Communicating anticancer treatment cessation and transition to palliative care: The need for a comprehensive and culturally relevant, person-centered approach

IntroductionNausea and vomiting are common symptoms for patients with advanced cancer. While there is evidence for acupuncture point stimulation for treatment of these symptoms for patients having anticancer treatment, there is little for when they are not related to such treatment.ObjectiveTo determine whether acupressure at the pericardium 6 site can help in the treatment of nausea and vomiting suffered by palliative care patients with advanced cancer.Materials and methodsDouble blind randomised controlled trial—active versus placebo acupressure wristbands. In-patients with advanced cancer in two specialist palliative care units who fitted either or both of the following criteria were approached: Nausea that was at least moderate; Vomiting daily on average for the prior 3 days.Results57 patients were randomised to have either active or placebo acupressure wristbands. There was no difference in any of the outcome measures between the two groups: change from baseline number of vomits; Visual Analogue Scale for ‘did acupressure wristbands help you to feel better?’; total number of as needed doses of antiemetic medication; need for escalation of antiemetics.ConclusionsIn contrast to a previously published feasibility study, active acupressure wristbands were no better than placebo for specialist palliative care in-patients with advanced cancer and nausea and vomiting.

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The outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.131 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 131-131

Author(s):

Si Won Lee ◽

Hye Jin Choi

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Group Performance ◽

Care Service ◽

Symptom Control ◽

Palliative Care Service ◽

Cancer Center ◽

Anticancer Treatment ◽

Tertiary Cancer Center

131 Background: The importance of palliative care in cancer patients continues to be emphasized and studies are proving its importance. Several studies proved the improvement of quality of life in advanced cancer patients. The efficacy of symptom control based on outpatient palliative care service has not yet been reported in Korea. The objective of this study is to review the outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea. Methods: We retrospectively reviewed 155 cancer patients who used outpatient clinic at Yonsei Cancer Center in Korea between April 2014 and December 2014. Symptom severity was measured by modified Korean version of Edmonton Symptom Assessment System. Twelve symptoms were assessed: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, anorexia, constipation, wellbeing, financial distress. Higher score means worse symptom. ESAS scores at baseline and follow-up assessments were analyzed. Results: The 155 patients had following characteristics: female 52.3%, median age 65 years (range 58-75), Hepatobiliary-pancreatic cancer and lung cancer patients accounted for the largest portion (n = 37, 23.9%; n = 36, 23.2% respectively). Most patients were Eastern Cooperative Oncology Group performance status 1 (n = 28, 18.1%) or 2 (n = 24, 15.5%). Ninety-two (59.4%) patients were referred to the palliative care team after anti-cancer treatments were all finished. Overall the symptoms did not change significantly from baseline to 2 consecutive follow up assessment except anorexia ( p value = 0.0195). Patients who were on active anticancer treatment had tendency of higher ESAS score than those finished with the anticancer treatment. However, all symptoms except nausea were not statistically significant. Conclusions: Most patients in this study did not have severe symptom scores that would show the differences of the symptom changes. Nevertheless, although not statistically significant, we found that patients on active anticancer treatment had higher symptom burden than those who were finished with the anticancer treatment. More meticulous symptom management is necessary to improve the symptom control.

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A Person-Centered Approach to Palliative Care Nursing

Journal of Hospice and Palliative Nursing ◽

10.1097/00129191-200609000-00015 ◽

2006 ◽

Vol 8 (5) ◽

pp. 294-301 ◽

Cited By ~ 4

Author(s):

Anita Green

Keyword(s):

Palliative Care ◽

Person Centered Approach ◽

Care Nursing

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Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

10.21203/rs.2.16088/v2 ◽

2020 ◽

Author(s):

Ellinor Christin Haukland ◽

Christian von Plessen ◽

Carsten Nieder ◽

Barthold Vonen

Keyword(s):

Palliative Care ◽

Adverse Events ◽

End Of Life ◽

Cancer Patients ◽

Cancer Care ◽

Quality And Safety ◽

Negative Consequences ◽

Specialist Palliative Care ◽

Early Integration ◽

Anticancer Treatment

Abstract Background: Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer care Methods: Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life. Results: 30 % of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62 % more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1 000 patient days (p<0.001, OR 1.62 (1.23 – 2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18 % (p=0.045, OR 1.85 (1.01 – 3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1 000 patient days in both groups by 29 % (p= 0.02, IRR 0.71, CI 95% 0.53 – 0.96). Conclusions: Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.

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Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

10.21203/rs.2.16088/v3 ◽

2020 ◽

Author(s):

Ellinor Christin Haukland ◽

Christian von Plessen ◽

Carsten Nieder ◽

Barthold Vonen

Keyword(s):

Palliative Care ◽

Adverse Events ◽

End Of Life ◽

Cancer Patients ◽

Cancer Care ◽

Quality And Safety ◽

Negative Consequences ◽

Specialist Palliative Care ◽

Early Integration ◽

Anticancer Treatment

Abstract Background: Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer careMethods: Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway in 2012 and 2013. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life.Results: 30 % of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62 % more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1 000 patient days (p<0.001, OR 1.62 (1.23 – 2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18 % (p=0.045, OR 1.85 (1.01 – 3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1 000 patient days in both groups by 29 % (p= 0.02, IRR 0.71, CI 95% 0.53 – 0.96).Conclusions: Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.

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Palliative benefit of novel cell-free and concentrated ascites reinfusion therapy (CART) for refractory ascites associated with cancerous peritonitis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20591 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20591-e20591

Author(s):

Keisuke Matsusaki ◽

Akitaka Yoshizawa ◽

Keiichiro Ohta

Keyword(s):

Palliative Care ◽

Abdominal Pain ◽

Daily Living ◽

Abdominal Distention ◽

Refractory Ascites ◽

General Malaise ◽

Review Committee ◽

Appetite Loss ◽

Before And After ◽

Anticancer Treatment

e20591 Background: Refractory ascites associated with cancerous peritonitis causes severe abdominal distention, dyspnea and appetite loss, resulting in loss of patients’ activities of daily living (ADL) and discontinuation of their treatment for cancer such as chemotherapy. To improve the symptoms, we have developed a novel cell-free and concentrated ascites reinfusion therapy (CART) which is modified from a conventional CART approved by the Ministry of Health, Labor and Welfare in Japan and examined the efficacy in a pilot study. Methods: 87 patients with cancerous ascites were enrolled and subjected to novel CART from April 2012 to November 2012. The response was assessed by improvement of their ADL. Patients were asked in the form of questionnaires about general malaise, abdominal distention, abdominal pain, nausea, dyspnea, sleep disturbance, appetite loss, disturbance in gait, discomfort and frustration before and after treatment and each point was scored on a scale of zero to ten (ten being severe). Abdominal and thigh circumferences were also examined before and after treatment to evaluate efficacy. This study was approved by the ethics review committee of Kaname-cho hospital. Results: On average, 8.3 ± 4.4 L (range 2.3-27.0) of cancerous ascites was filtrated and concentrated to 0.69 ± 0.28 L (range 0.2-1.6) by novel CART. Any severe adverse events except fever were not observed. After treatment, the scores of all points were significantly improved. For example, abdominal distention was improved by 8.1 ± 2.4 vs. 2.0 ± 2.4 (p<0.0001), dyspnea by 3.7 ± 3.3 vs. 1.3 ± 2.1 (p<0.0001), and appetite loss by 5.3 ± 4.3 vs. 3.1 ± 3.4 (p<0.0001). Abdominal and thigh circumferences were also decreased by -13.3 ± 7.5 cm (p<0.0001) and -2.7 ± 2.6 cm (p<0.0001), respectively. Conclusions: This novel CART system is capable to process over 20 L of cancerous ascites and immediately improve their ADL and edematous lesions. Some patients also restarted anticancer treatment such as chemotherapy. Taken together, this CART is safe and effective for palliative care of patients with cancerous ascites.

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How do they view us? Oncology providers’ perceptions of early/concurrent palliative care.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.114 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 114-114

Author(s):

Dilip Sankar Babu ◽

J Nicholas Dionne-Odom ◽

Lisa Zubkoff ◽

Tasha Smith ◽

Marie Bakitas

Keyword(s):

Palliative Care ◽

Survey Instrument ◽

Early Integration ◽

Early Palliative Care ◽

Care Intervention ◽

Before And After ◽

Anticancer Treatment ◽

Original Survey ◽

Oncology Practice ◽

Oncology Providers

114 Background: Early integration of palliative care has been increasingly recognized as an important component in the care of cancer patients, including during active anticancer treatment. Yet, palliative and supportive care interventions remain to be well integrated into standard oncology practice. We sought to develop an original survey instrument in order to describe oncology providers’ perceptions of palliative care, particularly when introduced in the early and concurrent setting. Methods: We conducted a systematic review of literature pertaining to perceptions of palliative care and barriers to referral, and extracted survey items where they were found. This pool of questions was narrowed to focus on early/concurrent palliative care, and supplemented with original items. The draft survey was then systematically validated using a standardized scoring system and content-validity approach. Results: Twenty-two studies were reviewed. From an initial pool of fifty items, twenty-nine were selected for the draft survey. The draft was then reviewed by ten oncology providers, who scored each item and provided comments. Conclusions: We have produced a fully validated survey instrument that will be used to characterize oncology providers’ perceptions of early and concurrent palliative care interventions. The validated survey will be administered to oncology clinicians (including nurses, social workers and chaplains) at four academic medical centers at which an early palliative care intervention is currently being implemented. We hope to assess perceptions before and after implementation of the early palliative care intervention.

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