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Scotté F, Taylor A, Davies A. Supportive Care: The "Keystone" of Modern Oncology Practice. Cancers (Basel) 2023; 15:3860. [PMID: 37568675 PMCID: PMC10417474 DOI: 10.3390/cancers15153860] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The Multinational Association of Supportive Care in Cancer (MASCC) defines supportive care as "the prevention and management of the adverse effects of cancer and its treatment. This includes management of physical and psychological symptoms and side effects across the continuum of the cancer journey from diagnosis through treatment to post-treatment care. Supportive care aims to improve the quality of rehabilitation, secondary cancer prevention, survivorship, and end-of-life care". This article will provide an overview of modern supportive care in cancer, discussing its definition, its relationship with palliative care, models of care, "core" service elements (multi-professional/multidisciplinary involvement), the evidence that supportive care improves morbidity, quality of life, and mortality in various groups of patients with cancer, and the health economic benefits of supportive care. The article will also discuss the current and future challenges to providing optimal supportive care to all oncology patients.
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Affiliation(s)
| | - Amy Taylor
- Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Andrew Davies
- Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
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Abstract
PURPOSE OF REVIEW Supportive care services have evolved overtime to meet the growing supportive care need of patients with cancer and their families. In this review, we summarize existing definitions of supportive care, highlight empiric studies on supportive care delivery, and propose an integrated conceptual framework on supportive cancer care. RECENT FINDINGS Supportive care aims at addressing the patients' physical, emotional, social, spiritual, and informational needs throughout the disease trajectory. Interdisciplinary teams are needed to deliver multidimensional care. Oncology teams have an important role providing supportive care in the front lines and referring patients to supportive care services such as palliative care, social work, rehabilitation, psycho-oncology, and integrative medicine. However, the current model of as needed referral and siloed departments can lead to heterogeneous access and fragmented care. To overcome these challenges, we propose a conceptual model in which supportive care services are organized under one department with a unified approach to patient care, program development, and research. Key features of this model include universal referral, systematic screening, tailored specialist involvement, streamlined care, collaborative teamwork, and enhanced outcomes. SUMMARY Further research is needed to develop and test innovative supportive care models that can improve patient outcomes.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
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Schofield P, Gough K, Pascoe M, Bergin R, White K, Mileshkin L, Bernshaw D, Kinnane N, Jackson M, Do V, Brand A, Aranda S, Cheuk R, Drosdowsky A, Penberthy S, Juraskova I. A nurse- and peer-led psycho-educational intervention to support women with gynaecological cancers receiving curative radiotherapy: The PeNTAGOn randomised controlled trial – ANZGOG 1102. Gynecol Oncol 2020; 159:785-793. [DOI: 10.1016/j.ygyno.2020.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/08/2020] [Indexed: 12/01/2022]
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Olver I, Keefe D, Herrstedt J, Warr D, Roila F, Ripamonti CI. Supportive care in cancer—a MASCC perspective. Support Care Cancer 2020; 28:3467-3475. [DOI: 10.1007/s00520-020-05447-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/30/2020] [Indexed: 01/18/2023]
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Boucher NA, Nicolla J, Ogunseitan A, Kessler ER, Ritchie CS, Zafar YY. Feasibility and Acceptability of a Best Supportive Care Checklist among Clinicians. J Palliat Med 2018; 21:1074-1077. [PMID: 29683377 PMCID: PMC6486661 DOI: 10.1089/jpm.2017.0605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2018] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Best supportive care (BSC) is often not standardized across sites, consistent with best evidence, or sufficiently described. We developed a consensus-based checklist to document BSC delivery, including symptom management, decision making, and care planning. We hypothesized that BSC can be feasibly documented with this checklist consistent with consolidated standards of reporting trials. OBJECTIVE To determine feasibility/acceptability of a BSC checklist among clinicians. METHODS To test feasibility of a BSC checklist in standard care, we enrolled a sample of clinicians treating patients with advanced cancer at four centers. Clinicians were asked to complete the checklist at eligible patient encounters. We surveyed enrollees regarding checklist use generating descriptive statistics and frequencies. RESULTS We surveyed 15 clinicians and 9 advanced practice providers. Mean age was 41 (SD = 7.9). Mean years since fellowship for physicians was 7.2 (SD = 4.5). Represented specialties are medical oncology (n = 8), gynecologic oncology (n = 4), palliative care (n = 2), and other (n = 1). For "overall impact on your delivery of supportive/palliative care," 40% noted improved impact with using BSC. For "overall impact on your documentation of supportive/palliative care," 46% noted improvement. Impact on "frequency of comprehensive symptom assessment" was noted to be "increased" by 33% of providers. None noted decreased frequency or worsening impact on any measure with use of BSC. Regarding feasibility of integrating the checklist into workflow, 73% agreed/strongly agreed that checklists could be easily integrated, 73% saw value in integration, and 80% found it easy to use. CONCLUSION Clinicians viewed the BSC checklist favorably illustrating proof of concept, minor workflow impact, and potential of benefit to patients.
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Affiliation(s)
- Nathan A. Boucher
- Durham VA GRECC, Duke Center for the Study of Aging and Human Development; Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Jonathan Nicolla
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | | | | | | | - Yousuf Y. Zafar
- Duke University School of Medicine, Duke Cancer Institute, Durham, North Carolina
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Ferrara G, Luppi F, Birring SS, Cerri S, Caminati A, Sköld M, Kreuter M. Best supportive care for idiopathic pulmonary fibrosis: current gaps and future directions. Eur Respir Rev 2018; 27:27/147/170076. [PMID: 29436402 DOI: 10.1183/16000617.0076-2017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/25/2017] [Indexed: 11/05/2022] Open
Abstract
Best supportive care (BSC) is generally defined as all the interventions and the multiprofessional approach aimed to improve and optimise quality of life (QoL) in patients affected by progressive diseases. In this sense, it excludes and might be complementary to other interventions directly targeting the disease. BSC improves survival in patients with different types of cancer. Patients with idiopathic pulmonary fibrosis (IPF) experience a vast range of symptoms during the natural history of the disease and might have a beneficial effect of BSC interventions. This review highlights the current evidence on interventions targeting QoL and gaps for the clinical assessment of BSC in the treatment of IPF patients. Very few interventions to improve QoL or improve symptom control are currently supported by well-designed studies. Sound methodology is paramount in evaluating BSC in IPF, as well as the use of validated tools to measure QoL and symptom control in this specific group of patients.
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Affiliation(s)
- Giovanni Ferrara
- Section of Respiratory Medicine, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden .,Division of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Fabrizio Luppi
- Center for Rare Lung Diseases, University Hospital of Modena, Modena, Italy
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Stefania Cerri
- Center for Rare Lung Diseases, University Hospital of Modena, Modena, Italy
| | - Antonella Caminati
- Section of Respiratory Medicine, San Giuseppe Hospital Multimedica, Milan, Italy
| | - Magnus Sköld
- Section of Respiratory Medicine, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Division of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Michael Kreuter
- University of Heidelberg and Center for Interstitial and Rare Lung Disease, Division of Respiratory Medicine, University of Heidelberg, Heidelberg, Germany
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Strang P, Bergqvist J. Does palliative chemotherapy provide a palliative effect on symptoms in late palliative stages? An interview study with oncologists. Acta Oncol 2017; 56:1258-1264. [PMID: 28578604 DOI: 10.1080/0284186x.2017.1332426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The possible chemotherapy effects on symptoms in late stages of palliative chemotherapy are seldom registered in clinical practice or investigated as primary outcomes. The aim was therefore to study physicians' opinions and experiences about chemotherapy effects on symptoms. MATERIAL AND METHODS Thirty-five physicians (mainly oncologists) with variation as regards age, gender and experience were included in a qualitative study with semi-structured interviews. A qualitative content analysis was used for the 30-60 min long interviews. RESULTS According to all the informants, symptoms were possible to control in successful cases but the chances reduce rapidly with the number of chemotherapy lines. Symptoms possible to control included various types of pain (bone pain, neuropathic cranial as well as meningeal nerve pain, colic pain, "liver" pain, headache and pain from cutaneous metastases); nausea and vomiting caused by obstruction; dyspnoea due to pleural effusions or bronchial obstructions. Also fatigue and B-symptoms were possible targets, as were diagnosis-specific symptom clusters (e.g., liver metastasis causing pain, nausea, tumour fever and night sweats; or head-neck cancers resulting in nerve pain, ulcerations, odour, dysphagia and impaired breathing). Some of the oncologists discussed whether the effects were related to chemotherapy treatment only or partly to premedication with steroids. Despite the claimed effects, the physicians did not keep record on symptoms, they did not evaluate them with validated instruments. CONCLUSIONS Palliative chemotherapy has a substantial potential to reduce agonizing symptoms especially in first line treatments, but the effect is limited in late stages. The actual awareness of and knowledge about situations where the treatment has a reasonable potential, should be improved and symptoms should be monitored during treatment.
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Affiliation(s)
- Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Research and Development, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Jenny Bergqvist
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Capio St Görans Sjukhus, Stockholm, Sweden
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Rivoirard R, Bourmaud A, Oriol M, Tinquaut F, Méry B, Langrand-Escure J, Vallard A, Fournel P, Magné N, Chauvin F. Quality of reporting in oncology studies: A systematic analysis of literature reviews and prospects. Crit Rev Oncol Hematol 2017; 112:179-189. [DOI: 10.1016/j.critrevonc.2017.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/19/2017] [Accepted: 02/14/2017] [Indexed: 12/30/2022] Open
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Tauro S. The blind men and the AML elephant: can we feel the progress? Blood Cancer J 2016; 6:e424. [PMID: 27176800 PMCID: PMC4916302 DOI: 10.1038/bcj.2016.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/06/2016] [Indexed: 12/27/2022] Open
Abstract
The pharmacological therapy of non-promyelocytic acute myeloid leukemia (AML) has remained unchanged for over 40 years with an anthracycline-cytarabine combination forming the backbone of induction treatments. Nevertheless, the survival of younger patients has increased due to improved management of the toxicity of therapies including stem cell transplantation. Older patients and those with infirmity that precludes treatment-intensification have, however, not benefited from improvements in supportive care and continue to experience poor outcomes. An increased understanding of the genomic heterogeneity of AML raises the possibility of treatment-stratification to improve prognosis. Thus, efforts to identify agents with non-conventional anti-leukemic effects have paralleled those aiming to optimize leukemia cell-kill with conventional chemotherapy, resulting in a number of randomized controlled trials (RCT). In the last 18 months, RCTs investigating the effects of vosaroxin, azacitidine and gemtuzumab ozogamycin and daunorubicin dose have been reported with some studies indicating a statistically significant survival benefit with the investigational agent compared with standard therapy and potentially, a new era in AML therapeutics. Given the increasing costs of cancer care, a review of these studies, with particular attention to the magnitude of clinical benefit with the newer agents would be useful, especially for physicians treating patients in single-payer health systems.
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Affiliation(s)
- S Tauro
- Dundee Cancer Centre, Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland, UK
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Noguchi M, Matsumoto K, Uemura H, Arai G, Eto M, Naito S, Ohyama C, Nasu Y, Tanaka M, Moriya F, Suekane S, Matsueda S, Komatsu N, Sasada T, Yamada A, Kakuma T, Itoh K. An Open-Label, Randomized Phase II Trial of Personalized Peptide Vaccination in Patients with Bladder Cancer that Progressed after Platinum-Based Chemotherapy. Clin Cancer Res 2015; 22:54-60. [PMID: 26581246 DOI: 10.1158/1078-0432.ccr-15-1265] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/18/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE The prognosis of platinum-based chemotherapy-resistant metastatic urothelial cancer of the bladder remains poor. Personalized selection of the right peptides for each patient could be a novel approach for a cancer vaccine to boost anticancer immunity. EXPERIMENTAL DESIGN In this randomized, open-label, phase II study, patients ages ≥18 years with progressive bladder cancer after first-line platinum-based chemotherapy were randomly assigned (1:1) to receive personalized peptide vaccination (PPV) plus best supportive care (BSC) or BSC. PPV treatment used a maximum of four peptides chosen from 31 candidate peptides according to human leukocyte antigen types and peptide-reactive IgG titers, for 12 s.c. injections (8 injections, weekly; 4 injections, bi-weekly). The primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS), immune response, and toxicity. RESULTS Eighty patients were randomly assigned to receive either PPV plus BSC (n = 39) or BSC (n = 41). No significant improvement in PFS was noted [HR, 0.7; 95% confidence interval (CI), 0.4-1.2, P = 0.17]. For the secondary endpoints, PPV plus BSC significantly prolonged OS compared with BSC (HR, 0.58; 95% CI, 0.34-0.99, P = 0.049), with median OS of 7.9 months (95% CI, 3.5-12.0) in the PPV plus BSC and 4.1 months (95% CI, 2.8-6.9) in the BSC. PPV treatment was well tolerated, without serious adverse drug reactions. CONCLUSIONS PPV could not prolong PFS, but OS appeared to be improved with low toxicity and immune responses. Further large-scale, randomized trials are needed to confirm these results.
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Affiliation(s)
- Masanori Noguchi
- Divisions of Clinical Research, Kurume University School of Medicine, Kurume, Japan. Department of Urology, Kurume University School of Medicine, Kurume, Japan.
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Gaku Arai
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Masatoshi Eto
- Department of Urology, Kumamoto University, Kumamoto, Japan
| | - Seiji Naito
- Department of Urology, Graduate School of Medical Sciences, University of Kyushu, Fukuoka, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Okayama, Japan
| | | | - Fukuko Moriya
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Shigetaka Suekane
- Department of Urology, Kurume University School of Medicine, Kurume, Japan
| | - Satoko Matsueda
- Cancer Vaccine Center, Kurume University School of Medicine, Kurume, Japan
| | | | - Tetsuro Sasada
- Department of Immunology, Kurume University School of Medicine, Kurume, Japan
| | - Akira Yamada
- Cancer Vaccines, Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Japan
| | - Tatsuyuki Kakuma
- Bio-Statistics Center, Kurume University School of Medicine, Kurume, Japan
| | - Kyogo Itoh
- Cancer Vaccine Center, Kurume University School of Medicine, Kurume, Japan
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Lee R, Ramchandran K, Sanft T, Von Roenn J. Implementation of supportive care and best supportive care interventions in clinical trials enrolling patients with cancer. Ann Oncol 2015; 26:1838-1845. [DOI: 10.1093/annonc/mdv207] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/15/2015] [Indexed: 12/25/2022] Open
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Song HN, Lee US, Lee GW, Hwang IG, Kang JH, Eduardo B. Long-Term Intermittent Palliative Sedation for Refractory Symptoms at the End of Life in Two Cancer Patients. J Palliat Med 2015; 18:807-10. [PMID: 26244836 DOI: 10.1089/jpm.2014.0357] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Palliative sedation (PS) can be classified as either continuous or intermittent. Continuous PS is most commonly used in end-of-life care, while no specific indication for intermittent PS exists. CASE PRESENTATION Here we describe two cases of refractory severe cancer pain with psychological anguish that were controlled successfully by intermittent IPS for the long time. One patient complained of refractory severe cancer pain and insomnia. The other patient had uncontrollable pain and delirium, whose sufferings were relieved by intermittent PS. Case Management and Outcome: Intermittent PS was offered to the cases every night-time with family member/patient's consent. After providing intermittent PS, cancer pain decreased to mild intensity and psychological symptoms were significant improved simultaneously with patients awake during day time. CONCLUSIONS Palliative PS may stop vicious cycle of physical and psychological distress in terminal cancer patients. Furthermore, intermittent type of PS could keep patients consciousness alert during day time and may be performed repeatedly for the long time.
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Affiliation(s)
- Haa-Na Song
- 1 Department of Internal Medicine, School of Medicine, Gyeongsang National University , Jinju, Korea.,4 Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Un Seok Lee
- 1 Department of Internal Medicine, School of Medicine, Gyeongsang National University , Jinju, Korea
| | - Gyeong-Won Lee
- 1 Department of Internal Medicine, School of Medicine, Gyeongsang National University , Jinju, Korea
| | - In Gyu Hwang
- 2 Department of Internal Medicine, College of Medicine, Chung-Ang University , Seoul, South Korea
| | - Jung Hun Kang
- 1 Department of Internal Medicine, School of Medicine, Gyeongsang National University , Jinju, Korea
| | - Bruera Eduardo
- 3 Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center , Houston, Texas
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Nipp RD, Currow DC, Cherny NI, Strasser F, Abernethy AP, Zafar SY. Best supportive care in clinical trials: review of the inconsistency in control arm design. Br J Cancer 2015; 113:6-11. [PMID: 26068397 PMCID: PMC4647523 DOI: 10.1038/bjc.2015.192] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/07/2015] [Accepted: 05/07/2015] [Indexed: 02/08/2023] Open
Abstract
Background: Best supportive care (BSC) as a control arm in clinical trials is poorly defined. We conducted a review to evaluate clinical trials' concordance with published, consensus-based framework for BSC delivery in trials. Methods: A consensus-based Delphi panel previously identified four key domains of BSC delivery in trials: multidisciplinary care; supportive care documentation; symptom assessment; and symptom management. We reviewed trials including BSC control arms from 2002 to 2014 to assess concordance to BSC standards and to selected items from the CONSORT 2010 guidelines. Results: Of 408 articles retrieved, we retained 18 after applying exclusion criteria. Overall, trials conformed to the CONSORT guidelines better than the BSC standards (28% vs 16%). One-third of articles offered a detailed description of BSC, 61% reported regular symptom assessment, and 44% reported using validated symptom assessment measures. One-third reported symptom assessment at identical intervals in both arms. None documented evidence-based symptom management. No studies reported educating patients about symptom management or goals of therapy. No studies reported offering access to palliative care specialists. Conclusions: Reporting of BSC in trials is incomplete, resulting in uncertain internal and external validity. Such studies risk systematically over-estimating the net clinical effect of the comparator arms.
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Affiliation(s)
- R D Nipp
- Department of Medicine, Division of Medical Oncology, Dana-Farber/Harvard Cancer Center, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA 02114, USA
| | - D C Currow
- Discipline of Palliative and Supportive Services, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia
| | - N I Cherny
- Department of Oncology, Cancer Pain and Palliative Medicine Unit, 12 Bayit Street, Jerusalem 91031, Israel
| | - F Strasser
- Department of Internal Medicine and Palliative Care Center, Division of Oncology, Oncological Palliative Medicine, Cantonal Hospital, 9007 St Gallen, Switzerland
| | - A P Abernethy
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710, USA
| | - S Y Zafar
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710, USA
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14
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Patient-reported outcomes as end points and outcome indicators in solid tumours. Nat Rev Clin Oncol 2015; 12:358-70. [DOI: 10.1038/nrclinonc.2015.29] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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15
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Currow DC, Aranda S. Cancer control is not beyond us … but could be if we don't invest wisely. Med J Aust 2015; 202:63. [PMID: 25627722 DOI: 10.5694/mja14.01701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/23/2014] [Indexed: 11/17/2022]
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Partridge AH, Seah DS, King T, Leighl NB, Hauke R, Wollins DS, Von Roenn JH. Developing a Service Model That Integrates Palliative Care Throughout Cancer Care: The Time Is Now. J Clin Oncol 2014; 32:3330-6. [DOI: 10.1200/jco.2013.54.8149] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Palliative care is a fundamental component of cancer care. As part of the 2011 to 2012 Leadership Development Program (LDP) of the American Society of Clinical Oncology (ASCO), a group of participants was charged with advising ASCO on how to develop a service model integrating palliative care throughout the continuum of cancer care. This article presents the findings of the LDP group. The group focused on the process of palliative care delivery in the oncology setting. We identified key elements for models of palliative care in various settings to be potentially equitable, sustainable, feasible, and acceptable, and here we describe a dynamic model for the integrated, simultaneous implementation of palliative care into oncology practice. We also discuss critical considerations to better integrate palliative care into oncology, including raising consciousness and educating both providers and the public about the importance of palliative care; coordinating palliative care efforts through strengthening affiliations and/or developing new partnerships; prospectively evaluating the impact of palliative care on patient and provider satisfaction, quality improvement, and cost savings; and ensuring sustainability through adequate reimbursement and incentives, including linkage of performance data to quality indicators, and coordination with training efforts and maintenance of certification requirements for providers. In light of these findings, we believe the confluence of increasing importance of incorporation of palliative care education in oncology education, emphasis on value-based care, growing use of technology, and potential cost savings makes developing and incorporating palliative care into current service models a meaningful goal.
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Affiliation(s)
- Ann H. Partridge
- Ann H. Partridge and Davinia S.E. Seah, Dana-Farber Cancer Institute, Boston, MA; Tari King, Memorial Sloan-Kettering Cancer Center, New York, NY; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Ralph Hauke, Nebraska Cancer Specialists, Omaha, NE; Dana S. Wollins, American Society of Clinical Oncology, Alexandra, VA; and Jamie Hayden Von Roenn, Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Davinia S.E. Seah
- Ann H. Partridge and Davinia S.E. Seah, Dana-Farber Cancer Institute, Boston, MA; Tari King, Memorial Sloan-Kettering Cancer Center, New York, NY; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Ralph Hauke, Nebraska Cancer Specialists, Omaha, NE; Dana S. Wollins, American Society of Clinical Oncology, Alexandra, VA; and Jamie Hayden Von Roenn, Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Tari King
- Ann H. Partridge and Davinia S.E. Seah, Dana-Farber Cancer Institute, Boston, MA; Tari King, Memorial Sloan-Kettering Cancer Center, New York, NY; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Ralph Hauke, Nebraska Cancer Specialists, Omaha, NE; Dana S. Wollins, American Society of Clinical Oncology, Alexandra, VA; and Jamie Hayden Von Roenn, Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Natasha B. Leighl
- Ann H. Partridge and Davinia S.E. Seah, Dana-Farber Cancer Institute, Boston, MA; Tari King, Memorial Sloan-Kettering Cancer Center, New York, NY; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Ralph Hauke, Nebraska Cancer Specialists, Omaha, NE; Dana S. Wollins, American Society of Clinical Oncology, Alexandra, VA; and Jamie Hayden Von Roenn, Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Ralph Hauke
- Ann H. Partridge and Davinia S.E. Seah, Dana-Farber Cancer Institute, Boston, MA; Tari King, Memorial Sloan-Kettering Cancer Center, New York, NY; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Ralph Hauke, Nebraska Cancer Specialists, Omaha, NE; Dana S. Wollins, American Society of Clinical Oncology, Alexandra, VA; and Jamie Hayden Von Roenn, Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Dana S. Wollins
- Ann H. Partridge and Davinia S.E. Seah, Dana-Farber Cancer Institute, Boston, MA; Tari King, Memorial Sloan-Kettering Cancer Center, New York, NY; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Ralph Hauke, Nebraska Cancer Specialists, Omaha, NE; Dana S. Wollins, American Society of Clinical Oncology, Alexandra, VA; and Jamie Hayden Von Roenn, Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Jamie Hayden Von Roenn
- Ann H. Partridge and Davinia S.E. Seah, Dana-Farber Cancer Institute, Boston, MA; Tari King, Memorial Sloan-Kettering Cancer Center, New York, NY; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Ralph Hauke, Nebraska Cancer Specialists, Omaha, NE; Dana S. Wollins, American Society of Clinical Oncology, Alexandra, VA; and Jamie Hayden Von Roenn, Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
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Abstract
PURPOSE OF REVIEW 'Supportive care' is a commonly used term in oncology; however, no consensus definition exists. This represents a barrier to communication in both the clinical and research settings. In this review, we propose a unifying conceptual framework for supportive care and discuss the proper use of this term in the clinical and research settings. RECENT FINDINGS A recent systematic review revealed several themes for supportive care: a focus on symptom management and improvement of quality of life, and care for patients on treatments and those with advanced stage disease. These findings are consistent with a broad definition for supportive care: 'the provision of the necessary services for those living with or affected by cancer to meet their informational, emotional, spiritual, social, or physical needs during their diagnostic, treatment, or follow-up phases encompassing issues of health promotion and prevention, survivorship, palliation, and bereavement.' Supportive care can be classified as primary, secondary, and tertiary based on the level of specialization. For example, palliative care teams provide secondary supportive care for patients with advanced cancer. SUMMARY Until a consensus definition is available for supportive care, this term should be clearly defined or cited whenever it is used.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Gribble MO, Around Him DM. Ethics and Community Involvement in Syntheses Concerning American Indian, Alaska Native, or Native Hawaiian Health: A Systematic Review. AJOB Empir Bioeth 2014; 5:1-24. [PMID: 25089283 DOI: 10.1080/21507716.2013.848956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of the research was to review reporting of ethical concerns and community involvement in peer-reviewed systematic reviews or meta-analyses concerning American Indian, Alaska Native, or Native Hawaiian (AI/AN/NH) health. METHODS Text words and indexed vocabulary terms were used to query PubMed, Embase, Cochrane Library, and the Native Health Database for systematic reviews or meta-analyses concerning AI/AN/NH health published in peer-reviewed journals, followed by a search through reference lists. Each article was abstracted by two independent reviewers; results were discussed until consensus was reached. RESULTS We identified 107 papers published from 1986-2012 that were primarily about AI/AN/NH health or presented findings separately for AI/AN/NH communities. Two reported seeking indigenous reviewer feedback; none reported seeking input from tribes and communities. Approximately 7% reported on institutional review board (IRB) approval of included studies, 5% reported on tribal approval, and 4% referenced the sovereignty of AI/AN tribes. Approximately 63% used evidence from more than one AI/AN/NH population study, and 28% discussed potential benefits to communities from the synthesis research. CONCLUSIONS Reporting of ethics and community involvement are not prominent. Systematic reviews and meta-analyses making community-level inferences may pose risks to communities. Future systematic reviews and meta-analyses should consider ethical and participatory dimensions of research.
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Affiliation(s)
- Matthew O Gribble
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Deana M Around Him
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
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Schofield P, Juraskova I, Bergin R, Gough K, Mileshkin L, Krishnasamy M, White K, Bernshaw D, Penberthy S, Aranda S. A nurse- and peer-led support program to assist women in gynaecological oncology receiving curative radiotherapy, the PeNTAGOn study (peer and nurse support trial to assist women in gynaecological oncology): study protocol for a randomised controlled trial. Trials 2013; 14:39. [PMID: 23399476 PMCID: PMC3576284 DOI: 10.1186/1745-6215-14-39] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 01/15/2013] [Indexed: 12/05/2022] Open
Abstract
Background Women who undergo radiotherapy for gynaecological cancer (GC) can experience distressing side effects which impact on psychosocial functioning and intimate relationships. Cancer-related distress may be ameliorated by comprehensive preparation for treatment and addressing women’s informational, physical, psychological and psychosexual needs. This paper describes the protocol for a multisite randomised controlled trial (RCT) testing a novel intervention package which combines tailored specialist nursing consultations and telephone peer support with the primary aim to reduce psychological distress. Secondary aims assess patient quality of life, symptom distress, unmet supportive care needs, preparation for treatment, psychosexual functioning and vaginal stenosis. Methods/design This multifaceted intervention comprises four nurse-led consultations coupled with four phone calls from a peer support volunteer (GC survivor). The evidence-based intervention will be delivered at critical points in the illness trajectory: pre-treatment, mid-treatment, treatment completion and post-treatment. Nurses and peers undergo 2-day intensive training workshops, are guided by comprehensive study intervention manuals and receive ongoing supervision and support. Eligible patients will have a diagnosis of GC, be scheduled to receive curative radiotherapy, be aged 18 years or over and speak English. Three-hundred and six participants will be randomized to receive usual care or usual care with the intervention package. Study outcome measures will be collected at baseline, day 1 of radiotherapy and 1, 6 and 12 months post radiotherapy. Clinical assessments of vaginal toxicity will occur at baseline, and 3, 6, and 12 months post radiotherapy. Discussion This timely research has the potential to substantially reduce the physical, psychosexual and supportive care needs of women with GC. Using a telephone peer support model, the intervention package ensures equitable access to support services for geographically isolated patients. The novel intervention engages peer volunteers who liaise with nurses to encourage adherence to professionally-delivered information and provide emotional support. It has been designed to be potentially transferable to a range of treatment settings and diseases. Based on pilot data, the proposed intervention was found to be useful and acceptable to patients and clinicians. If effective and feasible in the multisite RCT, the program could be widely disseminated. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12611000744954
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Affiliation(s)
- Penelope Schofield
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 3002 East Melbourne, Vic, Australia.
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Ludwig WD, Schott G. Neue Arzneimittel in der Onkologie: Merkmale klinischer Zulassungsstudien und Argumente für die rasche Durchführung unabhängiger klinischer Studien nach der Zulassung. ACTA ACUST UNITED AC 2013; 36 Suppl 2:17-22. [DOI: 10.1159/000348253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Wolf-Dieter Ludwig
- Arzneimittelkommission der deutschen Ärzteschaft (AkdÄ), Berlin, Deutschland.
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Concepts and definitions for "supportive care," "best supportive care," "palliative care," and "hospice care" in the published literature, dictionaries, and textbooks. Support Care Cancer 2012; 21:659-85. [PMID: 22936493 DOI: 10.1007/s00520-012-1564-y] [Citation(s) in RCA: 202] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/31/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE Commonly used terms such as "supportive care," "best supportive care," "palliative care," and "hospice care" were rarely and inconsistently defined in the palliative oncology literature. We conducted a systematic review of the literature to further identify concepts and definitions for these terms. METHODS We searched MEDLINE, PsycInfo, EMBASE, and CINAHL for published peer-reviewed articles from 1948 to 2011 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. Dictionaries/textbooks were also searched. RESULTS Nine of 32 "SC/BSC," 25 of 182 "PC," and 12 of 42 "HC" articles focused on providing a conceptual framework/definition. Common concepts for all three terms were symptom control and quality-of-life for patients with life-limiting illness. "SC" focused more on patients on active treatment compared to other categories (9/9 vs. 8/37) and less often involved interdisciplinary care (4/9 vs. 31/37). In contrast, "HC" focused more on volunteers (6/12 vs. 6/34), bereavement care (9/12 vs. 7/34), and community care (9/12 vs. 6/34). Both "PC" and "SC/BSC" were applicable earlier in the disease trajectory (16/34 vs. 0/9). We found 13, 24, and 17 different definitions for "SC/BSC," "PC," and "HC," respectively. "SC/BSC" was the most variably defined, ranging from symptom management during cancer therapy to survivorship care. Dictionaries/textbooks showed similar findings. CONCLUSION We identified defining concepts for "SC/BSC," "PC," and "HC" and developed a preliminary conceptual framework unifying these terms along the continuum of care to help build consensus toward standardized definitions.
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Regan TW, Lambert SD, Girgis A, Kelly B, Kayser K, Turner J. Do couple-based interventions make a difference for couples affected by cancer? A systematic review. BMC Cancer 2012; 12:279. [PMID: 22769228 PMCID: PMC3464780 DOI: 10.1186/1471-2407-12-279] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 06/21/2012] [Indexed: 11/10/2022] Open
Abstract
Background With the growing recognition that patients and partners react to a cancer diagnosis as an interdependent system and increasing evidence that psychosocial interventions can be beneficial to both patients and partners, there has been a recent increase in the attention given to interventions that target couples. The aim of this systematic review was to identify existing couple-based interventions for patients with cancer and their partners and explore the efficacy of these interventions (including whether there is added value to target the couple versus individuals), the content and delivery of couple-based interventions, and to identify the key elements of couple-based interventions that promote improvement in adjustment to cancer diagnosis. Method A systematic review of the cancer literature was performed to identify experimental and quasi-experimental couple-based interventions published between 1990 and 2011. To be considered for this review, studies had to test the efficacy of a psychosocial intervention for couples affected by cancer. Studies were excluded if they were published in a language other than English or French, focused on pharmacological, exercise, or dietary components combined with psychosocial components, or did not assess the impact of the intervention on psychological distress (e.g., depression, anxiety) or quality of life. Data were extracted using a standardised data collection form, and were analysed independently by three reviewers. Results Of the 709 articles screened, 23 were included in this review. Couple-based interventions were most efficacious in improving couple communication, psychological distress, and relationship functioning. Interventions had a limited impact on physical distress and social adjustment. Most interventions focused on improving communication and increasing understanding of the cancer diagnosis within couples. Interventions were most often delivered by masters-level nurses or clinical psychologists. Although most were delivered in person, few were telephone-based. No difference in efficacy was noted based on mode of delivery. Factors associated with uptake and completion included symptom severity, available time and willingness to travel. Conclusion Given effect sizes of couple-based interventions are similar to those reported in recent meta-analyses of patient-only and caregiver-only interventions (~d=.35-.45), it appears couple-based interventions for patients with cancer and their partners may be at least as efficacious as patient-only and caregiver-only interventions. Despite evidence that couple-based interventions enhance psycho-social adjustment for both patients and partners, these interventions have not yet been widely adopted. Although more work is needed to facilitate translation to routine practice, evidence reviewed is promising in reducing distress and improving coping and adjustment to a cancer diagnosis or to cancer symptoms.
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Affiliation(s)
- Tim W Regan
- Centre for Translational Neuroscience and Mental Health, Faculty of Health, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.
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Frigeri M, De Dosso S, Castillo-Fernandez O, Feuerlein K, Neuenschwander H, Saletti P. Chemotherapy in patients with advanced pancreatic cancer: too close to death? Support Care Cancer 2012; 21:157-63. [PMID: 22648205 DOI: 10.1007/s00520-012-1505-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/20/2012] [Indexed: 12/18/2022]
Abstract
PURPOSE We evaluated the attitude in using chemotherapy near the end of life in advanced pancreatic adenocarcinoma (PAC). Clinical and laboratory parameters recorded at last chemotherapy administration were analyzed, in order to identify risk factors for imminent death. METHODS Retrospective analysis of patients who underwent at least one line of palliative chemotherapy was made. Data concerning chemotherapy (regimens, lines, and date of last administration) were collected. Clinical and laboratory factors recorded at last chemotherapy administration were: performance status, presence of ascites, hemoglobin, white blood cell (WBC), platelets, total bilirubin, albumin, LDH, C-reactive protein (C-rp), and Ca 19.9. RESULTS We analyzed 231 patients: males/females, 53/47 %; metastatic/locally advanced disease, 80/20 %; and median age, 66 years (range 32-85). All patients died due to disease progression. Median overall survival was 6.1 months (95 % CI 5.1-7.2). At the last chemotherapy delivery, performance status was 0-1 in 37 % and 2 in 63 %. Fifty-nine percent of patients received one chemotherapy line, while 32, 8, and 1 % had second-, third-, and fourth line, respectively. The interval between last chemotherapy administration and death was <4 weeks in 24 %, ≥4-12 in 47 %, and >12 in 29 %. Median survival from last chemotherapy to death was 7.5 weeks (95 % CI 6.7-8.4). In a univariate analysis, ascites, elevated WBC, bilirubin, LDH, C-rp and Ca 19.9, and reduced albumin were found to predict shorter survival; however, none of them remained significant in a multivariate analysis. CONCLUSIONS A significant proportion of patients with advanced PAC received chemotherapy within the last month of life. The clinical and laboratory parameters recorded at last chemotherapy delivery did not predict shorter survival.
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Affiliation(s)
- M Frigeri
- Centre Pluridisciplinaire d'Oncologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Kang JH, Lee SI, Lim DH, Park KW, Oh SY, Kwon HC, Hwang IG, Lee SC, Nam E, Shin DB, Lee J, Park JO, Park YS, Lim HY, Kang WK, Park SH. Salvage Chemotherapy for Pretreated Gastric Cancer: A Randomized Phase III Trial Comparing Chemotherapy Plus Best Supportive Care With Best Supportive Care Alone. J Clin Oncol 2012; 30:1513-1518. [DOI: 10.1200/jco.2011.39.4585] [Citation(s) in RCA: 478] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose When designing this trial, there was no evidence that salvage chemotherapy (SLC) in advanced gastric cancer (AGC) resulted in substantial prolongation of survival when compared with best supportive care (BSC). However, SLC is often offered to pretreated patients with AGC for anecdotal reasons. Patients and Methods Patients with AGC with one or two prior chemotherapy regimens involving both fluoropyrimidines and platinum and with an Eastern Cooperative Oncology Group performance status (PS) 0 or 1 were randomly assigned in a ratio of 2:1 to SLC plus BSC or BSC alone. Choice of SLC—either docetaxel 60 mg/m2 every 3 weeks or irinotecan 150 mg/m2 every 2 weeks—was left to the discretion of investigators. Primary end point was overall survival (OS). Results Median OS was 5.3 months among 133 patients in the SLC arm and 3.8 months among 69 patients in the BSC arm (hazard ratio, 0.657; 95% CI, 0.485 to 0.891; one-sided P = .007). OS benefit for SLC was consistent in most of the prospectively defined subgroups, including age, PS, number of prior treatments, metastatic sites, hemoglobin levels, and response to prior chemotherapy. SLC was generally well tolerated, and adverse events were similar in the SLC and BSC arms. We found no median OS difference between docetaxel and irinotecan (5.2 v 6.5 months; P = .116). Conclusion To our knowledge, this is the largest phase III trial comparing SLC plus BSC with BSC alone in AGC. In pretreated patients, SLC is tolerated and significantly improves OS when added to BSC.
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Affiliation(s)
- Jung Hun Kang
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Soon Il Lee
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Do Hyoung Lim
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Keon-Woo Park
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Sung Yong Oh
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Hyuk-Chan Kwon
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - In Gyu Hwang
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Sang-Cheol Lee
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Eunmi Nam
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Dong Bok Shin
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Jeeyun Lee
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Joon Oh Park
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Young Suk Park
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Ho Yeong Lim
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Won Ki Kang
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
| | - Se Hoon Park
- Jung Hun Kang, Gyeongsang National University Hospital, Jinju; Soon Il Lee, Do Hyoung Lim, and Keon-Woo Park, Dankook University Hospital, Cheonan; Sung Yong Oh and Hyuk-Chan Kwon, Dong-A University Hospital, Busan; In Gyu Hwang, Chung-Ang University College of Medicine; Sang-Cheol Lee, Soonchunhyang University Hospital; Eunmi Nam, Ewha Womans University School of Medicine; Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Won Ki Kang, and Se Hoon Park, Sungkyunkwan University Samsung Medical
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Currow DC, Tieman JJ, Greene A, Zafar SY, Wheeler JL, Abernethy AP. Refining a checklist for reporting patient populations and service characteristics in hospice and palliative care research. J Pain Symptom Manage 2012; 43:902-10. [PMID: 22445274 DOI: 10.1016/j.jpainsymman.2011.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 05/12/2011] [Accepted: 05/12/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT In specialist hospice and palliative care services, variations occur in diagnoses and prognoses of subpopulations referred, service configuration, and the health systems delivering care. These three levels of variation limit the ability to generalize study findings. OBJECTIVES This article reports on coding one year of palliative care research using a previously developed checklist. The aims were to 1) quantify current reporting of factors related to generalizability in specialist palliative care research; 2) review and potentially refine the checklist in light of the first aim; 3) demonstrate the feasibility of collecting these data; and 4) set out simple processes to aid researchers in reporting, and clinicians in applying, new research evidence in hospice and palliative care. METHODS A previously published checklist (five domains, 14 core subdomains, and 24 noncore subdomains) was used to code all research articles (n=189) published in 2007 in the three leading palliative care research journals. RESULTS The most frequently reported subdomains were patient age, gender, and diagnosis; model of service delivery; and patient performance status. Data in subdomains, including time from referral to death, socioeconomic indices, and ethnicity, were rarely reported; none reported whole-of-service or whole-of-population data. In total, 2646 (189×14) core subdomains could have been reported. Data were provided in 28% (746/2646). CONCLUSION Checklists such as the Consolidated Standards of Reporting Trials evaluate study design, focusing mainly on internal validity. The proposed checklist deals with specific content of hospice and palliative care, focusing on external validity.
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Affiliation(s)
- David C Currow
- Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
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Zafar SY, Currow DC, Cherny N, Strasser F, Fowler R, Abernethy AP. Consensus-based standards for best supportive care in clinical trials in advanced cancer. Lancet Oncol 2012; 13:e77-82. [PMID: 22300862 DOI: 10.1016/s1470-2045(11)70215-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Best supportive care is poorly defined in clinical trials, and a standard framework for delivery of such care is needed, using best available evidence and allowing replication of studies. We convened a panel of 36 experts to develop consensus statements via the Delphi method. The first round included open-ended questions; subsequent rounds sought to develop consensus-based standards. Consensus was assessed by use of a 5-point Likert agreement scale; more than 70% of panellists had to give a score of 5 to meet a-priori levels of consensus. The panel identified four key domains of best supportive care in clinical trials: multidisciplinary care; supportive care documentation; symptom assessment; and symptom management. Consensus was reached on 11 statements within these four domains. For example, 24 (96%) panellists recommended that the intervals between symptom assessments should be identical for control and experimental groups. Availability of resources was cited as a challenge to implementation of best supportive care standards.
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Affiliation(s)
- S Yousuf Zafar
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Hui D, Mori M, Parsons HA, Kim SH, Li Z, Damani S, Bruera E. The lack of standard definitions in the supportive and palliative oncology literature. J Pain Symptom Manage 2012; 43:582-92. [PMID: 22104619 PMCID: PMC3818788 DOI: 10.1016/j.jpainsymman.2011.04.016] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 04/20/2011] [Accepted: 04/21/2011] [Indexed: 01/10/2023]
Abstract
CONTEXT Multiple organizations have raised concerns about the lack of standard definitions for terminology in the supportive and palliative oncology literature. OBJECTIVES We aimed to determine 1) the frequency of 10 commonly used terms in the supportive and palliative oncology literature, 2) the proportion of articles that provided definitions for each term, and 3) how each term was defined. METHODS We systematically searched MEDLINE, PubMed, PsycINFO, the Cochrane Library, Embase, ISI Web of Science, and Cumulative Index to Nursing and Allied Health Literature for original studies, review articles, and systematic reviews related to palliative care and cancer in the first six months of 2004 and 2009. We counted the number of occurrences for "palliative care," "supportive care," "best supportive care," "hospice care," "terminal care," "end-of-life," "terminally ill," "goals of care," "actively dying," and "transition of care" in each article, reviewed them for the presence of definitions, and documented the journal characteristics. RESULTS Among the 1213 articles found, 678 (56%) were from 2009. "Palliative care" and "end-of-life" were the most frequently used terms. "Palliative care," "end-of-life," and "terminally ill" appeared more frequently in palliative care journals, whereas "supportive care" and "best supportive care" were used more often in oncology journals (P<0.001). Among 35 of 601 (6%) articles with a definition for "palliative care," there were 16 different variations (21 of 35 articles used the World Health Organization definition). "Hospice care" had 13 definitions among 13 of 151 (9%) articles. "Supportive care" and other terms were rarely defined (less than 5% of articles that used the term). CONCLUSION Our findings highlight the lack of definitional clarity for many important terms in the supportive and palliative oncology literature. Standard definitions are needed to improve administrative, clinical, and research operations.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Matter-Walstra K, Joerger M, Kühnel U, Szucs T, Pestalozzi B, Schwenkglenks M. Cost-effectiveness of maintenance pemetrexed in patients with advanced nonsquamous-cell lung cancer from the perspective of the Swiss health care system. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:65-71. [PMID: 22264973 DOI: 10.1016/j.jval.2011.08.1737] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/18/2011] [Accepted: 08/18/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES A recent randomized study showed switch maintenance with pemetrexed after nonpemetrexed-containing first-line chemotherapy in patients with advanced nonsmall-cell lung cancer to prolong overall survival by 2.8 months. We examined the cost-effectiveness of pemetrexed in this indication, from the perspective of the Swiss health care system, and assessed the influence of the costs of best supportive care (BSC) on overall cost-effectiveness. METHODS A Markov model was constructed based on the pemetrexed maintenance study, and the incremental cost-effectiveness ratio (ICER) of adding pemetrexed until disease progression was calculated as cost per quality-adjusted life-year gained. Uncertainties concerning the costs of BSC on the ICER were addressed. RESULTS The base case ICER for maintenance therapy with pemetrexed plus BSC compared to BSC alone was €106,202 per quality-adjusted life-year gained. Varying the costs for BSC had a marked effect. Assuming a reduction of the costs for BSC by 25% in the pemetrexed arm resulted in an ICER of €47,531 per quality-adjusted life-year, which is below predefined criteria for cost effectiveness in Switzerland. CONCLUSIONS Switch maintenance with pemetrexed in patients with advanced nonsquamous-cell lung cancer after standard first-line chemotherapy is not cost-effective. Uncertainties on the resource use and costs for BSC have a large influence on the cost-effectiveness calculation and should be reported in more detail.
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Abstract
As a growing medical field, palliative and supportive care should incorporate evidence-based medical practice. The gold standard research method continues to be the randomized clinical trial. This has been pursued with regard to cancer trials focused on cure. It has specific operational and methodological challenges in advanced disease. There are numerous reasons why effective research in palliative and supportive care is difficult. A consensus on the best research strategies and design is lacking. We will discuss the principles of palliative and supportive care research, examine the inherent challenges particularly in randomized controlled trials, and offer some suggestions to overcome them.
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Affiliation(s)
- Aynur Aktas
- Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, The Harry R Horvitz Center for Palliative Medicine a World Health Organization Demonstration Project in Palliative Medicine and an ESMO Designated Center of Integrated Oncology and Palliative Care, Cleveland, OH 44195, USA
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Adolph MD. Inpatient palliative care consultation: enhancing quality of care for surgical patients by collaboration. Surg Clin North Am 2011; 91:317-24, viii. [PMID: 21419254 DOI: 10.1016/j.suc.2010.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hospital-based surgeons will likely encounter palliative care service colleagues more frequently, given the growth of approved fellowships and hospital palliative care programs. Surgeons may consult with palliative care colleagues to help patients and families manage pain and other symptoms, cope with the distress of acute and chronic illness, manage complex decisions at end-of-life, and negotiate through a critical illness (or combinations thereof). Inpatient palliative care consultation has been shown to improve quality of care, including quality of life and satisfaction of patients, families, and referring clinicians.
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Affiliation(s)
- Michael D Adolph
- Division of Surgical Oncology, Pain & Palliative Medicine Service, James Cancer Hospital, Ohio State University College of Medicine, Columbus, OH 43210, USA.
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Affiliation(s)
- Janet L. Abrahm
- Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02115;
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Arkenau HT, Nordman I, Dobbins T, Ward R. Reporting time-to-event endpoints and response rates in 4 decades of randomized controlled trials in advanced colorectal cancer. Cancer 2010; 117:832-40. [DOI: 10.1002/cncr.25636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 07/15/2010] [Accepted: 08/03/2010] [Indexed: 12/20/2022]
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Zafar SY, Currow DC, Daugherty CK, Abernethy AP. Standards for Palliative Care Delivery in Oncology Settings. Cancer J 2010; 16:436-43. [DOI: 10.1097/ppo.0b13e3181f289f7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Management of dyspnea in advanced lung cancer: recent data and emerging concepts. Curr Opin Support Palliat Care 2010; 4:85-91. [DOI: 10.1097/spc.0b013e328339920d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dancey JE. From Quality of Publication to Quality of Care: Translating Trials to Practice. J Natl Cancer Inst 2010; 102:670-1. [DOI: 10.1093/jnci/djq142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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