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Brugel M, Dupont M, Carlier C, Botsen D, Essi DE, Sanchez V, Slimano F, Perrier M, Bouché O. Association of palliative care management and survival after chemotherapy discontinuation in patients with advanced pancreatic adenocarcinoma: A retrospective single-centre observational study. Pancreatology 2023:S1424-3903(23)00069-8. [PMID: 37037682 DOI: 10.1016/j.pan.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/20/2023] [Accepted: 03/16/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Palliative care (PC) is integrated into standard oncology care. However, its clinical impact at the end of life remains unclear in pancreatic adenocarcinoma (PA). We aimed to describe the end-of-life care pathway and to assess whether PC referral influences survival after chemotherapy discontinuation (CD) among advanced PA patients. METHODS This retrospective single-centre observational study was conducted among deceased patients with advanced PA who had received chemotherapy between January 1, 2016, and December 31, 2021. Baseline characteristics, the timing of PC referral and events after CD were collected. The primary outcome was time from CD to death. RESULTS Among the 148 included patients, 53.4% (n = 79) received PC, mostly late after the CD (n = 133, 89.9%), 16.9% (n = 25) received chemotherapy in the last 14 days of life and 75.6% died at the hospital. None received PC in the 8 weeks following the diagnosis. PC referral significantly increased PC department admissions (p < 0.001) and decreased medical unit admissions (p < 0.001). The median survival after the CD was 35 days (IQR: 19-64.5). PC referral was associated with increased survival after CD (HR: 0.65 [0.47-0.90], p = 0.010, Cox) and after adjusting (HR: 0.65 [0.42-0.99], p = 0.045, Cox). CONCLUSION The study suggests that PC may be associated with longer survival after CD in advanced PA patients. However, PC is underused, and patients are referred late in their care pathway.
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Affiliation(s)
- M Brugel
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France.
| | - M Dupont
- Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - C Carlier
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France; Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - D Botsen
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France; Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - D Edoh Essi
- Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - V Sanchez
- Department of Palliative Care, CHU Reims, Reims, France
| | - F Slimano
- Université de Reims Champagne-Ardenne, Department of Pharmacy, CHU Reims, Reims, France
| | - M Perrier
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France
| | - O Bouché
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France
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2
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Braulke F, Kober K, Arndt A, Papendick M, Strauss A, Kramm CM, Thoms KM, König A, Gaedcke J, Gallwas J, Wulf S, Szuszies C, Wulf G, Rödel R, Wolfer S, Malinova V, Overbeck TR, Hinterthaner M, Lotz J, Nauck F, Ernst M, Stadelmann C, Ströbel P, Ellenrieder V, Asendorf T, Rieken S. Optimizing the structure of interdisciplinary tumor boards for effective cancer care. Front Oncol 2023; 13:1072652. [PMID: 37182140 PMCID: PMC10171921 DOI: 10.3389/fonc.2023.1072652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Multi-professional interdisciplinary tumor boards (ITB) are essential institutions to discuss all newly diagnosed, relapsed or complex cancer patients in a team of specialists to find an optimal cancer care plan for each individual patient with regard to national and international clinical practice guidelines, patient´s preference and comorbidities. In a high-volume cancer center, entity-specific ITBs take place at least once a week discussing a large number of patients. To a high level of expertise and dedication, this also requires an enormous amount of time for physicians, cancer specialists and administrative support colleagues, especially for radiologists, pathologists, medical oncologists and radiation oncologists, who must attend all cancer-specific boards according to certification requirements. Methods In this 15-month prospective German single-center analysis, we examined the established structures of 12 different cancer-specific ITBs at the certified Oncology Center and demonstrate tools helping to optimize processes before, during and after the boards for optimal, time-saving procedures. Results By changing pathways, introducing revised registration protocols and new digital supports we could show that the workload of preparation by radiologists and pathologists could be reduced significantly by 22.9% (p=<0.0001) and 52.7% (p=<0.0001), respectively. Furthermore, two questions were added to all registration forms about the patient´s need for specialized palliative care support that should lead to more awareness and early integration of specialized help. Discussion There are several ways to reduce the workload of all ITB team members while maintaining high quality recommendations and adherence to national and international guidelines.
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Affiliation(s)
- Friederike Braulke
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Kathrin Kober
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Arndt
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Maximilian Papendick
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany
| | - Arne Strauss
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Christof Maria Kramm
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Kai-Martin Thoms
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Alexander König
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Jochen Gaedcke
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Julia Gallwas
- Department of Gynaecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Svenja Wulf
- Department of Gynaecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Christoph Szuszies
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Gerald Wulf
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Ralph Rödel
- Department of Otorhinolaryngology, University Medical Center Göttingen, Göttingen, Germany
| | - Susanne Wolfer
- Department of Oral and Maxillofacial Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Vesna Malinova
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias R. Overbeck
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Marielle Ernst
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Christine Stadelmann
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan Rieken
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
- *Correspondence: Stefan Rieken,
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Aboelkhir HAB, Elomri A, ElMekkawy TY, Kerbache L, Elakkad MS, Al-Ansari A, Aboumarzouk OM, El Omri A. A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16952. [PMID: 36554837 PMCID: PMC9778793 DOI: 10.3390/ijerph192416952] [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: 08/06/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The referral process is an important research focus because of the potential consequences of delays, especially for patients with serious medical conditions that need immediate care, such as those with metastatic cancer. Thus, a systematic literature review of recent and influential manuscripts is critical to understanding the current methods and future directions in order to improve the referral process. METHODS A hybrid bibliometric-structured review was conducted using both quantitative and qualitative methodologies. Searches were conducted of three databases, Web of Science, Scopus, and PubMed, in addition to the references from the eligible papers. The papers were considered to be eligible if they were relevant English articles or reviews that were published from January 2010 to June 2021. The searches were conducted using three groups of keywords, and bibliometric analysis was performed, followed by content analysis. RESULTS A total of 163 papers that were published in impactful journals between January 2010 and June 2021 were selected. These papers were then reviewed, analyzed, and categorized as follows: descriptive analysis (n = 77), cause and effect (n = 12), interventions (n = 50), and quality management (n = 24). Six future research directions were identified. CONCLUSIONS Minimal attention was given to the study of the primary referral of blood cancer cases versus those with solid cancer types, which is a gap that future studies should address. More research is needed in order to optimize the referral process, specifically for suspected hematological cancer patients.
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Affiliation(s)
| | - Adel Elomri
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Tarek Y. ElMekkawy
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
| | - Laoucine Kerbache
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Mohamed S. Elakkad
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - 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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Reid EA, Abathun E, Diribi J, Mamo Y, Wondemagegnhu T, Hall P, Fallon M, Grant L. Early palliative care in newly diagnosed cancer in Ethiopia: feasibility randomised controlled trial and cost analysis. BMJ Support Palliat Care 2022:spcare-2022-003996. [PMID: 36414402 DOI: 10.1136/spcare-2022-003996] [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: 10/18/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Globally, cancer deaths are rising. In low-and-middle-income countries, there is a gap in access to palliative care (PC). We designed a feasibility trial to study the initiation of early PC in patients with cancer in Addis Ababa, Ethiopia. METHODS A randomised controlled trial (RCT) of standard cancer care versus standard cancer care plus in-home PC was conducted. Follow-up was at 8 and 12 weeks. Primary outcomes were: (1) feasibility, (2) patient-reported PC outcomes (African Palliative Care Association Palliative Outcome Scale (APCA POS)), and (3) costs. RESULTS Of 95 adults randomised (mean age 49.5 years; 66% female), 27 completed 3 study visits. Of these, 89% had stage III or IV disease. Recruitment was feasible, but attrition was high. APCA POS use was feasible, with significant within-arm improvements: 24% versus 18% reduction (p<0.0002, p<0.0025) in PC versus standard care, respectively. Standard care subjects reported higher out-of-pocket payments (5810 Ethiopian birr) (ETB) and lost wages of informal caregivers (74 900 ETB), multiple times an average Ethiopian salary (3696 ETB). CONCLUSION It is feasible to conduct an RCT of early PC for patients with cancer in Ethiopia. Retention was the biggest challenge. This study revealed opportunities to improve care, and important feasibility results to inform future, larger scale PC research in Ethiopia and beyond.
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Affiliation(s)
- Eleanor Anderson Reid
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Usher Institute, Center for Population Health Sciences, University of Edinburgh Division of Medical and Radiological Sciences, Edinburgh, UK
| | | | - Jilcha Diribi
- Department of Oncology, Addis Ababa College of Health Sciences School of Medicine, Addis Ababa, Ethiopia
| | | | - Tigeneh Wondemagegnhu
- Department of Oncology, Addis Ababa College of Health Sciences School of Medicine, Addis Ababa, Ethiopia
| | - Peter Hall
- Department of Oncology, University of Edinburgh Western General Hospital, Edinburgh, UK
| | - Marie Fallon
- Palliative Medicine, University of Edinburgh Western General Hospital, Edinburgh, UK
| | - Liz Grant
- Programme Director Global Health: Non Communicable Diseases, University of Edinburgh Global Health Academy, Edinburgh, UK
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Auclair J, Sanchez S, Chrusciel J, Hannetel L, Frasca M, Economos G, Habert-Dantigny R, Bruera E, Burucoa B, Ecarnot F, Colombet I, Barbaret C. Duration of palliative care involvement and immunotherapy treatment near the end of life among patients with cancer who died in-hospital. Support Care Cancer 2022; 30:4997-5006. [PMID: 35192058 DOI: 10.1007/s00520-022-06901-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionised cancer treatment, but their use near the end of life in patients with advanced cancer is poorly documented. This study investigated the association between administration of ICI therapy in the last month of life and the duration of involvement of the palliative care (PC) team, among patients with advanced cancer who died in-hospital. METHODS In a retrospective, multicentre study, we included all patients who died in 2018 of melanoma, head and neck carcinoma, non-small cell lung cancer or urothelial or renal cancer, in 2 teaching hospitals and one community hospital in France. The primary outcome was the association between ICI therapy in the last month of life and duration of involvement of the PC team in patient management. RESULTS Among 350 patients included, 133 (38%) received anti-cancer treatment in the last month of life, including 71/133 (53%) who received ICIs. A total of 207 patients (59%) received palliative care, only 127 (36%) 30 days before death. There was a significant association between ongoing ICI therapy in the last month of life and shorter duration of PC management (p = 0.04). Receiving ICI therapy in the last month of life was associated with an increased risk of late PC initiation by multivariate regression analysis (hazard ratio 1.668; 95% CI 1.022-2.722). CONCLUSION ICI therapy is frequently used close to the end of life in patients with advanced cancer. Innovative new anti-cancer treatments should not delay PC referral. Improved collaboration between PC and oncological teams is needed to address this issue.
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Affiliation(s)
- Juline Auclair
- Department of Palliative Care, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Stéphane Sanchez
- Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France
| | - Jan Chrusciel
- Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France
| | - Louise Hannetel
- Department of Palliative Care, Hôpitaux Champagne Sud, Troyes, France
| | - Matthieu Frasca
- Department of Palliative Care, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Guillaume Economos
- Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Lyon-Sud, Lyon, France
| | - Raphaelle Habert-Dantigny
- Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Avenue du Maquis du Grésivaudan, La Tronche, 38700, Grenoble, France
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benoit Burucoa
- Department of Palliative Care, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, University of Franche-Comté, EA392025000, Besançon, France
| | | | - Cécile Barbaret
- Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Avenue du Maquis du Grésivaudan, La Tronche, 38700, Grenoble, France.
- Laboratoire ThEMAS (Techniques pour l'évaluation et la Modélisation des Actions de Santé (TIMC-IMAG : Technique de l'Ingénierie Médicale et de la Compléxité-Informatique, Mathématiques et Applications, Grenoble), Grenoble, France.
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6
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Ekinci F, Erdoğan AP. The Effect of Palliative Invasive Interventions on Overall Survival in the Last 3 Months of Life in Metastatic Gastric Cancer. J Gastrointest Cancer 2022; 53:496-501. [PMID: 35112313 DOI: 10.1007/s12029-021-00780-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Gastric cancer is one of the biologically aggressive and highly mortal cancers. In addition to limited treatment options, especially in advanced stages, palliative treatment methods are applied to increase patients' quality of life with gastric cancer. This study aims to discuss the effects of paracentesis, thoracentesis, tube thoracostomy, double J catheter nephrostomy, percutaneous transhepatic cholangiography (PTC), and abscess drainage catheter placement procedures applied in the last 3 months for problems requiring palliation, in the light of literature. METHOD The patient characteristics of the patients and, in addition, the history of any invasive intervention for palliative treatment in the last 3 months were questioned and recorded with the electronic medical record system. The effect of an invasive intervention on survival was examined. The data of patients with metastatic gastric cancer followed in the medical oncology clinic between February 2012 and May 2020 were reviewed retrospectively. CONCLUSIONS In this study, in which the effect of palliative invasive intervention (PIG) stories on survival in the last 3 months of life of patients diagnosed with metastatic gastric cancer was examined, no significant difference was found between those who underwent PIG and those who did not, in terms of overall survival. However, since PIG was not included in the design of our study, the effect of PIG in terms of quality of life, mood, motivation of patient relatives, and the cost is unknown. RESULTS In the final analysis, it was noted that 143 (94.1%) of the 152 patients included in the study died and 9 (5.9%) were still alive. Overall survival of all patients was reported as 12.9 months (95% CI, 10.9-14.9). The mean overall survival of 36 patients who underwent palliative invasive intervention (PIG) in the last 3 months was 13.0 months (95% CI, 9.1-17.0), and a similar 13.0 months (95% CI, 10.6-15.3) of 116 patients who did not undergo PIG no significant difference was found (p: 0.887).
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Affiliation(s)
- Ferhat Ekinci
- Manisa Celal Bayar University, Medical Oncology Department, Manisa, Turkey.
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7
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Ghabashi EH, Sharaf BM, Kalaktawi WA, Calacattawi R, Calacattawi AW. The Magnitude and Effects of Early Integration of Palliative Care Into Oncology Service Among Adult Advanced Cancer Patients at a Tertiary Care Hospital. Cureus 2021; 13:e15313. [PMID: 34211813 PMCID: PMC8237381 DOI: 10.7759/cureus.15313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Palliative care (PC) has a positive effect on symptom burden, quality of life, psychosocial communication, prognostic understanding, mood, and quality of care at the end of life of patients with advanced cancer. Objectives To investigate the timing of the first palliative consultation and referral of advanced cancer patients to the palliative care service and their determinants at King Faisal Specialist Hospital and Research Center (KFSHRC), Jeddah, Saudi Arabia. Subjects and methods A retrospective cohort study was conducted at KFSHRC. It included advanced cancer patients who died between January 1, 2019 and Jun 30, 2020. The dependent variable of primary interest is the timing of PC consultation and the timing of PC referral. The independent variables included age, sex, marital status, nationality, date of death, types of cancer, Eastern Cooperative Oncology Group (ECOG), palliative performance status (PPS), palliative prognostic index (PPI), code status (do not resuscitate [DNR]), the severity of symptoms (assessed by the Edmonton Symptom Assessment System - Revised [ESAS-r]), referral to home health care (HHC), referral to long-term care (LTC), referral to interdisciplinary team (IDT), length of survival after the first PC consultation, length of survival after the referral to the PC service, length of hospital stay, frequency of emergency room (ER) visits and hospital admission in the last year before death, and involvement in bereavement with advanced care planning (ACP) services. Results Of the 210 advanced cancer patients, 109 (51.9%) were male, and their ages ranged between 18 and 90 years. More than half of patients (56.7%) had a history of PC consultation. Among them, PC consultation was described as late in 60.5% of patients. Concerning the timing of palliative care referral among advanced cancer patients, it was too late and much too late among 25.7% and 58.1% of them, respectively. Patients who visited ER more frequently (≥3 times) (p=0.014) and those who referred to HHC (p=0.005) were more likely to consult PC early compared to their counterparts. Length of survival was significantly higher among patients who reported early PC consultation compared to those without PC consultation and those with late PC consultation, p<0.001. Referral to PC for both transfer of care and symptom management was associated with earlier PC consultation, p=0.021. Patients who were admitted to the hospital three times or more were less likely to be much too late referred to PC services, p=0.046. Also, patients who were not referred to long-term care or home health care were more likely to be referred to PC services much too late, p<0.001. Among 28.8% of patients whose PPS ranged between 30% and 50% compared to 14.9% of those whose PPS ranged between 10% and 20% expressed too late referral time to PC, p=0.040. Conclusion In a considerable proportion of terminal cancer patients, palliative care was consulted late, and the timing of palliative care referral was too late/much too late among most of those consulted palliative care. Length of survival was higher among patients who reported early PC consultation and who with ideal referral time to PC services than others. Therefore, future considerations to facilitate early integration of palliative care in cancer patients are highly recommended through mainly improving staff education in communication skills and palliative care approach.
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Affiliation(s)
| | - Belal M Sharaf
- Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | | | - Retaj Calacattawi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Narwal S, Jain S. Building Resilient Health Systems: Patient Safety during COVID-19 and Lessons for the Future. JOURNAL OF HEALTH MANAGEMENT 2021. [DOI: 10.1177/0972063421994935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: The COVID-19 pandemic has profoundly impacted the country’s health systems and diminished its capability to provide safe and effective healthcare. This article attempts to review patient safety issues during COVID-19 pandemic in India, and derive lessons from national and international experiences to inform policy actions for building a ‘resilient health system’. Methods: Systematic review of existing published articles, government and media reports was undertaken. Online databases were searched using key terms related to patient safety during COVID-19 and health systems resilience. Seventy-three papers were included dependent on their relevance to research objectives. Findings: Patient safety was impacted during COVID-19, owing to sub-optimal infection prevention and control measures coupled with reduced access to essential health services. This was largely due to inadequate infrastructure, human and material resources resulting from chronic underinvestment in public health systems, paucity of reliable data for evidence-based actions and limited leadership and regulatory capacity. Conclusions: India’s health systems were found ill prepared to tackle large-scale pandemic, which has major implications for patient safety. The shortcomings observed in the COVID-19 response must be rectified and comprehensive health sector reforms should be initiated for building agile and resilient health systems that can withstand future pandemics.
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Affiliation(s)
| | - Susmit Jain
- Associate Professor, IIHMR University, Jaipur, India
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9
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Janah A, Le Bihan-Benjamin C, Mancini J, Bouhnik AD, Bousquet PJ, Bendiane MK. Access to inpatient palliative care among cancer patients in France: an analysis based on the national cancer cohort. BMC Health Serv Res 2020; 20:798. [PMID: 32847565 PMCID: PMC7448507 DOI: 10.1186/s12913-020-05667-8] [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: 03/05/2020] [Accepted: 08/18/2020] [Indexed: 01/26/2023] Open
Abstract
Background Closely linked to the concept of supportive care, the integrated model of palliative care (PC) implies identifying, assessing and treating physical and psychological suffering as early as needed, irrespective of patient characteristics. In France, as in the most southern European countries, little is known about the proportion of cancer patients who have access to PC. Accordingly, we aimed in this study to estimate the proportion of cancer patients in France who have access to inpatient PC, and to explore associated factors. We carried out a nationwide retrospective cohort study using data from the French national health system database (SNDS) for all individuals diagnosed with cancer in 2013 and followed between 2013 and 2016. We compared patients who had inpatient PC with those who did not. Results Of the 313,059 cancer patients included in the national French cancer cohort in 2013, 53,437 (17%) accessed inpatient PC at least once between 2013 and 2016, ranging from 2% in survivors to 56% in the deceased population. Multivariate logistic regression revealed that women and younger patients (18–49 years old) were less likely to access inpatient PC while patients with a greater number of comorbidities, metastatic cancer, or cancer of the nervous system, were more likely to have done so. Conclusions A negligible proportion of cancer survivors accessed inpatient PC. More research and training are needed to convince healthcare providers, patients, and families about the substantial benefits of PC, and to promote better integration of PC and oncology.
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Affiliation(s)
- Asmaa Janah
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 27 Boulevard Jean Moulin, Marseille, France.
| | - Christine Le Bihan-Benjamin
- Department of Health Data and Assessment, Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 52 Avenue André Morizet, Boulogne-Billancourt, France
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 27 Boulevard Jean Moulin, Marseille, France.,APHM, La Timone Hospital, BiosTIC, 264 Rue Saint-Pierre, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 27 Boulevard Jean Moulin, Marseille, France
| | - Philippe-Jean Bousquet
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 27 Boulevard Jean Moulin, Marseille, France.,Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 52 Avenue André Morizet, Boulogne-Billancourt, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 27 Boulevard Jean Moulin, Marseille, France
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