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Santini A, Avagnina I, Affinita MC, Zanin A, Benini F. Is it early enough? The authentic meaning of the pediatric palliative approach between early and late referral in pediatric oncology: a case study. Front Oncol 2024; 14:1397983. [PMID: 39119084 PMCID: PMC11306152 DOI: 10.3389/fonc.2024.1397983] [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: 03/08/2024] [Accepted: 06/28/2024] [Indexed: 08/10/2024] Open
Abstract
The literature widely supports the benefits of early integration of palliative care into pediatric oncological care; however, many barriers to its successful integration remain. Integrating palliative care as early as possible in the oncology pathway is critical, but other criteria are relevant to positive results. This paper aims to contribute to the early/late referral dualism in pediatric palliative care (PPC) and highlight the importance of a collaborative approach between oncologists and palliative care teams. This study investigates the impact of early versus late referral to PPC, intersecting it with the synergy work between services and the related outcomes. The four pediatric cancer cases were selected based on clinical (e.g., disease duration, multiple treatments, and pain management), management (e.g., involvement of multiple services and multiple home-hospital transitions), and relevance of multidisciplinary team (e.g., difficult clinical decisions and ethical discussions) criteria. A mixed-methods approach was employed, combining qualitative case analysis using clinical diaries, literature review, and practice guidelines development. Critical clinical information, time course, clinician-family communication, and patient involvement were analyzed. The outcomes show how simultaneous care creates continuous discussion and dialogue between professionals. The results indicate the importance of better communication and care coordination to improve patient and family satisfaction, highlighting the uniqueness of the pediatric field and the relationship with children and families. Through the discussion of clinical cases and a literature review, we provide practical guidance for clinicians working in oncology and PPC. These findings underscore the crucial need for a multidisciplinary approach in pediatric oncology, advocating policy changes to support early PPC integration and translate it into complementarity best operating practices. In conclusion, besides assessing the timeliness of referral to the PPC service, the synergy, harmony, and choral work of the professionals involved are equally valuable for a quality-of-life-oriented care plan.
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Affiliation(s)
- Anna Santini
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Irene Avagnina
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Maria C. Affinita
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Anna Zanin
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
| | - Franca Benini
- Pediatric Pain and Palliative Care Service, Department of Women’s and Children’s Health, School of Medicine and Surgery, University of Padua, Padua, Italy
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Lewis-Norman C, Vidrine J, Thistlethwayte E. Improving supportive, palliative and end of life care for teenagers and young adults with cancer in adult haematology services. Curr Opin Support Palliat Care 2024; 18:86-91. [PMID: 38652458 DOI: 10.1097/spc.0000000000000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW Adolescents with haematological malignancies within adult services, in the UK from 16 years old, have unique needs and require developmentally targeted services and approaches to care delivery. High-risk intensive treatments are common for this cohort and a better understanding of what individualised supportive and palliative care means in this context is required. RECENT FINDINGS Being known and understood as an emerging adult, with particular recognition of developmental stage, is an essential component of quality measures and underpins the adolescent, and caregiver, experience when faced with an uncertain or poor cancer prognosis (UPCP). Healthcare professionals (HCPs) can experience increased emotional labour and feelings of professional inadequacy when caring for adolescents with UPCP. Therapeutic alliance improves HCPs understanding of optimum individualised care by improving communication and supported decision making. Access to training and support for HCPs is required to address the emotional impact of therapeutic alliance with teenage/adolescent and young adults (T/AYAs) with advanced cancer. SUMMARY Investment in therapeutic alliance, alongside robust support mechanisms and targeted training, can improve the skills, confidence and wellbeing for HCPs, and can also ensure optimum individualised care for T/AYAs with UPCP. Evidence for optimum care for adolescents with advanced cancer is relatively scarce, especially for younger T/AYAs (16-24) in the UK who sit within adult services. Further evaluation of the impact of current UK expertise, services and programs are needed to inform future development.
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Johnston EE, Rosenberg AR. Palliative Care in Adolescents and Young Adults With Cancer. J Clin Oncol 2024; 42:755-763. [PMID: 37862672 DOI: 10.1200/jco.23.00709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 08/25/2023] [Indexed: 10/22/2023] Open
Abstract
Palliative care (PC) aims to improve quality of life (QOL) for patients with serious illness and their families by recognizing and alleviating the physical, emotional, social, existential, and spiritual suffering of patients and their communities. Because adolescents and young adults (AYAs, age 15-39 years) with cancer commonly report distress across all these domains and because that distress translates to their QOL during and after their cancers, PC is particularly relevant for this population. Here, we review the evidence for PC among AYAs with cancer, including its rationale, gaps, opportunities, and implications for care delivery. For example, nearly 90% of AYAs with cancer report distressing symptoms during their treatment, those who survive report ongoing unmet psychosocial and physical health needs, and those who die from their cancers are highly likely to receive medically intense care that is discordant with their goals and values. AYA communication and decision making can be challenging because of ethical and developmental considerations regarding the patient's autonomy and competing priorities of patients and caregivers. PC interventions (including primary PC delivered by oncologists, routine PC subspecialty care, symptom tracking, advance care planning, and psychosocial programs promoting AYA resilience) are all associated with improved patient-centered outcomes. However, PC is inconsistently integrated into AYA oncology care, and access to PC programs is not equitable; marginalized groups continue to experience poorer outcomes. Ongoing and future research and clinical initiatives must continue to bridge these gaps. Improving the QOL of AYAs with cancer is a shared goal of the larger clinical oncology community, and including PC in AYA cancer care delivery can help attain that goal.
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Affiliation(s)
- Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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Malik M, Valiyaveettil D, Joseph DM. The Growing Burden of Cancer in Adolescent and Young Adults in Asia: A Call to Action. J Adolesc Young Adult Oncol 2024; 13:1-7. [PMID: 37327043 DOI: 10.1089/jayao.2023.0008] [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] [Indexed: 06/17/2023] Open
Abstract
Recent estimates suggest that the lower middle income countries in Asia carry the heaviest burden of cancer among adolescents and young adults (AYAs) (defined as age 15-39 years). A larger proportion of the population in Asia is aged 15-39 compared with the developed countries. This age group is different from the pediatric or the adult group in terms of physical, social, psychological, and financial needs. Cancer incidence, disability, survivorship needs, financial toxicity, psychosocial issues, and so on are underestimated in this group, and available literature is scarce. Global data show an increasing trend of adult-onset cancers such as colorectal, breast, pancreas, and lung in the AYA population. Data suggest that the disease biology and prognosis are different in this group; however, further research is needed. An ESMO/SIOPE/SIOP Asia survey on the care of AYA cancer patients in Asia found a suboptimal availability of AYA specialized centers in the region and identified several unmet needs including lack of training, clinical trials, and high rates of treatment abandonment. There is an urgent need for cancer care systems in Asia to develop specialized services to be able to cater to this growing burden. Training and research in this area also need to be upscaled with the goal of establishing a sustainable infrastructure and quality services to ensure that this vulnerable group receives appropriate care. Management guidelines and national health policies should consider giving special attention to this group as the World Health Assembly reinforces the inclusion of children and adolescents in cancer control programs.
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Affiliation(s)
- Monica Malik
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepthi Valiyaveettil
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepa M Joseph
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
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Nathan PC, Yabroff KR. The long economic shadow of a cancer diagnosis during adolescence or young adulthood. J Natl Cancer Inst 2023; 115:1237-1239. [PMID: 37459143 DOI: 10.1093/jnci/djad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 11/11/2023] Open
Affiliation(s)
- Paul C Nathan
- Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
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Abstract
BACKGROUND Little is known about where young adults with chronic illness die in the United States and factors associated with place of death. OBJECTIVES This study aimed to examine place of death and factors associated with place of death for young adults with chronic illness using the most recent national data. METHODS Our sample ( N = 405,535) from the National Center for Health Statistics Division of Vital Statistics death certificate data (2003-2018) included young adults (age 18-39 years) who died from chronic conditions common in childhood or young adulthood. Conditions were grouped by underlying pathophysiology (oncological, cardiovascular, neuromuscular, metabolic, hematological/immunological, renal, chromosomal/congenital, gastrointestinal, and respiratory). Place of death was dichotomized into acute care (inpatient, outpatient/emergency room, and dead on arrival) or nonacute care (home, hospice, nursing home/long-term care, other, and unknown). Examined factors were gender, year of death, age, race (White, Black, Asian/Pacific Islander, American Indian/Alaskan Native), cause of death, and city of residence population (100,000 or greater and under 100,000). Descriptive statistics and logistic regression were used to examine factors related to place of death. RESULTS Over half of young adults died in acute care settings. Young adults who were Asian/Pacific Islander or Black or who died from a respiratory or renal cause of death were most likely to die in an acute care setting. Rates of acute care death decreased over the studied years. DISCUSSION Many young adults died in an acute care setting. Race and cause of death were the most influential factors associated with place of death. Young adults with an oncological cause of death were less likely to die in an acute care setting than patients with other underlying causes. This may indicate that specific care needs or preferences at the end of life may differ in certain disease populations and may affect place of death. Previous research has shown similar results in other developmental populations; however, given the complex psychosocial concerns that often arise during young adulthood, further research is needed to describe how the young adult status may specifically affect place of death.
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Gupta S, Li Q, Kassam A, Rapoport A, Widger K, Chalifour K, Baxter NN, Nathan PC, Coburn NG, Sutradhar R. Specialty Palliative Care and Symptom Severity and Control in Adolescents and Young Adults With Cancer. JAMA Netw Open 2023; 6:e2338699. [PMID: 37862015 PMCID: PMC10589816 DOI: 10.1001/jamanetworkopen.2023.38699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/02/2023] [Indexed: 10/21/2023] Open
Abstract
Importance Adolescents and young adults (AYAs) with cancer experience substantial symptom burden. Specialty palliative care (SPC) is recommended but often not involved or involved late. Objectives To determine whether patient-reported symptom severity was associated with subsequent SPC involvement and whether SPC was associated with symptom improvement in AYAs with cancer. Design, Setting, and Participants This cohort study comprised AYAs (aged 15-29 years) with primary cancer diagnosed between January 1, 2010, and June 30, 2018, in Ontario, Canada. Data, including self-reported Edmonton Symptom Assessment System (ESAS) scores, were obtained from health care databases. Specialty palliative care was identified through billing codes and validated algorithms. Final data analysis was performed on April 4, 2023. Main Outcomes and Measures Associations of ESAS scores with subsequent SPC involvement were determined. A difference-in-differences approach was used for patients who died within 5 years of their cancer diagnosis. Case patients (SPC predeath, index date equals first SPC service) were matched 1:1 to control patients (no SPC at equivalent time before death). The study examined whether the difference between 90-day postindex and preindex mean ESAS scores was itself different between case and control patients. Results This study included 5435 AYAs with cancer, with a median follow-up of 5.1 (IQR, 2.5-7.9) years for analyses of general palliative care. Their median age at cancer diagnosis was 25 (IQR, 22-27) years, and more than half were male (2809 [51.7%]). For all symptoms, moderate and severe ESAS scores were associated with an increased likelihood of SPC involvement compared with mild scores. The greatest magnitude of association was seen for pain scores (hazard ratio for severe vs mild, 7.7 [95% CI, 5.8-10.2]; P < .001). A total of 721 AYAs (13.3%) died within 5 years of diagnosis, and 612 of these patients (84.9%) had received SPC before death. Among 202 case-control pairs, SPC involvement was associated with improved pain trajectories (mean scores improved from 3.41 to 3.07 in case patients and worsened from 1.86 to 2.16 in control patients; P = .003). Other symptom trajectories were not affected. Conclusions and Relevance In this cohort study of AYAs with cancer, those reporting moderate or severe symptoms through a screening program were more likely to subsequently receive SPC. These findings suggest that SPC was associated with a subsequent decrease in pain severity but did not affect other symptoms. New interventions targeting other symptoms during treatment and particularly at the end of life are needed.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Cancer Research Program, ICES (Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada
| | - Qing Li
- Cancer Research Program, ICES (Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Alisha Kassam
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Adam Rapoport
- Division of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Emily’s House Children’s Hospice, Toronto, Ontario, Canada
| | - Kimberley Widger
- Paediatric Advanced Care Team, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Karine Chalifour
- Young Adult Cancer Canada, St John’s, Newfoundland and Labrador, Canada
| | - Nancy N. Baxter
- Cancer Research Program, ICES (Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul C. Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Cancer Research Program, ICES (Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada
| | - Natalie G. Coburn
- Cancer Research Program, ICES (Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Cancer Research Program, ICES (Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Drake EK, Weeks LE, van Manen M, Shin HD, Wong H, Taylor D, McKibbon S, Curran J. The Delivery of Palliative and End-of-Life Care to Adolescents and Young Adults Living with Cancer: A Scoping Review. J Adolesc Young Adult Oncol 2023; 12:611-624. [PMID: 37155194 DOI: 10.1089/jayao.2023.0013] [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] [Indexed: 05/10/2023] Open
Abstract
The primary purpose of this scoping review was to provide an overview of the existing evidence on the delivery of palliative and end-of-life care to adolescents and young adults (AYAs) living with cancer, by identifying knowledge gaps and discussing the key characteristics and types of evidence in this field. This study employed a JBI scoping review design. CINAHL (EBSCO), Embase (Elsevier), MEDLINE (Ovid), APA PsycINFO (EBSCO), and Web of Science (Science Citation Index Expanded and Social Sciences Citation Index; Clarivate Analytics) databases were searched along with grey literature sources to February 2022 for related studies on the delivery of palliative and end-of-life care to AYAs. No search restrictions were applied. Two independent reviewers screened titles, abstracts, and full-text articles for eligibility, and they extracted data from studies that met the inclusion criteria. A total of 29,394 records were identified through our search strategy and 51 studies met the inclusion criteria of the study. The studies were published between 2004 and 2022, with the majority from North America (65%). The included studies involved patient, healthcare provider, caregiver, and public stakeholders. Their primary foci were often on end-of-life outcomes (41%) and/or advance care planning/end-of-life priorities and decision-making (35%). This review identified several evidence gaps within the field, including a focus primarily on patients who have died. Findings highlight the need for more collaborative research with AYAs on their experiences with palliative and end-of-life care, as well as their involvement as patient partners in research.
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Affiliation(s)
- Emily K Drake
- Faculty of Health, Dalhousie University, Halifax, Canada
- IWK Health, Halifax, Canada
- School of Nursing, Dalhousie University, Halifax, Canada
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A Joanna Briggs Institute Centre of Excellence, Halifax, Canada
| | - Lori E Weeks
- Faculty of Health, Dalhousie University, Halifax, Canada
- School of Nursing, Dalhousie University, Halifax, Canada
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A Joanna Briggs Institute Centre of Excellence, Halifax, Canada
- Nova Scotia Health, Halifax, Canada
| | - Michael van Manen
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Canada
| | - Hwayeon Danielle Shin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Centre for Complex Care Interventions, Centre for Addiction and Mental Health, Toronto, Canada
| | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, Canada
| | - Dani Taylor
- Patient Partner, St. John's, Canada
- Young Adult Cancer Canada, St. John's, Canada
| | - Shelley McKibbon
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A Joanna Briggs Institute Centre of Excellence, Halifax, Canada
- W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, Canada
| | - Janet Curran
- Faculty of Health, Dalhousie University, Halifax, Canada
- IWK Health, Halifax, Canada
- School of Nursing, Dalhousie University, Halifax, Canada
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A Joanna Briggs Institute Centre of Excellence, Halifax, Canada
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Lacerda A, Martínez MA, Dumont B, Leiss U, Kokkinou G, Scheinemann K, Craig F. Embracing paediatric palliative care in paediatric oncology from diagnosis onwards. Pediatr Blood Cancer 2023; 70:e30561. [PMID: 37430425 DOI: 10.1002/pbc.30561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
Paediatric palliative care aims to support children and young people with life-limiting or life-threatening conditions, and their families, from the time of diagnosis. Early integration within oncology has been recognised as having benefits for all involved, whatever the outcome may be. Through improved communication and advance care planning, it enables user-centred care, where concerns about quality of life, preferences and values are given the same relevance as cutting-edge therapy. Challenges to the integration of palliative care within paediatric oncology include raising awareness and providing education, whilst searching for the best care model and adapting to an ever-changing therapeutic scenario.
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Affiliation(s)
- Ana Lacerda
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- European Association for Palliative Care Children and Young People Reference Group, Vilvoorde, Belgium
- Department of Paediatrics, Portuguese Institute of Oncology, Lisbon, Portugal
| | - María Avilés Martínez
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Paediatric Palliative Care Unit, Niño Jesús Children's University Hospital, Madrid, Spain
- Department of Nursing, Autonomous University of Madrid, Madrid, Spain
| | - Benoît Dumont
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Paediatric Hematology and Oncology Institute, Léon Bérard Cancer Center, Lyon, France
| | - Ulrike Leiss
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Georgia Kokkinou
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Floga - Parents Association of Children with Cancer, Athens, Greece
- Childhood Cancer International Europe, Vienna, Austria
| | - Katrin Scheinemann
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Division of Oncology-Haematology, Department of Paediatrics, Kantonsspital Aarau, Aarau, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Paediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Finella Craig
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- European Association for Palliative Care Children and Young People Reference Group, Vilvoorde, Belgium
- Louis Dundas Paediatric Palliative Care Centre, Great Ormond Street Hospital, London, UK
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Hasegawa T, Ito Y, Furukawa Y, Okuyama T, Kojima N, Uchida M, Tasaki Y, Suzuki N, Ishida K, Kashima S, Kubota Y, Akechi T. Specialized Palliative Care and Intensity of End-of-Life Care Among Adolescents and Young Adults with Cancer: A Medical Chart Review. J Adolesc Young Adult Oncol 2023; 12:488-495. [PMID: 36508269 DOI: 10.1089/jayao.2022.0078] [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] [Indexed: 12/14/2022] Open
Abstract
Purpose: Adolescents and young adults (AYAs) with cancer often undergo aggressive end-of-life (EOL) care. We evaluated whether specialized palliative care (SPC) involvement is associated with the receipt of intensive EOL care among AYAs. Methods: This retrospective study included patients with cancer treated between the ages of 15 and 39 years at a university hospital, who died during 2009-2022. The primary outcome was high-intensity EOL (HI-EOL) care, which was defined as ≥1 session of intravenous chemotherapy <14 days from death or during the final 30 days of life, ≥1 hospitalization at an intensive care unit, >1 emergency room admission, or >1 hospitalization at an acute care unit during the final 30 days of life. We determined predictors of outcomes using multiple logistic regression models. Results: We analyzed 132 AYAs (75 with SPC involvement), of whom 42.4% (95% confidence interval [CI]: 33.9%-51.3%) underwent HI-EOL care. The prevalence of HI-EOL care was significantly lower in those who had SPC involvement than in those without SPC involvement (adjusted odds 0.30; 95% CI: 0.13-0.69; p = 0.005). Using no SPC involvement group as a reference, the adjusted odds for SPC involvement ≤60 days and >60 days were 0.71 (95% CI: 0.18-2.78; p = 0.63) and 0.22 (95% CI: 0.09-0.57; p = 0.002), respectively. Conclusion: In AYAs with cancer, SPC involvement and duration were associated with a lower incidence of HI-EOL care. Thus, integrating SPC into oncology may improve EOL care for AYAs.
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Affiliation(s)
- Takaaki Hasegawa
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Yoshinori Ito
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Yosuke Furukawa
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
- Department of Nursing, Nagoya City University Hospital, Nagoya, Japan
| | - Toru Okuyama
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Psychiatry, Nagoya City University West Medical Center, Nagoya, Japan
- Center for Psycho-oncology and Palliative Care, Nagoya City University West Medical Center, Nagoya, Japan
| | - Nanako Kojima
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Megumi Uchida
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshihiko Tasaki
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
- Department of Clinical Pharmaceutics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nana Suzuki
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
- Center for Psycho-oncology and Palliative Care, Nagoya City University West Medical Center, Nagoya, Japan
| | - Kyoko Ishida
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
- Department of Nursing, Nagoya City University Hospital, Nagoya, Japan
| | - Shuuto Kashima
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
- Department of Rehabilitation Medicine, Nagoya City University Hospital, Nagoya, Japan
| | - Yosuke Kubota
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tatsuo Akechi
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Gupta S, Li Q, Nathan PC, D'Agostino N, Baxter NN, Fox C, Chalifour K, Coburn N, Sutradhar R. Prevalence, severity, and predictors of symptom burden among adolescents and young adults with cancer. Cancer Med 2023. [DOI: 10.1002/cam4.5837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/23/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023] Open
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Jewitt N, Rapoport A, Gupta A, Srikanthan A, Sutradhar R, Luo J, Widger K, Wolfe J, Earle CC, Gupta S, Kassam A. The Effect of Specialized Palliative Care on End-of-Life Care Intensity in AYAs with Cancer. J Pain Symptom Manage 2023; 65:222-232. [PMID: 36423804 DOI: 10.1016/j.jpainsymman.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Many adolescents and young adults (AYAs; 15-39 years) with cancer receive high intensity (HI) care at the end of life (EOL). Palliative care (PC) involvement in this population is associated with lower risk of HI-EOL care. Whether this association differs by specialized vs. generalist PC (SPC, GPC) is unknown. OBJECTIVES (1) To evaluate whether SPC had an impact on the intensity of EOL care received by AYAs with cancer; (2) to determine which subpopulations are at highest risk for reduced access to SPC. METHODS A decedent cohort of AYAs with cancer who died between 2000-2017 in Ontario, Canada was identified using registry and population-based data. The primary composite measure of HI-EOL care included any of: intravenous chemotherapy <14 days from death; more than one ED visit, more than one hospitalization or any ICU admission <30 days from death. Physician's billing codes were used to define SPC and GPC involvement. RESULTS Of 7122 AYA decedents, 2140 (30%) received SPC and 943 (13%) received GPC. AYAs who died in earlier years, those with hematologic malignancies, males and rural AYAs were least likely to receive SPC. No PC involvement was associated with higher odds of receiving HI-EOL care (odds ratio (OR) 1.5; P < 0.0001). SPC involvement was associated with the lowest risk of HI-EOL care (OR SPC vs. GPC 0.8; P = 0.007) and decreased odds of ICU admission (OR 0.7; P = 0.006). CONCLUSION SPC involvement was associated with the lowest risk of HI-EOL care in AYAs with cancer. However, access to SPC remains a challenge.
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Affiliation(s)
- Natalie Jewitt
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada.
| | - Adam Rapoport
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Abha Gupta
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Amirrtha Srikanthan
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Rinku Sutradhar
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Jin Luo
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Kimberley Widger
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Joanne Wolfe
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Craig C Earle
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Sumit Gupta
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Alisha Kassam
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
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13
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Nogueira A, Correia D, Loureiro M, Gomes B, Cancelinha C. The needs of children receiving end of life care and the impact of a paediatric palliative care team: a retrospective cohort study. Eur J Pediatr 2023; 182:525-531. [PMID: 36445514 DOI: 10.1007/s00431-022-04683-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/01/2022] [Accepted: 10/26/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED Published data collected in hospital during the last year of life of children with life-limiting complex chronic conditions (CCC) is scarce, yet critical, for the implementation of paediatric palliative care (PPC). This study aims to describe the last year of life of children with CCC, in terms of clinical characteristics, hospital resources and the impact of referral to a hospital-based PPC team (PPCT). Using a retrospective cohort study, we examined the clinical records of children aged 1-18 years of age with CCC who died in a tertiary hospital between January 2016 and December 2020. Hospital resources utilised in the last year of life, therapies and procedures during the final week of life, decision to limit treatment (DLT), referral to the PPCT and place of death were analysed. Seventy-two patients (60% male) with a median age of 10.1 years were included. Most had ≥ 2 CCC (58%) with cancer as the most common diagnosis (47%). The group with ≥ 3 CCC (n = 23) had longer hospital stays (p = 0.041). Of the 17 patients referred to the PPCT, there was a higher frequency of DLT (94% vs. 40% in non-referred, p < 0.001), greater use of subcutaneous route (53% vs. 0%, p < 0.001), lower frequency of blood transfusions (12% vs. 55%, p = 0.002) and a lower proportion of deaths in the Intensive Care Unit (6% vs. 64%, p < 0.001). CONCLUSIONS Early implementation of PPC optimises the use of hospital resources, minimises invasive procedures and therapies, and may develop effective and sustainable alternatives which are better suited to the needs of children and families. WHAT IS KNOWN • In recent years, there has been an increased prevalence of complex chronic condition (CCC), which has led to more specialised and prolonged medical care until the end of life. • There are few paediatric studies on use of hospital resources and the invasiveness of procedures in the last year of life for children. WHAT IS NEW • This study is one of the few to provide a comprehensive characterisation of the last year of life of children/adolescents with CCC. • Timely referral to a specialised PPC team optimises the use of hospital resources, minimise invasive procedures and develop effective and sustainable alternatives which are better suited to the needs of children and/or families.
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Affiliation(s)
- Andreia Nogueira
- Paediatrics Department, Coimbra Hospital and University Center, Avenida Rua Dr. Afonso Romão, Coimbra, 3000-602, Portugal.
| | - Diana Correia
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Marisa Loureiro
- Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Barbara Gomes
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Cândida Cancelinha
- Paediatrics Department, Coimbra Hospital and University Center, Avenida Rua Dr. Afonso Romão, Coimbra, 3000-602, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Paediatric Palliative Care Team, Coimbra Hospital and University Center, Avenida Rua Dr. Afonso Romão, PT, Coimbra, 3000-602, Portugal
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14
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Frenkel B, Gerasimov E, Gustafson A, Gustafson P, McLean G, Ochasi A, Waanders A, Ramaswamy V. Postmortem Tissue Donation: Giving Families the Ability to Choose. J Clin Oncol 2023; 41:447-451. [PMID: 36027484 DOI: 10.1200/jco.21.02839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Beth Frenkel
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | | | - Aloysius Ochasi
- Center for Clinical Bioethics, St Joseph's University, Philadelphia, PA
| | - Angela Waanders
- Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Feinberg School of Medicine Northwestern University, Chicago, IL
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
- Departments of Medical Biophysics and Pediatrics, University of Toronto, Toronto, ON, Canada
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15
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Robertson C, Watanabe SM, Sinnarajah A, Potapov A, Faily V, Tarumi Y, Baracos VE. Association between Consultation by a Comprehensive Integrated Palliative Care Program and Quality of End-of-Life Care in Patients with Advanced Cancer in Edmonton, Canada. Curr Oncol 2023; 30:897-907. [PMID: 36661717 PMCID: PMC9858595 DOI: 10.3390/curroncol30010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/24/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
Literature assessing the impact of palliative care (PC) consultation on aggressive care at the end of life (EOL) within a comprehensive integrated PC program is limited. We retrospectively reviewed patients with advanced cancer who received oncological care at a Canadian tertiary center, died between April 2013 and March 2014, and had access to PC consultation in all healthcare settings. Administrative databases were linked, and medical records reviewed. Composite score for aggressive EOL care was calculated, assigning a point for each of the following: ≥2 emergency room visits, ≥2 hospitalizations, hospitalization >14 days, ICU admission, and chemotherapy administration in the last 30 days of life, and hospital death. Multivariable logistic regression was adjusted for age, sex, income, cancer type and PC consultation for ≥1 aggressive EOL care indicator. Of 1414 eligible patients, 1111 (78.6%) received PC consultation. In multivariable analysis, PC consultation was independently associated with lower odds of ≥1 aggressive EOL care indicator (OR 0.49, 95% CI 0.38−0.65, p < 0.001). PC consultation >3 versus ≤3 months before death had a greater effect on lower aggressive EOL care (mean composite score 0.59 versus 0.88, p < 0.001). We add evidence that PC consultation is associated with less aggressive care at the EOL for patients with advanced cancer.
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Affiliation(s)
- Cara Robertson
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Sharon M. Watanabe
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Aynharan Sinnarajah
- Division of Palliative Medicine, Queen’s University, Kingston, ON L1G 2B9, Canada
| | - Alexei Potapov
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Viane Faily
- Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI 53226, USA
| | - Yoko Tarumi
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Vickie E. Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada
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16
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Ebelhar J, DeGroote NP, Massie AM, Labudde E, Allen KE, Castellino SM, Wasilewski-Masker K, Brock KE. Differences in palliative opportunities across diagnosis groups in children with cancer. Pediatr Blood Cancer 2023; 70:e30081. [PMID: 36377714 DOI: 10.1002/pbc.30081] [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: 07/14/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Childhood cancer causes significant physical and emotional stress. Patients and families benefit from palliative care (PC) to reduce symptom burden, improve quality of life, and enhance family-centered care. We evaluated palliative opportunities across leukemia/lymphoma (LL), solid tumors (ST), and central nervous system (CNS) tumor groups. PROCEDURE A priori, nine palliative opportunities were defined: disease progression/relapse, hematopoietic stem cell transplant, phase 1 trial enrollment, admission for severe symptoms, social concerns or end-of-life (EOL) care, intensive care admission, do-not-resuscitate (DNR) status, and hospice enrollment. A single-center retrospective review was completed on 0-18-year olds with cancer who died from January 1, 2012 to November 30, 2017. Demographic, disease, and treatment data were collected. Descriptive statistics were performed. Opportunities were evaluated from diagnosis to death and across disease groups. RESULTS Included patients (n = 296) had LL (n = 87), ST (n = 114), or CNS tumors (n = 95). Palliative opportunities were more frequent in patients with ST (median 8) and CNS tumors (median 7) versus LL (median 5, p = .0005). While patients with ST had more progression/relapse opportunities (p < .0001), patients with CNS tumors had more EOL opportunities (p < .0001), earlier PC consultation, DNR status, and hospice enrollment. Palliative opportunities increased toward the EOL in all diseases (p < .0001). PC was consulted in 108 (36%) patients: LL (48%), ST (30%), and CNS (34%, p = .02). CONCLUSIONS All children with cancer incur many events warranting PC support. Patients with ST and CNS tumors had more palliative opportunities than LL, yet received less subspecialty PC. Understanding palliative opportunities within each disease group can guide PC utilization to ease patient and family stress.
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Affiliation(s)
- Jonathan Ebelhar
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia, USA
| | - Nicholas P DeGroote
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - A McCauley Massie
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Emily Labudde
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kristen E Allen
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia, USA
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia, USA
| | - Katharine E Brock
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Pediatric Palliative Care, Emory University, Atlanta, Georgia, USA
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17
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Kokaji M, Imoto N, Watanabe M, Suzuki Y, Fujiwara S, Ito R, Sakai T, Yamamoto S, Sugiura I, Kurahashi S. End-of-Life Care of Acute Myeloid Leukemia Compared with Aggressive lymphoma in Patients Who Are Eligible for Intensive Chemotherapy: An Observational Study in a Japanese Community Hospital. Palliat Med Rep 2023; 4:71-78. [PMID: 36960234 PMCID: PMC10029750 DOI: 10.1089/pmr.2022.0056] [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] [Accepted: 02/20/2023] [Indexed: 03/25/2023] Open
Abstract
Background Patients with hematological malignancies (HMs) are reported to receive more aggressive care at the end of life (EOL) than patients with solid tumors. However, the reasons behind this occurrence are not fully understood. Objectives To examine whether the care at EOL for HMs is mainly because of the disease characteristics or hematologists' attitudes and systems of care, we compared the EOL care of patients with acute myeloid leukemia (AML) and diffuse large B cell lymphoma (DLBCL). Design We retrospectively analyzed the EOL care of patients with AML and DLBCL younger than 80 years who were receiving combination chemotherapy at a city hospital in Japan. Results Fifty-nine patients with AML and 65 with DLBCL were included. Those with AML received chemotherapy more often within their last 30 days (48% vs. 19%, p < 0.001) and 14 days (37% vs. 1.5%, p < 0.001) of life, and consulted the palliative team less frequently (5.3% vs. 29%, p < 0.001). In the last 3 years, the mortality rate in hematological wards decreased from 74% to 29% in the DLBCL group, but only from 95% to 90% in the AML group. In multivariate analysis, AML (odds ratio [OR] 0.065) and death before 2018 (OR, 0.077) were significant factors associated with reduced referrals to specialized palliative teams. Conclusion Patients with AML tend to have lesser access to specialized palliative care and fewer options for their place of death than those with DLBCL. Detailed EOL care plans are needed for these patients, considering the characteristics of the disease.
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Affiliation(s)
- Masato Kokaji
- Department of Postgraduate Clinical Training Center, Toyohashi Municipal Hospital, Toyohashi, Japan
- Department of Obstetrics and Gynecology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Naoto Imoto
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi, Japan
- Address correspondence to: Naoto Imoto, MD, PhD, Department of Hematology and Oncology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake–Cho, Toyohashi, Aichi, Japan.
| | - Miki Watanabe
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yutaro Suzuki
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Shinji Fujiwara
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi, Japan
- Department of Hematology, Nagoya Graduate School of Medicine, Nagoya, Japan
| | - Rie Ito
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Toshiyasu Sakai
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Satomi Yamamoto
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Isamu Sugiura
- Department of Internal Medicine, Toyohashi Hematology Oncology Clinic, Toyohashi, Japan
| | - Shingo Kurahashi
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi, Japan
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18
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Abdelaal M, Avery J, Chow R, Saleem N, Fazelzad R, Mosher P, Hannon B, Zimmermann C, Al-Awamer A. Palliative care for adolescents and young adults with advanced illness: A scoping review. Palliat Med 2023; 37:88-107. [PMID: 36352490 PMCID: PMC9841827 DOI: 10.1177/02692163221136160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Age-related complex medical conditions have been commonly reported among adolescents and young adults with advanced life-limiting illness. There is increasing interest in exploring their palliative care needs and end-of-life experiences. AIM This scoping review aimed to explore the available literature about providing palliative and end-of-life care to adolescents and young adults with advanced life-limiting illnesses. DESIGN Scoping review. This review was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/SPTD7). DATA SOURCES Electronic databases (MEDLINEALL, Embase, Emcare, Cochrane Central Register of Controlled Trial CENTRAL, Scopus, PsycINFO, Cochrane Database of Systematic Reviews), Google Scholar and reference lists were searched up to October 2021. We included studies reporting on adolescents and/or young adults with advanced life-limiting illnesses. There were no limitations concerning location, type of illness or study design. RESULTS We identified 51 studies published between 2002 and 2021. Most studies were published in the United States (n = 34, 67%), and nine studies (18%) reported exclusively on patients with non-malignant illnesses. Two thirds of the identified studies were case reports and retrospective chart reviews (n = 33). Three main topics were identified: Physical symptom burden (n = 26, 51%), Psychological and social needs (n = 33, 65%), and end-of-life care (n = 30, 59%). Twenty-six studies (51%) were focused only on one topic, and the age range used to identify adolescents and young adults varied based on the study location. CONCLUSION The findings of this review shed light on the different palliative care experiences and knowledge gaps related to adolescents and young adults as an underserved and vulnerable patient population. Further research needs to be dedicated toward palliative care programs tailored for adolescents and young adults.
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Affiliation(s)
- Mohamed Abdelaal
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jonathan Avery
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Ronald Chow
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nasreen Saleem
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rouhi Fazelzad
- UHN Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Pamela Mosher
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Child and Adolescent Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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19
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Ananth P, Lindsay M, Nye R, Mun S, Feudtner C, Wolfe J. End-of-life care quality for children with cancer who receive palliative care. Pediatr Blood Cancer 2022; 69:e29841. [PMID: 35686746 PMCID: PMC10498672 DOI: 10.1002/pbc.29841] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND We previously developed stakeholder-informed quality measures to assess end-of-life care quality for children with cancer. We sought to implement a subset of these quality measures in the multi-center pediatric palliative care (PPC) database. PROCEDURES We utilized the Shared Data and Research database to evaluate the proportion of childhood cancer decedents from 2017-2021 who, in the last 30 days of life, avoided chemotherapy, mechanical ventilation, intensive care unit admissions, and > 1 hospital admission; were enrolled in hospice services, and reported ≤ 2 highly distressing symptoms. We then explored patient factors associated with the attainment of quality benchmarks. RESULTS Across 79 decedents, 82% met ≥ 4 quality benchmarks. Most (76%) reported > 2 highly distressing symptoms; 17% were enrolled in hospice. In univariable analyses, patients with an annual household income ≤$50,000 had lower odds of hospice enrollment and avoidance of mechanical ventilation or intensive care unit admissions near end of life (odds ratio [OR] 0.10 [95% confidence interval (C.I.) 0.01, 0.86], p = 0.04; OR 0.13 [0.02, 0.64], p = 0.01; OR 0.36 [0.13, 0.98], p = 0.04, respectively). In multivariable analyses, patients with an income ≤$50,000 remained less likely to enroll in hospice, after adjusting for cancer type (OR 0.10 [0.01, 0.87]; p = 0.04). CONCLUSIONS Childhood cancer decedents who received PPC met a large proportion of quality measures near the end of their life. Yet, many reported highly distressing symptoms. Moreover, patients with lower household incomes appeared less likely to enroll in hospice and more likely to receive intensive hospital services near the end of life. This study identifies opportunities for palliative oncology quality improvement.
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Affiliation(s)
- Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA
| | - Meghan Lindsay
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Russell Nye
- Justin Michael Ingerman Center for Palliative Care, Children’s Hospital of Philadelphia; Departments of Pediatrics, Medical Ethics, and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sophia Mun
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Chris Feudtner
- Justin Michael Ingerman Center for Palliative Care, Children’s Hospital of Philadelphia; Departments of Pediatrics, Medical Ethics, and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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20
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Mohyuddin GR, Sinnarajah A, Gayowsky A, Chan KKW, Seow H, Mian H. Quality of end-of-life care in multiple myeloma: A 13-year analysis of a population-based cohort in Ontario, Canada. Br J Haematol 2022; 199:688-695. [PMID: 35949180 DOI: 10.1111/bjh.18401] [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: 04/21/2022] [Revised: 07/06/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
Optimizing end-of-life (EOL) care for multiple myeloma (MM) represents an unmet need. An administrative cohort in Ontario, Canada was analysed between 2006 and 2018. Aggressive care was defined as two or more emergency-department visits in the last 30 days before death, or at least two new hospitalizations within 30 days of death, or an intensive care unit (ICU) admission within the last 30 days of life. Supportive care was defined as a physician house-call in the last two weeks before death, or a palliative nursing or personal support visit at home in the last 30 days before death. Among 5095 patients, 23.2% of patients received chemotherapy at EOL and 55.6% of patients died as inpatient. A minority received aggressive care at EOL [28.3%: autologous stem cell transplant (ASCT), 20.4%: non-ASCT], and a majority received supportive care at EOL (65.4%: ASCT, 61.5%: non-ASCT). Supportive care was less likely to be received by those aged over 80 years and in lower-income neighbourhoods. Supportive care at EOL increased from 56.0% in 2006 to 70.3% in 2018. Despite improvements, many patients with MM experience aggressive care at EOL. Even in a publicly funded health care system, disparities based on age, income and community size are present.
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Affiliation(s)
| | | | | | - Kelvin K W Chan
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Hira Mian
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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21
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Timely Palliative Care: Personalizing the Process of Referral. Cancers (Basel) 2022; 14:cancers14041047. [PMID: 35205793 PMCID: PMC8870673 DOI: 10.3390/cancers14041047] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
Timely palliative care is a systematic process to identify patients with high supportive care needs and to refer these individuals to specialist palliative care in a timely manner based on standardized referral criteria. It requires four components: (1) routine screening of supportive care needs at oncology clinics, (2) establishment of institution-specific consensual criteria for referral, (3) a system in place to trigger a referral when patients meet criteria, and (4) availability of outpatient palliative care resources to deliver personalized, timely patient-centered care aimed at improving patient and caregiver outcomes. In this review, we discuss the conceptual underpinnings, rationale, barriers and facilitators for timely palliative care referral. Timely palliative care provides a more rational use of the scarce palliative care resource and maximizes the impact on patients who are offered the intervention. Several sets of referral criteria have been proposed to date for outpatient palliative care referral. Studies examining the use of these referral criteria consistently found that timely palliative care can lead to a greater number of referrals and earlier palliative care access than routine referral. Implementation of timely palliative care at each institution requires oncology leadership support, adequate palliative care infrastructure, integration of electronic health record and customization of referral criteria.
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22
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Uber A, Ebelhar JS, Lanzel AF, Roche A, Vidal-Anaya V, Brock KE. Palliative Care in Pediatric Oncology and Hematopoietic Stem Cell Transplantation. Curr Oncol Rep 2022; 24:161-174. [DOI: 10.1007/s11912-021-01174-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
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23
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Amano K, Satomi E, Oyamada S, Ishiki H, Sakashita A, Miura T, Maeda I, Hatano Y, Yamauchi T, Oya K, Nakagawa J, Hiratsuka Y, Hirohashi T, Morita T, Mori M, Inoue S, Yokomichi N, Imai K, Tsukuura H, Naito AS, Uneno Y, Yoshioka A, Hiramoto S, Kikuchi A, Hori T, Matsuda Y, Kohara H, Funaki H, Tanaka K, Suzuki K, Kamei T, Azuma Y, Uno T, Miyamoto J, Katayama H, Kashiwagi H, Matsumoto E, Yamaguchi T, Okamura T, Hashimoto H, Kosugi S, Ikuta N, Matsumoto Y, Ohmori T, Nakai T, Ikee T, Unoki Y, Kitade K, Koito S, Ishibashi N, Ehara M, Kuwahara K, Ueno S, Nakashima S, Ishiyama Y, Matsunuma R, Takatsu H, Yamaguchi T, Ito S, Terabayashi T, Yamagiwa T, Inoue A, Yamaguchi T, Miyashita M, Yoshida S, Tagami K, Watanabe H, Odagiri T, Ito T, Ikenaga M, Shimizu K, Hayakawa A, Kamura R, Okoshi T, Nishi T, Kosugi K, Shibata Y, Hisanaga T, Higashibata T, Yabuki R, Hagiwara S, Shimokawa M, Miyake S, Nozato J, Iriyama T, Kaneishi K, Baba M, Matsumoto Y, Okizaki A, Sumazaki Watanabe Y, uehara Y, Nishijima K, Shimoinaba J, Nakahori R, Hamano J, Kawashima N, Kawaguchi T, Uchida M, Sato K, Matsuda Y, Tsuneto S, Maeda S, Kizawa Y, Otani H. The prevalence of artificially administered nutrition and hydration in different age groups among patients with advanced cancer admitted to palliative care units. CLINICAL NUTRITION OPEN SCIENCE 2021. [DOI: 10.1016/j.nutos.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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