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Gebel C, Ditscheid B, Meissner F, Slotina E, Kruschel I, Marschall U, Wedding U, Freytag A. Utilization and quality of palliative care in patients with hematological and solid cancers: a population-based study. J Cancer Res Clin Oncol 2024; 150:191. [PMID: 38607376 PMCID: PMC11014814 DOI: 10.1007/s00432-024-05721-6] [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: 02/19/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Palliative care (PC) contributes to improved end-of-life care for patients with hematologic malignancies (HM) and solid tumors (ST) by addressing physical and psychological symptoms and spiritual needs. Research on PC in HM vs. ST patients is fragmented and suggests less use. METHODS We analyzed claims data of all deceased members of a large German health insurance provider for the year before death. First, we analyzed the frequency and the beginning of different types of PC and compared patients with HM vs. ST. Second, we analyzed the adjusted impact of PC use on several end-of-life quality outcomes in patients with HM vs. ST. We performed simple and multiple (logistic) regression analysis, adjusted for relevant covariates, and standardized for age and sex. RESULTS Of the 222,493 deceased cancer patients from 2016 to 2020, we included 209,321 in the first analysis and 165,020 in the second analysis. Patients with HM vs. ST received PC less often (40.4 vs. 55.6%) and later (34 vs. 50 days before death). PC use significantly improved all six quality indicators for good end-of-life care. HM patients had worse rates in five of the six indicators compared with ST patients. Interaction terms revealed that patients with ST derived greater benefit from PC in five of six quality indicators than those with HM. CONCLUSION The data highlight the need to integrate PC more often, earlier, and more effectively into the care of patients with HM.
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Affiliation(s)
- Cordula Gebel
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany.
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland.
| | - Bianka Ditscheid
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Franziska Meissner
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Ekaterina Slotina
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Isabel Kruschel
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland
| | | | - Ullrich Wedding
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland
| | - Antje Freytag
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
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Ahmed S, Simon J, Biondo P, Slobogian V, Shirt L, King S, Paolucci A, Pabani A, Hao D, Bossio E, Cross R, Monds T, Nieuwenhuis J, Sinnarajah A. Acceptability of automatic referrals to supportive and palliative care by patients living with advanced lung cancer: qualitative interviews and a co-design process. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:36. [PMID: 38566198 PMCID: PMC10985851 DOI: 10.1186/s40900-024-00568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Timely access to supportive and palliative care (PC) remains a challenge. A proposed solution is to trigger an automatic referral process to PC by pre-determined clinical criteria. This study sought to co-design with patients and providers an automatic PC referral process for patients newly diagnosed with stage IV lung cancer. METHODS In Step 1 of this work, nine one on one phone interviews were conducted with advanced lung cancer patients on their perspectives on the acceptability of phone contact by a specialist PC provider triggered by an automatic referral process. Interviews were thematically analysed. Step 2: Patient advisors, healthcare providers (oncologists, nurses from oncology and PC, clinical social worker, psychologist), and researchers were invited to join a working group to provide input on the development and implementation of the automatic referral process. The group met biweekly (virtually) over the course of six months. RESULTS From interviews, the concept of an automatic referral process was perceived to be acceptable and beneficial for patients. Participants emphasized the need for timely support, access to peer and community resources. Using these findings, the co-design working group identified eligibility criteria for identifying newly diagnosed stage IV lung cancer patients using the cancer centre electronic health record, co-developed a telephone script for specialist PC providers, handouts on supportive care, and interview and survey guides for evaluating the implemented automatic process. CONCLUSION A co-design process ensures stakeholders are involved in program development and implementation from the very beginning, to make outputs relevant and acceptable for stage IV lung cancer patients.
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Affiliation(s)
- Sadia Ahmed
- Alberta SPOR SUPPORT Unit, Patient Engagement Team, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
| | - Jessica Simon
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
| | - Patricia Biondo
- Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
| | - Vanessa Slobogian
- Palliative and End of Life Care, Alberta Health Services, Calgary Zone, Calgary, Canada
| | - Lisa Shirt
- Palliative and End of Life Care, Alberta Health Services, Calgary Zone, Calgary, Canada
| | - Seema King
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Alessandra Paolucci
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Aliyah Pabani
- Department of Oncology, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
| | - Desiree Hao
- Department of Oncology, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
| | - Emi Bossio
- Patient and Family Advisor, Alberta Health Services, Calgary, AB, Canada
| | - Ralph Cross
- Patient and Family Advisor, Alberta Health Services, Calgary, AB, Canada
| | - Tim Monds
- Patient and Family Advisor, Alberta Health Services, Calgary, AB, Canada
| | - Jane Nieuwenhuis
- Patient and Family Advisor, Alberta Health Services, Calgary, AB, Canada
| | - Aynharan Sinnarajah
- Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
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Boddaert MS, Fransen HP, de Nijs EJM, van Gerven D, Spierings LEA, Raijmakers NJH, van der Linden YM. Association between Inappropriate End-of-Life Cancer Care and Specialist Palliative Care: A Retrospective Observational Study in Two Acute Care Hospitals. Cancers (Basel) 2024; 16:721. [PMID: 38398112 PMCID: PMC10886868 DOI: 10.3390/cancers16040721] [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: 12/21/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
A substantial number of patients with life-threatening illnesses like cancer receive inappropriate end-of-life care. Improving their quality of end-of-life care is a priority for patients and their families and for public health. To investigate the association between provision, timing, and initial setting of hospital-based specialist palliative care and potentially inappropriate end-of-life care for patients with cancer in two acute care hospitals in the Netherlands, we conducted a retrospective observational study using hospital administrative databases. All adults diagnosed with or treated for cancer in the year preceding their death in 2018 or 2019 were included. The main exposure was hospital-based specialist palliative care initiated >30 days before death. The outcome measures in the last 30 days of life were six quality indicators for inappropriate end-of-life care (≥2 ED-visits, ≥2 hospital admissions, >14 days hospitalization, ICU-admission, chemotherapy, hospital death). We identified 2603 deceased patients, of whom 14% (n = 359) received specialist palliative care >30 days before death (exposure group). Overall, 27% (n = 690) received potentially inappropriate end-of-life care: 19% in the exposure group, versus 28% in the non-exposure group (p < 0.001). The exposure group was 45% less likely to receive potentially inappropriate end-of-life care (AOR 0.55; 95% CI 0.41 to 0.73). Early (>90 days) and late (≤90 and >30 days) initiation of specialist palliative care, as well as outpatient and inpatient initiation, were all associated with less potentially inappropriate end-of-life care (AOR 0.49; 0.62; 0.32; 0.64, respectively). Thus, timely access to hospital-based specialist palliative care is associated with less potentially inappropriate end-of-life care for patients with cancer. The outpatient initiation of specialist palliative care seems to enhance this result.
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Affiliation(s)
- Manon S. Boddaert
- Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
- Center of Expertise in Palliative Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3501 DB Utrecht, The Netherlands
| | - Heidi P. Fransen
- Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3501 DB Utrecht, The Netherlands
| | - Ellen J. M. de Nijs
- Center of Expertise in Palliative Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Dagmar van Gerven
- Department of Medical Oncology, Alrijne Hospital, 2353 GA Leiderdorp, The Netherlands
| | | | - Natasja J. H. Raijmakers
- Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3501 DB Utrecht, The Netherlands
| | - Yvette M. van der Linden
- Netherlands Comprehensive Cancer Organisation (IKNL), 3501 DB Utrecht, The Netherlands
- Center of Expertise in Palliative Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Togashi S, Masukawa K, Aoyama M, Sato K, Miyashita M. Aggressive End-of-Life Treatments Among Inpatients With Cancer and Non-cancer Diseases Using a Japanese National Claims Database. Am J Hosp Palliat Care 2023:10499091231216888. [PMID: 38019734 DOI: 10.1177/10499091231216888] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
To describe aggressive treatments at end-of-life among inpatients with cancer and non-cancer diseases and to evaluate factors associated with these treatments using the Japanese national database (NDB). We conducted a retrospective cohort study among inpatients aged ≥ 20 years who died between 2012 and 2015 using a sampling dataset of NDB. The outcome was the proportion of aggressive treatments in the last 14 days of life. We considered the underlying causes of death as cancer, dementia/senility, and heart, cerebrovascular, renal, liver, respiratory, and neurodegenerative diseases. We analyzed 54,105 inpatients, with underlying cause of death distributed as follows: cancer, 24.9%; heart disease, 16.5%; respiratory disease, 12.3%; and cerebrovascular disease, 9.7%. The proportion of intensive care unit (ICU) admission was 9.7%, being the highest in heart disease (20.5%), followed by cerebrovascular diseases (12.6%), and least in dementia/senility (.6%). The proportion of cardiopulmonary resuscitation was 19.6%, being the highest in heart disease (38.1%), followed by renal diseases (19.5%), and least in cancer (6.2%). Multivariate logistic regression analysis revealed that having heart diseases, cerebrovascular diseases, younger age, less comorbidities, and shorter length of stay were associated with an increasing risk of aggressive treatments in the last 14 days of life. The proportion of aggressive treatments at the end-of-life varies depending on the disease; additionally, these treatments were associated with having heart diseases, younger age, less comorbidity, and shorter length of stay. Our findings may help develop and set benchmarks for quality indicators at the end-of-life for patients with non-cancer diseases.
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Affiliation(s)
- Shintaro Togashi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako-shi, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuki Sato
- Division of Integrated Health Sciences, Department of Nursing for Advanced Practice, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Santos MF, Reis-Pina P. Palliative care interventions in chronic respiratory diseases: A systematic review. Respir Med 2023; 219:107411. [PMID: 37717791 DOI: 10.1016/j.rmed.2023.107411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Chronic respiratory diseases represent a significant burden of disease globally, with high morbidity and mortality. Individuals living with these conditions, as well as their families, face considerable physical, emotional and social challenges. Palliative care might be a valuable approach to address their complex needs, but evidence to prove this is still scarce. OBJECTIVES This systematic review aimed to study the effectiveness of palliative care interventions in health-related outcomes (quality of life, symptom control, symptom burden, psychological well-being, advance care planning, use of health services, and survival) in chronic respiratory patients. METHODS Pubmed, Cochrane and Web of Science were searched for trials published in the last 10 years, comparing palliative care interventions to usual care, in patients with chronic respiratory diseases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. RESULTS Eight studies were included, seven randomized controlled trials and one cluster-controlled trial; the former with moderate risk of bias and the latter with high risk of bias. Findings revealed that palliative interventions improve breathlessness control and advance care planning. There were no significant differences for the other outcomes. CONCLUSIONS Palliative care appears to have a beneficial effect on breathlessness, one of the most distressing symptoms in patients suffering from chronic respiratory diseases and allows for advanced care planning. Additional research, with more robust trials, is needed to draw further conclusions about other health-related outcomes.
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Affiliation(s)
| | - Paulo Reis-Pina
- Faculty of Medicine, University of Lisbon, Portugal; Bento Menni's Palliative Care Unit, Casa de Saúde da Idanha, Sintra, Portugal.
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Haltia O, Vesinurm M, Leskelä RL, Rahko E, Tyynelä-Korhonen K, Lehto JT, Saarto T, Akrén OM. The effect of palliative outpatient units on resource use for cancer patients in Finland. Acta Oncol 2023; 62:1118-1123. [PMID: 37535611 DOI: 10.1080/0284186x.2023.2241988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND As cancer incidences are increasing, the means to provide effective palliative care (PC) are called for. There is evidence, that PC may prevent futile treatment at the end of life (EOL) thus implicating that PC decreases resource use at the EOL, however, the effects of outpatient PC units remain largely unknown. We surveyed the national use of Finnish tertiary care PC units and their effects on resource use at the EOL in real-life environments. PATIENTS AND METHODS Cancer patients treated in the departments of Oncology at all five Finnish university hospitals in 2013 and deceased by 31 December 2014 were identified; of the 6010 patients 2007 were randomly selected for the study cohort. The oncologic therapies received and the resource usage of emergency services and hospital wards were collected from the hospitals' medical records. RESULTS A PC unit was visited by 37% of the patients a median 112 days before death. A decision to terminate all life-prolonging cancer treatments was more often made for patients visiting the PC unit (90% vs. 66%, respectively). A visit to a PC unit was associated with significantly fewer visits to emergency departments (ED) and hospitalization during the last 90 days of life; the mean difference in ED visits decreased by 0.48 (SD 0.33 - 0.62, p < 0.001), and the mean inpatient days by 7.1 (SD 5.93 - 8.25, p < 0.001). A PC visit unit was independently associated with decreased acute hospital resource use during the last 30 and 90 days before death in multivariable analyses. CONCLUSION Cancer patients' contact with a PC unit was significantly associated with the reduced use of acute hospital services at the EOL, however; only one-third of the patients visited a PC unit. Thus, systematic PC unit referral practices for patients with advanced cancer are called for.
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Affiliation(s)
- Olli Haltia
- Helsinki Health Care Center; Faculty of Medicine, Department of General Practice and Primary Health Care, Helsinki University, Helsinki, Finland
| | - Märt Vesinurm
- Nordic Healthcare group, Helsinki, Finland
- Department of Industrial Engineering and Management, Institute of Healthcare Engineering and Management (HEMA), Aalto University School of Science, Espoo, Finland
| | | | - Eeva Rahko
- Cancer Center, Oulu University Hospital, Oulu, Finland
| | | | - Juho T Lehto
- Palliative Care Centre, Department of Oncology, Tampere University Hospital and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Tiina Saarto
- Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Outi M Akrén
- Palliative Center, Turku University Hospital and Faculty of Medicine, Turku University, Turku, Finland
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García Martínez A. Comment on the article "Teaching about Chronicity in Medical Schools - A Review of the Current Situation". Rev Clin Esp 2023; 223:327. [PMID: 36972731 DOI: 10.1016/j.rceng.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Ahmed S, Naqvi SF, Sinnarajah A, McGhan G, Simon J, Santana MJ. Patient & Caregiver Experiences: Qualitative Study Comparison Before and After Implementation of Early Palliative Care for Advanced Colorectal Cancer. Can J Nurs Res 2023; 55:110-125. [PMID: 35254117 PMCID: PMC9936441 DOI: 10.1177/08445621221079534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Palliative Care Early and Systematic (PaCES) program implemented an early palliative care pathway for advanced colorectal cancer patients in January 2019, to increase specialist palliative care consultation and palliative homecare referrals more than three months before death. This study aimed to understand the experience of patients with advanced colorectal cancer and family caregivers who received early palliative care supports from a specialist palliative care nurse and compared those experiences with participants who experienced standard oncology care prior to implementation of early palliative care. METHODS This was a qualitative and patient-oriented study. We conducted semi-structured telephone interviews with two cohorts of patients with advanced colorectal cancer before and after implementation of an early palliative care pathway. We conducted a thematic analysis of the transcripts guided by a Person-Centred Care Framework. RESULTS Seven patients living with advanced colorectal cancer and five family caregivers who received early palliative care supports expressed that visits from their early palliative care nurse was helpful, improved their understanding of palliative care, and improved their care. Four main themes shaped their experience of early palliative care: care coordination, perception of palliative care & advance care planning, coping with advanced cancer, and patient and family engagement. These findings were compared with experiences of 15 patients and seven caregivers prior to pathway implementation. CONCLUSION An early palliative care pathway can improve advanced cancer care, and improve understanding and acceptance of early palliative care. This work was conducted in the context of colorectal cancer but may have relevance for the care of other advanced cancers.
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Affiliation(s)
- Sadia Ahmed
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada,Sadia Ahmed, Community Health Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada.
| | - Syeda Farwa Naqvi
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Aynharan Sinnarajah
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gwen McGhan
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Simon
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maria J. Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada,O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Robertson C, Watanabe SM, Sinnarajah A, Potapov A, Faily V, Tarumi Y, Baracos VE. Association between Consultation by a Comprehensive Integrated Palliative Care Program and Quality of End-of-Life Care in Patients with Advanced Cancer in Edmonton, Canada. Curr Oncol 2023; 30:897-907. [PMID: 36661717 PMCID: PMC9858595 DOI: 10.3390/curroncol30010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/24/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
Literature assessing the impact of palliative care (PC) consultation on aggressive care at the end of life (EOL) within a comprehensive integrated PC program is limited. We retrospectively reviewed patients with advanced cancer who received oncological care at a Canadian tertiary center, died between April 2013 and March 2014, and had access to PC consultation in all healthcare settings. Administrative databases were linked, and medical records reviewed. Composite score for aggressive EOL care was calculated, assigning a point for each of the following: ≥2 emergency room visits, ≥2 hospitalizations, hospitalization >14 days, ICU admission, and chemotherapy administration in the last 30 days of life, and hospital death. Multivariable logistic regression was adjusted for age, sex, income, cancer type and PC consultation for ≥1 aggressive EOL care indicator. Of 1414 eligible patients, 1111 (78.6%) received PC consultation. In multivariable analysis, PC consultation was independently associated with lower odds of ≥1 aggressive EOL care indicator (OR 0.49, 95% CI 0.38−0.65, p < 0.001). PC consultation >3 versus ≤3 months before death had a greater effect on lower aggressive EOL care (mean composite score 0.59 versus 0.88, p < 0.001). We add evidence that PC consultation is associated with less aggressive care at the EOL for patients with advanced cancer.
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Affiliation(s)
- Cara Robertson
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Sharon M. Watanabe
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Aynharan Sinnarajah
- Division of Palliative Medicine, Queen’s University, Kingston, ON L1G 2B9, Canada
| | - Alexei Potapov
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Viane Faily
- Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI 53226, USA
| | - Yoko Tarumi
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Vickie E. Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
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Vercueil C, Sauleau E, Calvel L. Parcours de soins en fin de vie des patients suivis en soins palliatifs à Strasbourg : étude rétrospective. Bull Cancer 2022; 109:1193-1201. [DOI: 10.1016/j.bulcan.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/04/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022]
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Malhotra C, Bundoc F, Chaudhry I, Teo I, Ozdemir S, Finkelstein E, Dent RA, Kumarakulasinghe NB, Cheung YB, Malhotra R, Kanesvaran R, Yee ACP, Chan N, Wu HY, Chin SM, Allyn HYM, Yang GM, Neo PSH, Harding R, Heng LL. A prospective cohort study assessing aggressive interventions at the end-of-life among patients with solid metastatic cancer. Palliat Care 2022; 21:73. [PMID: 35578270 PMCID: PMC9109395 DOI: 10.1186/s12904-022-00970-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/12/2022] [Indexed: 01/08/2023] Open
Abstract
Background Many patients with a solid metastatic cancer are treated aggressively during their last month of life. Using data from a large prospective cohort study of patients with an advanced cancer, we aimed to assess the number and predictors of aggressive interventions during last month of life among patients with solid metastatic cancer and its association with bereaved caregivers’ outcomes. Methods We used data of 345 deceased patients from a prospective cohort study of 600 patients. We surveyed patients every 3 months until death for their physical, psychological and functional health, end-of-life care preference and palliative care use. We surveyed their bereaved caregivers 8 weeks after patients’ death regarding their preparedness about patient’s death, regret about patient’s end-of-life care and mood over the last week. Patient data was merged with medical records to assess aggressive interventions received including hospital death and use of anti-cancer treatment, more than 14 days in hospital, more than one hospital admission, more than one emergency room visit and at least one intensive care unit admission, all within the last month of life. Results 69% of patients received at least one aggressive intervention during last month of life. Patients hospitalized during the last 2–12 months of life, male patients, Buddhist or Taoist, and with breast or respiratory cancer received more aggressive interventions in last month of life. Patients with worse functional health prior to their last month of life received fewer aggressive interventions in last month of life. Bereaved caregivers of patients receiving more aggressive interventions reported feeling less prepared for patients’ death. Conclusion Findings suggest that intervening early in the sub-group of patients with history of hospitalization prior to their last month may reduce number of aggressive interventions during last month of life and ultimately positively influence caregivers’ preparedness for death during the bereavement phase. Trial registration NCT02850640. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00970-z.
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