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Hart NH, Nekhlyudov L, Smith TJ, Yee J, Fitch MI, Crawford GB, Koczwara B, Ashbury FD, Lustberg MB, Mollica M, Smith AL, Jefford M, Chino F, Zon R, Agar MR, Chan RJ. Survivorship care for people affected by advanced or metastatic cancer: MASCC-ASCO standards and practice recommendations. Support Care Cancer 2024; 32:313. [PMID: 38679639 PMCID: PMC11056340 DOI: 10.1007/s00520-024-08465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE People with advanced or metastatic cancer and their caregivers may have different care goals and face unique challenges compared to those with early-stage disease or those nearing the end-of-life. These MASCC-ASCO standards and practice recommendations seek to establish consistent provision of quality survivorship care for people affected by advanced or metastatic cancer. METHODS An expert panel comprising MASCC and ASCO members was formed. Standards and recommendations relevant to the provision of quality survivorship care for people affected by advanced or metastatic cancer were developed through conducting: (1) a systematic review of unmet supportive care needs; (2) a scoping review of cancer survivorship, supportive care, and palliative care frameworks and guidelines; and (3) an international modified Delphi consensus process. RESULTS A systematic review involving 81 studies and a scoping review of 17 guidelines and frameworks informed the initial standards and recommendations. Subsequently, 77 experts (including 8 people with lived experience) across 33 countries (33% were low-to-middle resource countries) participated in the Delphi study and achieved ≥ 94.8% agreement for seven standards (1. Person-Centred Care; 2. Coordinated and Integrated Care; 3. Evidence-Based and Comprehensive Care; 4. Evaluated and Communicated Care; 5. Accessible and Equitable Care; 6. Sustainable and Resourced Care; 7. Research and Data-Driven Care) and ≥ 84.2% agreement across 45 practice recommendations. CONCLUSION Standards of survivorship care for people affected by advanced or metastatic cancer are provided. These MASCC-ASCO standards will support optimization of health outcomes and care experiences by providing guidance to stakeholders in cancer care (healthcare professionals, leaders, and administrators; governments and health ministries; policymakers; advocacy agencies; cancer survivors and caregivers. Practice recommendations may be used to facilitate future research, practice, policy, and advocacy efforts.
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Affiliation(s)
- Nicolas H Hart
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia.
- Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University, Perth, WA, Australia.
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
- Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia.
| | - Larissa Nekhlyudov
- Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas J Smith
- Division of General Internal Medicine and Sidney Kimmel Comprehensive Cancer Center, John Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jasmine Yee
- Centre for Medical Psychology and Evidence-Based Decision-Making, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Margaret I Fitch
- School of Graduate Studies, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gregory B Crawford
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Cancer and Innovation Centre, Flinders Medical Centre, Adelaide, SA, Australia
| | - Fredrick D Ashbury
- VieCure, Clinical and Scientific Division, Greenwood Village, CO, USA
- Department of Oncology, University of Calgary, Calgary, ON, Canada
- Internal Medicine-Medical Oncology, College of Medicine, The Ohio State University, Columbus , OH, USA
| | - Maryam B Lustberg
- Department of Medicine, School of Medicine, Yale University, New Haven, CT, USA
- Medical Oncology Division, Yale Cancer Centre, New Haven, CT, USA
| | - Michelle Mollica
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Andrea L Smith
- The Daffodil Centre and University of Sydney: a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robin Zon
- Michiana Hematology-Oncology, Mishawaka, IN, USA
- Cincinnati Cancer Advisors, Norwood, OH, USA
| | - Meera R Agar
- IMPACCT Research Centre, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Sun M, Tian X, Peng Y, Wang Z, Lu Y, Xiao W. Effects of meaning therapy on spirituality, psychological health, and quality of life in patients with cancer: A systematic review and meta-analysis of randomized controlled trials. Asia Pac J Oncol Nurs 2024; 11:100388. [PMID: 38586470 PMCID: PMC10997828 DOI: 10.1016/j.apjon.2024.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/26/2024] [Indexed: 04/09/2024] Open
Abstract
Objective This study aimed to systematically review studies of meaning therapy on patients with cancer and to evaluate its effectiveness on spiritual outcomes, psychological outcomes, and quality of life (QOL). Methods A comprehensive literature search were performed in five international databases (PubMed, Embase, Web of Science, The Cochrane Library, and CINAHL) and four Chinese databases (CNKI, Wanfang Data, VIP, and CBM) from the inception to August 2023. The methodological quality of each included studies was evaluated by using the revised Cochrane risk-of-bias tool for randomized trials. The random-effects model or fixed-effects model was utilized for effect size analysis, and the standardized mean difference (SMD) or mean difference (MD) along with its corresponding 95% confidence interval (CI) was computed. Meta-analysis was conducted by using the RevMan software 5.4.1. Results Eight randomized controlled trials with 1251 participants were included in this review. Meta-analyses revealed that meaning therapy can significantly improve the spiritual outcomes including meaning in life (SMD = -0.48; 95% CI = -0.89 to -0.07; P = 0.02), hopelessness (SMD = -0.30; 95% CI = -0.51 to -0.09; P = 0.005), self-esteem (MD = -2.74; 95% CI = -4.17 to -1.32; P = 0.0002) and spiritual well-being (MD = -3.32; 95% CI = -5.63 to -1.01; P = 0.005), psychological outcomes including anxiety (MD = -0.66; 95% CI = -1.30 to -0.01; P = 0.05), depression (SMD = -0.37; 95% CI = -0.55 to -0.20; P < 0.0001), psychological distress (SMD = -0.35; 95% CI = -0.70 to -0.01; P = 0.04) and desire for hastened death (MD = -0.76; 95% CI = -1.47 to -0.05; P = 0.04), and QOL (SMD = -0.29; 95% CI = -0.50 to -0.09; P = 0.006) in patients with cancer. Conclusions Meaning therapy has positive effects on improving spirituality, psychological health, and QOL of patients with cancer. More high-quality randomized controlled trials with larger sample sizes are warranted to confirm the results of our review and to clarify the long-term effects of meaning therapy in the future. Systematic review registration PROSPERO (No. CRD42021278286).
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Affiliation(s)
| | | | - Yunyi Peng
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zheng Wang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yongmei Lu
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wenli Xiao
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Wang M, Xu Y, Shi J, Zhuang C, Zhuang Y, Li J, Cashin PH. The effect of cognitive behavioral therapy on chemotherapy-induced side effects and immune function in colorectal cancer patients undergoing chemotherapy: study protocol for a randomized controlled trial. J Gastrointest Oncol 2023; 14:1869-1877. [PMID: 37720456 PMCID: PMC10502537 DOI: 10.21037/jgo-23-625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Background Colorectal cancer (CRC) was one of the most widely diagnosed cancers in the United States in 2021. CRC patients may experience significant psychological stress and are susceptible to depression and anxiety. Previous studies have shown that cognitive behavioral therapy (CBT) can reduce fatigue and improve quality of life among breast cancer patients. However, as a non-pharmaceutical treatment, it remains unclear whether CBT improves chemotherapy-induced side effects and immune function in CRC patients. In this study, we will conduct a randomized controlled trial (RCT) among CRC patients undergoing chemotherapy to determine whether CBT can reduce the side effects of chemotherapy and improve the immune function of CRC patients. Methods The study will be a single-center RCT. CRC patients undergoing chemotherapy will receive either eight sessions of group-based CBT (every 2-3 weeks) or usual care (usual oncology care). Each participant will undergo assessments at baseline (T0), immediately post-intervention (T1), 3 months post-intervention (T2), and 6 months post-intervention (T3). The primary outcome will include chemotherapy-induced side effects in CRC patients. The secondary outcome will be immune function (measured by levels of inflammatory cytokines). Other outcomes will include the levels of tumor markers, assessments of psychological status (perception of stress, depression and anxiety, self-efficacy, sleep quality, quality of life, social support condition, and cognitive function), and necessary laboratory examinations (biochemical index and blood cell counts) among CRC patients undergoing chemotherapy. Discussion Our study will provide clinical evidence regarding whether CBT should be generalized in clinical treatment and the extent to which CBT reduces chemotherapy-induced side effects for CRC patients. Trial Registration ClinicalTrials.gov registration number NCT04741308.
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Affiliation(s)
- Meijuan Wang
- Department of Psychiatry, Shanghai 10th People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuanhong Xu
- Department of Psychiatry, Shanghai 10th People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jingqing Shi
- Department of Psychiatry, Shanghai 10th People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chengle Zhuang
- Department of Gastrointestinal Surgery, Shanghai 10th People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Colorectal Cancer Center, Shanghai 10th People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Zhuang
- Department of Nursing, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiyu Li
- Geriatric Cancer Center, Huadong Hospital, Fudan University, Shanghai, China
| | - Peter H. Cashin
- Department of Surgical Sciences, Bengt Ihre Fellow, Uppsala University, Uppsala, Sweden
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Integrating Palliative Care into Oncology Care Worldwide: The Right Care in the Right Place at the Right Time. Curr Treat Options Oncol 2023; 24:353-372. [PMID: 36913164 PMCID: PMC10009840 DOI: 10.1007/s11864-023-01060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 03/14/2023]
Abstract
OPINION STATEMENT While the benefits of early palliative care are indisputable, most of the current evidence has emerged from resource-rich settings in urban areas of high-income countries, with an emphasis on solid tumors in outpatient settings; this model of palliative care integration is not currently scalable internationally. A shortage of specialist palliative care clinicians means that in order to meet the needs of all patients who require support at any point along their advanced cancer trajectory, palliative care must also be provided by family physicians and oncology clinicians who require training and mentorship. Models of care that facilitate the timely provision of seamless palliative care across all settings (inpatient, outpatient, and home-based care), with clear communication between clinicians, are crucial to the provision of patient-centred palliative care. The unique needs of patients with hematological malignancies must be further explored and existing models of palliative care provision modified to meet these needs. Finally, care must be provided in an equitable and culturally sensitive manner, recognizing the challenges associated with the delivery of high-quality palliative care to both patients in high-income countries who live in rural areas, as well as to those in low- and middle-income countries. A one-size-fits-all model will not suffice, and there is an urgent need to develop innovative context-specific models of palliative care integration worldwide, in order to provide the right care, in the right place, and at the right time.
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Buonaccorso L, Alquati S, Ghirotto L, Annini A, Tanzi S. Dignity Therapy Training for the Healthcare Professionals: Lessons Learned From an Italian Experience. Front Psychol 2022; 13:859775. [PMID: 35959033 PMCID: PMC9358283 DOI: 10.3389/fpsyg.2022.859775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Dignity therapy (DT) is brief psychotherapy targeting psychological and existential suffering among patients with a life-limiting illness. Studies have been conducted on the use of DT by healthcare professionals. In Italy, the current legislation defines that any form of psychotherapy may be performed exclusively by psychotherapists. Consequently, this intervention is unlikely to be used by other healthcare professionals. Herein, we will describe a training on DT not as a psychotherapy intervention but as a narrative intervention for non-psychotherapists health care professionals. Finally, we will explore the potential enablers/barriers as experienced by palliative care physicians and nurses. Methods The study was conducted in the Psycho-Oncology Unit within the Cancer Research Hospital of Reggio Emilia (Italy). It consisted of an exploratory qualitative case study. Data were collected employing observations and interview data and thematically analyzed. Results The training was attended by six physicians and ten nurses and took place during two-afternoon sessions for 10 h. Two participants put their training into practice and administered DT under the supervision of a psychotherapist. Data analysis highlighted five overarching themes relating to the training experience and direct use of DT, namely, (i) time required, (ii) psychological skills, (iii) patient’s disease awareness, (iv) patient’s life history, and (v) distinguishing DT from Advance Care Planning. Conclusion Palliative care professionals found DT to be a valuable non-pharmacological hospital-based intervention to address the person beyond the patient and his clinical conditions. In our experience, considering that in Italy, psychotherapy is an intervention that psychotherapists can only perform, it can help organize different training on DT for psychotherapists and other healthcare professionals.
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Affiliation(s)
- Loredana Buonaccorso
- Scientific Directorate, Azienda USL—IRCSS di Reggio Emilia, Reggio Emilia, Italy
- *Correspondence: Loredana Buonaccorso,
| | - Sara Alquati
- Palliative Care Unit, Azienda USL—IRCSS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Scientific Directorate, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alice Annini
- Scientific Directorate, Azienda USL—IRCSS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL—IRCSS di Reggio Emilia, Reggio Emilia, Italy
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DURMAZ N, ÖZTELCAN GÜNDÜZ B, ATAS E. Evaluation of the need for hospital-based pediatric palliative care in a single center. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1039048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction/Aim: Cancer is one of the leading causes of death for children . Evidence suggests that these children experience substantial suffering from physical and emotional symptoms. Over the past two decades, paediatric palliative care has emerged as an approach that aims to ease suffering for children and their families coping with any life-threatening illness. Our aim is to encourage the expansion of palliative care centers for children with cancer and integration of these into healthcare services to assist clinicians and policy makers in developing services that address these needs.
Material and Method: Our study is a single-center retrospective cohort study. The records of 39 patients who were followed up in the pediatric oncology clinic between 2010-2021 and died were reviewed retrospectively.
Results: The age of diagnosis of patients was the most in the 6-12 range (n=16; 41%) and the least in the adolescent (n=11; 28.2%) age range. The cause of death was related to a disease in 79.5%. Treatment-related deaths were seen in eight patients, four of which were chemotherapy toxicity, two were engraftment failure in autologous hematopoietic stem cell transplantation, and two were post-transplant GVHD. 76.9% of the patients died in the intensive care unit.
Conclusion: In our study, patients with cancer and those who lost their lives were evaluated retrospectively in terms of symptom load, invasive procedures, and psychosocial needs and the need for end-of-life palliative care. Many studies have confirmed that the timely integration of palliative care into routine oncological care has many advantages, such as improvements in physical and psychological symptoms, quality of life and prognosis, as well as reducing costs. In Turkey, palliative treatment is tried to be provided to late stage pediatric cancer patients by pediatric intensive care units and pediatric oncologists. This both increases the workload of physicians and causes intensive care bed occupation. The development and expansion of palliative care on late stage pediatric cancer patients will contribute significantly to the quality of life of both children and their families.
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Affiliation(s)
- Nihal DURMAZ
- UNIVERSITY OF HEALTH SCIENCES, GÜLHANE SCHOOL OF MEDICINE, GÜLHANE MEDICINE PR. (ANKARA)
| | - Bahar ÖZTELCAN GÜNDÜZ
- UNIVERSITY OF HEALTH SCIENCES, GÜLHANE SCHOOL OF MEDICINE, GÜLHANE MEDICINE PR. (ANKARA)
| | - Erman ATAS
- UNIVERSITY OF HEALTH SCIENCES, GÜLHANE SCHOOL OF MEDICINE, GÜLHANE MEDICINE PR. (ANKARA)
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Jane Bates M, Gordon MRP, Gordon SB, Tomeny EM, Muula AS, Davies H, Morris C, Manthalu G, Namisango E, Masamba L, Henrion MYR, MacPherson P, Squire SB, Niessen LW. Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study. Lancet Glob Health 2021; 9:e1750-e1757. [PMID: 34756183 PMCID: PMC8600125 DOI: 10.1016/s2214-109x(21)00408-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/09/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inclusive universal health coverage requires access to quality health care without financial barriers. Receipt of palliative care after advanced cancer diagnosis might reduce household poverty, but evidence from low-income and middle-income settings is sparse. METHODS In this prospective study, the primary objective was to investigate total household costs of cancer-related health care after a diagnosis of advanced cancer, with and without the receipt of palliative care. Households comprising patients and their unpaid family caregiver were recruited into a cohort study at Queen Elizabeth Central Hospital in Malawi, between Jan 16 and July 31, 2019. Costs of cancer-related health-care use (including palliative care) and health-related quality-of-life were recorded over 6 months. Regression analysis explored associations between receipt of palliative care and total household costs on health care as a proportion of household income. Catastrophic costs, defined as 20% or more of total household income, sale of assets and loans taken out (dissaving), and their association with palliative care were computed. FINDINGS We recruited 150 households. At 6 months, data from 89 (59%) of 150 households were available, comprising 89 patients (median age 50 years, 79% female) and 64 caregivers (median age 40 years, 73% female). Patients in 55 (37%) of the 150 households died and six (4%) were lost to follow-up. 19 (21%) of 89 households received palliative care. Catastrophic costs were experienced by nine (47%) of 19 households who received palliative care versus 48 (69%) of 70 households who did not (relative risk 0·69, 95% CI 0·42 to 1·14, p=0·109). Palliative care was associated with substantially reduced dissaving (median US$11, IQR 0 to 30 vs $34, 14 to 75; p=0·005). The mean difference in total household costs on cancer-related health care with receipt of palliative care was -36% (95% CI -94 to 594; p=0·707). INTERPRETATION Vulnerable households in low-income countries are subject to catastrophic health-related costs following a diagnosis of advanced cancer. Palliative care might result in reduced dissaving in these households. Further consideration of the economic benefits of palliative care is justified. FUNDING Wellcome Trust; National Institute for Health Research; and EMMS International.
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Affiliation(s)
- Maya Jane Bates
- Department of Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Miriam R P Gordon
- Department of Economics, Global Development Institute, University of Manchester, Manchester, UK
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi
| | - Ewan M Tomeny
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Adamson S Muula
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Helena Davies
- Worldwide Hospice Palliative Care Alliance, London, UK
| | - Claire Morris
- Worldwide Hospice Palliative Care Alliance, London, UK
| | - Gerald Manthalu
- Department of Planning, Ministry of Health, Lilongwe, Malawi
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Leo Masamba
- Department of Medicine, Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi
| | - Marc Y R Henrion
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi
| | - Peter MacPherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi; London School of Hygiene & Tropical Medicine, London, UK
| | - S Bertel Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louis W Niessen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Johns Hopkins School of Public Health, Baltimore, MD, USA
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LeBaron V, Adhikari A, Bennett R, Chapagain Acharya S, Dhakal M, Elmore CE, Fitzgibbon K, Gongal R, Kattel R, Koirala G, Maurer M, Munday D, Neupane B, Sagar Sharma K, Shilpakar R, Shrestha S, Thapa U, Zhang H, Dillingham R, Dutta Paudel B. A survey of cancer care institutions in Nepal to inform design of a pain management mobile application. BMC Palliat Care 2021; 20:171. [PMID: 34740339 PMCID: PMC8570036 DOI: 10.1186/s12904-021-00824-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND One way to improve the delivery of oncology palliative care in low and middle-income countries (LMICs) is to leverage mobile technology to support healthcare providers in implementing pain management guidelines (PMG). However, PMG are often developed in higher-resourced settings and may not be appropriate for the resource and cultural context of LMICs. OBJECTIVES This research represents a collaboration between the University of Virginia and the Nepalese Association of Palliative Care (NAPCare) to design a mobile health application ('app') to scale-up implementation of existing locally developed PMG. METHODS We conducted a cross-sectional survey of clinicians within Nepal to inform design of the app. Questions focused on knowledge, beliefs, and confidence in managing cancer pain; barriers to cancer pain management; awareness and use of the NAPCare PMG; barriers to smart phone use and desired features of a mobile app. FINDINGS Surveys were completed by 97 palliative care and/or oncology healthcare providers from four diverse cancer care institutions in Nepal. 49.5% (n = 48) had training in palliative care/cancer pain management and the majority (63.9%, n = 62) reported high confidence levels (scores of 8 or higher/10) in managing cancer pain. Highest ranked barriers to cancer pain management included those at the country/cultural level, such as nursing and medical school curricula lacking adequate content about palliative care and pain management, and patients who live in rural areas experiencing difficulty accessing healthcare services (overall mean = 6.36/10). Most nurses and physicians use an Android Smart Phone (82%, n = 74), had heard of the NAPCare PMG (96%, n = 88), and reported frequent use of apps to provide clinical care (mean = 6.38/10, n = 92). Key barriers to smart phone use differed by discipline, with nurses reporting greater concerns related to cost of data access (70%, n = 45) and being prohibited from using a mobile phone at work (61%; n = 39). CONCLUSIONS Smart phone apps can help implement PMG and support healthcare providers in managing cancer pain in Nepal and similar settings. However, such tools must be designed to be culturally and contextually congruent and address perceived barriers to pain management and app use.
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Affiliation(s)
- Virginia LeBaron
- University of Virginia School of Nursing, 225 Jeannette Lancaster Way, Charlottesville, VA 22908 USA
| | | | - Rachel Bennett
- University of Virginia School of Nursing, 225 Jeannette Lancaster Way, Charlottesville, VA 22908 USA
| | | | - Manita Dhakal
- B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal
| | - Catherine E. Elmore
- University of Virginia School of Nursing, 225 Jeannette Lancaster Way, Charlottesville, VA 22908 USA
| | - Kara Fitzgibbon
- University of Virginia Center for Survey Research, Charlottesville, VA USA
| | | | - Regina Kattel
- Nepal Cancer Hospital & Research Center, Kathmandu, Nepal
| | | | - Martha Maurer
- University of Wisconsin School of Pharmacy, Sonderegger Research Center, Madison, WI USA
| | - Daniel Munday
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bijay Neupane
- B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal
| | | | - Ramila Shilpakar
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Sudip Shrestha
- Nepal Cancer Hospital & Research Center, Kathmandu, Nepal
| | - Usha Thapa
- B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal
| | - Hexuan Zhang
- University of Virginia Center for Survey Research, Charlottesville, VA USA
| | - Rebecca Dillingham
- University of Virginia Center for Global Health Equity, Charlottesville, VA USA
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Mulazzani GE, Corti F, Della Valle S, Di Bartolomeo M. Nutritional Support Indications in Gastroesophageal Cancer Patients: From Perioperative to Palliative Systemic Therapy. A Comprehensive Review of the Last Decade. Nutrients 2021; 13:nu13082766. [PMID: 34444926 PMCID: PMC8400027 DOI: 10.3390/nu13082766] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer treatments are rapidly evolving, leading to significant survival benefit. Recent evidence provided by clinical trials strongly encouraged the use of perioperative chemotherapy as standard treatment for the localized disease, whereas in the advanced disease setting, molecular characterization has improved patients’ selection for tailored therapeutic approaches, including molecular targeted therapy and immunotherapy. The role of nutritional therapy is widely recognized, with oncologic treatment’s tolerance and response being better in well-nourished patients. In this review, literature data on strategies or nutritional interventions will be critically examined, with particular regard to different treatment phases (perioperative, metastatic, and palliative settings), with the aim to draw practical indications for an adequate nutritional support of gastric cancer patients and provide an insight on future directions in nutritional strategies. We extensively analyzed the last 10 years of literature, in order to provide evidence that may fit current clinical practice both in terms of nutritional interventions and oncological treatment. Overall, 137 works were selected: 34 Randomized Clinical Trials (RCTs), 12 meta-analysis, 9 reviews, and the most relevant prospective, retrospective and cross-sectional studies in this setting. Eleven ongoing trials have been selected from clinicaltrial.gov as representative of current research. One limitation of our work lies in the heterogeneity of the described studies, in terms of sample size, study procedures, and both nutritional and clinical outcomes. Indeed, to date, there are no specific evidence-based guidelines in this fields, therefore we proposed a clinical algorithm with the aim to indicate an appropriate nutritional strategy for gastric cancer patients.
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Affiliation(s)
- Giulia E.G. Mulazzani
- Clinical Nutrition Unit, Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (G.E.G.M.); (S.D.V.)
| | - Francesca Corti
- Gastrointestinal Medical Oncology, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy;
| | - Serena Della Valle
- Clinical Nutrition Unit, Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (G.E.G.M.); (S.D.V.)
| | - Maria Di Bartolomeo
- Gastrointestinal Medical Oncology, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy;
- Correspondence: ; Tel.: +39-02-2390-2882
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10
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Chiorean EG, Nandakumar G, Fadelu T, Temin S, Alarcon-Rozas AE, Bejarano S, Croitoru AE, Grover S, Lohar PV, Odhiambo A, Park SH, Garcia ER, Teh C, Rose A, Zaki B, Chamberlin MD. Treatment of Patients With Late-Stage Colorectal Cancer: ASCO Resource-Stratified Guideline. JCO Glob Oncol 2021; 6:414-438. [PMID: 32150483 PMCID: PMC7124947 DOI: 10.1200/jgo.19.00367] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To provide expert guidance to clinicians and policymakers in resource-constrained settings on the management of patients with late-stage colorectal cancer. METHODS ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines, conducted a modified ADAPTE process, and used a formal consensus process with additional experts for two rounds of formal ratings. RESULTS Existing sets of guidelines from four guideline developers were identified and reviewed; adapted recommendations from five guidelines form the evidence base and provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% on all recommendations. RECOMMENDATIONS Common elements of symptom management include addressing clinically acute situations. Diagnosis should involve the primary tumor and, in some cases, endoscopy, and staging should involve digital rectal exam and/or imaging, depending on resources available. Most patients receive treatment with chemotherapy, where chemotherapy is available. If, after a period of chemotherapy, patients become candidates for surgical resection with curative intent of both primary tumor and liver or lung metastatic lesions on the basis of evaluation in multidisciplinary tumor boards, the guidelines recommend patients undergo surgery in centers of expertise if possible. On-treatment surveillance includes a combination of taking medical history, performing physical examinations, blood work, and imaging; specifics, including frequency, depend on resource-based setting. Additional information is available at www.asco.org/resource-stratified-guidelines.
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Affiliation(s)
- E Gabriela Chiorean
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Govind Nandakumar
- Columbia Asia Hospitals, Bangalore, India.,Weill Cornell Medical College, New York, NY
| | | | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | - Suyapa Bejarano
- Excelmedica, Liga Contra el Cancer Honduras, San Pedro Sulal, Honduras
| | | | | | | | - Andrew Odhiambo
- University of Nairobi, College of Health Sciences, Nairobi, Kenya
| | | | | | - Catherine Teh
- Philippine Association of HPB Surgeons/Makati Medical Center, Makati City, Philippines
| | - Azmina Rose
- Independent Colorectal Patient Representative, London, United Kingdom
| | - Bassem Zaki
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
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11
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Bourlon MT, Anazodo A, Woodruff TK, Segelov E. Oncofertility as a Universal Right and a Global Oncology Priority. JCO Glob Oncol 2021; 6:314-316. [PMID: 32119579 PMCID: PMC7113082 DOI: 10.1200/go.19.00337] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Maria T Bourlon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Eva Segelov
- Monash Health and Monash University, Clayton, Victoria, Australia
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12
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Palliative Care and Oncology in Colombia: The Potential of Integrated Care Delivery. Healthcare (Basel) 2021; 9:healthcare9070789. [PMID: 34201639 PMCID: PMC8304350 DOI: 10.3390/healthcare9070789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 12/25/2022] Open
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13
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Gautam D, Adhikari S. Palliative care services for cancer patients in Nepal, a lower-middle-income country. Palliat Care Soc Pract 2021; 15:26323524211021105. [PMID: 34164623 PMCID: PMC8191070 DOI: 10.1177/26323524211021105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/07/2021] [Indexed: 12/24/2022] Open
Abstract
With the rise in cancer burden, need for palliative care services has increased simultaneously and majority of people requiring services are from low- and middle-income countries where palliative care is in primitive stage. Nepal is also facing similar challenges of dealing with cancer care and end-of-life care. From its initiation in the early 1990s, there has been gradual progress in the development of palliative care with joint effort of government as well as non-governmental organizations. Morphine, a major milestone for pain management, is being manufactured in the country for nearly a decade, yet morphine equivalence mg per capita is far below the global average. Currently, Nepal has been placed under ‘Category 3a’ with isolated care provision and there are a lot of challenges to overcome to improve the existing services. Majority of hospice and palliative care centres are located in the capital city and only a few in the periphery. Scarcity of treatment centres and expertise, limited finances, lack of awareness among patients and health care workers, and difficult terrain are major barriers for optimal care. Proper implementation of national guidelines, human resource development and integration of palliative care to primary healthcare level would be crucial steps for further improvement.
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Affiliation(s)
- Deepa Gautam
- Department of Radiation Oncology, B.P. Koirala Memorial Cancer Hospital, Bharatpur 44207, Nepal
| | - Sudhir Adhikari
- Department of Paediatrics, Chitwan Medical College, Bharatpur, Nepal
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14
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Stout NL, Santa Mina D, Lyons KD, Robb K, Silver JK. A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA Cancer J Clin 2021; 71:149-175. [PMID: 33107982 PMCID: PMC7988887 DOI: 10.3322/caac.21639] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve integration of rehabilitation into oncology care. This report was developed as a part of the World Health Organization (WHO) Rehabilitation 2030 initiative to identify rehabilitation-specific recommendations in guidelines for oncology care. A systematic review of guidelines was conducted. Only guidelines published in English, for adults with cancer, providing recommendations for rehabilitation referral and assessment or interventions between 2009 and 2019 were included. 13840 articles were identified. After duplicates and applied filters, 4897 articles were screened. 69 guidelines were identified with rehabilitation-specific recommendations. Thirty-seven of the 69 guidelines endorsed referral to rehabilitation services but provided no specific recommendations regarding assessment or interventions. Thirty-two of the 69 guidelines met the full inclusion criteria and were assessed using the AGREE II tool. Twenty-one of these guidelines achieved an AGREE II quality score of ≥ 45 and were fully extracted. Guidelines exclusive to pharmacologic interventions and complementary and alternative interventions were excluded. Findings identify guidelines that recommend rehabilitation services across many cancer types and for various consequences of cancer treatment signifying that rehabilitation is a recognized component of oncology care. However, these findings are at odds with clinical reports of low rehabilitation utilization rates suggesting that guideline recommendations may be overlooked. Considering that functional morbidity negatively affects a majority of cancer survivors, improving guideline concordant rehabilitative care could have substantial impact on function and quality of life among cancer survivors.
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Affiliation(s)
- Nicole L Stout
- Department of Hematology/Oncology Cancer Prevention and Control, West Virginia University Cancer Institute, Morgantown, West Virginia
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kathleen D Lyons
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Norris Cotton Cancer Center, Geisel School of Medicine, Hanover, New Hampshire
| | - Karen Robb
- North East London Cancer Alliance, London, United Kingdom
- Transforming Cancer Services Team for London, Healthy London Partnership, London, United Kingdom
| | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
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15
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Pilleron S, Soto‐Perez‐de‐Celis E, Vignat J, Ferlay J, Soerjomataram I, Bray F, Sarfati D. Estimated global cancer incidence in the oldest adults in 2018 and projections to 2050. Int J Cancer 2021; 148:601-608. [PMID: 32706917 PMCID: PMC7754149 DOI: 10.1002/ijc.33232] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/25/2022]
Abstract
Using GLOBOCAN estimates, we describe the estimated cancer incidence among adults aged 80 years or older at the regional and global level in 2018, reporting the number of new cancer cases, and the truncated age-standardised incidence rates (per 100 000) for all cancer sites combined for this age group. We also presented the five most frequent cancers diagnosed by region and globally among females and males aged 65 to 79 years old and 80 years or older. We, finally, estimated the number of new cancer cases in 2050, the proportion of cases aged 80 years or older, and the proportional increase between 2018 and 2050 by region, by applying population projections to the 2018 incidence rates. In 2018, an estimated 2.3 million new cancer cases (excluding nonmelanoma skin cancers) were aged 80 years or older worldwide (13% of all cancer cases), with large variation in the profiles at regional levels. Globally, breast, lung and colon were the most common cancer sites diagnosed in the oldest females, while prostate, lung and colon were most frequent in the oldest males. In 2050, an estimated 6.9 million new cancers will be diagnosed in adults aged 80 years or older worldwide (20.5% of all cancer cases). Due to the complexity of cancer management in the oldest patients, the expected increase will challenge healthcare systems worldwide, posing a tangible economic and social impact on families and society. It is time to consider the oldest population in cancer control policies.
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Affiliation(s)
- Sophie Pilleron
- Department of Public HealthUniversity of OtagoWellingtonNew Zealand
| | - Enrique Soto‐Perez‐de‐Celis
- Department of Geriatrics, Cancer Care in the Elderly ClinicInstituto Nacional de Ciencas Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Jerome Vignat
- Cancer surveillance sectionInternational Agency for Research on CancerLyonFrance
| | - Jacques Ferlay
- Cancer surveillance sectionInternational Agency for Research on CancerLyonFrance
| | | | - Freddie Bray
- Cancer surveillance sectionInternational Agency for Research on CancerLyonFrance
| | - Diana Sarfati
- Department of Public HealthUniversity of OtagoWellingtonNew Zealand
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16
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Grau S, Herling M, Mauch C, Galldiks N, Golla H, Schlamann M, Scheel AH, Celik E, Ruge M, Goldbrunner R. [Brain metastases-Interdisciplinary approach towards a personalized treatment]. Chirurg 2021; 92:200-209. [PMID: 33502584 DOI: 10.1007/s00104-020-01344-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/01/2022]
Abstract
The incidence, treatment and prognosis of patients with brain metastases have substantially changed during the last decades. While the survival time after diagnosis of cerebral metastases was on average a maximum of 3-6 months only 10 years ago, the survival time could be significantly improved due to novel surgical, radiotherapeutic and systemic treatment modalities. Only a few years ago, the occurrence of brain metastases led to a withdrawal from systemic oncological treatment and the exclusion of drug therapy studies and to a purely palliatively oriented treatment in the sense of whole brain radiation therapy (WBRT) with or without surgery. The increasing availability of targeted and immunomodulatory drugs as well as adapted radio-oncological procedures enable increasingly more personalized treatment approaches. The aim of this review article is to demonstrate the progress and complexity of the treatment of brain metastases in the context of modern comprehensive interdisciplinary concepts.
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Affiliation(s)
- S Grau
- Klinik für Allgemeine Neurochirurgie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Kerpener Str. 62, 50937, Köln, Deutschland. .,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.
| | - M Herling
- Klinik I für Innere Medizin, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - C Mauch
- Klinik für Dermatologie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - N Galldiks
- Klinik für Neurologie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - H Golla
- Zentrumfür Palliativmedizin, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - M Schlamann
- Institut für Radiologie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - A H Scheel
- Institut für Pathologie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - E Celik
- Klinik für Radioonkologie, Cyberknife und Strahlentherapie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - M Ruge
- Klinik für Stereotaxie und funktionelle Neurochirurgie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - R Goldbrunner
- Klinik für Allgemeine Neurochirurgie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Kerpener Str. 62, 50937, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
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17
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Sleeman KE, Gomes B, de Brito M, Shamieh O, Harding R. The burden of serious health-related suffering among cancer decedents: Global projections study to 2060. Palliat Med 2021; 35:231-235. [PMID: 32945226 PMCID: PMC7797611 DOI: 10.1177/0269216320957561] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Palliative care improves outcomes for people with cancer, but in many countries access remains poor. Understanding future needs is essential for effective health system planning in response to global policy. AIM To project the burden of serious health-related suffering associated with death from cancer to 2060 by age, gender, cancer type and World Bank income region. DESIGN Population-based projections study. Global projections of palliative care need were derived by combining World Health Organization cancer mortality projections (2016-2060) with estimates of serious health-related suffering among cancer decedents. RESULTS By 2060, serious health-related suffering will be experienced by 16.3 million people dying with cancer each year (compared to 7.8 million in 2016). Serious health-related suffering among cancer decedents will increase more quickly in low income countries (407% increase 2016-2060) compared to lower-middle, upper-middle and high income countries (168%, 96% and 39% increase 2016-2060, respectively). By 2060, 67% of people who die with cancer and experience serious health-related suffering will be over 70 years old, compared to 47% in 2016. In high and upper-middle income countries, lung cancer will be the single greatest contributor to the burden of serious health-related suffering among cancer decedents. In low and lower-middle income countries, breast cancer will be the single greatest contributor. CONCLUSIONS Many people with cancer will die with unnecessary suffering unless there is expansion of palliative care integration into cancer programmes. Failure to do this will be damaging for the individuals affected and the health systems within which they are treated.
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Affiliation(s)
- Katherine E Sleeman
- King's College London, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Barbara Gomes
- King's College London, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, London, UK.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maja de Brito
- King's College London, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, London, UK.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Omar Shamieh
- Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan
| | - Richard Harding
- King's College London, Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
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18
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Yennurajalingam S, Amos CE, Weru J, Addo Opare-Lokko EBVND, Arthur JA, Nguyen K, Soyannwo O, Chidebe RCW, Williams JL, Lu Z, Baker E, Arora S, Bruera E, Reddy S. Extension for Community Healthcare Outcomes-Palliative Care in Africa Program: Improving Access to Quality Palliative Care. J Glob Oncol 2020; 5:1-8. [PMID: 31335237 PMCID: PMC6776016 DOI: 10.1200/jgo.19.00128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE There is limited access to quality palliative care (PC) for patients with
advanced cancer in sub-Saharan Africa. Our aim was to describe the
development of the Project Extension for Community Healthcare
Outcomes-Palliative Care in Africa (ECHO-PACA) program and describe a
preliminary evaluation of attitudes and knowledge of participants regarding
the ability of the program to deliver quality PC. METHODS An interdisciplinary team at the MD Anderson Cancer Center, guided by experts
in PC in sub-Saharan Africa, adapted a standardized curriculum based on PC
needs in the region. Participants were then recruited, and monthly
telementoring sessions were held for 16 months. The monthly telementoring
sessions consisted of case presentations, discussions, and didactic
lectures. Program participants came from 14 clinics and teaching hospitals
in Ghana, Kenya, Nigeria, South Africa, and Zambia. Participants were
surveyed at the beginning, midpoint, and end of the 16-month program to
evaluate changes in attitudes and knowledge of PC. RESULTS The median number of participants per session was 30. Thirty-three (83%) of
40 initial participants completed the feedback survey. Health care
providers’ self-reported confidence in providing PC increased with
participation in the Project ECHO-PACA clinic. There was significant
improvement in the participants’ attitudes and knowledge, especially
in titrating opioids for pain control (P = .042),
appropriate use of non-opioid analgesics (P = .012),
and identifying and addressing communication issues related to end-of-life
care (P = .014). CONCLUSION Project ECHO-PACA was a successful approach for disseminating knowledge about
PC. The participants were adherent to ECHO PACA clinics and the completion
of feedback surveys. Future studies should evaluate the impact of Project
ECHO-PACA on changes in provider practice as well as patient outcomes.
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Affiliation(s)
| | - Charles E Amos
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - John Weru
- Aga Khan University Hospital, Nairobi, Kenya
| | | | | | - Kristy Nguyen
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Zhanni Lu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ellen Baker
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Eduardo Bruera
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Suresh Reddy
- University of Texas MD Anderson Cancer Center, Houston, TX
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19
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MacRae MC, Fazal O, O'Donovan J. Community health workers in palliative care provision in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Glob Health 2020; 5:e002368. [PMID: 32457030 PMCID: PMC7252978 DOI: 10.1136/bmjgh-2020-002368] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Community health workers (CHWs) are currently deployed in improving access to palliative care in a limited number of low-income or middle-income countries (LMICs). This review therefore aimed to document evidence from LMICs regarding (1) where and how CHWs are currently deployed in palliative care delivery, (2) the methods used to train and support CHWs in this domain, (3) the evidence surrounding the costs attached with deploying CHWs in palliative care provision and (4) challenges and barriers to this approach. METHODS We conducted a systematic scoping review of the literature, adhering to established guidelines. 11 major databases were searched for literature published between 1978 and 2019, as well as the grey literature. FINDINGS 13 original studies were included, all of which were conducted in sub-Saharan African countries (n=10) or in India (n=3). Ten described a role for CHWs in adult palliative care services, while three described paediatric services. Roles for CHWs include raising awareness and identifying individuals requiring palliative care in the community, therapeutic management for pain, holistic home-based care and visitation, and provision of psychological support and spiritual guidance. Reports on training context, duration and outcomes were variable. No studies conducted a formal cost analysis. Challenges to this approach include training design and sustainability; CHW recruitment, retention and support; and stigma surrounding palliative care. CONCLUSION Despite relatively limited existing evidence, CHWs have important roles in the delivery of palliative care services in LMIC settings. There is a need for a greater number of studies from different geographical contexts to further explore the effectiveness of this approach.
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Affiliation(s)
| | - Owais Fazal
- Division of Research, Rice University, Houston, Texas, USA
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20
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Gahr S, Lödel S, Berendt J, Thomas M, Ostgathe C. Implementation of Best Practice Recommendations for Palliative Care in German Comprehensive Cancer Centers. Oncologist 2020; 25:e259-e265. [PMID: 32043783 PMCID: PMC7011673 DOI: 10.1634/theoncologist.2019-0126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/09/2019] [Indexed: 01/03/2023] Open
Abstract
Background From 2014 to 2017, the Palliative Medicine Working Group developed and published best practice recommendations for the integration of palliative care in Comprehensive Cancer Centers (CCCs) in Germany. To evaluate the implementation level of these recommendations in the CCCs an online survey was performed. Based on the results of this study, strategic tandem partnerships between CCCs should be built in order to foster further local development. Materials and Methods Directors of all CCCs were contacted by e‐mail between December 2017 and February 2018. At the time of the survey, 15 CCCs were funded by the German Cancer Aid. The level of implementation of the recommendations in individual CCCs was established using a transtheoretical model. Results Between December 2017 and February 2018, all 15 contacted directors or their representatives of the CCCs took part in the survey. More than two thirds of the CCCs have a palliative service as well as a day clinic and palliative outpatient clinic. Regional networking and the provision of a palliative care unit were approved by all CCCs. Conclusion The publication of best practice recommendations was a milestone for the integration of palliative care in the CCCs. The majority of the German CCCs already fulfill essential organizational and structural requirements. There is a particular need for optimization in the provision of a basic qualification for general palliative care and emergency admission personnel. Implications for Practice In 2017, the Palliative Medicine Working Group in the network of the German Comprehensive Cancer Centers (CCCs) published the best practice recommendations it had developed for the integration of palliative medicine in CCCs in Germany. In order to evaluate the level of implementation of the recommendations, an online survey of the CCC directors was established. The majority of German CCCs fulfil elementary organizational and structural requirements. However, there is still room for improvement in the provision of a basic qualification for general palliative care and emergency admission personnel. This article evaluates the implementation of best practice recommendations for the integration of palliative care in Comprehensive Cancer Centers in Germany and calls for strategic partnerships between cancer centers to foster local development. NOTE: authors indicated financial conflicts but they are of a non‐commercial nature and thus do not need to be disclosed per journal policy.
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Affiliation(s)
- Susanne Gahr
- Department of Palliative Medicine, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg and Comprehensive Cancer Center Erlangen–Europäische Metropolregion Nürnberg (EMN), University Hospital ErlangenErlangenGermany
| | - Sarah Lödel
- Department of Palliative Medicine, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg and Comprehensive Cancer Center Erlangen–Europäische Metropolregion Nürnberg (EMN), University Hospital ErlangenErlangenGermany
| | - Julia Berendt
- Bavarian Health and Food Safety AuthorityNürnbergGermany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg (TLRC‐H), member of the German Center for Lung Research (DZL)HeidelbergGermany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg and Comprehensive Cancer Center Erlangen–Europäische Metropolregion Nürnberg (EMN), University Hospital ErlangenErlangenGermany
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21
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Bakitas M, Allen Watts K, Malone E, Dionne-Odom JN, McCammon S, Taylor R, Tucker R, Elk R. Forging a New Frontier: Providing Palliative Care to People With Cancer in Rural and Remote Areas. J Clin Oncol 2020; 38:963-973. [PMID: 32023156 DOI: 10.1200/jco.18.02432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Mounting evidence supports oncology organizations' recommendations of early palliative care as a cancer care best practice for patients with advanced cancer and/or high symptom burden. However, few trials on which these best practices are based have included rural and remote community-based oncology care. Therefore, little is known about whether early palliative care models are applicable in these low-resource areas. This literature synthesis identifies some of the challenges of integrating palliative care in rural and remote cancer care. Prominent themes include being mindful of rural culture; adapting traditional geographically based specialty care delivery models to under-resourced rural practices; and using novel palliative care education delivery methods to increase community-based health professional, layperson, and family palliative expertise to account for limited local specialty palliative care resources. Although there are many limitations, many rural and remote communities also have strengths in their capacity to provide high-quality care by capitalizing on close-knit, committed community practitioners, especially if there are receptive local palliative and hospice care champions. Hence, adapting palliative care models, using culturally appropriate novel delivery methods, and providing remote education and support to existing community providers are promising advances to aid rural people to manage serious illness and to die in place. Reformulating health policy and nurturing academic-community partnerships that support best practices are critical components of providing early palliative care for everyone everywhere.
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Affiliation(s)
| | | | - Emily Malone
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - Ronit Elk
- University of Alabama at Birmingham, Birmingham, AL
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22
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Kamal AH, Bausewein C, Casarett DJ, Currow DC, Dudgeon DJ, Higginson IJ. Standards, Guidelines, and Quality Measures for Successful Specialty Palliative Care Integration Into Oncology: Current Approaches and Future Directions. J Clin Oncol 2020; 38:987-994. [PMID: 32023165 DOI: 10.1200/jco.18.02440] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Although robust evidence demonstrates that specialty palliative care integrated into oncology care improves patient and health system outcomes, few clinicians are familiar with the standards, guidelines, and quality measures related to integration. These types of guidance outline principles of best practice and provide a framework for assessing the fidelity of their implementation. Significant advances in the understanding of effective methods and procedures to guide integration of specialty palliative care into oncology have led to a proliferation of guidance documents around the world, with several areas of commonality but also some key differences. Commonalities originate from a shared vision for integration; differences arise from diverse roles of palliative care specialists within cancer care globally. In this review we discuss three of the most cited standards/guidelines, as well as quality measures related to integrated palliative and oncology care. We also recommend changes to the quality measurement framework for palliative care and a new way to match palliative care services to patients with advanced cancer on the basis of care complexity and patient needs, irrespective of prognosis.
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Affiliation(s)
| | - Claudia Bausewein
- Ludwig-Maximilians University (LMU) Hospital, LMU Munich, Munich, Germany
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23
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Al-Sukhun S, Temin S, Chavez-MacGregor M, Denduluri N, Oliver TK, Pyle D, Shah MA, Gralow J. ASCO Resource-Stratified Guidelines: Methods and Opportunities. J Glob Oncol 2019; 4:1-8. [PMID: 30110223 PMCID: PMC6223500 DOI: 10.1200/jgo.18.00113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The objectives of this article are to describe the ASCO Resource-Stratified Guidelines and to provide background within the context of ASCO Guidelines and efforts to address the global cancer burden.
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Affiliation(s)
- Sana Al-Sukhun
- Sana Al-Sukhun, Jordanian Oncology Society, Amman, Jordan; Sarah Temin, Thomas K. Oliver, and Doug Pyle, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; and Julie Gralow, University of Washington, Seattle, WA
| | - Sarah Temin
- Sana Al-Sukhun, Jordanian Oncology Society, Amman, Jordan; Sarah Temin, Thomas K. Oliver, and Doug Pyle, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; and Julie Gralow, University of Washington, Seattle, WA
| | - Mariana Chavez-MacGregor
- Sana Al-Sukhun, Jordanian Oncology Society, Amman, Jordan; Sarah Temin, Thomas K. Oliver, and Doug Pyle, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; and Julie Gralow, University of Washington, Seattle, WA
| | - Neelima Denduluri
- Sana Al-Sukhun, Jordanian Oncology Society, Amman, Jordan; Sarah Temin, Thomas K. Oliver, and Doug Pyle, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; and Julie Gralow, University of Washington, Seattle, WA
| | - Thomas K Oliver
- Sana Al-Sukhun, Jordanian Oncology Society, Amman, Jordan; Sarah Temin, Thomas K. Oliver, and Doug Pyle, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; and Julie Gralow, University of Washington, Seattle, WA
| | - Doug Pyle
- Sana Al-Sukhun, Jordanian Oncology Society, Amman, Jordan; Sarah Temin, Thomas K. Oliver, and Doug Pyle, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; and Julie Gralow, University of Washington, Seattle, WA
| | - Manish A Shah
- Sana Al-Sukhun, Jordanian Oncology Society, Amman, Jordan; Sarah Temin, Thomas K. Oliver, and Doug Pyle, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; and Julie Gralow, University of Washington, Seattle, WA
| | - Julie Gralow
- Sana Al-Sukhun, Jordanian Oncology Society, Amman, Jordan; Sarah Temin, Thomas K. Oliver, and Doug Pyle, American Society of Clinical Oncology, Alexandria; Neelima Denduluri, Virginia Cancer Specialists, Arlington, VA; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Manish A. Shah, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; and Julie Gralow, University of Washington, Seattle, WA
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24
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Which symptoms and problems do advanced cancer patients admitted to specialized palliative care report in addition to those included in the EORTC QLQ-C15-PAL? A register-based national study. Support Care Cancer 2019; 28:1725-1735. [DOI: 10.1007/s00520-019-04976-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/28/2019] [Indexed: 11/12/2022]
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25
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Khandelwal N, Long AC, Lee RY, McDermott CL, Engelberg RA, Curtis JR. Pragmatic methods to avoid intensive care unit admission when it does not align with patient and family goals. THE LANCET RESPIRATORY MEDICINE 2019; 7:613-625. [PMID: 31122895 DOI: 10.1016/s2213-2600(19)30170-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 12/20/2022]
Abstract
For patients with chronic, life-limiting illnesses, admission to the intensive care unit (ICU) near the end of life might not improve patient outcomes or be consistent with patient and family values, goals, and preferences. In this context, advance care planning and palliative care interventions designed to clarify patients' values, goals, and preferences have the potential to reduce provision of high-intensity interventions that are unwanted or non-beneficial. In this Series paper, we have assessed interventions that are effective at helping patients with chronic, life-limiting illnesses to avoid an unwanted ICU admission. The evidence found was largely from observational studies, with considerable heterogeneity in populations, methods, and types of interventions. Results from randomised trials of interventions to improve communication about goals of care are scarce, of variable quality, and mixed. Although observational studies show that advance care planning and palliative care interventions are associated with a reduced number of ICU admissions at the end of life, causality has not been well established. Using the available evidence we suggest recommendations to help to avoid ICU admission when it does not align with patient and family values, goals, and preferences and conclude with future directions for research.
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Affiliation(s)
- Nita Khandelwal
- Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA; Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, Seattle, WA, USA.
| | - Ann C Long
- Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, Seattle, WA, USA; Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - Robert Y Lee
- Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, Seattle, WA, USA; Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - Cara L McDermott
- Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, Seattle, WA, USA; Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, Seattle, WA, USA; Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Harborview Medical Center, Seattle, WA, USA; Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
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26
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Elmore SNC, Grover S, Bourque JM, Chopra S, Nyakabau AM, Ntizimira C, Krakauer EL, Balboni TA, Gospodarowicz MK, Rodin D. Global palliative radiotherapy: a framework to improve access in resource-constrained settings. ANNALS OF PALLIATIVE MEDICINE 2019; 8:274-284. [PMID: 30823841 DOI: 10.21037/apm.2019.02.02] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/13/2019] [Indexed: 12/18/2022]
Abstract
Radiotherapy is an essential component of cancer therapy. Lack of access to radiotherapy in less-developed countries prevents its use for both cure and symptom relief, resulting in a significant disparity in patient suffering. Several recent initiatives have highlighted the need for expanded access to both palliative medicine and radiotherapy globally. Yet, these efforts have remained largely independent, without attention to overlap and integration. This review provides an update on the progress toward global palliative radiotherapy access and proposes a strategic framework to address further scale-up. Synergies between radiotherapy, palliative medicine, and other global health initiatives will be essential in bringing palliative radiotherapy to patients around the globe.
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Affiliation(s)
- Shekinah N C Elmore
- Harvard Radiation Oncology Program, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA; Botswana-UPENN Partnership, University of Botswana, Gaborone, Botswana
| | - Jean-Marc Bourque
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ontario, Canada; Institute of Cancer Policy, Kings College London, Guy's Hospital, London, UK
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Anna Mary Nyakabau
- Ministry of Health and Child Welfare, Parirenyatwa Group of Hospitals, Harare, Zimbabwe; CancerServe Trust, Harare, Zimbabwe
| | - Christian Ntizimira
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric L Krakauer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Global Palliative Care Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tracy A Balboni
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA; 13Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Mary K Gospodarowicz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario,Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario,Canada; Department of Radiation Oncology, University of Toronto, Ontario, Canada
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27
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Puchalski CM, Sbrana A, Ferrell B, Jafari N, King S, Balboni T, Miccinesi G, Vandenhoeck A, Silbermann M, Balducci L, Yong J, Antonuzzo A, Falcone A, Ripamonti CI. Interprofessional spiritual care in oncology: a literature review. ESMO Open 2019; 4:e000465. [PMID: 30962955 PMCID: PMC6435249 DOI: 10.1136/esmoopen-2018-000465] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 01/08/2023] Open
Abstract
Spiritual care is recognised as an essential element of the care of patients with serious illness such as cancer. Spiritual distress can result in poorer health outcomes including quality of life. The American Society of Clinical Oncology and other organisations recommend addressing spiritual needs in the clinical setting. This paper reviews the literature findings and proposes recommendations for interprofessional spiritual care.
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Affiliation(s)
- Christina M Puchalski
- George Washington Institute for Spirituality and Health, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Andrea Sbrana
- Department of Translational Research, Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Betty Ferrell
- Division of Nursing Research and Education City of Hope, Duarte, California, USA
| | - Najmeh Jafari
- George Washington Institute for Spirituality and Health, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Stephen King
- Spiritual Health, Child Life, and Clinical Patient Navigators, Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Tracy Balboni
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Initiative on Health, Religion, and Spirituality–Harvard University, Boston, Massachusetts, USA
| | - Guido Miccinesi
- Clinical Epidemiology Unit, Cancer Network, Prevention and Research Institute-ISPRO, Florence, Italy
| | - Anna Vandenhoeck
- European Research Institute for Chaplains in Healthcare, Theology and Religious Studies KU Leuven, Leuven, Belgium
| | | | - Lodovico Balducci
- Moffitt Cancer Center, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Julianna Yong
- College of Nursing, WHO Collaborating Centre for Training in Hospice and Palliative Care, The Catholic University of Korea, Seoul, Korea
| | - Andrea Antonuzzo
- Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alfredo Falcone
- Department of Translational Research, Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Carla Ida Ripamonti
- Oncology-Supportive Care Unit, Department of Oncology-Haematology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
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28
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Lopes G, Stern MC, Temin S, Sharara AI, Cervantes A, Costas-Chavarri A, Engineer R, Hamashima C, Ho GF, Huitzil FD, Moghani MM, Nandakumar G, Shah MA, Teh C, Manjarrez SEV, Verjee A, Yantiss R, Correa MC. Early Detection for Colorectal Cancer: ASCO Resource-Stratified Guideline. J Glob Oncol 2019; 5:1-22. [PMID: 30802159 PMCID: PMC6426543 DOI: 10.1200/jgo.18.00213] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To provide resource-stratified, evidence-based recommendations on the early detection of colorectal cancer in four tiers to clinicians, patients, and caregivers. METHODS American Society of Clinical Oncology convened a multidisciplinary, multinational panel of medical oncology, surgical oncology, surgery, gastroenterology, health technology assessment, cancer epidemiology, pathology, radiology, radiation oncology, and patient advocacy experts. The Expert Panel reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus-based process with additional experts (Consensus Ratings Group) for two round(s) of formal ratings. RESULTS Existing sets of guidelines from eight guideline developers were identified and reviewed; adapted recommendations form the evidence base. These guidelines, along with cost-effectiveness analyses, provided evidence to inform the formal consensus process, which resulted in agreement of 75% or more. CONCLUSION In nonmaximal settings, for people who are asymptomatic, are ages 50 to 75 years, have no family history of colorectal cancer, are at average risk, and are in settings with high incidences of colorectal cancer, the following screening options are recommended: guaiac fecal occult blood test and fecal immunochemical testing (basic), flexible sigmoidoscopy (add option in limited), and colonoscopy (add option in enhanced). Optimal reflex testing strategy for persons with positive screens is as follows: endoscopy; if not available, barium enema (basic or limited). Management of polyps in enhanced is as follows: colonoscopy, polypectomy; if not suitable, then surgical resection. For workup and diagnosis of people with symptoms, physical exam with digital rectal examination, double contrast barium enema (only in basic and limited); colonoscopy; flexible sigmoidoscopy with biopsy (if contraindication to latter) or computed tomography colonography if contraindications to two endoscopies (enhanced only).
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Affiliation(s)
- Gilberto Lopes
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Mariana C. Stern
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | | | | | | | - Fidel David Huitzil
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Govind Nandakumar
- Columbia Asia Hospitals, Bangalore, India, and Weill Cornell Medical College, New York, NY
| | - Manish A. Shah
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY
| | | | | | - Azmina Verjee
- Homerton University Hospital Foundation Trust, Bowel Disease Research Foundation, London, United Kingdom
| | - Rhonda Yantiss
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Marcia Cruz Correa
- The University of Puerto Rico, San Juan, Puerto Rico, and MD Anderson Cancer Center, Houston, TX
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29
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Costas-Chavarri A, Nandakumar G, Temin S, Lopes G, Cervantes A, Cruz Correa M, Engineer R, Hamashima C, Ho GF, Huitzil FD, Malekzadeh Moghani M, Sharara AI, Stern MC, Teh C, Vázquez Manjarrez SE, Verjee A, Yantiss R, Shah MA. Treatment of Patients With Early-Stage Colorectal Cancer: ASCO Resource-Stratified Guideline. J Glob Oncol 2019; 5:1-19. [PMID: 30802158 PMCID: PMC6426503 DOI: 10.1200/jgo.18.00214] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To provide resource-stratified, evidence-based recommendations on the treatment and follow-up of patients with early-stage colorectal cancer. METHODS ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus process with additional experts for one round of formal ratings. RESULTS Existing sets of guidelines from 12 guideline developers were identified and reviewed; adapted recommendations from six guidelines form the evidence base and provide evidence to inform the formal consensus process, which resulted in agreement of 75% or more on all recommendations. RECOMMENDATIONS For nonmaximal settings, the recommended treatments for colon cancer stages nonobstructing, I-IIA: in basic and limited, open resection; in enhanced, adequately trained surgeons and laparoscopic or minimally invasive surgery, unless contraindicated. Treatments for IIB-IIC: in basic and limited, open en bloc resection following standard oncologic principles, if not possible, transfer to higher-level facility; in emergency, limit to life-saving procedures; in enhanced, laparoscopic en bloc resection, if not possible, then open. Treatments for obstructing, IIB-IIC: in basic, resection and/or diversion; in limited or enhanced, emergency surgical resection. Treatment for IIB-IIC with left-sided: in enhanced, may place colonic stent. Treatment for T4N0/T3N0 high-risk features or stage II high-risk obstructing: in enhanced, may offer adjuvant chemotherapy. Treatment for rectal cancer cT1N0 and cT2n0: in basic, limited, or enhanced, total mesorectal excision principles. Treatment for cT3n0: in basic and limited, total mesorectal excision, if not, diversion. Treatment for high-risk patients who did not receive neoadjuvant chemotherapy: in basic, limited, or enhanced, may offer adjuvant therapy. Treatment for resectable cT3N0 rectal cancer: in enhanced, base neoadjuvant chemotherapy on preoperative factors. For post-treatment surveillance, a combination of medical history, physical examination, carcinoembryonic antigen testing, imaging, and endoscopy is performed. Frequency depends on setting. Maximal setting recommendations are in the guideline. Additional information can be found at www.asco.org/resource-stratified-guidelines . NOTICE It is the view of the American Society of Clinical Oncology that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guidelines are intended to complement but not replace local guidelines.
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Affiliation(s)
| | - Govind Nandakumar
- Columbia Asia Hospitals, Bangalore, India
- Weill Cornell Medical College, New York, NY
| | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Marcia Cruz Correa
- The University of Puerto Rico, San Juan, PR
- The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | | | | | - Fidel David Huitzil
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Mariana C Stern
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | | | - Azmina Verjee
- Homerton University Hospital National Health Service Foundation Trust, London, United Kingdom
- Bowel Disease Research Foundation, London, United Kingdom
| | - Rhonda Yantiss
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Manish A Shah
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY
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