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Slominska A, Loban K, Kinsella EA, Ho J, Sandal S. Supportive care in transplantation: A patient-centered care model to better support kidney transplant candidates and recipients. World J Transplant 2024; 14:97474. [DOI: 10.5500/wjt.v14.i4.97474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 09/20/2024] Open
Abstract
Kidney transplantation (KT), although the best treatment option for eligible patients, entails maintaining and adhering to a life-long treatment regimen of medications, lifestyle changes, self-care, and appointments. Many patients experience uncertain outcome trajectories increasing their vulnerability and symptom burden and generating complex care needs. Even when transplants are successful, for some patients the adjustment to life post-transplant can be challenging and psychological difficulties, economic challenges and social isolation have been reported. About 50% of patients lose their transplant within 10 years and must return to dialysis or pursue another transplant or conservative care. This paper documents the complicated journey patients undertake before and after KT and outlines some initiatives aimed at improving patient-centered care in transplantation. A more cohesive approach to care that borrows its philosophical approach from the established field of supportive oncology may improve patient experiences and outcomes. We propose the "supportive care in transplantation" care model to operationalize a patient-centered approach in transplantation. This model can build on other ongoing initiatives of other scholars and researchers and can help advance patient-centered care through the entire care continuum of kidney transplant recipients and candidates. Multi-dimensionality, multi-disciplinarity and evidence-based approaches are proposed as other key tenets of this care model. We conclude by proposing the potential advantages of this approach to patients and healthcare systems.
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Affiliation(s)
- Anita Slominska
- MEDIC Program, Research Institute of the McGill University Health Centre, Montreal H4A3J1, QC, Canada
| | - Katya Loban
- MEDIC Program, Research Institute of the McGill University Health Centre, Montreal H4A3J1, QC, Canada
| | - Elizabeth Anne Kinsella
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal H4A3J1, QC, Canada
| | - Julie Ho
- Department of Medicine, University of Manitoba, Winnipeg R3A1R9, MB, Canada
| | - Shaifali Sandal
- Department of Medicine, McGill University Health Centre, Montreal H4A3J1, QC, Canada
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Monnery D, Droney J. Enhanced supportive care. Br J Hosp Med (Lond) 2024; 85:1-8. [PMID: 38557099 DOI: 10.12968/hmed.2023.0416] [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] [Indexed: 04/04/2024]
Abstract
Enhanced supportive care is a care model providing earlier access to multiprofessional, coordinated care for patients from the point of cancer diagnosis. As a proactive model of care, it stands as a contrast to providing access to a multidisciplinary team once a patient has hit a crisis point, or when their prognosis has become sufficiently poor that they are able to access traditional end-of-life services. Its arrival in the UK through palliative care teams working in cancer care has led to enhanced supportive care being synonymous with early palliative care. While enhanced supportive care has enabled early palliative care, as it has become more embedded in the UK, it has taken on a wider remit for patients living longer with cancer and the management of side effects. Enhanced supportive care services have also begun to provide care for cancer survivors. Enhanced supportive care services have a key role in modern cancer care in maintaining and improving patients' quality of life alongside cancer treatment and ensuring that patients' priorities and preferences for treatment are considered. Furthermore, enhanced supportive care has been shown to support the wider healthcare system by creating capacity within the NHS, reducing demand on hospital services and saving money. As enhanced supportive care services continue to grow and venture into the care and support of cancer survivors and those receiving potentially curative treatments, ongoing work is needed to determine how these services can be made available throughout the NHS and how a shared vision of the way enhanced supportive care operates can be realised.
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Affiliation(s)
- Daniel Monnery
- Department of Supportive and Palliative Care, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Joanne Droney
- Department of Symptom Control and Palliative Care, The Royal Marsden NHS Foundation Trust, London, UK
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Scotté F, Taylor A, Davies A. Supportive Care: The "Keystone" of Modern Oncology Practice. Cancers (Basel) 2023; 15:3860. [PMID: 37568675 PMCID: PMC10417474 DOI: 10.3390/cancers15153860] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The Multinational Association of Supportive Care in Cancer (MASCC) defines supportive care as "the prevention and management of the adverse effects of cancer and its treatment. This includes management of physical and psychological symptoms and side effects across the continuum of the cancer journey from diagnosis through treatment to post-treatment care. Supportive care aims to improve the quality of rehabilitation, secondary cancer prevention, survivorship, and end-of-life care". This article will provide an overview of modern supportive care in cancer, discussing its definition, its relationship with palliative care, models of care, "core" service elements (multi-professional/multidisciplinary involvement), the evidence that supportive care improves morbidity, quality of life, and mortality in various groups of patients with cancer, and the health economic benefits of supportive care. The article will also discuss the current and future challenges to providing optimal supportive care to all oncology patients.
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Affiliation(s)
| | - Amy Taylor
- Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Andrew Davies
- Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
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Monnery D, Tredgett K, Hooper D, Barringer G, Munton A, Thomas M, Vijeratnam N, Godfrey N, Summerfield L, Hawkes K, Staley P, Holyhead K, Liu Y, Lockhart J, Bass S, Tavabie S, White N, Stewart E, Droney J, Minton O. Delivery Models and Health Economics of Supportive Care Services in England: A Multicentre Analysis. Clin Oncol (R Coll Radiol) 2023; 35:e395-e403. [PMID: 36997458 DOI: 10.1016/j.clon.2023.03.002] [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: 12/09/2022] [Revised: 01/16/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023]
Abstract
AIMS Improvements in cancer treatment have led to more people living with and beyond cancer. These patients have symptom and support needs unmet by current services. The development of enhanced supportive care (ESC) services may meet the longitudinal care needs of these patients, including at the end of life. This study aimed to determine the impact and health economic benefits of ESC for patients living with treatable but not curable cancer. MATERIALS AND METHODS A prospective observational evaluation was undertaken over 12 months across eight cancer centres in England. ESC service design and costs were recorded. Data relating to patients' symptom burden were collected using the Integrated Palliative Care Outcome Scale (IPOS). For patients in the last year of life, secondary care use was compared against an NHS England published benchmark. RESULTS In total, 4594 patients were seen by ESC services, of whom 1061 died during follow-up. Mean IPOS scores improved across all tumour groups. In total, £1,676,044 was spent delivering ESC across the eight centres. Reductions in secondary care usage for the 1061 patients who died saved a total of £8,490,581. CONCLUSIONS People living with cancer suffer with complex and unmet needs. ESC services appear to be effective at supporting these vulnerable people and significantly reduce the costs of their care.
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Affiliation(s)
- D Monnery
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK.
| | - K Tredgett
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - D Hooper
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - G Barringer
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - A Munton
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Thomas
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - N Vijeratnam
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N Godfrey
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - L Summerfield
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - K Hawkes
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - P Staley
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - K Holyhead
- Somerset NHS Foundation Trust, Taunton, UK
| | - Y Liu
- NHS England Specialised Services Improving Value Team, UK
| | - J Lockhart
- NHS England Specialised Services Improving Value Team, UK
| | - S Bass
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - S Tavabie
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - N White
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - E Stewart
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - J Droney
- The Royal Marsden NHS Foundation Trust, London, UK
| | - O Minton
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
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Monnery D, Liu Y, Griffiths A, Lockhart J, Coyle S, Olsson-Brown A. Multidisciplinary supportive care in cancer: cost analysis. BMJ Support Palliat Care 2022:spcare-2022-004135. [PMID: 36581451 DOI: 10.1136/spcare-2022-004135] [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: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Enhanced supportive care (ESC) is the early implementation of supportive care in cancer. In England, this model is being developed to support patients with treatable but not curable cancer and implements a multiprofessional approach. OBJECTIVE To describe the workforce and cost-effectiveness of an outpatient ESC service in a tertiary cancer centre in England. METHODS Workforce costs to deliver ESC to 265 patients was collected. Service impact on secondary care usage in the last year of life was compared against the regional and national average derived from the National Health Service Digital Secondary Uses Service dataset. RESULTS Our ESC service required the input of seven professional groups and cost £125 542 for 12 months. ESC patients had an average of 1.72 fewer admissions per patient per last year of life than the national average. Length of stay was reduced from an average of 9.2 days to 4.78 days per admission in the last year of life. The reduced secondary care usage saved £2 398 537.68. CONCLUSIONS Outpatient ESC in this cohort required an multidisciplinary team approach and saved money through secondary care use reduction.
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Affiliation(s)
- Daniel Monnery
- Palliative Medicine, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | | | - Ann Griffiths
- Palliative Medicine, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Jill Lockhart
- NHS England Specialised Commissioning Improving Value Team, London, UK
| | - Seamus Coyle
- Palliative Medicine, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
- Liverpool Head and Neck Centre, University of Liverpool, Liverpool, UK
| | - Anna Olsson-Brown
- Department of Clinical and Molecular Pharmacology, University of Liverpool, University of Liverpool, Liverpool, UK
- Medical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
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