from cancer in Nova Scotia, Canada, 2000-2003. Support Care Cancer 2007; 15:1015-21. [PMID: 17277924 PMCID: PMC3747102 DOI: 10.1007/s00520-007-0218-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 01/10/2007] [Indexed: 11/25/2022]
Abstract
INTRODUCTION With our population aging, an increasing proportion of cancer deaths will occur in nursing homes, yet little is known about their end-of-life care. This paper identifies associations between residing in a nursing home and end-of-life palliative cancer care, controlling for demographic factors. METHODS For this population-based study, a data file was created by linking individual-level data from the Nova Scotia Cancer Centre Oncology Patient Information System, Vital Statistics, and the Halifax and Cape Breton Palliative Care Programs for all persons 65 years and over dying of cancer from 2000 to 2003. Multivariate logistic regression was used to compare nursing home residents to nonresidents. RESULTS Among the 7,587 subjects, 1,008 (13.3%) were nursing home residents. Nursing home residents were more likely to be female [adjusted odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2-1.7], older (for > or = 90 vs 65-69 years OR 5.4, CI 4.1-7.0), rural (OR 1.5, CI 1.2-1.8), have only a death certificate cancer diagnosis (OR 4.2, CI 2.8-6.3), and die out of hospital (OR 8.5, CI 7.2-10.0). Nursing home residents were less likely to receive palliative radiation (OR 0.6, CI 0.4-0.7), medical oncology consultation (OR 0.2, CI 0.1-0.4), and palliative care program enrollment (Halifax OR 0.2, CI 0.2-0.3; Cape Breton OR 0.4, CI 0.3-0.7). CONCLUSION Demographic characteristics and end-of-life services differ between those residing and those not residing in nursing homes. These inequalities may or may not reflect inequities in access to quality end-of-life care.
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Affiliation(s)
- Meaghan B O'Brien
- School of Health Services Administration, Dalhousie University and Surveillance and Epidemiology Unit, Cancer Care Nova Scotia, 5599 Fenwick Street, Halifax, Nova Scotia B3H 1R2, Canada
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