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Gebel C, Ditscheid B, Meissner F, Slotina E, Kruschel I, Marschall U, Wedding U, Freytag A. Utilization and quality of palliative care in patients with hematological and solid cancers: a population-based study. J Cancer Res Clin Oncol 2024; 150:191. [PMID: 38607376 PMCID: PMC11014814 DOI: 10.1007/s00432-024-05721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Palliative care (PC) contributes to improved end-of-life care for patients with hematologic malignancies (HM) and solid tumors (ST) by addressing physical and psychological symptoms and spiritual needs. Research on PC in HM vs. ST patients is fragmented and suggests less use. METHODS We analyzed claims data of all deceased members of a large German health insurance provider for the year before death. First, we analyzed the frequency and the beginning of different types of PC and compared patients with HM vs. ST. Second, we analyzed the adjusted impact of PC use on several end-of-life quality outcomes in patients with HM vs. ST. We performed simple and multiple (logistic) regression analysis, adjusted for relevant covariates, and standardized for age and sex. RESULTS Of the 222,493 deceased cancer patients from 2016 to 2020, we included 209,321 in the first analysis and 165,020 in the second analysis. Patients with HM vs. ST received PC less often (40.4 vs. 55.6%) and later (34 vs. 50 days before death). PC use significantly improved all six quality indicators for good end-of-life care. HM patients had worse rates in five of the six indicators compared with ST patients. Interaction terms revealed that patients with ST derived greater benefit from PC in five of six quality indicators than those with HM. CONCLUSION The data highlight the need to integrate PC more often, earlier, and more effectively into the care of patients with HM.
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Affiliation(s)
- Cordula Gebel
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany.
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland.
| | - Bianka Ditscheid
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Franziska Meissner
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Ekaterina Slotina
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
| | - Isabel Kruschel
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland
| | | | - Ullrich Wedding
- Department of Palliative Care, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena, Deutschland
| | - Antje Freytag
- Institute of General Practice, University Hospital Jena, Friedrich-Schiller University Jena, Jena, Germany
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Di Lorenzo S, Mozzi L, Salmaso F, Silvagni C, Soffientini S, Valenti V, Zagonel V. A multicentre survey on the perception of palliative care among health professionals working in haematology. Support Care Cancer 2024; 32:253. [PMID: 38536470 PMCID: PMC10973048 DOI: 10.1007/s00520-024-08452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/20/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Patients with haematologic malignancies have less access to palliative care and are referred later than patients with solid tumours. We developed a survey to investigate this phenomenon, with the intention of analysing palliative care perceptions among health professionals who treat haematology patients and identifying barriers and facilitators to referrals to palliative care services. METHODS This was a multicentre exploratory descriptive web-based survey. A questionnaire was administered to 320 medical and nursing staff members from five Italian haematological units and San Marino's hospital to investigate their perception of palliative care. Quantitative and qualitative analyses were performed. RESULTS A total of 142/320 healthcare professionals completed the survey, achieving a 44% response rate. Most of the respondents supported the integration of haematology and palliative care and were aware of the role of palliative care. Despite this, only half had an in-hospital palliative care team, and only a few had previously attended a specific training course. The majority agreed with palliative care referral when the prognosis was less than 3 months or when the symptoms were incoercible and with blood transfusions even in the last stages of the disease. Many considered the presence of an in-hospital palliative care team or a case manager, as well as structured palliative care training, as fundamental facilitators of palliative care referrals. CONCLUSION These results showed that healthcare professionals in haematology generally hold a favourable attitude and a high interest in integrating palliative care into their patients' care. The low referral rate could depend on clinical, cultural, and organisational issues.
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Affiliation(s)
- Sara Di Lorenzo
- Clinical Hematology and Bone Marrow Transplant and Cellular Therapies Center, Carlo Melzi", Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Lisa Mozzi
- Clinical Hematology, Azienda Ospedaliera Ulss 8 Berica, "St. Bortolo" Hospital, Vicenza, Italy
| | - Flavia Salmaso
- Palliative Care Unit, IRCCS Istituto Oncologico Veneto IOV, Padua, Italy
| | - Claudia Silvagni
- Continuity of Care Center, Istituto Per La Sicurezza Sociale, Cailungo, Republic of San Marino
| | - Silvia Soffientini
- Integrated Home Care Unit, AULLS 6 Euganea - Terme Colli District, Padua, Italy
| | - Vanessa Valenti
- Palliative Care Unit, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST), "Dino Amadori", Via P. Maroncelli 40, Meldola, FC, 47014, Italy.
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, IRCCS Istituto Oncologico Veneto IOV, Padua, Italy
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Tanzi S, Martucci G. Doing palliative care research on hematologic cancer patients: A realist synthesis of literature and experts’ opinion on what works, for whom and in what circumstances. Front Oncol 2023; 13:991791. [PMID: 37051541 PMCID: PMC10083487 DOI: 10.3389/fonc.2023.991791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BackgroundResearch in PC (Palliative Care) is frequently challenging for patient’s frailty, study design, professional misconceptions, and so on. Little is known about specificity in PC research on Hematologic cancer patients, who have distinct characteristics that might influence the enrollment process.AimsWhat works, how and for whom, in increasing enrollment in studies in PC on patients with hematologic malignancies?MethodsRealist review: a qualitative review whose goal is to identify and explain the interaction between Contexts, Mechanisms, and Outcomes (CMOs). The theory was informed by a narrative, theory-based literature research, including an initialsystematic research, and the addition of papers suggested by experts of the field. We also used 7 interviews with experts in PC about patients with hematologic malignancies research and our own experience from a PC pilot study on patients with hematologic malignancies to refine the initial theory.ResultsIn our initial theory we hypothesize that: - Access to palliative care could be beneficial to hematologic patients, even in early stages - Hematologists tend to under-use palliative care services in general, due to unpredictable disease trajectories and cultural barriers. - These factors may negatively impact the patients’ enrollment in PC researchWe included secondary literature as narrative reviews, if they presented interesting propositions useful for our theoretical construction. 23 papers met our inclusion criteria.We also searched for relevant CMOs impacting referral in palliative care, and we selected a list of CMOs that could be relevant also in hematology. We accordingly theorized a group of interventions that could increase the enrollment in PC research and presented them using “social exchange theory” (SET) as a theoretical framework.Prominent researchers in PC in hematologic malignancies were interviewed on their opinion on our results, and additional CMOs.ConclusionsBefore conducting research in PC on patients with hematologic malignancies, it’s probably advisable to assess: - The perception of the different actors (physicians, nurses, other professionals involved), in particular the hematologists, in terms of pros and cons of referral to PC and enrollment in PC trials - The existing relationship between PC and the Hematology departmentAccordingly, it’s possible to tailor different interventions on the various actors and choose a model of trial to increase the perception of benefits from PC and, consequently, enrollment.
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Affiliation(s)
- Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Gianfranco Martucci
- Palliative Care Local Program, Local Health Unit of Modena, Modena, Italy
- *Correspondence: Gianfranco Martucci,
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Gautama MSN, Damayanti A, Khusnia AF. Impact of Early Palliative Care to Improve Quality of Life of Advanced Cancer Patients: A Meta-Analysis of Randomised Controlled Trials. Indian J Palliat Care 2023; 29:28-35. [PMID: 36846281 PMCID: PMC9944329 DOI: 10.25259/ijpc_153_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/30/2022] [Indexed: 11/04/2022] Open
Abstract
Palliative care is often started late in patients with life-threatening conditions, particularly in patients with advanced cancer. However, with the emergence of the early palliative care (EPC) paradigm, their quality of life (QoL) may be better. Although several previous meta-analyses support the effectiveness of EPC in increasing QoL, essential issues related to the optimisation of EPC interventions are still needed. A systematic review and meta-analysis of randomised controlled trials (RCTs) were conducted to determine the effectiveness of EPC on the QoL of patients with advanced cancer. PubMed, ProQuest, MEDLINE through EBSCOhost and Cochrane Library and clinicaltrials.gov (register website) were searched for RCTs published before May 2022. Data synthesis used the Review Manager 5.4 to generate pooled estimates of effect size. A total of 12 empirical trials met the eligibility criteria and were included in this study. The results showed that EPC intervention had a significant effect (standard mean difference = 0.16, 95% confidence interval: 0.04, 0.28, Z = 2.68, P < 0.05). However, the secondary outcomes showed including mood (mean difference = -0.90, 95% CI: -2.32, 0.51, P > 0.05) and symptom controls (MD = -1.49, 95% CI: -3.81, 0.81, P > 0.05) had no significant effect. EPC is effective in improving the QoL of patients with advanced cancer. However, other outcomes still need to be reviewed, because the review of QoL is not enough to generalise the benchmarks for the effectiveness and optimisation of EPC interventions. Another notable aspect is to consider the most effective and efficient duration for starting and ending EPC interventions.
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Affiliation(s)
- Made Satya Nugraha Gautama
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Adelina Damayanti
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Anindita Farda Khusnia
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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McInturf G, Younger K, Sanchez C, Walde C, Abdallah AO, Ahmed N, Shune L, Sborov DW, Godara A, McClune B, Sinclair CT, Mohyuddin GR. Palliative care utilization, transfusion burden, and end-of-life care for patients with multiple myeloma. Eur J Haematol 2022; 109:559-565. [PMID: 36054450 DOI: 10.1111/ejh.13843] [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: 05/20/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Despite treatment advances, multiple myeloma (MM) remains a significant source of morbidity and mortality. We aimed to examine specialist palliative care (SPC) involvement and end-of-life care for patients with MM. METHODS We assessed all deceased patients with a diagnosis of MM who received care at a single institution from January 2010 to December 2019 and assessed SPC involvement. RESULTS We reviewed 456 deceased patients. Overall, 207 patients (45.4%) received SPC visits by clinicians during their disease, and 153 (33.5%) were on MM treatment in the month before death. Median time from SPC consultation to death was 1 month, with 42 (9.2%) of patients receiving SPC visits 6 or more months before death. Amongst the patients for which a place of death was reported (351), 117 (33.3%) died in the acute care setting. Outpatient SPC did not correlate with a reduction of death in the acute care setting. In the group of patients who received outpatient SPC, 22/84 (26.2%) died in an acute care setting, whereas 95/267 (35.5%) patients who did not receive outpatient SPC also died in an acute care setting, (p = .11). CONCLUSION In our analysis of the entire trajectory of the MM patient experience from diagnosis to death, we found low rates of SPC involvement and a significant proportion of patients receiving aggressive care at end-of-life. While there is no clear correlation that SPC involvement impacted the rate of acute care deaths or decreased utilization of MM treatment in the last month of life, further prospective research on optimal utilization of SPC is required.
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Affiliation(s)
- Geoffrey McInturf
- School of Medicine, University of Kansas Medical Center, Lawrence, Kansas, USA
| | - Kimberly Younger
- School of Medicine, University of Kansas Medical Center, Lawrence, Kansas, USA
| | - Courtney Sanchez
- School of Medicine, University of Kansas Medical Center, Lawrence, Kansas, USA
| | - Charles Walde
- School of Medicine, University of Kansas Medical Center, Lawrence, Kansas, USA
| | - Al-Ola Abdallah
- School of Medicine, University of Kansas Medical Center, Lawrence, Kansas, USA
| | - Nausheen Ahmed
- School of Medicine, University of Kansas Medical Center, Lawrence, Kansas, USA
| | - Leyla Shune
- School of Medicine, University of Kansas Medical Center, Lawrence, Kansas, USA
| | - Douglas W Sborov
- Division of Hematology, Huntsman Cancer Center, University of Utah, Salt Lake City, Utah, USA
| | - Amandeep Godara
- Division of Hematology, Huntsman Cancer Center, University of Utah, Salt Lake City, Utah, USA
| | - Brian McClune
- Division of Hematology, Huntsman Cancer Center, University of Utah, Salt Lake City, Utah, USA
| | | | - Ghulam Rehman Mohyuddin
- Division of Hematology, Huntsman Cancer Center, University of Utah, Salt Lake City, Utah, USA
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Shaulov A, Aviv A, Alcalde J, Zimmermann C. Early integration of palliative care for patients with haematological malignancies. Br J Haematol 2022; 199:14-30. [PMID: 35670630 PMCID: PMC9796711 DOI: 10.1111/bjh.18286] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/30/2022] [Accepted: 05/17/2022] [Indexed: 01/07/2023]
Abstract
Early palliative care (EPC) significantly improves quality of life, symptoms, and satisfaction with care for patients with advanced cancer. International organizations have recognized and promoted the role of palliative care as a distinct specialty, advocating its involvement throughout the cancer trajectory. Although patients with haematologic malignancies (HMs) have a comparable symptom burden to patients with solid tumours, they face multiple barriers to EPC integration. In this review, we discuss these barriers, present updated evidence from clinical trials of EPC in HMs and propose models to support EPC integration into care for patients with HMs.
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Affiliation(s)
- Adir Shaulov
- Department of HaematologyHadassah Medical CenterJerusalemIsrael,Faculty of MedicineHebrew University of JerusalemIsrael
| | - Ariel Aviv
- Department of HaematologyHaEmek Medical CenterAfulaIsrael
| | - Jacqueline Alcalde
- Department of Supportive Care, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada,Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada,Department of MedicineUniversity of TorontoTorontoOntarioCanada,Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
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Karacan Y, Akkus Y, Ozcelik ET, Ali R. Identification of Psychological and Social Problems in Caregivers of Individuals Diagnosed with Hematologic Malignancy. Asia Pac J Oncol Nurs 2021; 8:204-210. [PMID: 33688570 PMCID: PMC7934589 DOI: 10.4103/apjon.apjon_53_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: Caring for patients with hematological malignancy could lead to many problems in different aspects regarding the lives of caregivers. However, there is limited data on the emotional and social problems of caregivers, who deal with patients of hematological malignancy. The aim of this study is to determine the emotional and social problems in caregivers of individuals diagnosed with hematological malignancy. Methods: The study was carried out descriptively to identify the emotional and social problems in the relatives of the patients diagnosed with hematological malignancy as their caregivers, as well as the factors affecting these problems. The data of the study were collected with the Introductory Information Form and Identification of Emotional and Social Problems Form that were administered to the relatives of the patients. The data were evaluated by using Spearman's Rho correlation analysis and the Logit analysis in Statistical Package for the Social Sciences software. Results: Among the caregivers, 59.8% were in the age group of 30–51 years, and 66.2% were female. Of the caregivers, 70.1% had difficulty in fulfilling their responsibilities. Spiritual distress had the highest score among the emotional problems, and experiencing caregiver strain had the highest score among the social problems. In the Logit model, the changes in the professional life was the variable that affects the emotional and social problems the most and significantly. In addition, emotional problems were affected by the financial problems at a statistically significant level. Conclusions: In this study, it is suggested that the caregivers should be provided with certain conveniences in their professional lives based on the fact that the problem, which affected emotional and social problems the most, is the change in the professional life; it is recommended that further studies should be carried out on the caregivers.
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Affiliation(s)
- Yasemin Karacan
- Division of Nursing, Health Science Faculty, Bursa Uludag University, Bursa, Turkey
| | - Yeliz Akkus
- Division of Nursing, Faculty of Health Science, Kafkas University, Kars, Turkey
| | | | - Ridvan Ali
- Department of Hematology, Bursa Uludag University, Bursa, Turkey
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Tanzi S, Venturelli F, Luminari S, Merlo FD, Braglia L, Bassi C, Costantini M. Early palliative care in haematological patients: a systematic literature review. BMJ Support Palliat Care 2020; 10:395-403. [DOI: 10.1136/bmjspcare-2020-002386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/24/2020] [Accepted: 09/04/2020] [Indexed: 12/29/2022]
Abstract
BackgroundEarly palliative care together with standard haematological care for advanced patients is needed worldwide. Little is known about its effect. The aim of the review is to synthesise the evidence on the impact of early palliative care on haematologic cancer patients’ quality of life and resource use.Patients and methodsA systematic review was conducted. The search terms were early palliative care or simultaneous or integrated or concurrent care and haematological or oncohaematological patients. The following databases were searched: PubMed, Embase, Cochrane, CINHAL and Scopus. Additional studies were identified through cross-checking the reference articles. Studies were in the English language, with no restriction for years. Two researchers independently reviewed the titles and abstracts, and one author assessed full articles for eligibility.ResultsA total of 296 studies titles were reviewed. Eight articles were included in the synthesis of the results, two controlled studies provided data on the comparative efficacy of PC interventions, and six one-arm studies were included. Since data pooling and meta-analysis were not possible, only a narrative synthesis of the study results was performed. The quality of the two included comparative studies was low overall. The quality of the six non-comparative studies was high overall, without the possibility of linking the observed results to the implemented interventions.ConclusionsStudies on early palliative care and patients with haematological cancer are scarce and have not been prospectively designed. More research on the specific population target, type and timing of palliative care intervention and standardisation of collected outcomes is required.PROSPERO registration numberCRD42020141322.
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