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Paiz CC, Owodunni OP, Courville EN, Schmidt M, Alunday R, Bowers CA. Frailty Predicts 30-day mortality following major complications in neurosurgery patients: The risk analysis index has superior discrimination compared to modified frailty index-5 and increasing patient age. World Neurosurg X 2024; 23:100286. [PMID: 38516023 PMCID: PMC10955078 DOI: 10.1016/j.wnsx.2024.100286] [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] [Received: 01/28/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Background Postoperative complications after cranial or spine surgery are prevalent, and frailty can be a key contributing patient factor. Therefore, we evaluated frailty's impact on 30-day mortality. We compared the discrimination for risk analysis index (RAI), modified frailty index-5 (mFI-5) and increasing patient age for predicting 30-day mortality. Methods Patients with major complications following neurosurgery procedures between 2012- 2020 in the ACS-NSQIP database were included. We employed receiver operating characteristic (ROC) curve and examined discrimination thresholds for RAI, mFI-5, and increasing patient age for 30-day mortality. Independent relationships were examined using multivariable analysis. Results There were 19,096 patients included in the study and in the ROC analysis for 30-day mortality, RAI showed superior discriminant validity threshold C-statistic 0.655 (95% CI: 0.644-0.666), compared to mFI-5 C-statistic 0.570 (95% CI 0.559-0.581), and increasing patient age C-statistic 0.607 (95% CI 0.595-0.619). When the patient population was divided into subsets based on the procedures type (spinal, cranial or other), spine procedures had the highest discriminant validity threshold for RAI (Cstatistic 0.717). Furthermore, there was a frailty risk tier dose response relationship with 30-day mortalityy (p<0.001). Conclusion When a major complication arises after neurosurgical procedures, frail patients have a higher likelihood of dying within 30 days than their non-frail counterparts. The RAI demonstrated a higher discriminant validity threshold than mFI-5 and increasing patient age, making it a more clinically relevant tool for identifying and stratifying patients by frailty risk tiers. These findings highlight the importance of initiatives geared toward optimizing frail patients, to mitigate long-term disability.
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Affiliation(s)
- Christopher C. Paiz
- New Mexico School of Medicine, Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Oluwafemi P. Owodunni
- Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Evan N. Courville
- Department of Neurosurgical Sciences, University of New Mexico Hospital, Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Meic Schmidt
- Department of Neurosurgical Sciences, University of New Mexico Hospital, Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Robert Alunday
- Department of Neurosurgical Sciences, University of New Mexico Hospital, Albuquerque, NM, USA
- Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, NM, USA
- Center for Adult Critical Care, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Christian A. Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
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Sanders JJ, Temin S, Ghoshal A, Alesi ER, Ali ZV, Chauhan C, Cleary JF, Epstein AS, Firn JI, Jones JA, Litzow MR, Lundquist D, Mardones MA, Nipp RD, Rabow MW, Rosa WE, Zimmermann C, Ferrell BR. Palliative Care for Patients With Cancer: ASCO Guideline Update. J Clin Oncol 2024; 42:2336-2357. [PMID: 38748941 DOI: 10.1200/jco.24.00542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE To provide evidence-based guidance to oncology clinicians, patients, nonprofessional caregivers, and palliative care clinicians to update the 2016 ASCO guideline on the integration of palliative care into standard oncology for all patients diagnosed with cancer. METHODS ASCO convened an Expert Panel of medical, radiation, hematology-oncology, oncology nursing, palliative care, social work, ethics, advocacy, and psycho-oncology experts. The Panel conducted a literature search, including systematic reviews, meta-analyses, and randomized controlled trials published from 2015-2023. Outcomes of interest included quality of life (QOL), patient satisfaction, physical and psychological symptoms, survival, and caregiver burden. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 52 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations address the integration of palliative care in oncology. Oncology clinicians should refer patients with advanced solid tumors and hematologic malignancies to specialized interdisciplinary palliative care teams that provide outpatient and inpatient care beginning early in the course of the disease, alongside active treatment of their cancer. For patients with cancer with unaddressed physical, psychosocial, or spiritual distress, cancer care programs should provide dedicated specialist palliative care services complementing existing or emerging supportive care interventions. Oncology clinicians from across the interdisciplinary cancer care team may refer the caregivers (eg, family, chosen family, and friends) of patients with cancer to palliative care teams for additional support. The Expert Panel suggests early palliative care involvement, especially for patients with uncontrolled symptoms and QOL concerns. Clinicians caring for patients with solid tumors on phase I cancer trials may also refer them to specialist palliative care.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
| | - Sarah Temin
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Arun Ghoshal
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Erin R Alesi
- Virginia Commonwealth University Health System, Massey Cancer Center, Richmond, VA
| | | | | | - James F Cleary
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | | | | | | | - Michael W Rabow
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Taylor S, Vercell A, Sawyer C, Khatoon B, Coomber-Moore J, Yorke J, Mula C, Berman R. Enhanced supportive care: prospective cohort study of oncology patients and caregivers. BMJ Support Palliat Care 2024; 14:103-117. [PMID: 37696586 DOI: 10.1136/spcare-2023-004231] [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: 02/15/2023] [Accepted: 08/09/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES A prospective cohort study to evaluate clinical effectiveness of the enhanced supportive care (ESC) service at a comprehensive cancer centre and to explore the impact of the service on patient and caregiver outcomes and experience. METHODS Patients who received care under the ESC service and their caregivers were eligible. Consented patients (n=184) and caregivers (n=67) completed questionnaires at baseline, 4 weeks and 8 weeks post-ESC. Patient questionnaires assessed quality of life (QOL), symptoms, experience of ESC and health service use. Caregiver questionnaires included QOL and needs assessment. Selected patients (n=13) participated in qualitative interviews. Quantitative analysis explored differences in questionnaire responses over time (p<0.05). Qualitative data were analysed thematically. RESULTS Patient quantitative data showed improvements in QOL (p=0.004 for European Quality of Life Questionnaire 5 dimensions (EQ5D) health index scores) and anxiety (p=0.006) at 4 weeks, reduction in some symptoms (pain p=0.02 at 4 weeks), improvement in self-efficacy, an increase in problems being addressed and a decrease in health service use (reduction in outpatient appointments). Qualitative findings suggested patients were generally satisfied with the ESC service but identified areas for improvement such as increased awareness of ESC and earlier referral. Fewer improvements were noted for caregivers; however, they did report a decrease in unmet needs. CONCLUSION The ESC service had a positive impact on various patient-reported and caregiver-reported outcomes. There were also positive impacts on health service use. Increasing awareness of ESC and engaging patients at an earlier stage in the disease trajectory may further improve patient satisfaction and outcomes.
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Affiliation(s)
- Sally Taylor
- Christie Patient Centred Research Team, The Christie NHS Foundation Trust, Manchester, UK
- School of Nursing and Midwifery, The University of Manchester, Manchester, UK
| | - Amy Vercell
- Christie Patient Centred Research Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Chelsea Sawyer
- Christie Patient Centred Research Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Binish Khatoon
- Christie Patient Centred Research Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Jake Coomber-Moore
- Christie Patient Centred Research Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Janelle Yorke
- Christie Patient Centred Research Team, The Christie NHS Foundation Trust, Manchester, UK
- School of Nursing and Midwifery, The University of Manchester, Manchester, UK
| | - Carole Mula
- Department of Supportive Care, The Christie NHS Foundation Trust, Manchester, UK
| | - Richard Berman
- Department of Supportive Care, The Christie NHS Foundation Trust, Manchester, UK
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Maessen M, Fliedner MC, Gahl B, Maier M, Aebersold DM, Zwahlen S, Eychmüller S. An economic evaluation of an early palliative care intervention among patients with advanced cancer. Swiss Med Wkly 2024; 154:3591. [PMID: 38579309 DOI: 10.57187/s.3591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Early integration of palliative care into oncology care has shown positive effects on patient symptoms and quality of life. It may also reduce health care costs. However given the heterogeneity of settings and interventions and the lack of information on the minimally effective dose for influencing care utilisation and costs, it remains uncertain whether early palliative care reduces costs. OBJECTIVES We sought to determine whether an early palliative care intervention integrated in usual oncology care in a Swiss hospital setting reduced utilisation and costs of health care in the last month of life when compared with usual oncology care alone. METHODS We performed a cost-consequences analysis alongside a multicentre trial. We extracted costs from administrative health insurance data and health care utilisation from family caregiver surveys to compare two study arms: usual oncology care and usual oncology care plus the palliative care intervention. The intervention consisted of a single-structured, multiprofessional conversation with the patient about symptoms, end-of-life decisions, network building and support for carers (SENS). The early palliative care intervention was performed within 16 weeks of the diagnosis of a tumour stage not amenable or responsive to curative treatment. RESULTS We included 58 participants with advanced cancer in our economic evaluation study. Median overall health care costs in the last month of life were 7892 Swiss Francs (CHF) (interquartile range: CHF 5637-13,489) in the intervention arm and CHF 8492 [CHF 5411-12,012] in the control arm. The average total intervention treatment cost CHF 380 per patient. Integrating an early palliative care intervention into usual oncology care showed no significant difference in health care utilisation or overall health care costs between intervention and control arms (p = 0.98). CONCLUSION Although early palliative care is often presented as a cost-reducing care service, we could not show a significant effect of the SENS intervention on health care utilisation and costs in the last month of life. However, it may be that the intervention was not intensive enough, the timeframe too short or the study population too small for measurable effects. Patients appreciated the intervention. Single-structured early palliative care interventions are easy to implement in clinical practice and present low treatment costs. Further research about the economic impact of early palliative care should focus on extracting large, detailed cost databases showing potential shifts in cost and cost-effectiveness. CLINICAL TRIALS gov Identifier: NCT01983956.
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Affiliation(s)
- Maud Maessen
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- University Centre for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Monica C Fliedner
- University Centre for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Marina Maier
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Susanne Zwahlen
- Unit for Specialised Palliative Care, Lindenhof Hospital, Bern, Switzerland
| | - Steffen Eychmüller
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
- University Centre for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Hjermstad MJ, Pirnat A, Aass N, Andersen S, Astrup GL, Dajani O, Garresori H, Guldhav KV, Hamre H, Haukland EC, Jordal F, Lundeby T, Løhre ET, Mjåland S, Paulsen Ø, Semb KA, Staff ES, Wester T, Kaasa S. PALLiative care in ONcology (PALLiON): A cluster-randomised trial investigating the effect of palliative care on the use of anticancer treatment at the end of life. Palliat Med 2024; 38:229-239. [PMID: 38193250 PMCID: PMC10865754 DOI: 10.1177/02692163231222391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Effects on anticancer therapy following the integration of palliative care and oncology are rarely investigated. Thus, its potential effect is unknown. AIM To investigate the effects of the complex intervention PALLiON versus usual care on end-of-life anticancer therapy. DESIGN Cluster-randomised controlled trial (RCT), registered at ClinicalTrials.gov (No. NCT01362816). The complex intervention consisted of a physician education program enhancing theoretical, clinical and communication skills, a patient-centred care pathway and patient symptom reporting prior to all consultations. Primary outcome was overall use, start and cessation of anticancer therapy in the last 3 months before death. Secondary outcomes were patient-reported outcomes. Mixed effects logistic regression models and Cox proportional hazard were used. SETTING A total of 12 Norwegian hospitals (03/2017-02/2021). PARTICIPANTS Patients ⩾18 years, advanced stage solid tumour, starting last line of anticancer therapy, estimated life expectancy ⩽12 months. RESULTS A total of 616 (93%) patients were included (intervention: 309/control:307); 63% males, median age 69, 77% had gastrointestinal cancers. Median survival time from inclusion was 8 (IQR 3-14) and 7 months (IQR 3-12), and days between anticancer therapy start and death were 204 (90-378) and 168 (69-351) (intervention/control). Overall, 78 patients (13%) received anticancer therapy in the last month (intervention: 33 [11%]/control: 45 [15%]). No differences were found in patient-reported outcomes. CONCLUSION We found no significant differences in the probability of receiving end-of-life anticancer therapy. The intervention did not have the desired effect. It was probably too general and too focussed on communication skills to exert a substantial influence on conventional clinical practice.
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Affiliation(s)
- Marianne Jensen Hjermstad
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Aleksandra Pirnat
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nina Aass
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigve Andersen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Institute of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Guro L Astrup
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav Dajani
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Herish Garresori
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Kristin V Guldhav
- Department of Oncology and Palliative Care, Førde Hospital Trust, Førde, Norway
| | - Hanne Hamre
- Department of Oncology, Akershus University Hospital, Akershus, Norway
| | - Ellinor C Haukland
- Department of Oncology and Palliative Care, Nordland Hospital Trust, Nordland, Norway
| | - Frode Jordal
- Department of Clinical Oncology, Østfold Hospital Trust, Østfold, Norway
| | - Tonje Lundeby
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Torbjorn Løhre
- Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Svein Mjåland
- Center for Cancer Treatment, Sorlandet Hospital, Kristiansand, Norway
| | - Ørnulf Paulsen
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | - Karin A Semb
- Department of Oncology and Palliative Care, Vestfold Hospital Trust, Tønsberg, Norway
| | - Erik S Staff
- Department of Oncology, Ålesund Hospital Trust, Ålesund, Norway
| | - Torunn Wester
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Nadolny S, Schildmann E, Gaßmann ES, Schildmann J. What is an "early palliative care" intervention? A scoping review of controlled studies in oncology. Cancer Med 2023; 12:21335-21353. [PMID: 37902232 PMCID: PMC10726823 DOI: 10.1002/cam4.6490] [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: 01/31/2023] [Revised: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Early palliative care (EPC) has been advocated to improve cancer patients' health. However, EPC differs with regard to its elements and target groups. It is not known which parts of EPC contribute to effectiveness for which patient group. This scoping review provides a structured analysis of EPC interventions and outcome measures. DESIGN We searched EMBASE, MEDLINE, CINAHL, and CENTRAL up to February 2022. We included randomized controlled trials (RCT), nonrandomized trials, cohort studies (CS), and controlled before-after studies of EPC in adult patients in English, Dutch, and German language. Interventions had to be self-labeled as EPC. Screening and data extraction were performed by two raters. A structured analysis incorporating the TIDieR checklist was performed to describe the elements of the interventions. RESULTS We screened 2651 articles, resulting in 40 articles being included: 34 studies were RCT and six studies were CS with a mean sample size of 208 patients. Patients with pancreatic (n = 10) and lung cancer (n = 9) were most often included. Studies reported different reference points for the onset of EPC such as time after diagnosis of incurable cancer (n = 18) or prognosis (n = 9). Thirteen studies provided information about elements of EPC and eight studies about the control intervention. Most frequent elements of EPC were symptom management (n = 28), case management (n = 16), and advance care planning (ACP; n = 15). Most frequently reported outcome measures were health-related quality of life (n = 26), symptom intensity (n = 6), resource use, and the patient's mood (n = 4 each). CONCLUSION The elicited heterogeneity of ECP in combination with deficits of reporting are considerable barriers that should be addressed to further develop effective EPC interventions for different groups of cancer patients.
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Affiliation(s)
- Stephan Nadolny
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health SciencesMartin Luther University Halle‐WittenbergHalleGermany
- Institute for Educational and Health‐Care Research in the Health SectorHochschule Bielefeld—University of Applied Sciences and ArtsBielefeldGermany
| | - Eva Schildmann
- Department of Palliative MedicineMedical Faculty, University of AugsburgAugsburgGermany
- Department of Palliative MedicineLMU University Hospital, LMU MunichMunichGermany
| | - Elena S. Gaßmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health SciencesMartin Luther University Halle‐WittenbergHalleGermany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health SciencesMartin Luther University Halle‐WittenbergHalleGermany
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Cui J, Fang P, Bai J, Tan L, Wan C, Yu L. Meta-Analysis of Effects of Early Palliative Care on Health-Related Outcomes Among Advanced Cancer Patients. Nurs Res 2023; 72:E180-E190. [PMID: 37733650 DOI: 10.1097/nnr.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Early palliative care (PC) has received more attention for improving health-related outcomes for advanced cancer patients in recent years, but the results of previous studies are inconsistent. OBJECTIVES This study aimed to use meta-analysis and trial sequence analysis to evaluate the effect of early PC on health-related outcomes of advanced cancer patients. METHODS All English publications were searched in PubMed, Web of Science, Embase, and the Cochrane Library from inception to March 2023, with a restriction that the study type was a randomized controlled trial. RESULTS The results showed that early PC positively affected quality of life, satisfaction with care, and symptom burden reduction. However, early PC had no significant effect on anxiety or survival. Trial sequence analysis results showed that the effect of early PC on the quality of life was stable. DISCUSSION This systematic review suggested that early PC could positively affect health-related outcomes for advanced cancer patients. Early PC can be used widely in clinical settings to improve health-related outcomes of advanced cancer. However, because of the trial sequence analysis results, further well-designed, clinical, randomized controlled trials with larger sample sizes are necessary to draw definitive conclusions.
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Paley CA, Boland JW, Santarelli M, Murtagh FEM, Ziegler L, Chapman EJ. Non-pharmacological interventions to manage psychological distress in patients living with cancer: a systematic review. BMC Palliat Care 2023; 22:88. [PMID: 37407974 DOI: 10.1186/s12904-023-01202-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Psychological distress is common in patients with cancer; interfering with physical and psychological wellbeing, and hindering management of physical symptoms. Our aim was to systematically review published evidence on non-pharmacological interventions for cancer-related psychological distress, at all stages of the disease. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered on PROSPERO (CRD42022311729). Searches were made using eight online databases to identify studies meeting our inclusion criteria. Data were collected on outcome measures, modes of delivery, resources and evidence of efficacy. A meta-analysis was planned if data allowed. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). RESULTS Fifty-nine studies with 17,628 participants were included. One third of studies included mindfulness, talking or group therapies. Half of all studies reported statistically significant improvements in distress. Statistically significant intervention effects on distress were most prevalent for mindfulness techniques. Four of these mindfulness studies had moderate effect sizes (d = -0.71[95% CI: -1.04, -0.37] p < 0.001) (d = -0.60 [95% CI: -3.44, -0.89] p < 0.001) (d = -0.77 [CI: -0.146, -1.954] p < 0.01) (d = -0.69 [CI: -0.18, -1.19] p = 0.008) and one had a large effect size (d = -1.03 [95% CI: -1.51, -0.54] p < 0.001). Heterogeneity of studies precluded meta-analysis. Study quality was variable and some had a high risk of bias. CONCLUSIONS The majority of studies using a mindfulness intervention in this review are efficacious at alleviating distress. Mindfulness-including brief, self-administered interventions-merits further investigation, using adequately powered, high-quality studies. SYSTEMATIC REVIEW REGISTRATION This systematic review is registered on PROSPERO, number CRD42022311729.
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Affiliation(s)
- Carole A Paley
- University of Leeds, Academic Unit of Palliative Care, Leeds, UK.
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Martina Santarelli
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lucy Ziegler
- University of Leeds, Academic Unit of Palliative Care, Leeds, UK
| | - Emma J Chapman
- University of Leeds, Academic Unit of Palliative Care, Leeds, UK
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Gautama MSN, Damayanti A, Khusnia AF. Impact of Early Palliative Care to Improve Quality of Life of Advanced Cancer Patients: A Meta-Analysis of Randomised Controlled Trials. Indian J Palliat Care 2023; 29:28-35. [PMID: 36846281 PMCID: PMC9944329 DOI: 10.25259/ijpc_153_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/30/2022] [Indexed: 11/04/2022] Open
Abstract
Palliative care is often started late in patients with life-threatening conditions, particularly in patients with advanced cancer. However, with the emergence of the early palliative care (EPC) paradigm, their quality of life (QoL) may be better. Although several previous meta-analyses support the effectiveness of EPC in increasing QoL, essential issues related to the optimisation of EPC interventions are still needed. A systematic review and meta-analysis of randomised controlled trials (RCTs) were conducted to determine the effectiveness of EPC on the QoL of patients with advanced cancer. PubMed, ProQuest, MEDLINE through EBSCOhost and Cochrane Library and clinicaltrials.gov (register website) were searched for RCTs published before May 2022. Data synthesis used the Review Manager 5.4 to generate pooled estimates of effect size. A total of 12 empirical trials met the eligibility criteria and were included in this study. The results showed that EPC intervention had a significant effect (standard mean difference = 0.16, 95% confidence interval: 0.04, 0.28, Z = 2.68, P < 0.05). However, the secondary outcomes showed including mood (mean difference = -0.90, 95% CI: -2.32, 0.51, P > 0.05) and symptom controls (MD = -1.49, 95% CI: -3.81, 0.81, P > 0.05) had no significant effect. EPC is effective in improving the QoL of patients with advanced cancer. However, other outcomes still need to be reviewed, because the review of QoL is not enough to generalise the benchmarks for the effectiveness and optimisation of EPC interventions. Another notable aspect is to consider the most effective and efficient duration for starting and ending EPC interventions.
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Affiliation(s)
- Made Satya Nugraha Gautama
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Adelina Damayanti
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Anindita Farda Khusnia
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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10
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Utilization of palliative care resource remains low, consuming potentially avoidable hospital admissions in stage IV non-small cell lung cancer: a community-based retrospective review. Support Care Cancer 2022; 30:10117-10126. [PMID: 36374328 PMCID: PMC9661463 DOI: 10.1007/s00520-022-07364-0] [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] [Received: 06/20/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022]
Abstract
Purpose Early referral of patients with stage IV non-small cell lung cancer (NSCLC) to outpatient palliative care has been shown to increase survival and reduce unnecessary healthcare resource utilization. We aimed to determine outpatient palliative care referral rate and subsequent resource utilization in patients with stage IV NSCLC in a multistate, community-based hospital network and identify rates and reasons for admissions within a local healthcare system of Washington State. Methods A retrospective chart review of a multistate hospital network and a local healthcare system. Patients were identified using ICD billing codes. In the multistate network, 2844 patients diagnosed with stage IV NSCLC between January 1, 2013, and March 1, 2018, were reviewed. In the state healthcare system, 283 patients between August 2014 and June 2017 were reviewed. Results Referral for outpatient palliative care was low: 8% (217/2844) in the multistate network and 11% (32/283) in the local healthcare system. Early outpatient palliative care (6%, 10/156) was associated with a lower proportion of patients admitted into the intensive care unit in the last 30 days of life compared to no outpatient palliative care (15%, 399/2627; p = 0.003). Outpatient palliative care referral was associated with improved overall survival in Kaplan Meier survival analysis. Within the local system, 51% (104/204) of admissions could have been managed in outpatient setting, and of the patients admitted in the last 30 days of life, 59% (87/147) experienced in-hospital deaths. Conclusion We identified underutilization of outpatient palliative care services within stage IV NSCLC patients. Many patients with NSCLC experience hospitalization the last month of life and in-hospital death. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07364-0.
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Ross L, Neergaard MA, Petersen MA, Groenvold M. The quality of end of life care for Danish cancer patients who have received specialized palliative: a national survey using the Danish version of VOICES-SF. Support Care Cancer 2022; 30:3593-3602. [PMID: 35028718 DOI: 10.1007/s00520-021-06756-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND National recommendations state that Danish patients with complex palliative needs should have access to specialized palliative care but little is known about the perceived quality of this care or end of life care in general. AIM To assess how end of life care was evaluated by the bereaved spouses and to investigate whether the perceived quality was associated with (1) quantity of specialized palliative care provided, (2) place of death, and (3) emotional state when completing the questionnaire. DESIGN The bereaved spouses of 1584 cancer patients who had received specialized palliative care were invited to answer the Views Of Informal Carers - Evaluation of Services - Short Form (VOICES-SF) and the Hospital Anxiety and Depression Scale (HADS) approximately 3-9 months after the patient's death. RESULTS A total of 787 (50%) of the invited spouses participated. In the last 3 months of the patient's life, the quality of all services taken together was rated as good, excellent, or outstanding in 83% of the cases and it was significantly associated with place of death (p = 0.0051, fewest considered it "fair" or "poor" if the patient died at home). In total, 93% reported that the patient died at the right place although only 74% died at the patient's preferred place. Higher levels of anxiety (p = 0.01) but not depression at the time of questionnaire completion was associated with lower satisfaction with the overall quality of care. CONCLUSION The quality of care was rated very highly by bereaved spouses of patients receiving specialized palliative care.
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Affiliation(s)
- Lone Ross
- The Research Unit, Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark.
| | | | - Morten Aagaard Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark
| | - Mogens Groenvold
- The Research Unit, Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark
- Department of Health Services Research, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
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Schlau H. [Early Integration of Palliative Care - A Definition for Daily Practice]. PRAXIS 2021; 110:855-860. [PMID: 34814727 DOI: 10.1024/1661-8157/a003791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Early Integration of Palliative Care - A Definition for Daily Practice Abstract. The integration of palliative care into the treatment of patients with chronically progressive or incurable diseases can be useful early in the course of the disease. The integrative approach of disease-specific and palliative therapy can improve the quality of life of those affected. Different aspects, such as symptom relief, decision making, advance planning, network building or support for relatives can be addressed from the bio-psycho-social-spiritual perspective. The article gives an overview of the most important aspects of early integration of palliative care and shows, also with actual case reports, how integration can be managed in practice.
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