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Dang J, Wen Yong AC, Fong ZH, Lyn Ng AS, Ang K. A Systematic Review of Palliative Care Needs in Young-Onset Dementia. J Am Med Dir Assoc 2024:105219. [PMID: 39155044 DOI: 10.1016/j.jamda.2024.105219] [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: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND The distinctive differences in clinical needs and disease trajectory between persons with young-onset (YOD) and late-onset dementia (LOD) make dementia palliative care unique. Limited studies have reported on the differences in palliative care needs between YOD and LOD, and the optimal time point to introduce palliative care in YOD remains controversial. We performed a systematic review to summarize key issues surrounding palliative care in YOD and highlight unmet needs in this pertinent area. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed database for all studies published between January 2000 and July 2022 that reported on palliative care in YOD. RESULTS Of 32 records identified, 8 articles were eligible for inclusion. The top 3 themes extracted centered around (1) clinical differences between YOD and LOD, (2) symptoms and causes of death in end-stage YOD, and (3) the importance of early advanced care planning (ACP). YOD diagnosis is often delayed and persons with YOD have fewer somatic comorbidities but more neuropsychiatric symptoms, longer survival times, and a more malignant disease course. Persons with YOD and their families face unique psychosocial challenges when symptoms start at a younger age. End-stage YOD is not dissimilar to LOD where patients suffer from a broad spectrum of physical and psychological symptoms requiring palliation. Early initiation of ACP discussion is crucial in YOD given the more rapid progression of disease affecting cognition and decision-making capacity; however, rates of ACP completion in YOD remain low. CONCLUSIONS Given the complex care needs and more rapid disease trajectory in YOD, palliative care in YOD should be considered from the time of diagnosis, and to be incorporated into routine dementia care.
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Affiliation(s)
- Jiaojiao Dang
- Department of Neurology, National Neuroscience Institute, Singapore.
| | - Alisa Cui Wen Yong
- Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
| | - Zhi Hui Fong
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Adeline Su Lyn Ng
- Department of Neurology, National Neuroscience Institute, Singapore; Neuroscience and Behavioural Disorders Unit, Duke-NUS Medical School, Singapore
| | - Kexin Ang
- Department of Neurology, National Neuroscience Institute, Singapore
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2
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Mohamed A, Salman B, Shaikh AJ. Evaluating the clinical benefit of pembrolizumab as a first-line agent in advanced solid tumors: A comprehensive review. J Oncol Pharm Pract 2024:10781552241252100. [PMID: 38710475 DOI: 10.1177/10781552241252100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
INTRODUCTION The study evaluates the first-line application of pembrolizumab in metastatic non-small-cell lung cancer (mNSCLC), head and neck squamous cell cancer (HNSCC), gastric cancer, and renal cell carcinoma. Utilizing the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) and the American Society of Clinical Oncology Value Framework (ASCO-VF), the analysis incorporates data from pivotal KEYNOTE trials. METHODS The study systematically assessed the clinical benefit of pembrolizumab in advanced solid malignancies through nine randomized controlled trials, one of which comprised two experimental arms. Data extraction from primary sources was conducted from PubMed, ASCO, and ESMO publications. Utilizing ESMO-MCBS and ASCO-VF forms, the evaluation focused on clinical benefit, toxicity, and bonus points, with discrepancies resolved through consensus discussions. RESULTS Nine first-line indications for pembrolizumab received Food and Drug Administration approval for metastatic solid tumors between 2018 and 2023. Notable distinctions in ESMO-MCBS grades revealed seven trials with substantial clinical benefit (grades 5 to 4) and three with moderate to negligible benefit (grades 3 to 1). Bonus points, primarily based on the tail of the curve, were allocated to three trials for overall survival, one for progression-free survival, and one for a significant improvement in quality of life. CONCLUSIONS Our evaluation of pembrolizumab across diverse cancers, especially in mNSCLC and HNSCC, revealed varied outcomes and challenges in clinical benefit interpretation. The assessment of clinical benefit, incorporating quantitative and qualitative endpoints, underscores the need to consider survivorship outcomes and patient perspectives for a comprehensive understanding.
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Affiliation(s)
- Amna Mohamed
- Department of Pharmacy, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
| | - Bushra Salman
- Department of Pharmacy, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
| | - Asim Jamal Shaikh
- Department of Medical Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
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3
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Chutarattanakul L, Jarusukthavorn V, Dejkriengkraikul N, Oo MZ, Tint SS, Angkurawaranon C, Wiwatkunupakarn N. Misconception between palliative care and euthanasia among Thai general practitioners: a cross-sectional study. BMC Palliat Care 2024; 23:96. [PMID: 38600512 PMCID: PMC11007896 DOI: 10.1186/s12904-024-01430-6] [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: 01/04/2024] [Accepted: 04/08/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Palliative care lower medical expenses and enhances quality of life, but misconception with euthanasia delays timely care and makes inappropriate patient management. OBJECTIVE To examine the magnitude of misconceptions between palliative care and euthanasia among Thai general practitioners, explore the association with knowledge, attitudes, and practical experience, and assess the association between misconception and confidence in practicing and referring patients to palliative care centers. METHODS All 144 general practitioners who were going to start residency training at Maharaj Nakorn Chiang Mai Hospital in 2021 participated in this observational cross-sectional study. A chi-square test was utilized to examine the relationship between misconception and knowledge, attitude, practical experience, confidence to practice, and confidence to refer patients. Multivariable logistic regression was carried out while controlling for age, sex, knowledge, attitude, and experience to examine the relationship between misconception and confidence to practice and refer patients for palliative care. Statistical significance was defined at p < 0.05. RESULTS About 41% of general physicians had misconceptions regarding palliative care and euthanasia. High knowledge was associated with a lower level of misconception (p = 0.01). The absence of misconceptions was weakly associated with a higher level of confidence in practicing palliative care, with an adjusted odds ratio of 1.51 (95% confidence interval 0.73 to 3.10, p = 0.07). CONCLUSION High misconception rates between palliative care and euthanasia among young Thai physicians might impact their confidence in delivering palliative care. Training initiatives for medical students and practitioners can mitigate misconceptions, fostering better palliative care utilization in Thailand.
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Affiliation(s)
- Lalita Chutarattanakul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
| | - Viriya Jarusukthavorn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
| | - Nisachol Dejkriengkraikul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
| | - Myo Zin Oo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Soe Sandi Tint
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang, Chiang Mai, 50200, Thailand.
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand.
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Johnston BM, Miller M, Normand C, Cardona M, May P, Lowney AC. Primary data on symptom burden and quality of life among elderly patients at risk of dying during unplanned admissions to an NHS hospital: a cohort study using EuroQoL and the integrated palliative care outcome scale. BMC Palliat Care 2024; 23:46. [PMID: 38374101 PMCID: PMC10877897 DOI: 10.1186/s12904-024-01384-9] [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: 11/29/2023] [Accepted: 02/15/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Older people account heavily for palliative care needs at the population level and are growing in number as the population ages. There is relatively little high-quality data on symptom burden and quality of life, since these data are not routinely collected, and this group are under-recruited in primary research. It is unclear which measurement tools are best suited to capture burdens and experience. METHODS We recruited a cohort of 221 patients aged 75 + years with poor prognosis who had an unplanned admission via the emergency department in a large urban hospital in England between 2019 and 2020. Risk of dying was assessed using the CriSTAL tool. We collected primary data and combined these with routine health records. Baseline clinical data and patient reported quality of life outcomes were collected on admission and reassessed within the first 72 h of presentation using two established tools: EQ-5D-5 L, EQ-VAS and the Integrated Palliative Outcomes Scale (IPOS). RESULTS Completion rate was 68% (n = 151) and 33.1% were known to have died during admission or within 6 months post-discharge. The vast majority (84.8%) reported severe difficulties with at least one dimension of EQ-5D-5 L at baseline and improvements in EQ-VAS observed at reassessment in 51.7%. The baseline IPOS revealed 78.2% of patients rating seven or more items as moderate, severe or overwhelming, but a significant reduction (-3.6, p < 0.001) in overall physical symptom severity and prevalence was also apparent. No significant differences were noted in emotional symptoms or changes in communication/practical issues. IPOS total score at follow up was positively associated with age, having comorbidities (Charlson index score > = 1) and negatively associated with baseline IPOS and CriSTAL scores. CONCLUSION Older people with poor prognosis admitted to hospital have very high symptom burden compared to population norms, though some improvement following assessment was observed on all measures. These data provide valuable descriptive information on quality of life among a priority population in practice and policy and can be used in future research to identify suitable interventions and model their effects.
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Affiliation(s)
- Bridget M Johnston
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland.
| | - Mary Miller
- Department of Palliative Care, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Nuffield Department of Medicine, Oxford University, Oxford, England
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, England
| | - Magnolia Cardona
- Faculty of Health and Behavioural Sciences, School of Psychology, The University of Queensland, Brisbane, Australia
- Institute for Evidence Based Healthcare, Bond University, Gold Coast, Australia
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, England
| | - Aoife C Lowney
- Department of Palliative Care, Marymount University Hospital and Hospice and Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
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Sørensen DM, Dalton SO, Egholm CL, Bidstrup P, Brodersen JB, Rosted E. Barriers and facilitators to national guideline implementation for palliative cancer care in a Danish cross-sectoral healthcare setting: A qualitative study of healthcare professionals' experiences. Psychooncology 2024; 33:e6267. [PMID: 38078707 DOI: 10.1002/pon.6267] [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: 09/28/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Patients with incurable cancer should receive general palliative care according to their needs, as provided through collaboration between hospital departments, municipalities, and general practices and as outlined in national guidelines. However, the implementation of general palliative care in Denmark has been inadequate. This study aimed to investigate the healthcare professionals' (HCPs') perceptions on barriers to and facilitators of the implementation of the Danish National Guideline (NG) for general palliative care. METHODS This descriptive, qualitative study was guided by the Consolidated Framework for Implementation Research (CFIR). Qualitative focus group and individual interviews were conducted with 23 HCPs. The interview guide, coding, analysis, and reporting of findings were developed within the CFIR framework. RESULTS The main barriers to implementing NG were as follows: lack of knowledge about the NG, lack of an implementation plan, and insufficient communication and collaboration across sectors. Important facilitators were as follows: HCP motivation to meet palliative care needs, HCPs with special functions taking responsibility for incorporating NG into local guidelines, and the role of district nurses specialised in palliative care as opinion leaders providing security and continuity for the HCPs working in palliative care. CONCLUSIONS To address the needs of patients with incurable cancer, greater efforts are required on implementing general palliative care. Although HCPs in our setting were motivated to improve NG implementation, financial resources and strategies are necessary to ensure sufficient knowledge uptake and accommodate identified barriers in order to translate the NG into practice.
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Affiliation(s)
- Dina Melanie Sørensen
- Danish Research Center for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Susanne Oksbjerg Dalton
- Danish Research Center for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health, Copenhagen University, Copenhagen, Denmark
| | - Cecilie Lindström Egholm
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pernille Bidstrup
- Psychological Aspects of Cancer, Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - John Brandt Brodersen
- The Centre of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
- Research Unit for General Practice, Region Zealand, Denmark
- Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT Arctic University of Norway, Tromsø, Norway
| | - Elizabeth Rosted
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Bos – van den Hoek DW, Smets EMA, Ali R, Tange D, van Laarhoven HWM, Henselmans I. Through the Eyes of Patients: The Effect of Training General Practitioners and Nurses on Perceived Shared Decision-Making Support. Med Decis Making 2024; 44:76-88. [PMID: 37876223 PMCID: PMC10714703 DOI: 10.1177/0272989x231203693] [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: 02/04/2023] [Accepted: 08/25/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE To examine the effects of training general practitioners and nurses in shared decision-making (SDM) support as perceived by cancer patients and survivors. DESIGN An innovative, experimental design was adopted that included analogue patients (APs), that is, people who have or have had cancer and who imagine themselves in the position of the actor-patient presented in a video. Each AP assessed a video-recorded simulated consultation of a health care professional (HCP) conducted before or after an SDM support training program. The primary outcome was the APs' perceived SDM support with 13 self-developed items reflecting the perceived patient benefit of SDM support as well as the perceived HCP support behavior. Secondary outcomes included an overall rating of SDM support, AP-reported extent of SDM (CollaboRATE), satisfaction with the communication (Patient Satisfaction Questionnaire), conversation appreciation and helpfulness, as well as decision-making satisfaction and confidence (visual analog scale, 0-100). In addition, patient and HCP characteristics associated with AP-perceived SDM support were examined. RESULTS APs (n = 131) did not significantly differentiate trained from untrained HCPs in their perceptions of SDM support nor in secondary outcomes. Agreement between APs' perceptions was poor. The higher the perceived comparability of the consultation with APs' previous personal experiences, the higher their rating of SDM support. LIMITATIONS We used a nonvalidated primary outcome and an innovative study design that should be tested in future work. CONCLUSIONS Despite the limitations of the study design, the training seemed to not affect cancer patients' and survivors' perceived SDM support. IMPLICATIONS The clinical relevance of the training on SDM support needs to be established. The variation in APs' assessments suggests patients differ in their perception of SDM support, stressing the importance of patient-tailored SDM support. HIGHLIGHTS Cancer patients and survivors did not significantly differentiate trained from untrained HCPs when evaluating SDM support, and agreement between their perceptions was poor.The clinical relevance of training GPs and nurses in SDM support needs to be established.Patient-tailored SDM support may be recommended, given the variation in APs' assessments and their possible diverging perceptions of SDM support.This innovative study design (having patients watch and assess videos of simulated consultations made in the context of training evaluation) needs to be further developed.
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Affiliation(s)
- Danique W. Bos – van den Hoek
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care Program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Ellen M. A. Smets
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care Program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Rania Ali
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Dorien Tange
- Dutch Federation of Cancer Patient Organizations (NFK), Utrecht, The Netherlands
| | - Hanneke W. M. van Laarhoven
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Medical Oncology, Amsterdam, The Netherlands
| | - Inge Henselmans
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care Program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Department of General Practice, Amsterdam, The Netherlands
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Osagiede O, Nayar K, Raimondo M, Kumbhari V, Lukens FJ. The Determinants of Inpatient Palliative Care Use in Patients With Pancreatic Cancer. Am J Hosp Palliat Care 2023:10499091231218257. [PMID: 37991926 DOI: 10.1177/10499091231218257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Symptom burden management is a major goal of pancreatic cancer care given that most patients are diagnosed late. Early palliative care is recommended in addition to concurrent active treatment; however, disparities exist. We sought to determine the factors associated with inpatient palliative treatment among pancreatic cancer patients and compare treatment outcomes in terms of mortality, discharge disposition and resource utilization. METHODS We conducted a retrospective study of 22,053 pancreatic cancers using the National Inpatient Sample (NIS) database (January - December 2020). Patient and hospital characteristics, mortality, discharge disposition, length of stay (LOS), hospital costs and charges were compared between pancreatic cancer patients based on palliative treatment. Multivariate regression was used to evaluate patient and hospital characteristics and outcomes associated with palliative treatment. RESULTS A total number of 3839 (17.4%) patients received palliative care. Patients who received palliative care were more likely to be older, Medicaid insured, and nonobese. Patients were less likely to receive palliative care if they are males, Medicare insured, had a lower Charlson comorbidity score, or treated in Urban nonteaching hospitals. Patients who received palliative care displayed higher odds of in-hospital mortality and prolonged LOS. The adjusted additional mean hospital cost and charges in patients who received palliative care were lower by $1459, and $4222 respectively. CONCLUSIONS Inpatient palliative treatment in pancreatic cancer patients is associated with an older age, a higher comorbidity burden, non-obesity, insurance status and urban teaching hospitals. Our study suggests that inpatient palliative treatment decreased hospital resource utilization without prolonging survival.
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Affiliation(s)
- Osayande Osagiede
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Kapil Nayar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Massimo Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Frank J Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Satheeshkumar PS, Pili R, Epstein JB, Thazhe SBK, Sukumar R, Mohan MP. Characteristics and predictors associated with cancer-related fatigue among solid and liquid tumors. J Cancer Res Clin Oncol 2023; 149:13875-13888. [PMID: 37540252 DOI: 10.1007/s00432-023-05197-w] [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] [Received: 06/11/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Cancer-related fatigue (CRF) is a devastating complication with limited recognized clinical risk factors. We examined characteristics among solid and liquid cancers utilizing Machine learning (ML) approaches for predicting CRF. METHODS We utilized 2017 National Inpatient Sample database and employed generalized linear models to assess the association between CRF and the outcome of burden of illness among hospitalized solid and non-solid tumors patients. And further applied lasso, ridge and Random Forest (RF) for building our linear and non-linear ML models. RESULTS The 2017 database included 196,330 prostate (PCa), 66,385 leukemia (Leuk), 107,245 multiple myeloma (MM), and 41,185 cancers of lip, oral cavity and pharynx (CLOP) patients, and among them, there were 225, 140, 125 and 115 CRF patients, respectively. CRF was associated with a higher burden of illness among Leuk and MM, and higher mortality among PCa. For the PCa patients, both the test and the training data had best areas under the ROC curve [AUC = 0.91 (test) vs. 0.90 (train)] for both lasso and ridge ML. For the CLOP, this was 0.86 and 0.79 for ridge; 0.87 and 0.84 for lasso; 0.82 for both test and train for RF and for the Leuk cohort, 0.81 (test) and 0.76 (train) for both ridge and lasso. CONCLUSION This study provided an effective platform to assess potential risks and outcomes of CRF in patients hospitalized for the management of solid and non-solid tumors. Our study showed ML methods performed well in predicting the CRF among solid and liquid tumors.
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Affiliation(s)
- Poolakkad S Satheeshkumar
- Division of Hematology and Oncology, Department of Medicine, University at Buffalo, Buffalo, NY, 14203, USA.
| | - Roberto Pili
- Division of Hematology and Oncology, Department of Medicine, University at Buffalo, Buffalo, NY, 14203, USA
| | - Joel B Epstein
- City of Hope Comprehensive Cancer Center, Duarte CA and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical System, Los Angeles, CA, USA
| | | | - Rhine Sukumar
- Naseem Al Rabeeh Medical Center, C Ring Road, Doha, Qatar
| | - Minu Ponnamma Mohan
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Yeo SL, Ng RHL, Peh TY, Lwin MO, Chong PH, Neo PSH, Zhou JX, Lee A. Public sentiments and the influence of information-seeking preferences on knowledge, attitudes, death conversation, and receptiveness toward palliative care: results from a nationwide survey in Singapore. Palliat Care Soc Pract 2023; 17:26323524231196311. [PMID: 37719387 PMCID: PMC10504834 DOI: 10.1177/26323524231196311] [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: 10/04/2022] [Accepted: 08/03/2023] [Indexed: 09/19/2023] Open
Abstract
Background Low awareness about palliative care among the global public and healthcare communities has been frequently cited as a persistent barrier to palliative care acceptance. Given that knowledge shapes attitudes and encourages receptiveness, it is critical to examine factors that influence the motivation to increase knowledge. Health information-seeking from individuals and media has been identified as a key factor, as the process of accessing and interpreting information to enhance knowledge has been shown to positively impact health behaviours. Objective Our study aimed to uncover public sentiments toward palliative care in Singapore. A conceptual framework was additionally developed to investigate the relationship between information-seeking preferences and knowledge, attitudes, receptiveness of palliative care, and comfort in death discussion. Design and Methods A nationwide survey was conducted in Singapore with 1226 respondents aged 21 years and above. The data were analysed through a series of hierarchical multiple regression to examine the hypothesised role of information-seeking sources as predictors. Results Our findings revealed that 53% of our participants were aware of palliative care and about 48% were receptive to receiving the care for themselves. It further showed that while information-seeking from individuals and media increases knowledge, attitudes and receptiveness to palliative care, the comfort level in death conversations was found to be positively associated only with individuals, especially healthcare professionals. Conclusion Our findings highlight the need for public health authorities to recognize people's deep-seated beliefs and superstitions surrounding the concept of mortality. As Asians view death as a taboo topic that is to be avoided at all costs, it is necessary to adopt multipronged communication programs to address those fears. It is only when the larger communicative environment is driven by the media to encourage public discourse, and concurrently supported by timely interventions to trigger crucial conversations on end-of-life issues between individuals, their loved ones, and the healthcare team, can we advance awareness and benefits of palliative care among the public in Singapore.
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Affiliation(s)
- Su Lin Yeo
- Associate Professor, Lee Kong Chian School of Business, Singapore Management University, 50 Stamford Road, 178899, Singapore
| | - Raymond Han Lip Ng
- Senior Consultant, Palliative and Supportive Care, Woodlands Health Singapore
| | - Tan-Ying Peh
- Senior Consultant, Division of Supportive & Palliative Care, National Cancer Centre Singapore & Clinical Director at Assisi Hospice, Singapore
| | - May O. Lwin
- Professor, Wee Kim Wee School of Communication & Information, Nanyang Technological University Singapore, Singapore
| | - Poh-Heng Chong
- Medical Director, HCA Hospice Care & Vice Chair, Singapore Hospice Council, Singapore
| | - Patricia Soek Hui Neo
- Senior Consultant & Head, Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jamie Xuelian Zhou
- Consultant, Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Angel Lee
- Medical Director, St Andrew’s Community Hospital, Singapore
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Chowdhury MK, Saikot S, Farheen N, Ahmad N, Alam S, Connor SR. Impact of Community Palliative Care on Quality of Life among Cancer Patients in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6443. [PMID: 37568985 PMCID: PMC10418368 DOI: 10.3390/ijerph20156443] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Abstract
Cancer, a leading cause of mortality worldwide, is often diagnosed at late stages in low- and middle-income countries, resulting in preventable suffering. When added to standard oncological care, palliative care may improve the quality of life (QOL) of these patients. A longitudinal observational study was conducted from January 2020 to December 2021. Thirty-nine cancer patients were enrolled in the Compassionate Narayanganj community palliative care group (NPC), where they received comprehensive palliative care in addition to oncological care. Thirty-one patients from the Dept. of Oncology (DO) at BSMMU received standard oncological care. In contrast to the DO group, the NPC group had a higher percentage of female patients, was older, and had slightly higher levels of education. At 10 to 14 weeks follow-up, a significant improvement in overall QOL was observed in the NPC group (p = 0.007), as well as in the psychological (p = 0.003), social (p = 0.002), and environmental domains (p = 0.15). Among the secondary outcomes, the palliative care group had reduced disability and neuropathic pain scores. Additionally, there were statistically significant reductions in pain, drowsiness, and shortness of breath, as well as an improvement in general wellbeing, based on the results of the Edmonton Symptom Assessment Scale-Revised. At the community level in Bangladesh, increased access to palliative care may improve cancer patient outcomes such as QOL and symptom burden.
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Affiliation(s)
- Mostofa Kamal Chowdhury
- Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh; (M.K.C.); (N.F.); (N.A.)
| | - Shafiquejjaman Saikot
- Compassionate Narayanganj (Community-Based Palliative Care Project), c/o Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh;
| | - Nadia Farheen
- Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh; (M.K.C.); (N.F.); (N.A.)
| | - Nezamuddin Ahmad
- Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh; (M.K.C.); (N.F.); (N.A.)
| | - Sarwar Alam
- Department of Clinical Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh;
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11
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Bagheri S, Barkhordari-Sharifabad M. Translation and psychometric validation of the Persian version of palliative care attitudes scale in cancer patients. BMC Palliat Care 2023; 22:95. [PMID: 37460923 DOI: 10.1186/s12904-023-01223-3] [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: 03/27/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION To improve cancer patients' quality of life, palliative care is necessary. The growth of palliative care, along with the assistance of the government and the collaboration of specialists, also relies on the knowledge and attitude of people. In Iran, there is no tool available to gauge patient attitudes about palliative treatment. The Persian version of the Palliative Care Attitude Scale (PCAS-9) was translated and psychometrically validated in this research among cancer patients. METHODS This methodological study was conducted in two stages: translation stage and psychometric validation stage. The method of translation was based on that proposed by Polit and Yang. Utilizing a qualitative approach, the scale's face and content validity were investigated. 162 cancer patients who required palliative care based on expert diagnosis participated in the confirmatory factor analysis to establish construct validity. Stability and internal consistency provided evidence of reliability. The data was examined using SPSS18 and AMOS. RESULTS The "Palliative Care Attitudes Scale" translated well across cultures. Validity on both the face and the content was acceptable. Confirmatory factor analysis (CFA) revealed a good fit for the original three-factor structure. The intra-class correlation coefficient (ICC) was equal to 0.89, while the internal consistency (Cronbach's alpha) reliability of the whole scale was equal to 0.77. CONCLUSIONS Persian version of the "Palliative Care Attitudes Scale" was acceptable and adequate in cancer patients. Using this tool makes it easier to assess how patients feel about receiving palliative care and how well training sessions are working to change patients' views.
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Affiliation(s)
- Sajjad Bagheri
- Department of Nursing, School of Medical Sciences, Yazd Branch, Islamic Azad University, Yazd, Iran
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12
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Gandhi AK, Rastogi M, Rath GK. Translational cancer research in India: Challenges and Promises. J Cancer Res Ther 2023; 19:526-529. [PMID: 37470569 DOI: 10.4103/jcrt.jcrt_1248_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ajeet Kumar Gandhi
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Madhup Rastogi
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Goura Kishor Rath
- Head, National Cancer Institute (2nd Campus AIIMS, Jhajjar, Haryana) & Chief, DRBRAIRCH, Professor, Radiation Oncology, All India Institute of Medical Sciences, New Delh, India
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13
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Brites MA, Gonçalves J, Rego F. Admission to the Emergency Department by Patients Being Followed up for Palliative Care Consultations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15204. [PMID: 36429920 PMCID: PMC9690894 DOI: 10.3390/ijerph192215204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Palliative care aims to improve the quality of life of patients and families facing life-threatening diseases. Admissions to the emergency department are considered potentially avoidable. This study aims to characterize the use of the emergency department by palliative care patients at a public hospital in Portugal. METHODS This retrospective study included patients who had their first palliative care appointment during the year 2019; 135 patients were included, with 255 admissions to the emergency department. Descriptive statistical analysis consisted of calculating the absolute (n) and relative (%) frequencies for categorical variables and medians (Mdn) and percentiles (P25 and P75) for continuous variables. The multivariable associations were calculated via logistic models, with the statistical significance set to p < 0.05 and 95% confidence intervals. RESULTS Dying in hospital was associated with going to the emergency department. Patients who died in hospital had more admissions and spent more time there. CONCLUSION Emergency department admissions suggest that there are gaps in the provision of care. It is necessary to anticipate crisis situations, provide home and telephone appointments, and invest in professionals' education to respond to the needs that will grow in the future.
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Affiliation(s)
- Mariana Azevedo Brites
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Family Health Unit Corino de Andrade, Póvoa de Varzim, 4490-602 Póvoa de Varzim, Portugal
| | - Joana Gonçalves
- Póvoa de Varzim—Vila do Conde Hospital Center, 4490-421 Póvoa de Varzim, Portugal
| | - Francisca Rego
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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14
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Fhoula B, Hadid M, Elomri A, Kerbache L, Hamad A, Al Thani MHJ, Al-Zoubi RM, Al-Ansari A, Aboumarzouk OM, El Omri A. Home Cancer Care Research: A Bibliometric and Visualization Analysis (1990-2021). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13116. [PMID: 36293702 PMCID: PMC9603182 DOI: 10.3390/ijerph192013116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Home cancer care research (HCCR) has accelerated, as considerable attention has been placed on reducing cancer-related health costs and enhancing cancer patients' quality of life. Understanding the current status of HCCR can help guide future research and support informed decision-making about new home cancer care (HCC) programs. However, most current studies mainly detail the research status of certain components, while failing to explore the knowledge domain of this research field as a whole, thereby limiting the overall understanding of home cancer care. We carried out bibliometric and visualization analyses of Scopus-indexed papers related to home cancer care published between 1990-2021, and used VOSviewer scientometric software to investigate the status and provide a structural overview of the knowledge domain of HCCR (social, intellectual, and conceptual structures). Our findings demonstrate that over the last three decades, the research on home cancer care has been increasing, with a constantly expanding stream of new papers built on a solid knowledge base and applied to a wide range of research themes.
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Affiliation(s)
- Boutheina Fhoula
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Majed Hadid
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Adel Elomri
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Laoucine Kerbache
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Anas Hamad
- Pharmacy Department, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha 3050, Qatar
| | | | - Raed M. Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha 2713, Qatar
- Department of Chemistry, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Abdulla Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- College of Medicine, QU-Health, Qatar University, Doha 2713, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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15
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Kaiser U, Vehling-Kaiser U, Hoffmann A, Kaiser F. Inpatient Hospices in Germany: Medical Care Situation and Use of Supportive Oncological Therapies for Symptom Control in Tumor Patients. Palliat Med Rep 2022; 3:169-180. [PMID: 36059908 PMCID: PMC9438444 DOI: 10.1089/pmr.2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background: More than 80% of the residents in German hospices suffer from tumor disease. But the administration of supportive-oncological therapies in hospices for symptom control is controversially discussed. Objectives: This study aims to investigate the care situation of tumor patients in German hospices with regard to medical care and the use of supportive-oncological therapies. Methods: In February 2019, all hospices in Germany were offered the opportunity to participate in an anonymous online survey on medical and drug care for their tumor patients. The survey was conducted using the online platform SoSci Survey and ended in April 2019. The analysis was descriptive. Results: Of 202 hospices, 112 responded to the questionnaire. The hospices were distributed nationwide. Most have 8 to 10 places. More than 80% of hospice residents are tumor patients, and the length of stay is usually three to four weeks. Medical care is primarily provided by primary care physicians. While specialized outpatient palliative care is increasingly involved in care, hematologists/oncologists are rarely represented. Supportive-oncological therapies are rarely prescribed, whereas medication for other chronic conditions is often continued. The percentage of supportive-oncological therapies prescribed is higher in hospices with oncology co-care. Conclusions: Although most hospice residents suffer from malignant disease, co-care by a hematologist/oncologist is rare. Supportive-oncology therapies, particularly for symptom relief, may therefore be rarely used. However, since a small select group of hospice residents may benefit from these therapies, further investigation in this direction should be undertaken.
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Affiliation(s)
- Ulrich Kaiser
- Clinic and Polyclinic for Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Florian Kaiser
- Oncology/Palliative Care Network Landshut, Landshut, Germany
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
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16
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Wu A, Ugiliweneza B, Wang D, Hsin G, Boakye M, Skirboll S. Trends and outcomes of early and late palliative care consultation for adult patients with glioblastoma: A SEER-Medicare retrospective study. Neurooncol Pract 2022; 9:299-309. [PMID: 35859543 PMCID: PMC9290893 DOI: 10.1093/nop/npac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Glioblastoma (GBM) carries a poor prognosis despite standard of care. Early palliative care (PC) has been shown to enhance survival and quality of life while reducing healthcare costs for other cancers. This study investigates differences in PC timing on outcomes for patients with GBM. Methods This study used Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1997 to 2016. Based on ICD codes, three groups were defined: (1) early PC within 10 weeks of diagnosis, (2) late PC, and (3) no PC. Outcomes were compared between the three groups. Results Out of 10 812 patients with GBM, 1648 (15.24%) patients had PC consultation with an overall positive trend over time. There were no significant differences in patient characteristics. The late PC group had significantly higher number of hospice claims (1.06 ± 0.69) compared to those without PC, in the last month of life. There were significant differences in survival among the three groups (P < .0001), with late PC patients with the longest mean time to death from diagnosis (11.72 ± 13.20 months). Conclusion We present the first investigation of PC consultation prevalence and outcomes, stratified by early versus late timing, for adult GBM patients. Despite an overall increase in PC consultations, only a minority of GBM patients receive PC. Patients with late PC had the longest survival times and had greater hospice use in the last month of life compared to other subgroups. Prospective studies can provide additional valuable information about this unique population of patients with GBM.
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Affiliation(s)
- Adela Wu
- Department of Neurosurgery, Stanford University, Palo Alto, California, USA
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Dengzhi Wang
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Gary Hsin
- Department of Extended Care and Palliative Medicine Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Maxwell Boakye
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Stephen Skirboll
- Department of Neurosurgery, Stanford University, Palo Alto, California, USA
- Section of Neurosurgery, VA Palo Alto Health Care System, Palo Alto, California, USA
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Fürst P, Strang P, Hedman C, Schultz T. Advanced cancer and concomitant dementia: access to specialized palliative care, emergency room, hospital care, and place of death. Acta Oncol 2022; 61:874-880. [PMID: 35411838 DOI: 10.1080/0284186x.2022.2062681] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dementia and advanced cancer are complex, life-limiting conditions that benefit from specialized palliative care (SPC) interventions at the end of life. The objective was to study possible differences in care for patients with concomitant advanced cancer and dementia (CA-DEM) or cancer only (CA) regarding access to SPC, acute hospital care, and place of death. MATERIALS AND METHODS A retrospective observational registry study on health care consumption data from the Stockholm Regional Council involving logistic regression analyses of age, sex, living arrangements, comorbidities, dementia diagnosis, and socio-economic status. RESULTS Of the 12,667 persons aged ≥65 years who died from advanced cancer between 2015 and 2019, 605 had concomitant dementia. Of these, 76% of patients with CA and 42% of patients with CA-DEM had access to SPC (p<.0001). There were more admissions to palliative care for persons not living in nursing homes (p<.0001), women (p<.0001), socioeconomically privileged patients (p<.05), those with fewer comorbidities (p<.0001), and younger patients (<85 years) (p<.0001). Access to SPC reduced ER visits, hospitalizations, and acute hospital deaths for CA, whereas access to SPC only reduced hospital deaths in the CA-DEM group. CONCLUSIONS The probability of being admitted to SPC was lower in cancer patients with known dementia. Access to SPC reduced emergency room visits and acute admissions to hospitals for the whole group, and hospital deaths both for CA and CA-DEM.
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Affiliation(s)
- Per Fürst
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Peter Strang
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Regional Cancer Centre in Stockholm, Gotland, Sweden
| | - Christel Hedman
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences Lund, Division of Palliative Care, Lund University, Lund, Sweden
| | - Torbjörn Schultz
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Formagini T, Poague C, O'Neal A, Brooks JV. "When I Heard the Word Palliative": Obscuring and Clarifying Factors Affecting the Stigma Around Palliative Care Referral in Oncology. JCO Oncol Pract 2022; 18:e72-e79. [PMID: 34310185 PMCID: PMC8758121 DOI: 10.1200/op.21.00088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Palliative care (PC) can help patients with cancer manage symptoms and achieve a greater quality of life. However, there are many barriers to patients with cancer receiving referrals to PC, including the stigmatizing association of PC with end of life. This study explores factors that obscure or clarify the stigma around PC referrals and its associations with end of life in cancer care. METHODS A qualitative descriptive design using grounded theory components was designed to investigate barriers to PC referrals for patients receiving treatment at an outpatient cancer center. Interviews with patients, caregivers, and oncology professionals were audio-recorded, transcribed, and independently coded by three investigators to ensure rigor. Participants were asked about their perceptions of PC and PC referral experiences. RESULTS Interviews with 44 participants revealed both obscuring and clarifying factors surrounding the association of PC as end of life. Prognostic uncertainty, confusion about PC's role, and social network influence all perpetuated an inaccurate and stigmatizing association of PC with end of life. Contrarily, familiarity with PC, prognostic confidence, and clear referral communication helped delineate PC as distinct from end of life. CONCLUSION To reduce the stigmatizing association of PC with end of life, referring clinicians should clearly communicate prognosis, PC's role, and the reason for referral within the context of each patient and his or her unique cancer trajectory. The oncology team plays a vital role in framing the messaging surrounding referrals to PC.
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Affiliation(s)
- Taynara Formagini
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Claire Poague
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Alicia O'Neal
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS,University of Kansas Cancer Center, Kansas City, KS,Joanna Veazey Brooks, MBE, PhD, 3901 Rainbow Blvd, Mail Stop 3044, Kansas City, KS 66106; e-mail:
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Wantonoro W, Suryaningsih EK, Anita DC, Nguyen TV. Palliative Care: A Concept Analysis Review. SAGE Open Nurs 2022; 8:23779608221117379. [PMID: 35966230 PMCID: PMC9364202 DOI: 10.1177/23779608221117379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Palliative care is critically important for the world’s aging population and can change illness trajectories and promote advances in health care technologies. As health care team members, nurses have the most contact with palliative care patients. However, misconceptions about which patients need to receive palliative care may be an obstacle to meeting patients’ needs for palliative care. Objectives This study aimed to describe preceding events, characteristics and outcomes of patients in palliative care according to current concept analysis studies. Methods A literature review was conducted. Inclusion criteria were: (1) concept analysis studies, (2) use of the term palliative care or palliative nursing care, (3) palliative care explanation including antecedents, attributes, and consequences, and (4) articles written in English published between 2004 and 2021. Results Four concept analysis studies on palliative care were included in this review. Palliative care was described as an approach to alleviating physical and psychological suffering and improving patients’ and families’ quality of life in the early stages of diagnosed illness. Terminal illnesses, acute or chronic diseases, and actual or potentially life-threatening illnesses were confirmed as the events preceding palliative care. Characteristics of palliative care include holistic care, interdisciplinary teamwork, and compassionate, patient- and family-centered care. Improved patient and family quality of life, enhanced human dignity, improved self-care, and strengthened coping abilities are outcomes of palliative care. Conclusions/Implications for Practice Palliative care is a concept that is related to the early stage of an illness, the timing of illness diagnosis, and the onset of symptoms. Including palliative care terms in nursing education and training and developing palliative care models in clinical practice are recommended to ensure nurses understand the services of the palliative care needs of patients and their families. Future reviews, including grounded qualitative studies on the concept of palliative care, are recommended.
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Affiliation(s)
- Wantonoro Wantonoro
- Department of Nursing, Universitas ‘Aisyiyah Yogyakarta, Yogyakarta, Indonesia
| | | | - Diyah Chandra Anita
- Department of Nursing, Universitas ‘Aisyiyah Yogyakarta, Yogyakarta, Indonesia
| | - Tuan Van Nguyen
- Department of Nursing, Faculty of Nursing and Medical Technology, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
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Gemmell R, Halley A, Stevens AM, Allam A, Perkins M, Ethell M, Sriskandarajah P, Droney J. Palliative care for patients around the time of haematopoietic stem cell transplant: a qualitative study of patients' perceptions and experiences of unmet need and attitudes towards palliative care involvement. Support Care Cancer 2021; 30:2253-2261. [PMID: 34716484 DOI: 10.1007/s00520-021-06556-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Haemato-oncology patients are likely to be referred later to palliative care than patients with solid tumours, despite experiencing similar symptom burden. Patients prior to stem cell transplant may benefit from symptom control, advance care planning and shared decision-making, and previous studies have demonstrated feasibility and benefit of such a service. However, the views of patients are not yet established, and are vital to ensure acceptability of the service. AIMS To identify areas where a palliative care team may help to support patients being considered for a stem cell transplant, and to explore the attitudes and perceptions of patients towards palliative care at this time. DESIGN A qualitative study including interviews (N = 12) and a focus group (N = 4) for patients pre- and post-transplant, using a semi-structured format via telephone, online video-conferencing and face-to-face discussions. Recordings were transcribed and analysed using thematic analysis. SETTING A tertiary cancer centre in the UK. FINDINGS Themes identified were the following: Identified needs, Information and decision-making, Importance of relationships, Changing perceptions of what palliative care means, and The future. Patients associate palliative care with terminal care due to indirect experiences. Patients were open to palliative care once its purpose was explained and described emotional and physical needs relevant to early palliative care. CONCLUSIONS The involvement of early palliative care alongside haematology treatment prior to stem cell transplant may improve quality of life for patients and facilitate shared decision-making at a crucial stage of treatment. Early palliative care should be offered alongside haematology care around the time of stem cell transplant, with information provided to patients regarding its role.
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Affiliation(s)
- Rebecca Gemmell
- Palliative Care Department, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
| | - Angela Halley
- Palliative Care Department, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Anna-Marie Stevens
- Palliative Care Department, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Alison Allam
- Public and Patient Representative, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Margaret Perkins
- Public and Patient Representative, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Mark Ethell
- Haematology Department, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Priya Sriskandarajah
- Haematology Department, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Joanne Droney
- Palliative Care Department, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
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Quality of End-of-Life Care for People with Advanced Non-Small Cell Lung Cancer in Ontario: A Population-Based Study. ACTA ACUST UNITED AC 2021; 28:3297-3315. [PMID: 34590598 PMCID: PMC8406090 DOI: 10.3390/curroncol28050286] [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: 06/25/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
Ensuring high quality end of life (EOL) care is necessary for people with advanced non-small-cell lung cancer (NSCLC), given its high incidence, mortality and symptom burden. Aggressive EOL care can adversely affect the quality of life of NSCLC patients without providing meaningful oncologic benefit. Objectives: (1) To describe EOL health services quality indicators and timing of palliative care consultation provided to patients dying of NSCLC. (2) To examine associations between aggressive and supportive care and patient, disease and treatment characteristics. Methods: This retrospective population-based cohort study describes those who died of NSCLC in Ontario, Canada from 2009–2017. Socio-demographic, patient, disease and treatment characteristics as well as EOL health service quality and use of palliative care consultation were investigated. Multivariable logistic regression models examined factors associated with receiving aggressive or supportive care. Results: Aggressive care quality indicators were present in 50.3% and supportive care indicators in 60.3% of the cohort (N = 37,203). Aggressive care indicators decreased between 2009 and 2017 (57.4% to 45.3%) and increased for supportive care (54.2% to 67.5%). Benchmarks were not met by 2017 in 3 of 4 cases. Male sex and greater comorbidity were associated with more aggressive EOL care and less supportive care. Older age was negatively associated and rurality positively associated with aggressive care. No palliative care consultation occurred in 56.0%. Conclusions: While improvements in the use of supportive rather than aggressive care were noted, established Canadian benchmarks were not met. Moreover, there is variation in EOL quality between groups and use of earlier palliative care must improve.
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Qureshi M, Robinson MC, Sinnarajah A, Chary S, de Groot JM, Feldstain A. Reflecting on Palliative Care Integration in Canada: A Qualitative Report. Curr Oncol 2021; 28:2753-2762. [PMID: 34287295 PMCID: PMC8293234 DOI: 10.3390/curroncol28040240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/04/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
Studies have identified integrated interdisciplinary care as a hallmark of effective palliative care. Although models attempt to show how integration may function, there is little literature available that practically explores how integration is fostered and maintained. In this study we asked palliative care clinicians across Canada to comment on how services are integrated across the healthcare system. This is an analysis of qualitative data from a larger study, wherein clinicians provided written responses regarding their experiences. Content analysis was used to identify response categories. Clinicians (n = 14) included physicians, a nurse and a social worker from six provinces. They identified the benefits of formalized relationships and collaboration pathways with other services to streamline referral and consultation. Clinicians perceived a need for better training of residents and primary care physicians in the community and more acceptance, shared understanding, and referrals. Clinicians also described integrating well with oncology departments. Lastly, clinicians considered integration a complex process with departmental, provincial, and national involvement. The needs and strengths identified by the clinicians mirror the qualities of successfully integrated palliative care programs globally and highlight specific areas in policy, education, practice, and research that could benefit those in Canada.
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Affiliation(s)
- Maryam Qureshi
- Werklund School of Education, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Maggie C. Robinson
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB T2N 4N2, Canada; (M.C.R.); (J.M.d.G.); (A.F.)
| | - Aynharan Sinnarajah
- Department of Medicine, Queen’s University, Kingston, ON K7L 3J7, Canada;
- Department of Medicine, Lakeridge Health, Ajax, ON L1S 2J4, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Srini Chary
- Palliative Medicine, Queens University, Kingston, ON K7L 3J7, Canada;
| | - Janet M. de Groot
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB T2N 4N2, Canada; (M.C.R.); (J.M.d.G.); (A.F.)
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Andrea Feldstain
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB T2N 4N2, Canada; (M.C.R.); (J.M.d.G.); (A.F.)
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Camacho-Rivera M, Islam JY, Rodriguez DL, Vidot DC. Cannabis Use among Cancer Survivors amid the COVID-19 Pandemic: Results from the COVID-19 Cannabis Health Study. Cancers (Basel) 2021; 13:3495. [PMID: 34298708 PMCID: PMC8303109 DOI: 10.3390/cancers13143495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 12/18/2022] Open
Abstract
Clinical indications for medicinal cannabis use include those with cancer, a subgroup advised to avoid exposure to COVID-19. This study aims to identify changes to cannabis use, methods of cannabis delivery, and coping strategies among cancer survivors since the pandemic by cancer status. Chi-squared tests were used for univariate comparisons of demographic characteristics, cannabis use patterns, COVID-19 symptoms, and coping behaviors by cancer survivor status. Data included 158 responses between 21 March 2020 and 23 March 2021, from medicinal cannabis users, categorized as cancer survivors (n = 79) along with age-matched medicinal cannabis users without a history of cancer (n = 79). Compared to adults without a history of cancer, cancer survivors were more likely to report use of cannabis as a way of managing nausea/vomiting (40.5% versus 20.3%, p = 0.006), headaches or migraines (35.4% versus 19.0%, p = 0.020), seizures (8.9% versus 1.3%, p = 0.029), and sleep problems (70.9% versus 54.4%, p = 0.033), or as an appetite stimulant (39.2% versus 17.7%, p = 0.003). Nearly 23% of cancer survivors reported an advanced cannabis supply of more than 3 months compared to 14.3% of adults without a history of cancer (p = 0.002); though the majority of cancer survivors reported less than a one-month supply. No statistically significant differences were observed by cancer survivor status by cannabis dose, delivery, or sharing of electronic vaping devices, joints, or blunts. Cancer survivors were more likely to report a fear of being diagnosed with COVID-19 compared to adults without a history of cancer (58.2% versus 40.5%, p = 0.026). Given the frequency of mental and physical health symptoms reported among cancer survivors, clinicians should consider conversations about cannabis use with their patients, in particular among cancer survivors.
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Affiliation(s)
- Marlene Camacho-Rivera
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA;
| | - Jessica Y. Islam
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA;
| | - Diane L. Rodriguez
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA;
| | - Denise C. Vidot
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146, USA
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Sumarsono N, Sudore RL, Smith AK, Pantilat SZ, Anderson WG, Makam AN. Availability of Palliative Care in Long-Term Acute Care Hospitals. J Am Med Dir Assoc 2021; 22:2207-2211. [PMID: 33965406 PMCID: PMC10186213 DOI: 10.1016/j.jamda.2021.04.007] [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: 11/30/2020] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the availability of palliative care programs in long-term acute care hospitals (LTACHs) DESIGN: Cross-sectional analysis using the 2016 American Hospital Association (AHA) Annual Survey. SETTING AND PARTICIPANTS LTACHs in the United States. METHOD We used descriptive analyses to compare the prevalence of palliative care programs in LTACHs across the United States in 2016. For LTACHs without a program, we also examined palliative care physician capacity in regions where those LTACHs resided to evaluate if expertise existed in those regions. RESULTS One-third (36.5%) of 405 LTACHs (50.6% response rate) self-reported having a palliative care program. Among LTACHs without palliative care, 42.4% were in regions with the highest palliative care physician capacity nationwide. CONCLUSIONS AND IMPLICATIONS LTACHs care for patients with serious and prolonged illnesses, many of whom would benefit from palliative care. Despite this, our study finds that specialty palliative care is limited in LTACHs. The limited palliative care availability in LTACHs is mismatched with the needs of this seriously ill population. Greater focus on increasing palliative care in LTACHs is essential and may be feasible as 40% of LTACHs without a palliative care program were located in regions with the highest palliative care physician capacity.
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Affiliation(s)
- Nathan Sumarsono
- University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Rebecca L Sudore
- Division of Geriatrics, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Alexander K Smith
- Division of Geriatrics, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, University of California, San Francisco, CA, USA
| | - Wendy G Anderson
- Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA; Supportive and Palliative Care Program, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Anil N Makam
- Division of Hospital Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, CA, USA.
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25
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Kummar S, Berlin J, Mascarenhas L, van Tilburg CM, Geoerger B, Lassen UN, Schilder RJ, Turpin B, Nanda S, Keating K, Childs BH, Chirila C, Laetsch TW, Hyman DM, Drilon A, Hong DS. Quality of Life in Adult and Pediatric Patients with Tropomyosin Receptor Kinase Fusion Cancer Receiving Larotrectinib. Curr Probl Cancer 2021; 45:100734. [PMID: 33865615 DOI: 10.1016/j.currproblcancer.2021.100734] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/18/2021] [Accepted: 03/02/2021] [Indexed: 01/08/2023]
Abstract
Neurotrophic tyrosine receptor kinase (NTRK) gene fusions lead to chimeric tropomyosin receptor kinase (TRK) fusion proteins, which act as primary oncogenic drivers in diverse tumor types in adults and children. Larotrectinib, a highly selective and central nervous system-active TRK inhibitor, has shown high objective response rates, durable disease control, and a favorable safety profile in patients with TRK fusion cancer. The impact of larotrectinib on health-related quality of life (HRQoL) was evaluated in adult and pediatric patients in two phase I/II clinical trials (NAVIGATE; NCT02576431 and SCOUT; NCT02637687). Patients completed HRQoL questionnaires (EORTC QLQ-C30, EQ-5D-5L, and PedsQL) at baseline and at planned treatment cycle visits. Changes in questionnaire scores were evaluated over time, and by tumor type and treatment response. Questionnaires from 40 adult and 17 pediatric (2-19 years of age) patients receiving larotrectinib were completed at baseline and at least one post-baseline timepoint. Meaningful within-patient HRQoL improvements occurred at one or more timepoints in 60% of adults and 76% of pediatric patients. Sustained improvements in EORTC QLQ-C30 and PedsQL scores were rapid, occurring within 2 months of treatment initiation in 68% and 71% of patients, respectively. Improvements were observed regardless of tumor type and appeared to correlate with clinical efficacy. The rapid within-patient HRQoL improvements in adult and pediatric patients with TRK fusion cancer are consistent with the clinical profile of larotrectinib. Our results provide valuable information for use of this agent in this patient population. A plain language summary of this article is available in the supplementary appendix.
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Affiliation(s)
- Shivaani Kummar
- Stanford Cancer Institute, Stanford University, Palo Alto, CA.
| | | | - Leo Mascarenhas
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Cornelis M van Tilburg
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg University Hospital and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Birgit Geoerger
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France
| | - Ulrik N Lassen
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Russell J Schilder
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Brian Turpin
- Division of Pediatric Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Shivani Nanda
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ
| | - Karen Keating
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ
| | | | | | - Theodore W Laetsch
- Department of Pediatrics and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center/Children's Health, Dallas, TX
| | - David M Hyman
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Alexander Drilon
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - David S Hong
- University of Texas MD Anderson Cancer Center, Houston, TX.
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26
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Cusimano MC, Sajewycz K, Harle I, Giroux J, Hanna T, Willing S, Martin V, Francis JA. Acceptability and Feasibility of Early Palliative Care Among Women with Advanced Epithelial Ovarian Cancer: A Randomized Controlled Pilot Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:707-715. [PMID: 33731311 DOI: 10.1016/j.jogc.2021.03.005] [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: 12/11/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the acceptability of early palliative care (EPC) among patients with advanced ovarian cancer and to determine the feasibility of larger-scale phase III trials. METHODS We performed a randomized controlled pilot study of adult women (>18 years) with pathologically confirmed epithelial ovarian cancer that had recurred or progressed on first-line therapy and had no immediate need for palliative care. We randomly assigned patients to either EPC or standard oncologic care (SOC), and collected patient-reported outcomes (PRO) at baseline, 3 months, and 6 months; end-of-life care quality indicators were collected at study completion. Study endpoints were rates of enrollment, EPC adherence, and PRO completion. RESULTS Of 32 eligible patients approached, 23 enrolled (72%; 95% CI 53-86) and were randomly assigned to either EPC (n = 12) or SOC (n = 11). At baseline, participants had poor physical and emotional wellbeing, high rates of depression (65%), and understood that their disease was not curable (87%). Eleven patients (92%; 95% CI 62-100) attended their EPC consultation, and all visits took place within 4 weeks of enrollment. However, PRO completion was low due to deaths by 3 (5/23) and 6 months (9/23). CONCLUSION Patients had accurate perceptions of their disease status, were willing to be randomly assigned to EPC, and attended scheduled appointments. However, a definitive trial in this group is not feasible without major adjustments to eligibility criteria and a multicentre, international effort. We propose that EPC be considered routinely at progression or recurrence given patients' symptom burden and clear acceptance of the intervention, as well as evidence of benefit from adequately powered trials in other malignancies.
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Affiliation(s)
- Maria C Cusimano
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON
| | - Katrina Sajewycz
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Ingrid Harle
- Department of Medicine, Kingston Health Sciences Centre, Kingston, ON; Department of Oncology, Kingston Health Sciences Centre, Kingston, ON
| | - Janet Giroux
- Department of Obstetrics & Gynecology, Queen's University, Kingston, ON; Division of Gynecologic Oncology, Kingston Health Sciences Centre, Kingston, ON; School of Nursing, Queen's University, Kingston, ON
| | - Tracie Hanna
- Cancer Clinic Research Team, Kingston Health Sciences Centre, Kingston, ON
| | - Stephanie Willing
- Cancer Clinic Research Team, Kingston Health Sciences Centre, Kingston, ON
| | - Vickie Martin
- Department of Obstetrics & Gynecology, Queen's University, Kingston, ON; Division of Gynecologic Oncology, Kingston Health Sciences Centre, Kingston, ON; Division of Gynaecologic Oncology, Saskatchewan Cancer Agency, Kingston, ON
| | - Julie-Ann Francis
- Department of Obstetrics & Gynecology, Queen's University, Kingston, ON; Division of Gynecologic Oncology, Kingston Health Sciences Centre, Kingston, ON; Division of Gynecologic Oncology, Lakeridge Health Oshawa, Oshawa, ON.
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Taguchi A, Nakajima Y, Furusawa A, Yoshino Y, Takao M, Kashiyama T, Kino N, Yasugi T. High neutrophil-to-lymphocyte ratio is a predictor of short-term survival for patients with recurrent cervical cancer after radiation-based therapy. J Obstet Gynaecol Res 2021; 47:1862-1870. [PMID: 33611808 DOI: 10.1111/jog.14712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/20/2021] [Accepted: 02/06/2021] [Indexed: 01/04/2023]
Abstract
AIM Patients with recurrent cervical cancer after radiotherapy have poor prognoses because of the lack of effective treatment options. Biomarkers to predict survival outcomes for recurrent cervical cancer are warranted because patients with limited life expectancy sometimes benefit from less aggressive treatment in combination with early palliative care. Therefore, we aimed to explore a predictive biomarker for the outcomes of patients with recurrent cervical cancer. METHODS We retrospectively investigated 231 patients initially treated with radiation-based therapy between January 2004 and December 2015. The associations between clinicopathological features at the time of relapse and overall survival after relapse were assessed. As factors which reflect patients' conditions, we particularly focused on C-reactive protein-to-albumin ratio (CAR) and neutrophil-to-lymphocyte ratio (NLR) at the time of relapse. Additionally, we investigated biomarkers predictive of short-term survival. RESULTS Among 231 patients, 91 patients experienced relapse and 74 patients died during the follow-up period. Multivariate analysis revealed that treatment after relapse, CAR, and NLR was significantly associated with overall survival. Among them, treatment after relapse significantly affected survival outcomes, and patients who received definitive local treatment had a better 3-year survival rate than those who received other treatments. Conversely, NLR was the most influential biomarker for short-term survival, and the prognosis of patients with high NLRs was much worse than those with low NLRs. CONCLUSIONS This study thus demonstrated that, for the patients with recurrent cervical cancer who received radiation-based therapy, definitive local treatment can provide long-term survival and extremely high NLRs are predictive of short-term survival.
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Affiliation(s)
- Ayumi Taguchi
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.,Department of Obstetrics and Gynecology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Yujiro Nakajima
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.,Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akiko Furusawa
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yasunori Yoshino
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Maki Takao
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Tomoko Kashiyama
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.,Department of Obstetrics and Gynecology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Nao Kino
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Toshiharu Yasugi
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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Abstract
In the health care setting, and especially in cancer patients nearing the end of life, administrators, medical staff, patients, and families face challenges of a social, legal, religious, and cultural nature in the process of care. The present study aimed to perform a metasynthesis of qualitative studies conducted on providing end-of-life care for cancer patients. The present metasynthesis was conducted using Sandelowski and Barroso's method. A literature search was performed in PubMed, Scopus, Web of Science, and Embase databases, from the inception to date, and a total of 21 articles were identified as eligible for inclusion in the study. Critical Appraisal Skills Programme (CASP) criteria were used for assessing the articles, and data were analyzed by the subject review. Six themes were extracted for end-of-life care including psychological support, palliative support, educational-counseling support, spiritual support, preferential support, and supportive interactions, each comprising a number of categories. The most frequently mentioned categories were high-value care (67%) and adaptive acceptance (57%). The findings of this metasynthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The present study showed that providing high-value care and facilitating adaptive acceptance are important constituents of a holistic strategy for providing end-of-life care to cancer patients.
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29
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Necchi A, Nishiyama H, Matsubara N, Lee JL, Petrylak DP, de Wit R, Drakaki A, Liepa AM, Mao H, Bell-McGuinn K, Powles T. Health-related quality of life in the randomized phase 3 study of ramucirumab plus docetaxel versus placebo plus docetaxel in platinum-refractory advanced urothelial carcinoma (RANGE). BMC Urol 2020; 20:181. [PMID: 33160359 PMCID: PMC7648381 DOI: 10.1186/s12894-020-00752-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/26/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate patient-reported outcomes with ramucirumab plus docetaxel, a regimen which improved progression-free survival in platinum-refractory advanced urothelial carcinoma (aUC). METHODS RANGE-a randomized, double-blinded, phase 3 trial in patients with platinum-refractory aUC. Ramucirumab (10 mg/kg) plus docetaxel (75 mg/m2) or placebo plus docetaxel were administered every 21 days until disease progression or unacceptable toxicity. Patients received maximum 10 cycles of docetaxel. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and EuroQoL five-dimensions (EQ-5D-5L) were administered at baseline, start of each cycle, and 30-day follow-up visit. A ≥ 10-point change in QLQ-C30 scores was considered meaningful. Rates of improved/stable scores were compared between treatment arms using Fisher's exact test. Time to deterioration (TtD) was estimated and compared using Kaplan-Meier estimation and log-rank test. RESULTS Of the 530 patients, ~ 97% patients in each arm provided baseline QLQ-C30 data. On-treatment compliance was ≥ 88% for first 8 cycles. Mean baseline QLQ-C30 scores were similar between arms, with global quality of life (QoL), fatigue, pain, and insomnia having greatest impairment. Postbaseline rates of improved/stable QLQ-C30 scores were similar between treatment arms except for greater improvement in pain score with ramucirumab. TtD of QLQ-C30 scales favored ramucirumab arm. Baseline EQ-5D-5L index and visual analogue scale scores were similar between arms, followed by relatively stable on-treatment scores. EQ-5D-5L scores worsened at post-discontinuation follow-up visit. CONCLUSIONS Ramucirumab plus docetaxel did not negatively impact QoL compared with docetaxel alone in platinum-refractory aUC. Improved TtD and tumor associated rates of pain favored ramucirumab treatment. CLINICAL TRAIL REGISTRATION NCT02426125. https://clinicaltrials.gov/ct2/show/NCT02426125 . Date of registration: April 24th 2015.
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Affiliation(s)
- Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, 20133, Milan, Italy.
| | | | | | - Jae-Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | - Huzhang Mao
- Eli Lilly and Company, Indianapolis, IN, USA
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30
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Kaiser U, Vehling-Kaiser U, Kück F, Mechie NC, Hoffmann A, Kaiser F. Use of symptom-focused oncological cancer therapies in hospices: a retrospective analysis. BMC Palliat Care 2020; 19:140. [PMID: 32919468 PMCID: PMC7488695 DOI: 10.1186/s12904-020-00648-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/06/2020] [Indexed: 12/04/2022] Open
Abstract
Background There is controversy regarding the practical implementation of symptom-focused oncological cancer therapies to hospice residents. In this study, we aim to analyse the use and indication of supportive-oncological cancer therapies in hospices. Methods We conducted a retrospective survey of all residents of two hospice centres in the government district of Lower Bavaria, Germany. Hospice 1 (H1) was a member of an oncological–palliative medical network, and hospice 2 (H2) was independently organized. The evaluation period was the first 40 months after the opening of the respective hospice care centre. Demographical and epidemiological data as well as indications and type of supportive-oncological cancer therapies were recorded. A descriptive analysis and statistical tests were performed. Results Of the 706 residents, 645 had an underlying malignant disease. The average age was 72 years and the mean residence time was 28 days. The most frequent cancer types were gastrointestinal cancers, gynaecological cancers and bronchial carcinomas. Overall 39 residents (33 in H1 and 6 in H2, p < 0.01) received symptom-focused oncological cancer therapy. The average age of these residents was 68 years, and the mean residence time was 55 days. The most common therapeutic indications were dyspnoea and pain. The most common symptom-focused oncological cancer therapies were bisphosphonates, transfusions (erythrocyte- and platelet- concentrates), radiotherapy and anti-proliferative drugs (chemotherapy, anti-hormonal- and targeted- therapies). Patients with therapy lived significantly longer than patients without therapy (p < 0.01). Conclusions Symptom-focused oncological cancer therapies can be implemented in hospices; however, their implementation seems to require certain structural and organizational prerequisites as well as careful patient selection. As a palliative medical approach, the focus is to ameliorate the symptoms and not prolong life. Symptom-focused oncology treatment could be a further and important part for the therapy of hospice patients in the future.
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Affiliation(s)
- Ulrich Kaiser
- University Hospital Regensburg, Clinic and Polyclinic for Internal Medicine III, Regensburg, Germany
| | | | - Fabian Kück
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Nicolae-Catalin Mechie
- University Medicine Göttingen, Clinic for Gastroenterology and Gastrointestinal Oncology, Göttingen, Germany
| | | | - Florian Kaiser
- University Medicine Göttingen, Clinic for Haematology and Medical Oncology, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
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Thomas HR, Deckx L, Sieben NA, Foster MM, Mitchell GK. General practitioners' considerations when deciding whether to initiate end-of-life conversations: a qualitative study. Fam Pract 2020; 37:554-560. [PMID: 31796956 DOI: 10.1093/fampra/cmz088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND End-of-life discussions often are not initiated until close to death, even in the presence of life-limiting illness or frailty. Previous research shows that doctors may not explicitly verbalize approaching end-of-life in the foreseeable future, despite shifting their focus to comfort care. This may limit patients' opportunity to receive information and plan for the future. General Practitioners (GPs) have a key role in caring for increasing numbers of patients approaching end-of-life. OBJECTIVE To explore GPs' thought processes when deciding whether to initiate end-of-life discussions. METHODS A qualitative approach was used. We purposively recruited 15 GPs or GP trainees from South-East Queensland, Australia, and each participated in a semi-structured interview. Transcripts were analyzed using inductive thematic analysis. RESULTS Australian GPs believe they have a responsibility to initiate end-of-life conversations, and identify several triggers to do so. Some also describe caution in raising this sensitive topic, related to patient, family, cultural and personal factors. CONCLUSIONS These findings enable the development of approaches to support GPs to initiate end-of-life discussions that are cognizant both of GPs' sense of responsibility for these discussions, and factors that may contribute to caution initiating them, such as anticipated patient response, cultural considerations, societal taboos, family dynamics and personal challenges to doctors.
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Affiliation(s)
- Hayley R Thomas
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Laura Deckx
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Nicolas A Sieben
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Michele M Foster
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Woolloongabba, Australia
| | - Geoffrey K Mitchell
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, Australia
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32
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Look Hong NJ, Liu N, Wright FC, MacKinnon M, Seung SJ, Earle CC, Gradin S, Sati S, Buchman S, Mittmann N. Assessing the Impact of Early Identification of Patients Appropriate for Palliative Care on Resource Use and Costs in the Final Month of Life. JCO Oncol Pract 2020; 16:e688-e702. [DOI: 10.1200/jop.19.00397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE:This study evaluates whether an intervention to identify Canadian patients eligible for a palliative approach changes the use of health care resources and costs within the final month of life.METHODS:Between 2014 and 2017, physicians identified 1,187 patients in family practice units and cancer centers who were likely to die within 1 year based on diagnosis, symptom assessment, and performance status. A multidisciplinary intervention that included activation of community resources and initiation of palliative planning was started. By using propensity-score matching, patients in the intervention group were matched 1:1 with nonintervention controls selected from provincial administrative data. We compared health care use and costs (using 2017 Canadian dollars) for 30 days before death between patients who died within the 1-year follow-up and matched controls.RESULTS:Groups (n = 629 in each group) were well-balanced in sociodemographic characteristics, comorbidities, and previous health care use. In the last 30 days, there was no differences in proportions between the two groups of patients regarding emergency department visits, intensive care unit admissions, or inpatient hospitalizations. However, patients in the intervention group had greater use of palliative physician encounters, community home care visits, and/or physician home visits (92.8% v 88.4%; P = .007). In the 507 pairs with cancer, more patients in the intervention group underwent chemotherapy (44% v 33%; P < .001) and radiation (18.7% v 3.2%; P = .043) in the last 30 days. Mean cost per patient was similar for the intervention group (mean, $17,231; 95% CI, $16,027 to $18,436) and for the control group (mean, $16,951; 95% CI, $15,899 to $18,004).CONCLUSION:Even with the limitations in our observational study design, identification of palliative patients did not significantly change overall costs but may shift resources toward palliative services.
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Affiliation(s)
- Nicole J. Look Hong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Frances C. Wright
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Soo Jin Seung
- Health Outcomes and PharmacoEconomic Research Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Craig C. Earle
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sharon Gradin
- British Columbia Renal Agency, Toronto, Ontario, Canada
| | | | | | - Nicole Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Deckx L, Thomas HR, Sieben NA, Foster MM, Mitchell GK. General practitioners' practical approach to initiating end-of-life conversations: a qualitative study. Fam Pract 2020; 37:401-405. [PMID: 31786593 PMCID: PMC7448298 DOI: 10.1093/fampra/cmz074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As doctors who provide care across the life-course, general practitioners (GPs) play a key role in initiating timely end-of-life discussions. Nonetheless, these discussions are often not initiated until close to death. Given the ageing of the population, GPs will be confronted with end-of-life care more often, and this needs to become a core skill for all GPs. OBJECTIVE To describe GPs' approach to initiating end-of-life discussions. METHODS Fifteen GPs or GP trainees from South-East Queensland, Australia, were purposively recruited to participate in a semi-structured interview. We analysed transcripts using a thematic analysis. RESULTS GPs' approach to initiating end-of-life discussions was summarized by four themes: (1) Preparing the ground; (2) finding an entry point; (3) tailoring communication and (4) involving the family. CONCLUSIONS Emphasis on the doctor-patient relationship; assessing patient readiness for end-of-life discussions; and sensitive information delivery is consistent with factors previously reported to be important to both GPs and patients in this context. Our findings provide a framework for GPs initiating end-of-life discussions, which must be tailored to patient and GP personality factors. Further research is required to evaluate its outcomes.
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Affiliation(s)
- Laura Deckx
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Hayley R Thomas
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Nicolas A Sieben
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Michele M Foster
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Woolloongabba, Australia
| | - Geoffrey K Mitchell
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, Australia
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Scherrens AL, Cohen J, Mahieu A, Deliens L, Deforche B, Beernaert K. The perception of people with cancer of starting a conversation about palliative care: A qualitative interview study. Eur J Cancer Care (Engl) 2020; 29:e13282. [PMID: 32613675 DOI: 10.1111/ecc.13282] [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: 07/23/2019] [Revised: 04/14/2020] [Accepted: 06/08/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Communication and patient-centred care are important determinants for timely initiation of palliative care. Therefore, we aimed to understand and explain the behaviour "starting a conversation about palliative care with a professional carer" from the perspective of people with incurable cancer. METHODS A qualitative study using semi-structured face-to-face interviews with 25 people with incurable cancer: 13 not (yet) receiving palliative care and 12 receiving palliative care; 4 started the conversation themselves. Determinants related to the defined behaviour were matched with concepts in existing behavioural theories. RESULTS Both positive and negative stances towards starting a conversation about palliative care with a professional carer were found. Influencing behavioural factors were identified, such as knowledge (e.g. about palliative care), attitude (e.g. association of palliative care with quality of life) and social influence (e.g. relationship with the professional carer). We modelled the determinants into a behavioural model. CONCLUSION The behavioural model developed helps to explain why people with incurable cancer do or do not start a conversation about palliative care with their professional carer. By targeting the modifiable determinants of the model, promising interventions can be developed to help patients taken the initiative in communication about palliative care with a professional carer.
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Affiliation(s)
- Anne-Lore Scherrens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Annick Mahieu
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Belgium
| | - Benedicte Deforche
- Department of Public Health and Primary Care, Ghent University, Belgium.,Department of Movement and Sport Sciences, Physical activity, nutrition and health research unit, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kim Beernaert
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Belgium
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Kubi B, Enumah ZO, Lee KT, Freund KM, Smith TJ, Cooper LA, Owczarzak JT, Johnston FM. Theory-Based Development of an Implementation Intervention Using Community Health Workers to Increase Palliative Care Use. J Pain Symptom Manage 2020; 60:10-19. [PMID: 32092401 PMCID: PMC8787809 DOI: 10.1016/j.jpainsymman.2020.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/29/2022]
Abstract
CONTEXT Opportunities for the use of palliative care services are missed in African American (AA) communities, despite Level I evidence demonstrating their benefits. OBJECTIVES Single-institution and stakeholder-engaged study to design an intervention to increase palliative care use in AA communities. METHODS Two-phased qualitative research design guided by the Behavior Change Wheel and Theoretical Domains Framework models. In Phase 1, focus group sessions were conducted to identify barriers and facilitators of palliative care use and the viability of community health workers (CHWs) as a solution. After applying the Behavior Change Wheel and Theoretical Domains Framework to data gathered from Phase 1, Phase 2 consisted of a stakeholder meeting to select intervention content and prioritize modes of delivery. RESULTS A total of 15 stakeholders participated in our study. Target behaviors identified were for patients to gain knowledge about benefits of palliative care, physicians to begin palliative care discussions earlier in treatment, and to improve patient-physician interpersonal communication. The intervention was designed to improve patient capability, physician capability, patient motivation, physician motivation, and increase patient opportunities to use palliative care services. Strategies to change patient and physician behaviors were all facilitated by CHWs and included creation and dissemination of brochures about palliative care to patients, empowerment and activation of patients to initiate goals-of-care discussions, outreach to community churches, and expanding patient social support. CONCLUSION Use of a theory-based approach to facilitate the implementation of a multi-component strategy provided a comprehensive means of identifying relevant barriers and enablers of CHWs as an agent to increase palliative care use in AA communities.
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Affiliation(s)
- Boateng Kubi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zachary O Enumah
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kimberley T Lee
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen M Freund
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Thomas J Smith
- Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jill T Owczarzak
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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36
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Patient-reported symptoms in metastatic gastric cancer patients in the last 6 months of life. Support Care Cancer 2020; 29:515-524. [DOI: 10.1007/s00520-020-05501-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
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Tol I, Cumber E, Nakakande D, Wijaya S, Turberfield C, Badran A, Siddiqui S, Srivastava P, Chung B, Dineen M, Devlin C, Worrall C, Green R, Bennett E, Golding E, Lillis A, Sabharwal A, Protheroe AS, Watson RA. Cardiopulmonary resuscitation discussions with patients admitted to acute oncology wards: A national audit of current practice. Eur J Cancer Care (Engl) 2020; 29:e13218. [DOI: 10.1111/ecc.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/12/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Isabel Tol
- Oxford University HospitalsJohn Radcliffe Hospital Oxford UK
| | | | - Daphne Nakakande
- University of Cambridge School of Clinical Medicine Cambridge UK
| | - Silvana Wijaya
- University of Cambridge School of Clinical Medicine Cambridge UK
| | | | - Abdul Badran
- University of Cambridge School of Clinical Medicine Cambridge UK
| | - Safia Siddiqui
- University of Cambridge School of Clinical Medicine Cambridge UK
| | - Prakhar Srivastava
- Faculty of Biology, Medicine and Health University of Manchester Medical School Manchester University Manchester UK
| | | | | | | | | | | | | | | | | | - Ami Sabharwal
- Department of Oncology Oxford Cancer and Haematology CentreOxford University Hospitals NHS Foundation Trust Oxford UK
| | - Andrew S. Protheroe
- Department of Oncology Oxford Cancer and Haematology CentreOxford University Hospitals NHS Foundation Trust Oxford UK
| | - Robert A. Watson
- Department of Oncology Oxford Cancer and Haematology CentreOxford University Hospitals NHS Foundation Trust Oxford UK
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Vettori JC, da Silva LG, Pfrimer K, Jordão Junior AA, Moriguti JC, Ferriolli E, Lima NKC. Older Adult Cancer Patients Under Palliative Care With a Prognosis of 30 Days or More: Clinical and Nutritional Changes. J Am Coll Nutr 2020; 40:148-154. [PMID: 32275483 DOI: 10.1080/07315724.2020.1747032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: The aim of this study was to characterize nutritional status, body composition, oxidative stress, and inflammatory activity and to determine the possible associations between nutritional status and clinical variables in advanced cancer patients.Method: This was a cross-sectional study of 46 elderly cancer patients under palliative care with a prognosis of 30 days or more. Nutritional status, food intake, anthropometry, body composition (deuterium oxide method), metabolic profile, inflammation damage (C-reactive protein), oxidative damage (8-hydroxy-2'-deoxyguanosine), and symptom intensity were evaluated.Results: Among elderly cancer patients, 36.9% were malnourished or at risk of malnutrition. Systemic inflammation was detected, with a correlation between worse nutritional status and higher C-reactive protein levels (p < 0.01, r= -0.57), while lower lean mass (p < 0.01, r = 0.62) and higher fat mass percentages (p < 0.01, r = 0.62) correlated with higher levels of 8-hydroxy-2'-deoxyguanosine. Furthermore, daily energy (n = 25; 57.4%) and protein intake (n = 24; 52.2%) were lower than recommended in more than half the patients. The most prevalent symptoms were anxiety, impairment of well-being, drowsiness, tiredness, and lack of appetite.Conclusions: Despite preserved functionality, patients already had clinical and laboratory changes that, together with inadequate food intake, risk of malnutrition, systemic inflammation, and the presence of uncontrolled symptoms, alerted to the importance of an early and comprehensive palliative approach.
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Affiliation(s)
- Josiane C Vettori
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Luanda G da Silva
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Karina Pfrimer
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Alceu A Jordão Junior
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Júlio C Moriguti
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Eduardo Ferriolli
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Nereida K C Lima
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brasil
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Al-Ansari AM, Suroor SN, AboSerea SM, Abd-El-Gawad WM. Development of palliative care attitude and knowledge (PCAK) questionnaire for physicians in Kuwait. BMC Palliat Care 2019; 18:49. [PMID: 31170968 PMCID: PMC6555752 DOI: 10.1186/s12904-019-0430-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/20/2019] [Indexed: 01/01/2023] Open
Abstract
Background Over the past five decades, palliative care has changed from helping patients at the end of life into a highly dedicated service focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. To date there is no common agreement on universally applicable measurement tool to know the areas of weakness in physicians’ understanding of palliative care and identifying misconceptions about palliative care. This paper describes the development of a reliable and valid questionnaire to provide a measure of the attitude and knowledge of physicians toward palliative care (PCAK). Methods Item pool was generated paying particular attention to content and face validity. The initial version of the questionnaire was piloted and assessed based on psychometric criteria. Items which did not reach acceptable validity were excluded, and the final 37 item version was administered to two groups differing in their palliative care attitude and knowledge on two occasions to assess the construct validity and test-retest reliability. Two hundred thirty two physicians working in primary care clinics and general hospitals completed the questionnaire at the piloting stage. The final version (PCAK) was administered to 35 oncologists and 76 physicians. SPSS v20 was used for statistical analysis. Results Of the Pilot study, 20 items were excluded because didn’t meet the criteria for item difficulty and discrimination. Item-to-total-score correlations (r) was ranging from 0.347 up to 0.806. Internal consistency (Cronbach’s alpha) was high ranging from 0.636 to 0.824. While testing the final PCAK, oncologist scored consistently higher than the other physicians on all sections of the questionnaire (P < 0.001) suggesting good construct validity. Test to retest reliability for each section was very high, ranging from 0.879 to 0.97 and the overall reliability was 0.95. The internal consistency reliability of each section was very good ranging from 0.681 ± 0.893. Conclusion The findings demonstrate that PCAK meets psychometric criteria for reliability and construct validity. It provides a useful scale to assess the attitude and knowledge of physicians about palliative care helping in planning of educational programs for physicians. Electronic supplementary material The online version of this article (10.1186/s12904-019-0430-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Wafaa Mostafa Abd-El-Gawad
- Geriatrics and Gerontology department, Faculty of Medicine, Ain Shams University, Al- Abbasseya, Cairo, Egypt.
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Mroueh R, Haapaniemi A, Saarto T, Grönholm L, Grénman R, Salo T, Mäkitie AA. Non-curative treatment of patients with oral tongue squamous-cell carcinoma. Eur Arch Otorhinolaryngol 2019; 276:2039-2045. [PMID: 31069467 PMCID: PMC6581924 DOI: 10.1007/s00405-019-05456-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 04/27/2019] [Indexed: 12/13/2022]
Abstract
Purpose Late-stage OTSCC is associated with poor overall survival (OS). Non-curative treatment approach aims to improve quality of life and prolong survival of patients deemed incurable. The purpose of this study was to investigate the used non-curative treatment modalities for OTSSC and patient survival. Methods All patients diagnosed with OTSCC and treated with non-curative intent at the HUS Helsinki University Hospital (Helsinki, Finland) during the 12-year period of 2005–2016 were included. Survival analysis after the non-curative treatment decision was conducted using the Kaplan–Meier method in this population-based study. Results Eighty-two patients were identified. A non-curative treatment decision was made at presentation without any previous treatment in 26 patients (7% of all patients diagnosed with OTSCC during the study period). Palliative radiotherapy was administered to 24% of all patients. The average survival time after the non-curative treatment decision was 3.7 months (median 2 and range 0–26). Conclusions Due to the short mean survival time after decision for treatment with non-curative intent, and the notable symptom burden in this patient population, a prompt initiation of all non-curative measures is warranted.
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Affiliation(s)
- R Mroueh
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O. Box 263, 00029 HUS, FI-00029, Finland
| | - A Haapaniemi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O. Box 263, 00029 HUS, FI-00029, Finland
| | - T Saarto
- Department of Oncology, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - L Grönholm
- Department of Oncology, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - R Grénman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - T Salo
- Cancer and Translational Medicine Unit, University of Oulu, Oulu, Finland.,Medical Research Unit, Oulu University Hospital, Oulu, Finland.,Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.,Haartman Institute, Helsinki, Finland
| | - A A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O. Box 263, 00029 HUS, FI-00029, Finland. .,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland. .,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden.
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Smith WH, Luskin I, Resende Salgado L, Scarborough BM, Lin JY, Özbek U, Miles BA, Gupta V, Bakst RL. Risk of prolonged opioid use among cancer patients undergoing curative intent radiation therapy for head and neck malignancies. Oral Oncol 2019; 92:1-5. [PMID: 31010616 DOI: 10.1016/j.oraloncology.2019.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Patients undergoing radiation treatment (RT) for head and neck malignancies often suffer significant disease- and treatment-related pain requiring opioids for effective management. However, the prevalence and associated risk factors of prolonged opioid use in this population remain poorly characterized. We sought to quantify the rate of prolonged opioid use among opioid naïve patients receiving curative-intent RT for head and neck malignancies and to identify associated risk factors. METHODS We retrospectively identified patients who had undergone RT for head and neck malignancies at our institution between Jan 2011 and Sept 2017. Our primary endpoint was persistent opioid use 6-months following completion of RT. Patients were included if they were opioid-naïve, underwent curative intent RT, had adequate follow-up, and did not have residual or recurrent disease within our follow-up period. Univariable and multivariable logistic regression was utilized to identify risk factors for prolonged opioid use. RESULTS We identified 311 patients meeting our inclusion criteria; 40 (12.9%) continued to use opioids 6-months following RT. Univariable analysis found current smoking, alcohol abuse, RT dose, treatment to the bilateral necks, induction chemotherapy, concurrent chemotherapy, PEG tube, daily milligram morphine equivalents, and adjuvant analgesic medication use to be positively associated with prolonged opioid use; prior surgery was negatively associated with prolonged opioid use. Delivery of induction chemotherapy (OR 2.86, CI (95%) 1.32-6.21) and alcohol abuse (OR 3.75, CI (95%) 1.66-8.47) remained statistically significant on multivariable analysis. CONCLUSION The prevalence of prolonged opioid use in previously opioid naïve patients undergoing curative intent head and neck RT was just under 13%. Patients with history of alcohol abuse and those who undergo induction chemotherapy were most at risk.
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Affiliation(s)
- William H Smith
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1236, New York, NY 10029, USA
| | - Ian Luskin
- Riverdale Country School, Riverdale, Bronx, NY, USA
| | - Lucas Resende Salgado
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1236, New York, NY 10029, USA
| | - Bethann M Scarborough
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1070, New York, NY 10029, USA
| | - Jung-Yi Lin
- Biostatistics Shared Resource Facility, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1077, New York, NY, USA
| | - Umut Özbek
- Biostatistics Shared Resource Facility, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1077, New York, NY, USA
| | - Brett A Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1189, New York, NY, USA
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1236, New York, NY 10029, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1236, New York, NY 10029, USA.
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Whitelaw S, Clark D. Palliative care and public health: an asymmetrical relationship? Palliat Care 2019; 12:1178224218819745. [PMID: 30814842 PMCID: PMC6383085 DOI: 10.1177/1178224218819745] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022] Open
Abstract
Interest in the potential for public health and palliative care to work together is now widely established. Based on a mapping review of existing literature, we describe for the first time the ways in which public health has entered palliative care policy and practice and how this has been specifically articulated. We then go on to pursue analytical and critical lines of enquiry that are largely absent from the existing literature. We do this in three ways: (i) by considering why the link between public health and palliative care has become so ubiquitous within palliative care policy; (ii) by establishing how this has been constructed; and (iii) by exploring public health as a 'reference discipline' from which its 'secondary deployment' can become embedded inside another disciplinary field. From this, we develop a range of critical perspectives on the relationship between public health and palliative care by scrutinising its claims of utility and effectiveness and questioning the strength of the interdisciplinary interaction between the two disciplines. We see their relationship in a 'cross disciplinary' context which is still largely symbolic and tactical in nature. We conclude by considering the significance of these insights for policy and practice, with two possible scenarios. If the use of public health is essentially figurative and its resources are not unique, the particular and exclusive use of the term becomes insignificant. Progressive and effective policy and practice is possible, independent of any explicit public health label. If however public health is considered to have intrinsic and definable worth, we suggest that this currently asymmetrical association needs to be significantly developed with much higher levels of theoretical, practical and critical engagement between the two disciplines. Such work would result in more reflective and robust policy and practice.
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Affiliation(s)
- Sandy Whitelaw
- School of Interdisciplinary Studies, University
of Glasgow, Dumfries, UK
| | - David Clark
- School of Interdisciplinary Studies, University
of Glasgow, Dumfries, UK
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Rubens M, Ramamoorthy V, Saxena A, Das S, Appunni S, Rana S, Puebla B, Suarez DT, Khawand-Azoulai M, Medina S, Viamonte-Ros A. Palliative Care Consultation Trends Among Hospitalized Patients With Advanced Cancer in the United States, 2005 to 2014. Am J Hosp Palliat Care 2018; 36:294-301. [DOI: 10.1177/1049909118809975] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Although palliative care services are increasing in the United States, disparities exist in access and utilization. Hence, we explored these factors in hospitalized patients with advanced cancers using the National Inpatient Sample (NIS). Methods: This was a retrospective analysis of NIS data, 2005 to 2014, and included patients ≥18 years with advanced cancers with and without palliative care consultations. Both χ2 and independent t tests were used for categorical and continuous variables. Multivariate logistic regressions were used for identifying factors associated with palliative care consultations. Results: Palliative care consultations were recorded in 9.9% of 4 732 172 weighted advanced cancer hospitalizations and increased from 3.0% to 15.5% during 2005 to 2014 (relative increase, 172.2%, Ptrend < .01). Factors associated with higher palliative care consultations were increasing age, ≥80 years (odds ratio [OR]: 1.47; 95% confidence interval [CI]: 1.38-1.56); black race (OR: 1.21; 95% CI: 1.14-1.28); private insurance coverage (OR: 1.10; 95% CI: 1.02-1.18); West region (OR: 1.15; 95% CI: 1.01-1.33); large hospitals (OR: 1.19; 95% CI: 1.02-1.34); high income (OR: 1.08; 95% CI: 1.08-1.17); do-not-resuscitate (dying patients) status (OR: 10.55; 95% CI: 10.14-10.99); and in-hospital radiotherapy (OR: 1.13; 95% CI: 1.06-1.21). Palliative care consultations were lower in patients with chemotherapy (OR: 0.71; 95% CI: 0.60-0.84). Conclusion: Many demographic, socioeconomic, health-care, and geographic disparities were identified in palliative care consultations. Additionally, palliative care resources were underutilized by hospitalized patients with advanced cancers and commonly utilized by patients who are dying. Health-care providers and policy makers should focus on these disparities in order to improve palliative care use.
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Affiliation(s)
- Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | | | - Anshul Saxena
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL, USA
| | - Sankalp Das
- Employee Health and Wellness Advantage, Baptist Health South Florida, Miami, FL, USA
| | - Sandeep Appunni
- Malabar Medical College Hospital and Research Center, Kerala, India
| | - Sagar Rana
- Department of Biometrics, Chiltern Inc, Reston, VA, USA
| | - Brittany Puebla
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Deborah T. Suarez
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | | | - Suleyki Medina
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Ana Viamonte-Ros
- Bioethics and Palliative Care, Baptist Health South Florida, Miami, FL, USA
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Knox-Rice T, Xuan L, Wadsworth H, Halm EA, Rhodes RL. Examining the Association between Healthcare Utilization and Clinical Characteristics among Cancer Patients in a Safety Net Health System. J Palliat Med 2018; 22:80-83. [PMID: 30265596 DOI: 10.1089/jpm.2018.0202] [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] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The goal of this study was to examine the association between available patient and clinical characteristics and healthcare utilization in a cohort of breast, lung, and colorectal cancer patients within a safety-net hospital system. METHODS Data for 979 breast, lung, and colorectal cancer patients admitted to a large, urban hospital for the year 2010 were extracted from the electronic medical record (EMR). Univariate and multivariate logistic regression analyses were performed to examine the association between relevant independent variables that were able to be captured from the EMR in discrete fields, emergency room (ER) utilization, and hospitalizations among members of the cohort. Spearman correlation coefficients to test the correlations between nonsteroidal anti-inflammatory drug and opioid prescriptions and healthcare utilization were also calculated. RESULTS Of the 979 patients, 22% were 65 years and older, 43% were non-Hispanic black, 42% had Medicare, and 56% had colorectal cancer. Patient and clinical characteristics that were associated with increased ER utilization, included Hispanic ethnicity (adjusted odds ratio; AOR: 2.21, 95% confidence interval; CI: 1.52-3.21), non-Hispanic black race (AOR: 2.01, 95% CI: 1.43-2.82), and referral to palliative care (AOR: 2.15, 95% CI: 1.36-3.41). Referral to palliative care (AOR: 3.84, 95% CI: 1.47-10.0), low albumin (AOR: 2.42, 95% CI: 1.20-4.89), and presence of metastases (AOR: 1.98, 95% CI: 1.29-3.06) were associated with greater odds of hospitalization. Number of opioids prescribed strongly correlated with number of hospitalizations (ρ correlation = 0.74). Only 10.6% of patients had been referred to outpatient palliative care during the study period. CONCLUSIONS Some patient and clinical characteristics associated with increased ER visits and hospitalizations in this cohort include race/ethnicity, palliative care referral, markers of advanced disease, and number opioids prescribed. Increasing knowledge of palliative care and access to palliative care among the underserved should be a focus of future research.
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Affiliation(s)
- Tori Knox-Rice
- 1 Department of Psychiatry, University of Texas (UT) Southwestern Medical Center , Dallas, Texas
| | - Lei Xuan
- 2 Department of Clinical Services, University of Texas (UT) Southwestern Medical Center , Dallas, Texas
| | - Hanna Wadsworth
- 1 Department of Psychiatry, University of Texas (UT) Southwestern Medical Center , Dallas, Texas
| | - Ethan A Halm
- 3 Division of General Internal Medicine, University of Texas (UT) Southwestern Medical Center , Dallas, Texas
| | - Ramona L Rhodes
- 4 Division of Geriatric Medicine, University of Texas (UT) Southwestern Medical Center , Dallas, Texas
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Bhulani N, Gupta A, Gao A, Li J, Guenther C, Ahn C, Paulk E, Houck S, Beg MS. Palliative care and end-of-life health care utilization in elderly patients with pancreatic cancer. J Gastrointest Oncol 2018; 9:495-502. [PMID: 29998015 DOI: 10.21037/jgo.2018.03.08] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Palliative care has been associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room/intensive care unit (ICU) utilization and costs in the last 30 days of life were compared between both groups using propensity score-matched (PSM) analysis. Results Of the 54,130 patients, 3,166 (5.8%) received palliative care and 70% received it in the last 30 days of life. The proportion of patients receiving palliative care increased from 1.4% in 2000 to 7.4% in 2009 (P<0.001). Patients with palliative care were more likely to be older, Asian and women. In the unmatched and PSM population, the average visits to the ER in the last 30 days of life were significantly higher for patients who received palliative care, and had a significantly higher cost of care. Similarly, ICU length of stay in the last 30 days of life was higher in patients who did not receive palliative care in both PSM and unmatched patients. Cost of care and number of ICU admissions were not different between palliative and non-palliative care groups in PSM and unmatched patients. Conclusions In this study of Medicare patients with pancreatic cancer, palliative care use has increased between 2000 and 2009. Palliative care was largely offered close to the end of life and was not associated with reduced health care utilization or cost.
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Affiliation(s)
- Nizar Bhulani
- Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Arjun Gupta
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ang Gao
- Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jenny Li
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Chad Guenther
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Chul Ahn
- Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Elizabeth Paulk
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Stephanie Houck
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Muhammad S Beg
- Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Watson GA, Saunders J, Coate L. Evaluating the Time to Palliative Care Referrals in Patients With Small-Cell Lung Cancer: A Single-Centre Retrospective Review. Am J Hosp Palliat Care 2018; 35:1426-1432. [PMID: 29739231 DOI: 10.1177/1049909118775066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Lung cancer is a leading cause of morbidity and mortality worldwide. Patients with lung cancer may experience a plethora of symptoms, which can be debilitating and affect their quality of life. Palliative care input to manage their physical and psychological well-being is a crucial component of their oncological care. The benefit of early palliative care input has been shown in patients with non-small cell lung cancer; however, data pertaining to patients with small-cell lung cancer are scarce. Nevertheless, early palliative care input is recommended by several national and international guidelines. Thus, we aimed to assess the time to palliative care referrals in patients diagnosed with small-cell lung cancer in an Irish tertiary hospital and to determine what impact this had on overall survival. METHODS We performed a retrospective, single-center audit of all patients diagnosed with extensive stage small-cell lung cancer over a 6-year period in an Irish tertiary hospital. RESULTS Overall, 91 patients were identified. Median age at diagnosis was 66 years (range: 38-83 years). The median Eastern Cooperative Oncology Group Performance Status at diagnosis was 1 (range: 0-3); 24 (26%) patients had multiple sites of distant metastasis at diagnosis; 45 (49.5%) patients were alive at 6 months, and 15 (16.5%) patients were alive at 12 months. One hundred percent of patients received palliative care input in our center over the course of their care. In the patients alive at 6 months after diagnosis, there was no survival advantage in those receiving palliative care within 1 month ( P = .002, odd ratio: 0.23, 95% confidence interval: 0.09-0.59). CONCLUSION Palliative care treatment is a critical aspect in the oncological treatment of all patients diagnosed with advanced cancer, and this study highlights good compliance with existing national guidelines. Further research focusing on quality-of-life issues with the use of questionnaires to assess physical and psychological symptoms should be performed to further understand the impact of palliative care in these patients.
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Affiliation(s)
- Geoffrey Alan Watson
- 1 Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Jean Saunders
- 2 Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Linda Coate
- 1 Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
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Clark CS. Medical Cannabis: The Oncology Nurse's Role in Patient Education About the Effects of Marijuana on Cancer Palliation
. Clin J Oncol Nurs 2018; 22:E1-E6. [PMID: 29350699 DOI: 10.1188/18.cjon.e1-e6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cannabis, also known as marijuana, is legal either medicinally or recreationally in 29 states and the District of Columbia, with a majority of the U.S. adult population now living in states where cannabis is legal for medicinal use. As an advocate for patient autonomy and informed choice, the oncology nurse has an ethical responsibility to educate patients about and support their use of cannabis for palliation.
. OBJECTIVES This article aims to discuss the human endocannabinoid system as a basis for better understanding the palliative and curative nature of cannabis as a medicine, as well as review cannabis delivery methods and the emerging role of the oncology nurse in this realm.
. METHODS This article examines the literature and uses a theoretical-conceptual method to explore the oncology nurse's role in supporting the use of medicinal cannabis by patients with cancer.
. FINDINGS The oncology nurse can play a pivotal role in supporting patients' use of cannabis for palliation.
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Williams M, Cardona-Morrell M, Stevens P, Bey J, Smith Glasgow M. Timing of palliative care team referrals for inpatients receiving rapid response services: A retrospective pilot study in a US hospital. Int J Nurs Stud 2017; 75:147-153. [DOI: 10.1016/j.ijnurstu.2017.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/28/2017] [Accepted: 07/29/2017] [Indexed: 01/13/2023]
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Abstract
Survivorship encompasses the entire therapeutic, psychosocial, functional, and financial experience of living with and through a cancer diagnosis. The period of survivorship starts on the day of the cancer diagnosis and lasts until the end of the survivor's life, regardless of the cause of death. The National Cancer Institute's Office of Cancer Survivorship expands the term "survivor" to include, importantly, caregivers, family, and friends close to the survivor who also live through this period.
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