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Roberts HN, Solomon B, Harden S, Lingaratnam S, Alexander M. Utility of 30-Day Mortality Following Systemic Anti-Cancer Treatment as a Quality Indicator in Advanced Lung Cancer. Clin Lung Cancer 2024; 25:e211-e220.e1. [PMID: 38772809 DOI: 10.1016/j.cllc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND 30-day mortality after systemic anti-cancer therapy (SACT) has been suggested as a quality indicator primarily for measuring use of chemotherapy towards the end of life. Utility across different cancer types is unclear, especially when using immunotherapy and targeted therapies. METHODS This retrospective study included patients with a diagnosis of lung cancer who received palliative-intent SACT at an Australian metropolitan cancer center between 2015 and 2022. Using a prospectively maintained lung cancer database, patient, disease, and treatment characteristics were evaluated against annual 30-day mortality rates following SACT. RESULTS 1072 patients were identified. Annual 30-day mortality rate after palliative-intent SACT for lung cancer ranged between 9% and 15%, with significant variance between treatment types. Calculated rates of 30-day mortality are higher if longer reporting time periods are used. Patients who died within 30 days of SACT were more likely to have received targeted therapies or immunotherapy as their final line of treatment, have a poorer performance status at diagnosis, and have received multiple lines of treatment. CONCLUSIONS Our data support differential interpretation of 30-day mortality for quality assurance, especially with regard to lung cancer. Consistency in population and reporting time periods, and accounting for treatment type is crucial if 30-day mortality is to be utilized as cancer care performance quality indicator. Relevance to quality care is questionable in the lung cancer setting.
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Affiliation(s)
| | - Benjamin Solomon
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3052, Australia
| | - Susan Harden
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3052, Australia
| | - Senthil Lingaratnam
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3052, Australia
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3052, Australia.
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Geyer T, Le NS, Groissenberger I, Jutz F, Tschurlovich L, Kreye G. Systemic Anticancer Treatment Near the End of Life: a Narrative Literature Review. Curr Treat Options Oncol 2023; 24:1328-1350. [PMID: 37501037 PMCID: PMC10547806 DOI: 10.1007/s11864-023-01115-x] [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: 05/24/2023] [Indexed: 07/29/2023]
Abstract
OPINION STATEMENT Systemic anticancer therapy (SACT) includes different treatment modalities that can be effective in treating cancer. However, in the case of disease progression, cancers might become incurable and SACT might reach its limits. In the case of incurable cancers, SACT is often given in a palliative setting, with the goal of improving the patients' quality of life (QOL) and their survival. In contrast, especially for patients who approach end of life (EOL), such treatments might do more harm than good. Patients receiving EOL anticancer treatments often experience belated palliative care referrals. The use of systemic chemotherapy in patients with advanced cancer and poor prognosis approaching the EOL has been associated with significant toxicity and worse QOL compared to best supportive care. Therefore, the American Society of Clinical Oncology (ASCO) has discouraged this practice, and it is considered a metric of low-value care by Choosing Wisely (Schnipper et al. in J Clin Oncol 4;30(14):1715-24). Recommendations of the European Society for Medical Oncology (ESMO) suggest that especially chemotherapy and immunotherapy should be avoided in the last few weeks of the patients' lives. In this narrative review, we screened the current literature for the impact of SACT and factors predicting the use of SACT near the EOL with discussion on this topic.
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Affiliation(s)
- Teresa Geyer
- Karl Landsteiner University of Health Sciences, Dr. Karl Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Nguyen-Son Le
- Karl Landsteiner University of Health Sciences, Dr. Karl Dorrek-Straße 30, 3500 Krems an der Donau, Austria
- Division of Palliative Care, Department of Internal Medicine 2, Karl Landsteiner University of Health Sciences, University Hospital of Krems, Mitterweg 10, 3500 Krems an Der Donau, Austria
| | - Iris Groissenberger
- Karl Landsteiner University of Health Sciences, Dr. Karl Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Franziska Jutz
- Karl Landsteiner University of Health Sciences, Dr. Karl Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Lisa Tschurlovich
- Karl Landsteiner University of Health Sciences, Dr. Karl Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Gudrun Kreye
- Karl Landsteiner University of Health Sciences, Dr. Karl Dorrek-Straße 30, 3500 Krems an der Donau, Austria
- Division of Palliative Care, Department of Internal Medicine 2, Karl Landsteiner University of Health Sciences, University Hospital of Krems, Mitterweg 10, 3500 Krems an Der Donau, Austria
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Collins A, Sundararajan V, Le B, Mileshkin L, Hanson S, Emery J, Philip J. The feasibility of triggers for the integration of Standardised, Early Palliative (STEP) Care in advanced cancer: A phase II trial. Front Oncol 2022; 12:991843. [PMID: 36185312 PMCID: PMC9520487 DOI: 10.3389/fonc.2022.991843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background While multiple clinical trials have demonstrated benefits of early palliative care for people with cancer, access to these services is frequently very late if at all. Establishing evidence-based, disease-specific ‘triggers’ or times for the routine integration of early palliative care may address this evidence-practice gap. Aim To test the feasibility of using defined triggers for the integration of standardised, early palliative (STEP) care across three advanced cancers. Method Phase II, multi-site, open-label, parallel-arm, randomised trial of usual best practice cancer care +/- STEP Care conducted in four metropolitan tertiary cancer services in Melbourne, Australia in patients with advanced breast, prostate and brain cancer. The primary outcome was the feasibility of using triggers for times of integration of STEP Care, defined as enrolment of at least 30 patients per cancer in 24 months. Triggers were based on hospital admission with metastatic disease (for breast and prostate cancer), or development of disease recurrence (for brain tumour cohort). A mixed method study design was employed to understand issues of feasibility and acceptability underpinning trigger points. Results The triggers underpinning times for the integration of STEP care were shown to be feasible for brain but not breast or prostate cancers, with enrolment of 49, 6 and 10 patients across the three disease groups respectively. The varied feasibility across these cancer groups suggested some important characteristics of triggers which may aid their utility in future work. Conclusions Achieving the implementation of early palliative care as a standardized component of quality care for all oncology patients will require further attention to defining triggers. Triggers which are 1) linked to objective points within the illness course (not dependent on recognition by individual clinicians), 2) Identifiable and visible (heralded through established service-level activities) and 3) Not reliant upon additional screening measures may enhance their feasibility.
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Affiliation(s)
- Anna Collins
- Department of Medicine, St Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Anna Collins,
| | - Vijaya Sundararajan
- Department of Medicine, St Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Le
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Linda Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Jon Emery
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Philip
- Department of Medicine, St Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Palliative Care Service, St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
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Quality of End-of-Life Care for People with Advanced Non-Small Cell Lung Cancer in Ontario: A Population-Based Study. ACTA ACUST UNITED AC 2021; 28:3297-3315. [PMID: 34590598 PMCID: PMC8406090 DOI: 10.3390/curroncol28050286] [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: 06/25/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
Ensuring high quality end of life (EOL) care is necessary for people with advanced non-small-cell lung cancer (NSCLC), given its high incidence, mortality and symptom burden. Aggressive EOL care can adversely affect the quality of life of NSCLC patients without providing meaningful oncologic benefit. Objectives: (1) To describe EOL health services quality indicators and timing of palliative care consultation provided to patients dying of NSCLC. (2) To examine associations between aggressive and supportive care and patient, disease and treatment characteristics. Methods: This retrospective population-based cohort study describes those who died of NSCLC in Ontario, Canada from 2009–2017. Socio-demographic, patient, disease and treatment characteristics as well as EOL health service quality and use of palliative care consultation were investigated. Multivariable logistic regression models examined factors associated with receiving aggressive or supportive care. Results: Aggressive care quality indicators were present in 50.3% and supportive care indicators in 60.3% of the cohort (N = 37,203). Aggressive care indicators decreased between 2009 and 2017 (57.4% to 45.3%) and increased for supportive care (54.2% to 67.5%). Benchmarks were not met by 2017 in 3 of 4 cases. Male sex and greater comorbidity were associated with more aggressive EOL care and less supportive care. Older age was negatively associated and rurality positively associated with aggressive care. No palliative care consultation occurred in 56.0%. Conclusions: While improvements in the use of supportive rather than aggressive care were noted, established Canadian benchmarks were not met. Moreover, there is variation in EOL quality between groups and use of earlier palliative care must improve.
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Chen JJ, Rawal B, Krishnan MS, Hertan LM, Shi DD, Roldan CS, Huynh MA, Spektor A, Balboni TA. Patterns of Specialty Palliative Care Utilization Among Patients Receiving Palliative Radiation Therapy. J Pain Symptom Manage 2021; 62:242-251. [PMID: 33383147 DOI: 10.1016/j.jpainsymman.2020.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/22/2022]
Abstract
CONTEXT Palliative radiation therapy (RT) is frequently used to ameliorate cancer-associated symptoms and improve quality of life. OBJECTIVES To examine how palliative care (PC) as a specialty is integrated at the time of RT consultation for patients with advanced cancer. METHODS We retrospectively reviewed 162 patients with metastatic cancer who received palliative RT at our institution (7/2017-2/2018). Fisher's exact test identified differences in incidence of receiving any specialty PC. Logistic regression analyses determined predictors of receiving PC. RESULTS Of the 74 patients (46%) who received any specialty PC, 24 (32%) initiated PC within four weeks of RT consultation. The most common reasons for specialty PC initiation were pain (64%) and goals of care/end-of-life care management (23%). Referrals to specialty PC were made by inpatient care teams (48.6%), medical oncologists (48.6%), radiation oncologists (1.4%), and self-referring patients (1.4%). Patients with pain at RT consultation had a higher incidence of receiving specialty PC (58.7% vs. 37.4%, P = 0.0097). There was a trend toward decreased PC among patients presenting with neurological symptoms (34.8% vs. 50%, P = 0.084). On multivariable analysis, receiving specialty PC significantly differed by race (non-white vs. white, odds ratio [OR] = 6.295 [95% CI 1.951-20.313], P = 0.002), cancer type (lung vs. other histology, OR = 0.174 [95% CI 0.071-0.426], P = 0.0006), and RT consultation setting (inpatient vs. outpatient, OR = 3.453 [95% CI 1.427-8.361], P = 0.006). CONCLUSION Fewer than half of patients receiving palliative RT utilized specialty PC. Initiatives are needed to increase PC, especially for patients with lung cancer and neurological symptoms, and to empower radiation oncologists to refer patients to specialty PC.
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Affiliation(s)
- Jie Jane Chen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Bhupendra Rawal
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Monica S Krishnan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Lauren M Hertan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Diana D Shi
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Claudia S Roldan
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Mai Anh Huynh
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Alexander Spektor
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Tracy A Balboni
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.
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Philip J, Le Gautier R, Collins A, Nowak AK, Le B, Crawford GB, Rankin N, Krishnasamy M, Mitchell G, McLachlan SA, IJzerman M, Hudson R, Rischin D, Sousa TV, Sundararajan V. Care plus study: a multi-site implementation of early palliative care in routine practice to improve health outcomes and reduce hospital admissions for people with advanced cancer: a study protocol. BMC Health Serv Res 2021; 21:513. [PMID: 34044840 PMCID: PMC8157619 DOI: 10.1186/s12913-021-06476-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 12/25/2022] Open
Abstract
Background Current international consensus is that ‘early’ referral to palliative care services improves cancer patient and family carer outcomes. In practice, however, these referrals are not routine. An approach which directly addresses identified barriers to early integration of palliative care is required. This protocol details a trial of a standardized model of early palliative care (Care Plus) introduced at key defined, disease-specific times or transition points in the illness for people with cancer. Introduced as a ‘whole of system’ practice change for identified advanced cancers, the key outcomes of interest are population health service use change. The aims of the study are to examine the effect of Care Plus implementation on (1) acute hospitalisation days in the last 3 months of life; (2) timeliness of access to palliative care; (3) quality and (4) costs of end of life care; and (5) the acceptability of services for people with advanced cancer. Methods Multi-site stepped wedge implementation trial testing usual care (control) versus Care Plus (practice change). The design stipulates ‘control’ periods when usual care is observed, and the process of implementing Care Plus which includes phases of planning, engagement, practice change and evaluation. During the practice change phase, all patients with targeted advanced cancers reaching the transition point will, by default, receive Care Plus. Health service utilization and unit costs before and after implementation will be collated from hospital records, and state and national health service administrative datasets. Qualitative data from patients, consumers and clinicians before and after practice change will be gathered through interviews and focus groups. Discussion The study outcomes will detail the impact and acceptability of the standardized integration of palliative care as a practice change, including recommendations for ongoing sustainability and broader implementation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN 12619001703190. Registered 04 December 2019.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Palliative Care Service, St Vincent's Hospital Melbourne, Melbourne, Australia.,Palliative Care Service, Royal Melbourne Hospital, Melbourne, Australia.,Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Roslyn Le Gautier
- Department of Medicine, University of Melbourne, Melbourne, Australia.
| | - Anna Collins
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia and Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Brian Le
- Palliative Care Service, Royal Melbourne Hospital, Melbourne, Australia.,Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Gregory B Crawford
- Northern Adelaide Local Health Network, Modbury Hospital, Adelaide, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Nicole Rankin
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Meinir Krishnasamy
- Department of Nursing and Centre for Cancer Research, University of Melbourne, Melbourne, Australia.,Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Geoff Mitchell
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Maarten IJzerman
- Cancer Health Services Research, University of Melbourne, Melbourne, Australia
| | - Robyn Hudson
- Safer Care Victoria, Victoria State Government, Melbourne, Australia
| | - Danny Rischin
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centr, Melbourne, Australia
| | - Tanara Vieira Sousa
- Centre for Health Policy, Health Economics Unit, University of Melbourne, Melbourne, Australia
| | - Vijaya Sundararajan
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Public Health, La Trobe University, Melbourne, Australia
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Pitson G, Matheson L, Garrard B, Eastman P, Rogers M. Population-based analysis of radiotherapy and chemotherapy treatment in the last month of life within regional Australia. Intern Med J 2021; 50:596-602. [PMID: 31161700 DOI: 10.1111/imj.14377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cancer treatment near end of life is not likely to add meaningful benefit and minimising intervention rates has been promoted as an indicator of quality of care. Population-based analysis of treatment allows comparative analysis of treatment rates and provides insight into patterns of care. AIMS To report a population-based analysis of both radiotherapy and active systemic therapy (AST) delivery rates along with patterns of treatment within the last 14 and 30 days of life. METHODS The Evaluation of Cancer Outcomes Registry records clinical information on all newly diagnosed cancer patients for the Barwon South West Region of Victoria, Australia. Diagnosis details, tumour type and stage as well as core treatment details and date of death were extracted for all patients diagnosed from 2009 to 2015 inclusive. RESULTS A total of 12 760 cases cancers were recorded. The median age of all cases was 68.8, and 53% were male. AST was received by 3699 (29%) of patients and radiotherapy by 3811 (30%). Patient deaths within 14 and 30 days of treatment for AST were 4.3 and 8.7%, respectively, and deaths within 14 and 30 days of treatment for radiotherapy 3.8 and 8.0% respectively. Factors associated with death within 30 days of AST and/or radiotherapy were male gender, age greater than 70 years and higher disease stage (all P < 0.01). Treatment rates within 30 days of death were highest for lung cancer (23% of cases) and lowest for breast cancer (2% of cases). CONCLUSIONS This population-based analysis of AST and radiotherapy treatment within the last 30 days of life within a region of Australia has shown overall treatment rates below 10%. Treatment rates appear influenced by both patient and tumour characteristics. Future focus on subgroups with high rates of late intervention may help minimise treatment unlikely to add benefit.
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Affiliation(s)
- Graham Pitson
- Cancer Services, Barwon Health, Geelong, Victoria, Australia.,Barwon South Western Region Integrated Cancer Service, Geelong, Victoria, Australia
| | - Leigh Matheson
- Barwon South Western Region Integrated Cancer Service, Geelong, Victoria, Australia
| | - Brooke Garrard
- Barwon South Western Region Integrated Cancer Service, Geelong, Victoria, Australia
| | - Peter Eastman
- Palliative Care, Barwon Health, Geelong, Victoria, Australia
| | - Margaret Rogers
- Barwon South Western Region Integrated Cancer Service, Geelong, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Sridharan K, Paul E, Stirling RG, Li C. Impacts of multidisciplinary meeting case discussion on palliative care referral and end-of-life care in lung cancer: a retrospective observational study. Intern Med J 2021; 51:1450-1456. [PMID: 33463032 DOI: 10.1111/imj.15215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multidisciplinary meeting (MDM) discussion and early palliative care are recommended in lung cancer management. The literature is unclear whether MDM discussion leads to early palliative care and improved end-of-life care. AIMS To evaluate impacts of discussion at an Australian lung MDM on palliative care referral, and MDM and early palliative care on aggressive end-of-life care. METHODS A retrospective, cross-sectional study was conducted of 352 patients diagnosed with primary lung cancer from 2017 to 2019 at the Alfred Hospital, Melbourne. The primary question was whether MDM discussion influenced palliative care referrals. Secondary questions were whether MDM discussion and early palliative care reduced aggressive treatment (chemotherapy, hospitalisation, emergency department visits, intensive care admission and in-hospital death) during the last 30 days of life. Multivariable logistic regression was used to determine independent association between MDM discussion and palliative care referral. RESULTS MDM discussion did not independently impact palliative care referral. There was reduced likelihood of MDM presentation in patients with metastatic disease (P < 0.0001) and poorer performance status (P = 0.025), and higher likelihood of palliative care referral in these patients (both P < 0.001). MDM discussion reduced end-of-life intensive care unit (ICU) admission in patients with metastatic disease (P = 0.04). A palliative care referral-to-death interval of ≥30 days was associated with reduced hospitalisation at the end of life (P < 0.0001) and hospital deaths (P = 0.001). CONCLUSION Discussion at lung MDM did not increase palliative care referral, but did reduce ICU admission among metastatic patients at the end of life. Longer palliative care referral-to-death interval was associated with reduced aggressive end-of-life care. Further research is needed in these areas.
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Affiliation(s)
- Krita Sridharan
- Department of Palliative Care, Alfred Health, Melbourne, Victoria, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert G Stirling
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chi Li
- Department of Palliative Care, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Majdinasab EJ, Puckett Y, Pei KY. Increased in-hospital mortality and emergent cases in patients with stage IV cancer. Support Care Cancer 2020; 29:3201-3207. [PMID: 33094359 DOI: 10.1007/s00520-020-05837-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cancer patients in the USA are still being treated with aggressive, life-prolonging interventions. Palliative care services remain vastly underutilized despite surges in both quality and quantity of programs. We evaluated surgical outcomes of metastatic cancer patients to question whether palliative care may be a better option. STUDY DESIGN We queried the 2014 National Surgical Quality Improvement Program database (NSQIP) for patients with a diagnosis of malignancy (ICD 9 Codes 145.00 to 200.00). Cases were divided into metastatic and non-metastatic cancer. Demographic data including preoperative, intraoperative, and postoperative factors, as well as complications and comorbidities were compared between these two groups. Independent t testing was used to compare continuous variables. Chi-square testing was used to compare categorical variables. Multiple logistic regression was used to assess for predictors of mortality in metastatic cancer. RESULTS A total of 80,275 cancer patients were analyzed, 11.8% (9423) of whom had metastatic disease. In-hospital mortality rate was found to be 4 times higher among patients with metastatic cancer (2.1% vs. 0.5%; P = < 0.0001). Of those metastatic cancer patients that died while in hospital, 18.5% had an emergency surgery performed. After adjusting for confounders, dyspnea at rest/moderate exertion (OR 5.7/2.4; 95% CI 2.7/1.6 to 11.9/3.7; P < 0.0001) was found to be the most significant predictor of in hospital mortality in stage IV cancer patients. CONCLUSION Aggressive treatment in advanced cancer patients contributes to alarmingly high in-hospital mortality. Improved, deliberate communication of palliative care options with patients is exceedingly conducive to enhancing end-of-life cancer care.
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Affiliation(s)
- Elleana J Majdinasab
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Yana Puckett
- Department of Surgery, West Virgina University School of Medicine, 3200 MacCorkle Ave SE,, Charleston, WV, 25304, USA.
| | - Kevin Y Pei
- Department of Acute Care Surgery and Surgical Critical Care, Houston Methodist, Houston, TX, USA
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Tanguy-Melac A, Denis P, Pestel L, Fagot-Campagna A, Gastaldi-Ménager C, Tuppin P. Intensity of care, expenditure, place and cause of death people with lung cancer in the year before their death: A French population based study. Bull Cancer 2020; 107:308-321. [PMID: 32035648 DOI: 10.1016/j.bulcan.2019.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/12/2019] [Accepted: 11/16/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Health care utilization of people with lung cancer (LC) the last year of life, their causes of death and place of death and the associated expenditure have been poorly described together. Then we conducted an observational study. METHODS People with LC covered by the French health Insurance general scheme (77% of the population) who died in 2015 were identified in the national health data system, together with their health care utilization and, in 95% of cases, their causes of death. RESULTS A total of 22,899 individuals were included (mean age: 68 years, SD±11.4), 72% of whom died in short-stay hospitals (SSH), 4% in hospital-at-home, 8% in Rehab hospital, 2% in skilled nursing homes and 14% at home. One-half of these people had also a chronic respiratory tract disease and 18% another cancer. Hospital palliative care (HPC) was identified for 65% of people, but for only 9% prior to their end-of-life stay. During the last month of life, 49% of people had two or more SSH stays, 15% were admitted to an intensive care unit, 23% received a chemotherapy session (13% during the last 14 days). The main cause of death was cancer for 92% of individuals (LC for 82%) The mean expenditure during the last year of life was €43,329 per individual. DISCUSSION This study indicates high rates of intensive care unit admissions and chemotherapy during the last month of life and a SSH hospital-centered management with intensive use of HPC mainly during the end-of-life stay.
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Affiliation(s)
- Audrey Tanguy-Melac
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Pierre Denis
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Laurence Pestel
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Anne Fagot-Campagna
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Christelle Gastaldi-Ménager
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Philippe Tuppin
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France.
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Nguyen M, Ng Ying Kin S, Shum E, Wann A, Tamjid B, Sahu A, Torres J. Anticancer therapy within the last 30 days of life: results of an audit and re-audit cycle from an Australian regional cancer centre. BMC Palliat Care 2020; 19:14. [PMID: 31987038 PMCID: PMC6986019 DOI: 10.1186/s12904-020-0517-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/15/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The therapeutic landscape in medical oncology continues to expand significantly. Newer therapies, especially immunotherapy, offer the hope of profound and durable responses with more tolerable side effect profiles. Integrating this information into the decision making process is challenging for patients and oncologists. Systemic anticancer treatment within the last thirty days of life is a key quality of care indicator and is one parameter used in the assessment of aggressiveness of care. METHODS A retrospective review of medical records of all patients previously treated at Goulburn Valley Health oncology department who died between 1 January 2015 and 30 June 2018 was conducted. Information collected related to patient demographics, diagnosis, treatment, and hospital care within the last 30 days of life. These results were presented to the cancer services meeting and a quality improvement intervention program was instituted. A second retrospective review of medical records of all patients who died between 1 July 2018 and 31 December 2018 was conducted in order to measure the effect of this intervention. RESULTS The initial audit period comprised 440 patients. 120 patients (27%) received treatment within the last 30 days of life. The re-audit period comprised 75 patients. 19 patients (25%) received treatment within the last 30 days of life. Treatment rates of chemotherapy reduced after the intervention in contrast to treatment rates of immunotherapy which increased. A separate analysis calculated the rate of mortality within 30 days of chemotherapy from the total number of patients who received chemotherapy was initially 8% and 2% in the re-audit period. Treatment within the last 30 days of life was associated with higher use of aggressive care such as emergency department presentation, hospitalisation, ICU admission and late hospice referral. Palliative care referral rates improved after the intervention. CONCLUSION This audit demonstrated that a quality improvement intervention can impact quality of care indicators with reductions in the use of chemotherapy within the last 30 days of life. However, immunotherapy use increased which may be explained by increased access and a better risk benefit balance.
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Affiliation(s)
| | | | - Evonne Shum
- Goulburn Valley Health, Shepparton, Australia
| | | | | | - Arvind Sahu
- Goulburn Valley Health, Shepparton, Australia
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12
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Stubbs JM, Assareh H, Achat HM, Jalaludin B. Inpatient palliative care of people dying in New South Wales hospitals or soon after discharge. Intern Med J 2019; 49:232-239. [PMID: 30091196 DOI: 10.1111/imj.14074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Palliative care can benefit all patients with life-limiting diseases. AIM To describe hospital use in the final year of life, timing of palliative care and variations by age and disease for patients receiving inpatient palliative care. METHODS Retrospective cohort study of all New South Wales residents aged 50 years and older who died (decedents) between July 2010 and June 2015 in hospital or within 30 days of discharge. Care type and diagnosis codes identified decedents who received inpatient palliative care. RESULTS Of 150 770 decedents, 34.4% received palliative care a median of 10 days before death. Decedents were more likely to receive palliative care if they had cancer (64.7% vs 13.3% for those without chronic conditions) or were younger (46.3% vs 25.0% of the oldest decedents). In their last year of life, palliated decedents, on average, had three emergency department presentations and four hospital admissions - one involving surgery and one where palliation was the intent of care. Of the 30.1 days spent in hospital, 8.7 days involved palliative care. Older age and non-cancer diagnoses were associated with fewer days of inpatient palliation and shorter time between first palliative admission and death. Decedents dying out of hospital started palliative care 18 days earlier than those dying in hospital. CONCLUSION Most decedents did not receive palliative care during hospital admission, and even then only very late in life, limiting its benefits. Improved recognition of palliative need, including earlier identification regardless of age and disease, will enhance the quality of care for the dying.
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Affiliation(s)
- Joanne M Stubbs
- Epidemiology and Health Analytics, Western Sydney Local Health District, New South Wales, Australia
| | - Hassan Assareh
- Epidemiology and Health Analytics, Western Sydney Local Health District, New South Wales, Australia
| | - Helen M Achat
- Epidemiology and Health Analytics, Western Sydney Local Health District, New South Wales, Australia
| | - Bin Jalaludin
- Epidemiology, Healthy People and Places Unit, South Western Sydney Local Health District, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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13
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Philip J, Collins A, Le B, Sundararajan V, Brand C, Hanson S, Emery J, Hudson P, Mileshkin L, Ganiatsas S. A randomised phase II trial to examine feasibility of standardised, early palliative (STEP) care for patients with advanced cancer and their families [ACTRN12617000534381]: a research protocol. Pilot Feasibility Stud 2019; 5:44. [PMID: 30915228 PMCID: PMC6417202 DOI: 10.1186/s40814-019-0424-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/24/2019] [Indexed: 11/12/2022] Open
Abstract
Background Current international consensus is that 'early' referral to palliative care services improves cancer patient and family carer outcomes; however, in practice, these referrals are not routine. Uncertainty about the 'best time' to refer has been highlighted as contributing to care variation. Previous work has identified clear disease-specific transition points in the cancer illness which heralded subsequent poor prognosis (less than 6 months) and which, we contest, represent times when palliative care should be routinely introduced as a standardised approach, if not already in place, to maximise patient and carer benefit. This protocol details a trial that will test the feasibility of a novel standardised outpatient model of early palliative care [Standardised Early Palliative Care (STEP Care)] for advanced cancer patients and their family carers, with referrals occurring at the defined disease-specific evidence-based transition points.The aims of this study are to (1) determine the feasibility of conducting a definitive phase 3 randomised trial, which evaluates effectiveness of STEP Care (compared to usual best practice cancer care) for patients with advanced breast or prostate cancer or high grade glioma; (2) examine preliminary efficacy of STEP Care on patient/family caregiver outcomes, including quality of life, mood, symptoms, illness understanding and overall survival; (3) document the impact of STEP Care on quality of end-of-life care; and (4) evaluate the timing of palliative care introduction according to patients, families and health care professionals. Methods Phase 2, multicenter, open-label, parallel-arm, randomised controlled trial (RCT) of STEP Care plus standard best practice cancer care versus standard best practice cancer care alone. Discussion The research will test the feasibility of standardised palliative care introduction based on illness transitions and provide guidance on subsequent development of phase 3 studies of integration. This will directly address the current uncertainty about palliative care timing. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12617000534381.
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Affiliation(s)
- Jennifer Philip
- 1Department of Medicine, University of Melbourne, c/o St Vincent's Hospital, Victoria Pde, Fitzroy, 3065 Australia.,2Palliative Care Service, St Vincent's Hospital Melbourne, Fitzroy, Australia.,3Palliative Care Service, Royal Melbourne Hospital, Parkville, Australia.,4Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Anna Collins
- 1Department of Medicine, University of Melbourne, c/o St Vincent's Hospital, Victoria Pde, Fitzroy, 3065 Australia
| | - Brian Le
- 3Palliative Care Service, Royal Melbourne Hospital, Parkville, Australia.,4Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Vijaya Sundararajan
- 1Department of Medicine, University of Melbourne, c/o St Vincent's Hospital, Victoria Pde, Fitzroy, 3065 Australia.,5Public Health, La Trobe University, Bundoora, Australia
| | - Caroline Brand
- 6Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Jon Emery
- 8Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Peter Hudson
- 9Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Linda Mileshkin
- 10Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Soula Ganiatsas
- 9Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia
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14
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Duggan KJ, Wiltshire J, Strutt R, Boxer MM, Berthelsen A, Descallar J, Vinod SK. Palliative care and psychosocial care in metastatic non-small cell lung cancer: factors affecting utilisation of services and impact on patient survival. Support Care Cancer 2018; 27:911-919. [PMID: 30066201 DOI: 10.1007/s00520-018-4379-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/24/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Palliative care (PC) and psychosocial care (PSC) are essential services, which can positively impact on quality of life in patients with metastatic lung cancer, when advanced disease and poor prognosis preclude the use of curative therapies. The aims of this study were to describe patterns of PC and PSC and identify factors associated with service utilisation and overall patient survival. METHOD A retrospective Australian cohort of South Western Sydney residents with newly diagnosed stage IV non-small cell lung cancer (NSCLC) in 2006-2012 was identified from the Local Health District Clinical Cancer Registry. Supplemental information was sourced from the area PC database and hospital medical records. Cox regression models with robust variance identified factors associated with PC and PSC and examined patient survival. RESULTS A total of 923 patients were identified. Eighty-three per cent of patients were seen by PC, with 67% seen within 8 weeks of diagnosis. PSC utilisation was 82%. Radiotherapy treatment and residential area were associated with both PC and PSC. Increasing age was associated with early PC referral. Median overall survival was 4 months. PC was associated with patient survival; however, the effect varied over time. CONCLUSION The rate of PC and PSC in our metastatic NSCLC population was high when compared with published data. Despite this, there were gaps in PC and PSC provision in this population, notably with patients not receiving active treatment, and those receiving systemic therapy utilising these services less frequently. PSC and PC contact were not convincingly associated with improved patient survival.
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Affiliation(s)
- Kirsten J Duggan
- South West Sydney Local Health District Clinical Cancer Registry, Liverpool, NSW, Australia. .,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
| | - Jennifer Wiltshire
- Department of Palliative Care, South Western Sydney Local Health District, Liverpool, NSW, Australia.,Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Rebecca Strutt
- Department of Palliative Care, South Western Sydney Local Health District, Liverpool, NSW, Australia.,Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Miriam M Boxer
- Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Angela Berthelsen
- South West Sydney Local Health District Clinical Cancer Registry, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Shalini K Vinod
- Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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15
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Zhuang H, Ma Y, Wang L, Zhang H. Effect of early palliative care on quality of life in patients with non-small-cell lung cancer. ACTA ACUST UNITED AC 2018; 25:e54-e58. [PMID: 29507496 DOI: 10.3747/co.25.3639] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Patients with metastatic non-small-cell lung cancer (nsclc) experience great pain and stress. Our study aimed to explore the effect of early palliative care on quality of life in patients with nsclc. Methods A total of 150 patients were randomly divided into two groups: control group with conventional care and study group with early palliative care. The quality of life (qol) rating scale and self-rating scale of life quality (sslq) were used to analyze the patients' quality of life. The Hospital Anxiety and Depression Scale-D/A (hads-d/a) and Patient Health Questionnaire 9 (phq-9) were used to analyze the patients' mood. Pulmonary function indexes of peak expiratory flow (pef), functional residual capacity (frc), and trachea-esophageal fistula 25% (tef 25%) were analyzed using the lung function detector. Results The qol and sslq scales scores of patients receiving early palliative care were significantly higher than those in the control group (p < 0.05). Moreover, the questionnaire results of the hads-d/a and phq-9 were better in patients receiving palliative care than in the control group (p < 0.05 or p < 0.01). In addition, analytical results of pulmonary function showed that the levels of pef, frc, and tef 25% in patients assigned to early palliative care were remarkably higher than those in the control group (p < 0.01 or p < 0.001). Conclusions These data demonstrate that early palliative care improves life quality, mood, and pulmonary function of nsclc patients, indicating that early palliative care could be used as a clinically meaningful and feasible care model for patients with metastatic nsclc.
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Affiliation(s)
- H Zhuang
- Department of Respiratory Medicine, Weifang People's Hospital, Weifang 261041, China
| | - Y Ma
- Department of Nursing, The First People's Hospital of Xianyang City, Xianyang 712000, China
| | - L Wang
- Department of Oncology, Binzhou City Central Hospital, Binzhou 251700, China
| | - H Zhang
- Department of Respiratory Medicine, Baoji Central Hospital, Baoji 721008, China
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16
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Collins A, McLachlan SA, Philip J. Initial perceptions of palliative care: An exploratory qualitative study of patients with advanced cancer and their family caregivers. Palliat Med 2017; 31:825-832. [PMID: 28367679 DOI: 10.1177/0269216317696420] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite evidence for early integration of palliative care for people with advanced cancer and their families, patterns of late engagement continue. Prior research has focused on health professionals' attitudes to palliative care with few studies exploring the views of patients and their carers. AIM To explore initial perceptions of palliative care when this is first raised with patients with advanced cancer and their families in Australian settings. DESIGN Cross-sectional, prospective, exploratory qualitative design, involving narrative-style interviews and underpinned by an interpretative phenomenological framework. SETTING/PARTICIPANTS Purposively sampled, English-speaking, adult patients with advanced cancer ( n = 30) and their nominated family caregivers ( n = 25) recruited from cancer services at a tertiary metropolitan hospital in Melbourne, Victoria, Australia. RESULTS Three major themes evolved which represent the common initial perceptions of palliative care held by patients with advanced cancer and their carers when this concept is first raised: (1) diminished care, (2) diminished possibility and (3) diminished choice. Palliative care was negatively associated with a system of diminished care which is seen as a 'lesser' treatment alternative, diminished possibilities for hope and achievement of ambitions previously centred upon cure and diminished choices for the circumstances of one's care given all other options have expired. CONCLUSION While there is an increasing move towards early integration of palliative care, this study suggests that patient and caregiver understandings have not equally progressed. A targeted public health campaign is warranted to disentangle understandings of palliative care as the 'institutional death' and to reframe community rhetoric surrounding palliative care from that of disempowered dying to messages of choice, accomplishment and possibility.
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Affiliation(s)
- Anna Collins
- 1 Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,2 Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Sue-Anne McLachlan
- 2 Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.,3 Medical Oncology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Jennifer Philip
- 1 Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,2 Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.,4 Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
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17
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Ong WL, Khor R, Bressel M, Tran P, Tedesco J, Tai KH, Ball D, Duchesne G, Foroudi F. Patterns of health services utilization in the last two weeks of life among cancer patients: Experience in an Australian academic cancer center. Asia Pac J Clin Oncol 2017; 13:400-406. [DOI: 10.1111/ajco.12701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 04/08/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Wee Loon Ong
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Victoria Australia
- Department of Radiation Oncology; Olivia Newton John Cancer Centre/Austin Health; Heidelberg Victoria Australia
| | - Richard Khor
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Radiation Oncology; Olivia Newton John Cancer Centre/Austin Health; Heidelberg Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Australia
| | - Mathias Bressel
- Department of Biostatistics and Clinical Trial; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Phillip Tran
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Jo Tedesco
- Department of Medical Radiations; Monash University; Melbourne Australia
| | - Keen Hun Tai
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
| | - David Ball
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Australia
| | - Gillian Duchesne
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Australia
- Department of Medical Radiations; Monash University; Melbourne Australia
| | - Farshad Foroudi
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Radiation Oncology; Olivia Newton John Cancer Centre/Austin Health; Heidelberg Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Australia
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18
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Nieder C, Tollåli T, Haukland E, Reigstad A, Flatøy LR, Engljähringer K. Impact of early palliative interventions on the outcomes of care for patients with non-small cell lung cancer. Support Care Cancer 2016; 24:4385-91. [PMID: 27209479 DOI: 10.1007/s00520-016-3278-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/10/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study is to address the question "does early palliative care in addition to standard oncology care or late additional palliative care improve patterns of terminal care in patients who died from non-small cell lung cancer (NSCLC)?" METHODS We performed retrospective single-institution study of 286 patients. Palliative care was provided by a dedicated multidisciplinary palliative care team (PCT). An arbitrarily defined cutoff of 3 months before death was chosen to distinguish between early and late additional palliative care. Referral was at the discretion of the treating physicians who provided standard anticancer treatments. RESULTS Patients who received early (8 %) or late (27 %) additional palliative care were significantly younger than those who did not receive additional palliative care. The likelihood of active anticancer treatment in the last month of life was lowest in the early additional palliative care group, p = 0.03. Patients who received early or late additional palliative care were significantly less likely to lack a documented resuscitation preference, p = 0.0001. Patients who received early additional palliative care were significantly less likely to become hospitalized in the last 3 months of life, p = 0.003. Place of death was also numerically different, with hospital death occurring in 33 % of patients who received early additional palliative care, as compared to 48 % in the late and 50 % in the no PCT group, p = 0.35. Anticancer treatment intensity was not reduced if the PCT contributed to the overall management. CONCLUSION Early additional palliative care resulted in relevant improvements. The optimal timing of this intervention should be examined prospectively.
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Affiliation(s)
- Carsten Nieder
- Departments of Oncology and Palliative Medicine, Nordland Hospital Trust, P.O. Box 1480, 8092, Bodø, Norway.
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
| | - Terje Tollåli
- Departments of Pulmonology, Nordland Hospital Trust, Bodø, Norway
| | - Ellinor Haukland
- Departments of Oncology and Palliative Medicine, Nordland Hospital Trust, P.O. Box 1480, 8092, Bodø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Anne Reigstad
- Departments of Pulmonology, Nordland Hospital Trust, Bodø, Norway
| | - Liv Randi Flatøy
- Departments of Pulmonology, Nordland Hospital Trust, Bodø, Norway
| | - Kirsten Engljähringer
- Departments of Oncology and Palliative Medicine, Nordland Hospital Trust, P.O. Box 1480, 8092, Bodø, Norway
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Philip J, Collins A. Routine integration of palliative care: what will it take? Med J Aust 2015; 203:385. [DOI: 10.5694/mja15.00994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/18/2015] [Indexed: 11/17/2022]
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