1
|
Munir MM, Rashid Z, Endo Y, Dillhoff M, Tsai S, Pawlik TM. Association between quality metric adherence and overall survival among patients undergoing resection of pancreatic ductal adenocarcinoma. Surgery 2024; 176:873-879. [PMID: 38890100 DOI: 10.1016/j.surg.2024.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/16/2024] [Accepted: 04/29/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Process-based quality metrics are important for improving long-term outcomes after surgical resection. We sought to develop a practical surgical quality score for patients diagnosed with pancreatic ductal adenocarcinoma undergoing curative-intent resection. METHODS Patients who underwent surgical resection for pancreatic ductal adenocarcinoma between 2010 and 2017 were identified using the National Cancer Database. Five surgical quality metrics were defined: minimally invasive approach, adequate lymphadenectomy, negative surgical margins, receipt of adjuvant therapy, and no prolonged hospitalization. Log-rank test and multivariable Cox regression analysis were used to determine the association of quality metrics with overall survival. RESULTS A total of 38,228 patients underwent curative-intent resection for pancreatic ductal adenocarcinoma. Median age at diagnosis was 68 years (interquartile range = 61-75), and roughly half the cohort was male (n = 19,562; 51.2%). Quality metrics were achieved on a varied basis: minimally invasive approach (n = 5,701; 14.9%), adequate lymphadenectomy (n = 27,122; 80.0%), negative surgical margin (n = 29,248; 76.5%), receipt of adjuvant therapy (n = 26,006; 68.0%), and absence of prolonged hospitalization (n = 26,470; 69.2%). An integer-based surgical quality score from 0 (no quality metrics) to 16 (all quality metrics) was calculated. Patients with higher scores had progressively better overall survival. Median overall survival differed substantially among the score categories (score = 0-4 points, 8.7 [8.0-9.6] months; 5-8 points, 17.5 [16.9-18.2] months; 9-12 points, 22.1 [21.6-22.8] months; and 13-16 points, 30.8 [30.2-31.3] months; P < .001). On multivariable analysis, risk-adjusted mortality hazards decreased in a stepwise manner with higher scores (0-4 points: reference; 5-8 points: multivariable adjusted hazard ratio = 0.60; 95% CI, 0.57-0.63; 9-12 points: adjusted hazard ratio = 0.49; 95% CI, 0.47-0.52; 13-16 points: and adjusted hazard ratio = 0.37; 95% CI, 0.34-0.40; all P < .001). CONCLUSION Adherence to quality metrics may be associated with improved overall survival. Efforts aimed at increasing compliance with quality metric measures may help optimize long-term outcomes among patients undergoing surgical resection for pancreatic ductal adenocarcinoma.
Collapse
Affiliation(s)
- Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Zayed Rashid
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Susan Tsai
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
| |
Collapse
|
2
|
Duru EE, Ben-Umeh KC, Mattingly TJ. Cost of long-term care and balancing caregiver wellbeing: a narrative review. Expert Rev Pharmacoecon Outcomes Res 2024:1-15. [PMID: 39030716 DOI: 10.1080/14737167.2024.2383406] [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: 04/13/2024] [Accepted: 07/18/2024] [Indexed: 07/21/2024]
Abstract
INTRODUCTION Long-term care (LTC) refers to care and support services that are required by individuals who lack the ability to perform important daily routines and may be dependent on others for personal, social, and medical needs over a sustained period of time. LTC may be broadly categorized into formal and informal care, where formal care is provided by professionals who are compensated to provide these services and informal care captures the care services provided without compensation by family members, friends, or other unpaid individuals. AREAS COVERED In this narrative review, we identify and synthesize evidence to evaluate the cost of long-term care while balancing the needs of caregivers. We searched Embase and EconLit for studies published from 2010 to November 2023. Our search strategy used a combination of keywords such as 'long-term care,' 'caregiver burden,' 'caregiver support,' 'cost of care,' and 'caregiver wellbeing.' We include both formal and informal LTC, as well as predictors of caregiver wellbeing. EXPERT COMMENTARY This review highlights the global variability in LTC costs and the significant burden on caregivers, emphasizing the need for policy interventions and comprehensive insurance schemes. Future research should focus on standardized assessment tools, intervention effectiveness, and integrating caregiver support into healthcare models, ensuring holistic and sustainable LTC solutions.
Collapse
Affiliation(s)
- Emeka Elvis Duru
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT, Salt Lake City, USA
| | - Kenechukwu C Ben-Umeh
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT, Salt Lake City, USA
| | - T Joseph Mattingly
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT, Salt Lake City, USA
| |
Collapse
|
3
|
Cuba L, Dürr P, Gessner K, Häcker B, Fietkau R, Siebler J, Pavel M, Neurath MF, Berking C, Wullich B, Brückl V, Beckmann MW, Fromm MF, Dörje F. A Hybrid Type III Effectiveness-Implementation Trial to Optimize Medication Safety With Oral Antitumor Therapy in Real-World: The AMBORA Competence and Consultation Center. JCO Oncol Pract 2024:OP2300694. [PMID: 38848539 DOI: 10.1200/op.23.00694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/30/2024] [Accepted: 04/18/2024] [Indexed: 06/09/2024] Open
Abstract
PURPOSE Implementation science endeavors to facilitate the translation of evidence-based research into clinical routine. The clinical pharmacological/pharmaceutical care program evaluated in the randomized AMBORA trial on medication safety with oral antitumor therapeutics (OAT) optimizes care delivery and provides significant benefits for patients, treatment teams, and health care systems. Thus, we aimed to investigate the implementation of this care program within the AMBORA Competence and Consultation Center (AMBORA Center). METHODS The AMBORA Center within a University Comprehensive Cancer Center offered several services (eg, patient consultations) and was evaluated according to the RE-AIM framework. This multicenter hybrid type III trial focused on implementation outcomes (eg, patient recruitment, referring units, evaluation of services) while concurrently investigating effectiveness (eg, side effects, medication errors). Quantitative and qualitative assessments were combined. RESULTS The AMBORA Center conducted over 800 consultations with 420 patients in seven institutions. The primary end point of counseling 70% of patients treated with OAT was not reached. Patients were referred by 15 treatment units compared with 11 units in the AMBORA trial. On the basis of heterogeneous referral rates and characteristics across the institutions, barriers and facilitators of the implementation process were derived. Several survey results (eg, stakeholder interviews, online/paper-based questionnaires) reflected a high appreciation of services by patients and health care professionals. The severity of 60.1% (178 of 296) of detected side effects improved, and 86.3% (297 of 344) of medication errors were resolved. CONCLUSION Despite not reaching the primary implementation outcome, the AMBORA Center included more treatment units and demonstrated patient benefit of the AMBORA care program by meeting all effectiveness outcomes. We outlined quantitative and qualitative implementation characteristics to enhance outreach and foster further dissemination of centers to optimize medication safety with OAT.
Collapse
Affiliation(s)
- Lisa Cuba
- Pharmacy Department, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Pauline Dürr
- Pharmacy Department, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Katja Gessner
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | | | - Rainer Fietkau
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- Department of Radiation Oncology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jürgen Siebler
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- Department of Medicine 1, Gastroenterology, Pneumology and Endocrinology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Marianne Pavel
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- Department of Medicine 1, Gastroenterology, Pneumology and Endocrinology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F Neurath
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- Department of Medicine 1, Gastroenterology, Pneumology and Endocrinology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carola Berking
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- Department of Dermatology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Bernd Wullich
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Valeska Brückl
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- Department of Medicine 5, Hematology and Oncology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- Department of Obstetrics and Gynecology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Martin F Fromm
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- FAU NeW - Research Center New Bioactive Compounds, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Dörje
- Pharmacy Department, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Universitätsklinikum Erlangen, Erlangen, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
- FAU NeW - Research Center New Bioactive Compounds, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
4
|
Pao M, Horowitz L. Palliative care and suicidality: Complicated conversations at two ends of the spectrum. Pediatr Blood Cancer 2024; 71:e30956. [PMID: 38511908 PMCID: PMC11039356 DOI: 10.1002/pbc.30956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Maryland Pao
- Office of the NIMH Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa Horowitz
- Office of the NIMH Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
5
|
Huang HL, Chen PJ, Mori M, Suh SY, Wu CY, Peng JK, Shih CY, Yao CA, Tsai JS, Chiu TY, Hiratsuka Y, Kim SH, Morita T, Yamaguchi T, Tsuneto S, Hui D, Cheng SY. Improved Symptom Change Enhances Quality of Dying in Patients With Advanced Cancer: An East Asian Cross-Cultural Study. Oncologist 2024; 29:e553-e560. [PMID: 37758042 PMCID: PMC10994251 DOI: 10.1093/oncolo/oyad269] [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: 03/05/2023] [Accepted: 06/20/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Symptom burdens tend to increase for patients with cancer and their families over the disease trajectory. There is still a lack of evidence on the associations between symptom changes and the quality of dying and death. In this context, this research investigated how symptom changes influence the quality of dying and death. METHODS This international prospective cohort study (the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED), 2017-2019) included 22, 11, and 4 palliative care units across Japan, South Korea, and Taiwan. Eligible participants were adults (Japan and Korea, ≥18 years; Taiwan, ≥20 years) with locally advanced or metastatic cancer. Physical and psychological symptoms were assessed by physicians upon admission and within 3 days before death. Death quality was assessed using the Good Death Scale (GDS), developed in Taiwan. Univariate and multivariate regression analyses were used to identify correlations between symptom severity changes and GDS scores. RESULTS Among 998 patients (542 [54.3%] men and 456 [45.7%] women; mean [SD] age = 70.1 [± 12.5] years), persistent dyspnea was associated with lower GDS scores when compared to stable dyspnea (β = -0.427, 95% CI = -0.783 to -0.071). Worsened (-1.381, -1.932 to -0.831) and persistent (-1.680, -2.701 to -0.659) delirium were also significantly associated with lower GDS scores. CONCLUSIONS Better quality of dying and death was associated with improved symptom control, especially for dyspnea and delirium. Integrating an outcome measurement for the quality of dying and death is important in the management of symptoms across the disease trajectory in a goal-concordant manner.
Collapse
Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Ping-Jen Chen
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Republic of China
- Department of Family Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Republic of China
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea
| | - Chien-Yi Wu
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Republic of China
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Republic of China
| | - Jen-Kuei Peng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Chih-Yuan Shih
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Jaw-Shiun Tsai
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Miyagi Prefecture, Japan
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - David Hui
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, USA
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| |
Collapse
|
6
|
Habib MH, Tiger YKR, Dima D, Schlögl M, McDonald A, Mazzoni S, Khouri J, Williams L, Anwer F, Raza S. Role of Palliative Care in the Supportive Management of AL Amyloidosis-A Review. J Clin Med 2024; 13:1991. [PMID: 38610755 PMCID: PMC11012321 DOI: 10.3390/jcm13071991] [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: 02/20/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Light chain amyloidosis is a plasma-cell disorder with a poor prognosis. It is a progressive condition, causing worsening pain, disability, and life-limiting complications involving multiple organ systems. The medical regimen can be complex, including chemotherapy or immunotherapy for the disease itself, as well as treatment for pain, gastrointestinal and cardiorespiratory symptoms, and various secondary symptoms. Patients and their families must have a realistic awareness of the illness and of the goals and limitations of treatments in making informed decisions about medical therapy, supportive management, and end-of-life planning. Palliative care services can thus improve patients' quality of life and may even reduce overall treatment costs. Light chain (AL) amyloidosis is a clonal plasma cell disorder characterized by the excessive secretion of light chains by an indolent plasma cell clone that gradually accumulates in vital organs as amyloid fibrils and leads to end-organ damage. With progressive disease, most patients develop diverse clinical symptoms and complications that negatively impact quality of life and increase mortality. Complications include cardiac problems including heart failure, hypotension, pleural effusions, renal involvement including nephrotic syndrome with peripheral edema, gastrointestinal symptoms leading to anorexia and cachexia, complex pain syndromes, and mood disorders. The prognosis of patients with advanced AL amyloidosis is dismal. With such a complex presentation, and high morbidity and mortality rates, there is a critical need for the establishment of a palliative care program in clinical management. This paper provides an evidence-based overview of the integration of palliative care in the clinical management of AL amyloidosis as a means of reducing ER visits, rehospitalizations, and in-hospital mortality. We also discuss potential future collaborative directions in various aspects of clinical care related to AL amyloidosis.
Collapse
Affiliation(s)
- Muhammad Hamza Habib
- Department of Palliative Care, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, USA
| | - Yun Kyoung Ryu Tiger
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Danai Dima
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Mathias Schlögl
- Department of Geriatric Medicine, Clinic Barmelweid, 5017 Barmelweid, Switzerland;
| | - Alexandra McDonald
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Sandra Mazzoni
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Jack Khouri
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Louis Williams
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Faiz Anwer
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Shahzad Raza
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| |
Collapse
|
7
|
Kinsey E, Lee HM. Management of Hepatocellular Carcinoma in 2024: The Multidisciplinary Paradigm in an Evolving Treatment Landscape. Cancers (Basel) 2024; 16:666. [PMID: 38339417 PMCID: PMC10854554 DOI: 10.3390/cancers16030666] [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: 12/22/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Liver cancer is the third most common cause of cancer-related deaths worldwide, and hepatocellular carcinoma (HCC) makes up the majority of liver cancer cases. Despite the stabilization of incidence rates in recent years due to effective viral hepatitis treatments, as well as improved outcomes from early detection and treatment advances, the burden of HCC is anticipated to rise again due to increasing rates of metabolic dysfunction-associated steatotic liver disease and alcohol-related liver disease. The treatment landscape is evolving and requires a multidisciplinary approach, often involving multi-modal treatments that include surgical resection, transplantation, local regional therapies, and systemic treatments. The optimal approach to the care of the HCC patient requires a multidisciplinary team involving hepatology, medical oncology, diagnostic and interventional radiology, radiation oncology, and surgery. In order to determine which approach is best, an individualized treatment plan should consider the patient's liver function, functional status, comorbidities, cancer stage, and preferences. In this review, we provide an overview of the current treatment options and key trials that have revolutionized the management of HCC. We also discuss evolving treatment paradigms for the future.
Collapse
Affiliation(s)
- Emily Kinsey
- Division of Hematology, Oncology, and Palliative Care, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA 23219, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
- Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Hannah M. Lee
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
- Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University, Richmond, VA 23298, USA
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA 23298, USA
| |
Collapse
|
8
|
Sacca L, Lobaina D, Burgoa S, Rao M, Jhumkhawala V, Zapata SM, Issac M, Medina S. Using Patient-Centered Dissemination and Implementation Frameworks and Strategies in Palliative Care Settings for Improved Quality of Life and Health Outcomes: A Scoping Review. Am J Hosp Palliat Care 2023:10499091231214241. [PMID: 37956239 DOI: 10.1177/10499091231214241] [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: 11/15/2023] Open
Abstract
BACKGROUND There is a need for patient-provider dissemination and implementation frameworks, strategies, and protocols in palliative care settings for a holistic approach when it comes to addressing pain and other distressing symptoms affecting the quality of life, function, and independence of patients with chronic illnesses. The purpose of this scoping review is to explore patient-centered D&I frameworks and strategies that have been adopted in PC settings to improve behavioral and environmental determinants influencing health outcomes through evidence-based programs and protocols. METHODS The five step Arksey and O'Malley's (2005) York methodology was adopted as a guiding framework: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results. RESULTS Only 6 out of the 38 (16%) included studies applied a D&I theory and/or framework. The RE-AIM framework was the most prominently cited (n = 3), followed by the Diffusion of Innovation Model (n = 2), the CONNECT framework (n = 1), and the Transtheoretical Stages of Change Model (n = 1). The most frequently reported ERIC strategy was strategy #6 "Develop and organize quality monitoring systems", as it identified in all 38 of the included studies. CONCLUSION This scoping review identifies D&I efforts to translate research into practice in U.S. palliative care settings. Results may contribute to enhancing future D&I initiatives for dissemination/adaptation, implementation, and sustainability efforts aiming to improve patient health outcomes and personal satisfaction with care received.
Collapse
Affiliation(s)
- Lea Sacca
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Diana Lobaina
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sara Burgoa
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Meera Rao
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Vama Jhumkhawala
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sheena M Zapata
- Symptom Management and Palliative Medicine, Baptist Health of South Florida, Miami Cancer Institute, Miami, FL, USA
| | - Michelle Issac
- Symptom Management and Palliative Medicine, Baptist Health of South Florida, Miami Cancer Institute, Miami, FL, USA
| | - Suleyki Medina
- Symptom Management and Palliative Medicine, Baptist Health of South Florida, Miami Cancer Institute, Miami, FL, USA
| |
Collapse
|
9
|
Kako J, Morikawa M, Kobayashi M, Kanno Y, Kajiwara K, Nakano K, Matsuda Y, Shimizu Y, Hori M, Niino M, Suzuki M, Shimazu T. Nursing support for breathlessness in patients with cancer: a scoping review. BMJ Open 2023; 13:e075024. [PMID: 37827741 PMCID: PMC10582874 DOI: 10.1136/bmjopen-2023-075024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE To identify nursing support provided for the relief of breathlessness in patients with cancer. DESIGN A scoping review following a standard framework proposed by Arksey and O'Malley. STUDY SELECTION Electronic databases (PubMed, CINAHL, CENTRAL and Ichushi-Web of the Japan Medical Abstract Society Databases) were searched from inception to 31 January 2022. Studies reporting on patients with cancer (aged ≥18 years), intervention for relief from breathlessness, nursing support and quantitatively assessed breathlessness using a scale were included. RESULTS Overall, 2629 articles were screened, and 27 were finally included. Results of the qualitative thematic analysis were categorised into 12 nursing support components: fan therapy, nurse-led intervention, multidisciplinary intervention, psychoeducational programme, breathing technique, walking therapy, inspiratory muscle training, respiratory rehabilitation, yoga, acupuncture, guided imagery and abdominal massage. CONCLUSIONS We identified 12 components of nursing support for breathlessness in patients with cancer. The study results may be useful to understand the actual state of nursing support provided for breathlessness in patients with terminal cancer and to consider possible support that can be implemented.
Collapse
Affiliation(s)
- Jun Kako
- Graduate School of Medicine, Mie University, Tsu, Mie, Japan
| | - Miharu Morikawa
- Palliative Nursing, Course of Advanced Nursing Sciences, Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Masamitsu Kobayashi
- Graduate of Nursing Science, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Yusuke Kanno
- Graduate School of Health Care Science, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kohei Kajiwara
- Faculty of Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan
| | - Kimiko Nakano
- Clinical Research Center for Developmental Therapeutics, Tokushima University Hospital, Kuramoto-cho, Tokushima, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Yoichi Shimizu
- School of Nursing, National College of Nursing, Kiyose, Tokyo, Japan
| | - Megumi Hori
- Faculty of Nursing, University of Shizuoka, Suruga-ku, Shizuoka, Japan
| | - Mariko Niino
- Center for Cancer Registries, Institute for Cancer Control, National Cancer Center Japan, Chuo-ku, Tokyo, Japan
| | - Miho Suzuki
- Faculty of Nursing and Medical Care, Keio University-Shonan Fujisawa Campus, Fujisawa, Kanagawa, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, Research Center for Cancer Prevention and Screening, National Cancer Center, Chuo-ku, Tokyo, Japan
| |
Collapse
|
10
|
Rosa WE, Levoy K, Doyon K, McDarby M, Ferrell BR, Parker PA, Sanders JJ, Epstein AS, Sullivan DR, Rosenberg AR. Integrating evidence-based communication principles into routine cancer care. Support Care Cancer 2023; 31:566. [PMID: 37682354 PMCID: PMC10805358 DOI: 10.1007/s00520-023-08020-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE The global incidence of cancer and available cancer-directed therapy options is increasing rapidly, presenting patients and clinicians with more complex treatment decisions than ever before. Despite the dissemination of evidence-based communication training tools and programs, clinicians cite barriers to employing effective communication in cancer care (e.g., discomfort of sharing serious news, concern about resource constraints to meet stated needs). We present two composite cases with significant communication challenges to guide clinicians through an application of evidence-based approaches to achieve quality communication. METHODS Composite cases, communication skills blueprint, and visual conceptualization. RESULTS High-stakes circumstances in each case are described, including end-of-life planning, advanced pediatric illness, strong emotions, and health inequities. Three overarching communication approaches are discussed: (1) content selection and delivery; (2) rapport development; and (3) empathic connection. The key takeaways following each case provide succinct summaries of challenges encountered and approaches used. A communication blueprint from the Memorial Sloan Kettering Cancer Center Communication Skills Training Program and Research Laboratory has been adapted and is comprised of strategies, skills, process tasks, and sample talking points. A visually concise tool - the Communication Blueprint Traffic Circle - illustrates these concepts and demonstrates the iterative, holistic, and agile considerations inherent to effective communication. CONCLUSION Evidence-based communication is foundational to person-centeredness, associated with improved clinician and patient/caregiver outcomes, and can be integrated throughout routine oncology care. When used by clinicians, evidence-based communication can improve patient and caregiver experiences and assist in ensuring goal-concordant cancer care delivery.
Collapse
Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Kristin Levoy
- School of Nursing, Indiana University, Indianapolis, IN, USA
- Indiana University Center for Aging Research (IUCAR), Regenstrief Institute, Indianapolis, IN, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | | | - Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin J Sanders
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Andrew S Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Donald R Sullivan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
- Center to Improve Veteran Involvement in Care (CIVIC), Portland-Veterans Affairs Medical Center, Portland, OR, USA
| | - Abby R Rosenberg
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Farrag JM, Ibrahim AM, Anwr DB, Ibrahim Ibrahim NM, Saadoon MM. Pediatric Nurses' Perceived Competencies toward Palliative Care for Terminally Ill Children. Asian Pac J Cancer Prev 2023; 24:3275-3282. [PMID: 37774082 PMCID: PMC10762766 DOI: 10.31557/apjcp.2023.24.9.3275] [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: 06/16/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Paediatric palliative care involves the physical, psychological, and spiritual well-being of terminally ill children and their families. Competency in palliative care centred on personal traits and attributes, key abilities to satisfy professional duty through practise, and knowledge of palliative care. OBJECTIVE Is to identify paediatric nurses' perceived Competencies toward Palliative Care for Terminally Ill Children. METHOD Used was a descriptive research design. The sample included 72 nurses who worked at neonatal, pediatric intensive care units ( NICU, PICU) in four hospitals affiliated to Universal Health Insurance (UHI) in Port Said City, namely ( El Nasr, El Salam, El Hayah, and pain outpatient clinic at El Tadamon) hospital. The structured questionnaire and the nursing palliative care quiz are the first tools used to evaluate sociodemographic characteristics. Data were gathered using a second tool, the Nurses' Core Competencies in Palliative Care questionnaire. RESULTS Based on the study, 56.9% of nurses had adequate knowledge, and 47.2% of paediatric nurses agreed that they had some extendable palliative care competences.It can be summarized that more than sighlty half of the studied sample have adequate knowledge while the rest of the studied sample have inadequate knowledge,with statistically significant relationship between nurses' overall perceived competence and overall knowledge. CONCLUSION The relationship between nurses' overall perceived competence and overall knowledge was very statistically significant. The Recommendation study's findings highlight the urgent need of creating an evidence-based programme for competency training in palliative care, which should be available in every hospital and adhered to all paediatric nurses.
Collapse
Affiliation(s)
- Jihan Mahmoud Farrag
- Pediatric Nursing Department, Faculty of Nursing, Port Said University, Port Said, Egypt.
| | - Ateya Megahed Ibrahim
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
- Family and Community Health Nursing Department, Faculty of Nursing, Port Said University, Port Said, Egypt.
| | - Doaa Bahig Anwr
- Pediatric Nursing Department, Faculty of Nursing, Aswan University, Aswan, Egypt.
| | - Noha Mohamed Ibrahim Ibrahim
- Medical- Surgical Nursing Department, Faculty of Nursing, Port Said University, Port Said, Egypt.
- College of Applied Medical Sciences, Bisha City, Bisha University, Saudi Arabia.
| | - Maha Mahmoud Saadoon
- Pediatric Nursing Department, Faculty of Nursing, Port Said University, Port Said, Egypt.
| |
Collapse
|
12
|
Blanes-Selva V, Asensio-Cuesta S, Doñate-Martínez A, Pereira Mesquita F, García-Gómez JM. User-centred design of a clinical decision support system for palliative care: Insights from healthcare professionals. Digit Health 2023; 9:20552076221150735. [PMID: 36644661 PMCID: PMC9837281 DOI: 10.1177/20552076221150735] [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: 06/30/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
Objective Although clinical decision support systems (CDSS) have many benefits for clinical practice, they also have several barriers to their acceptance by professionals. Our objective in this study was to design and validate The Aleph palliative care (PC) CDSS through a user-centred method, considering the predictions of the artificial intelligence (AI) core, usability and user experience (UX). Methods We performed two rounds of individual evaluation sessions with potential users. Each session included a model evaluation, a task test and a usability and UX assessment. Results The machine learning (ML) predictive models outperformed the participants in the three predictive tasks. System Usability Scale (SUS) reported 62.7 ± 14.1 and 65 ± 26.2 on a 100-point rating scale for both rounds, respectively, while User Experience Questionnaire - Short Version (UEQ-S) scores were 1.42 and 1.5 on the -3 to 3 scale. Conclusions The think-aloud method and including the UX dimension helped us to identify most of the workflow implementation issues. The system has good UX hedonic qualities; participants were interested in the tool and responded positively to it. Performance regarding usability was modest but acceptable.
Collapse
Affiliation(s)
- Vicent Blanes-Selva
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain,Vicent Blanes-Selva, Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, 46022, Spain.
| | - Sabina Asensio-Cuesta
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain
| | | | - Felipe Pereira Mesquita
- Divisão de Hematologia, departamento de Clínica Médica, da Universidade Federal de Juiz de Fora, Minas Gerais, Brasil
| | - Juan M. García-Gómez
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain
| |
Collapse
|
13
|
Gofton C, Agar M, George J. Early Implementation of Palliative and Supportive Care in Hepatocellular Carcinoma. Semin Liver Dis 2022; 42:514-530. [PMID: 36193677 DOI: 10.1055/a-1946-5592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Early palliative and supportive care referral is the standard of care for many malignancies. This paradigm results in improvements in patients' symptoms and quality of life and decreases the costs of medical care and unnecessary procedures. Leading oncology guidelines have recommended the integration of early referral to palliative and supportive services to care pathways for advanced malignancies. Currently, early referral to palliative care within the hepatocellular carcinoma (HCC) population is not utilized, with gastroenterology guidelines recommending referral of patients with Barcelona Clinic Liver Cancer stage D to these services. This review addresses this topic through analysis of the existing data within the oncology field as well as literature surrounding palliative care intervention in HCC. Early palliative and supportive care in HCC and its impact on patients, caregivers, and health services allow clinicians and researchers to identify management options that improve outcomes within existing service provisions.
Collapse
Affiliation(s)
- Cameron Gofton
- Department of Gastroenterology and Hepatology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia.,Storr Liver Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Meera Agar
- Department of Palliative Care, University of Technology Sydney, New South Wales, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Hospital, Westmead, New South Wales, Australia.,Department of Medicine, University of Sydney, Camperdown and Darlington Campus, Camperdown, New South Wales, Australia
| |
Collapse
|
14
|
Chung V, Sun V, Ruel N, Smith TJ, Ferrell BR. Improving Palliative Care and Quality of Life in Pancreatic Cancer Patients. J Palliat Med 2022; 25:720-727. [PMID: 34704841 PMCID: PMC9080991 DOI: 10.1089/jpm.2021.0187] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2012] [Indexed: 01/31/2023] Open
Abstract
Background: Pancreatic cancer patients often present with complications, which can impact treatment tolerance. Thus, symptom management is a vital component of treatment in addition to traditional chemotherapeutics. Concurrent palliative care with an emphasis on aggressive symptom management may sustain both clinical and patient-centered outcomes during treatment. The purpose of this article is to explore the impact of a concurrent palliative care intervention in patients with pancreatic cancer treated on phase I clinical trials. Materials and Methods: This is a secondary analysis of a National Cancer Institute (NCI)-funded randomized trial of an advanced practice nurse driven palliative care intervention for solid tumor patients treated on phase I clinical trials. Only pancreatic cancer patients were included in the analysis. Patients received two educational sessions around the quality of life (QOL) domains and completed the Functional Assessment of Cancer Therapy-General (FACT-G), patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE), and the psychological distress thermometer at baseline, 4 and 12 weeks. Mixed model with repeated measures analysis was used to explore outcomes by study arm. Results: Of the 479 patients accrued to the study, 42 were diagnosed with pancreatic cancer (26 intervention, 16 usual care). A trend toward improvement in the physical, social, emotional, and functional FACT-G QOL subscales and psychological distress (baseline to 12 weeks) were observed for the intervention arm. Patients reported moderate severity in psychological and physical stress. Conclusions: In this secondary analysis, a nurse-led palliative care intervention may improve the QOL and psychological distress of pancreatic cancer patients. A phase III trial focused on patients with pancreatic cancer is needed to determine the effectiveness of the intervention.
Collapse
Affiliation(s)
- Vincent Chung
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Virginia Sun
- Division of Nursing Research and Education, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Nora Ruel
- Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Thomas J. Smith
- Department of Medicine, Division of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Betty R. Ferrell
- Division of Nursing Research and Education, Beckman Research Institute, City of Hope, Duarte, California, USA
| |
Collapse
|
15
|
Fessele KL, Davis ME, Lasa-Blandon MS, Reidy ME, Barton-Burke M. Perceived End-of-Life Educational Needs by Clinical Trials Nurses at a Comprehensive Cancer Center. Asia Pac J Oncol Nurs 2022; 9:100052. [PMID: 35651541 PMCID: PMC9149015 DOI: 10.1016/j.apjon.2022.03.004] [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] [Received: 01/10/2022] [Accepted: 03/03/2022] [Indexed: 11/04/2022] Open
Abstract
Objective Determine palliative care end-of-life (EOL) educational needs among clinical trials nurses (CTNs) at an urban comprehensive cancer center. Methods The End-Of-Life Professional Caregiver Survey (EPCS) was used to determine the EOL educational needs of CTNs and collect demographics on years of experience, education, past EOL-specific training, and possession of their own advanced directive. The “Surprise Question” was also asked to explore the percent of patients on clinical trials who may be nearing EOL. Results Twenty-nine CTNs completed the survey. Mean years of experience as an RN and CTN was 10.45 and 2.5, respectively. 79% and 17% held a bachelors or master's degree, respectively. Twenty-seven percent reported previous End-of-Life Nursing Education Consortium (ELNEC) or similar training and 20% stated they had their own advanced directive. Mean total score for the EPCS was 94.83, with subscale means of 42.41 for the Patient and Family Centered Communication (PFCC), 26.9 for Cultural and Ethical Values (CEV), and 25.52 for the Effective Care Delivery (ECD). Highest scoring items included confidence in communicating with colleagues about EOL care, being present with dying patients, and recognizing patients who are appropriate for hospice referral. Lowest scoring items included participating in code status discussions, resolving ethical issues and family conflicts at EOL, and addressing requests for assisted suicide. Responses to the Surprise Question indicated that 27.5% of the CTNs would not be surprised if half or more of their patients died within the next 12 months. Conclusions Many patients with cancer on clinical trials may be nearing EOL. CTNs perceive the need for education to increase confidence in handling difficult communication.
Collapse
|
16
|
Jensen-Battaglia M, Lei L, Xu H, Kehoe L, Patil A, Loh KP, Ramsdale E, Magnuson A, Kleckner AS, Wildes TM, Lin PJ, Mustian KM, Giri G, Whitehead M, Bearden J, Burnette BL, Geer J, Mohile SG, Dunne RF. Association of Oncologist-Patient Communication With Functional Status and Physical Performance in Older Adults: A Secondary Analysis of a Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e223039. [PMID: 35302628 PMCID: PMC8933739 DOI: 10.1001/jamanetworkopen.2022.3039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE The functional status and physical performance of older adults with cancer are underassessed and undertreated despite the high prevalence of impaired functional status and physical performance in this population and their associations with chemotherapy-induced toxic effects and mortality. OBJECTIVE To examine the association between providing oncologists with a geriatric assessment (GA) summary with recommendations and having oncologist-patient conversations about functional and physical performance. DESIGN, SETTING, AND PARTICIPANTS Data for this secondary analysis were collected from October 29, 2014, to April 28, 2017, for a national cluster randomized clinical trial conducted by the University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program evaluating the effect of a GA intervention on patient satisfaction with communication about aging-related concerns. There were 17 practice clusters in the intervention group and 14 in the usual care group. All 541 participants underwent a GA including standardized functional and physical performance measures and had 1 clinical encounter audio-recorded, transcribed, and blindly coded to categorize conversations by GA domain. Participants were aged 70 years or older, with a stage III or IV solid tumor or lymphoma with palliative treatment intent, and impairment in 1 or more GA domain. Statistical analysis was performed from August 18, 2020, to January 10, 2022. INTERVENTIONS Oncologist practices randomized to the intervention received a GA summary and validated recommendations for each patient prior to the audio-recorded clinical encounter. MAIN OUTCOMES AND MEASURES The primary analysis of this clinical trial assessed the effect of the intervention on patient satisfaction with oncologist communication about aging-related concerns. This secondary analysis assessed the post hoc hypothesis that the intervention would be associated with an increase in the proportion of patients having conversations with their oncologists and receiving oncologist recommendations specific to functional and physical performance concerns. RESULTS A total of 541 patients (276 men [51%]; mean [SD] age, 77.5 [5.2] years [range, 70-96 years]) were analyzed at baseline. Excluding 13 patients without audio recordings, 86% of patients (95% CI, 78%-91%) in the intervention group vs 59% of patients (95% CI, 47%-69%; P < .001) receiving usual care had conversations about functional or physical performance. Conversations were more frequently initiated by oncologists in the intervention group (84%; 95% CI, 77%-90%) than oncologists in the usual care group (58%; 95% CI, 45%-70%; P < .001). Oncologists in the intervention group were more likely to address patients' concerns (43%; 95% CI, 33%-53%) than oncologists in the usual care group (17%; 95% CI, 10%-26%; P < .001). CONCLUSIONS AND RELEVANCE In this secondary analysis of a cluster randomized clinical trial, providing oncologists with a GA summary was associated with an increase in the number of oncologist-patient conversations about functional and physical performance-related concerns with recommendations to address these concerns. These findings support the use of the GA summary and recommendations as important tools in caring for older adults with advanced cancer and functional or physical impairments. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02107443.
Collapse
Affiliation(s)
- Marielle Jensen-Battaglia
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lianlian Lei
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Huiwen Xu
- Sealy Center on Aging, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
| | - Lee Kehoe
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Amita Patil
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Kah Poh Loh
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Erika Ramsdale
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Amber S. Kleckner
- School of Nursing, Department of Pain and Translational Symptom Science, University of Maryland, Baltimore
| | | | - Po-Ju Lin
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Karen M. Mustian
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Gilbert Giri
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Mary Whitehead
- SCOREboard Advisory Group, University of Rochester Medical Center, Rochester, New York
| | - James Bearden
- Upstate Carolina National Cancer Institute Community Oncology Research Program, Spartanburg, South Carolina
| | - Brian L. Burnette
- Cancer Research of Wisconsin and Northern Michigan National Cancer Institute Community Oncology Research Program, Green Bay
| | - Jodi Geer
- Metro Minnesota Community Oncology Research Program National Cancer Institute Community Oncology Research Program, St Louis Park
| | - Supriya G. Mohile
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Richard F. Dunne
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| |
Collapse
|
17
|
Kutluk T, Ahmed F, Cemaloğlu M, Aydın B, Şengelen M, Kirazli M, Yurduşen S, Sullivan R, Harding R. Progress in palliative care for cancer in Turkey: a review of the literature. Ecancermedicalscience 2021; 15:1321. [PMID: 35047072 PMCID: PMC8723752 DOI: 10.3332/ecancer.2021.1321] [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: 10/09/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The demographic transition in Turkey is shifting the burden of diseases towards non-communicable diseases including cancer. Palliative care (PC) as a component of Universal Health Coverage assures patient and family-centred care provision throughout the spectrum of cancer. OBJECTIVES This study aimed to make a detailed evaluation of the progress achieved since the mid-90s and the current situation of cancer PC in Turkey. METHODS A literature review was conducted in PubMed, Scopus, Embase, ScienceDirect, Web of Science, Google Scholar, The Turkish Academic Network and Information Centre databases, Ministry of Health documents, Council of Higher Education's thesis 01/1995 to 07/2020. The information was categorised into the six domains: history of the cancer PC; law and regulations; education and research; opioid use; patient care and palliative centres; public awareness, psychosocial support and end of life ethics. RESULTS Of 27,489 studies, 331 met the inclusion criteria. The majority were published in the Turkish language and were journal articles. The findings showed that the development of PC in Turkey can be divided into three stages: early initiatives before 2000, the dissemination stage, 2000-2010 and the advanced stage after 2010. There is evidence of progress in terms of legal regulations, opioid use and number of PC services and research output. However, there is still a need for improvement in professional education, public awareness and end of life care. CONCLUSION There is evidence of progress, barriers and opportunities. However, bringing research into practice is needed for scale-up and integration of PC in cancer care in Turkey.
Collapse
Affiliation(s)
- Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Fahad Ahmed
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Mustafa Cemaloğlu
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Burça Aydın
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Meltem Şengelen
- Department of Public Health, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
| | - Meral Kirazli
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Sema Yurduşen
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Richard Sullivan
- King’s College London, Institute of Cancer Policy, Conflict & Health Research Group, London, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK
| |
Collapse
|
18
|
D'Ambruoso SF, Glaspy JA, Hurvitz SA, Wenger NS, Pietras C, Ahmed K, Drakaki A, Goldman JW, Anand S, Simon W, Kung J, Coscarelli A, Rosen LS, Peddi PF, Wong DJL, Santos K, Phung P, Karlin D, Walling AM. Impact of a Palliative Care Nurse Practitioner in an Oncology Clinic: A Quality Improvement Effort. JCO Oncol Pract 2021; 18:e484-e494. [PMID: 34748398 DOI: 10.1200/op.21.00046] [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 Guidelines support early integration of palliative care (PC) into standard oncology practice; however, little is known as to whether outcomes can be improved by modifying health care delivery in a real-world setting. METHODS We report our 6-year experience of embedding a nurse practitioner in an oncology clinic (March 2014-March 2020) to integrate early, concurrent advance care planning and PC. RESULTS Compared with patients with advanced cancer not enrolled in the palliative care nurse practitioner program, in March 2020, patients who are enrolled are more likely to have higher quality of PC (eg, goals of care note documentation [82% v 15%; P < .01], referral to the psychosocial oncology program [67% v 37%; P < .01], and referral to hospice [61% v 34%; P < .01]) and less inpatient utilization in the last 6 months of life (eg, hospital days [12 v 18; P < .01] and intensive care unit days [1.2 v 2.3; P < .01]). The program expanded over time with the support of faculty skills training for advance care planning and PC, supporting a shared mental model of PC delivery within the oncology clinic. CONCLUSION Embedding a trained palliative care nurse practitioner in oncology clinics to deliver early integrated PC can lead to improved quality of care for patients with advanced cancer.
Collapse
Affiliation(s)
| | - John A Glaspy
- Department of Medicine, University of California, Los Angeles, CA
| | - Sara A Hurvitz
- Department of Medicine, University of California, Los Angeles, CA
| | - Neil S Wenger
- Department of Medicine, University of California, Los Angeles, CA
| | | | - Kauser Ahmed
- Simms/Mann-UCLA Center for Integrative Oncology, Los Angeles, CA
| | | | | | - Sidharth Anand
- Department of Medicine, University of California, Los Angeles, CA
| | - Wendy Simon
- Department of Medicine, University of California, Los Angeles, CA
| | - Jennie Kung
- Hospital Operations, University of California, Los Angeles, CA
| | - Anne Coscarelli
- Department of Medicine, University of California, Los Angeles, CA
| | - Lee S Rosen
- Department of Medicine, University of California, Los Angeles, CA
| | - Parvin F Peddi
- Department of Medicine, University of California, Los Angeles, CA
| | - Deborah J L Wong
- Department of Medicine, University of California, Los Angeles, CA
| | - Katherine Santos
- Department of Medicine, University of California, Los Angeles, CA
| | - Peter Phung
- Department of Medicine, University of California, Los Angeles, CA
| | - Daniel Karlin
- Department of Medicine, University of California, Los Angeles, CA
| | - Anne M Walling
- Department of Medicine, University of California, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA
| |
Collapse
|
19
|
Caponero R. Palliative Care in Colorectal Cancer. COLORECTAL CANCER 2021. [DOI: 10.5772/intechopen.93513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Approximately 25% of patients present with liver metastases at the time of the first diagnosis and up to 50% will further develop recurrence in the liver during their disease course. Traditionally approached surgically, by resection of the primitive tumor or stoma, the management to incurable stage IV colorectal cancer patients has significantly changed over the last three decades and is nowadays multidisciplinary, with a pivotal role played by chemotherapy. Most patients with stage IV colorectal cancer have a poor prognosis, but numerous palliative modalities are available today. When a cure is no longer possible, treatment is directed toward providing symptomatic relief. Good symptom management in oncology is associated with improved patient and family quality of life, greater treatment compliance, and may even offer survival advantages.
Collapse
|
20
|
Temel JS, Jacobsen PB. Palliative Care in Oncology: Continuing to Build the Evidence Base and Disseminate Effective Care Models. J Clin Oncol 2020; 38:849-851. [PMID: 32023160 DOI: 10.1200/jco.19.01069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|