Symptom control and quality of life in the end-of-life phase of brain tumour patients

2010 ◽  
Vol 3 (S3) ◽  
pp. 18-20
Author(s):  
E. M. Sizoo ◽  
M. J. B. Taphoorn
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Brain Tumour ◽  
Symptom Control ◽  
Life Phase

scholarly journals Integration of palliative care into the neuro-oncology practice: patterns in the United States

2014 ◽  
Vol 1 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Tobias Walbert
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Brain Tumor ◽  
End Of Life ◽  
Symptom Control ◽  
Tumor Patients ◽  
Life Phase ◽  
Improve Symptom ◽  
Oncology Practice

Abstract Background Between 80%–85 percent of all adult brain tumors are high-grade gliomas (HGGs). Despite aggressive treatment with surgical resection, radiotherapy and chemotherapy, the survival of patients with HGG is limited. Brain tumor patients develop unique symptoms and needs throughout their disease trajectory, and the majority lose the ability to communicate during the end-of-life phase. Palliative care (PC) is a proactive and systematic approach to manage issues that are important to patients and families affected by serious illness. The goal is to improve quality of life and symptom control and thereby reduce suffering. Most PC interventions take place during the end-of-life phase; however, newer data suggest that early PC interventions might improve symptom control and quality of life. Methods A literature review focusing on PC, hospice care, and end-of-life care was performed with the aim to describe the integration of PC into neuro-oncology practice. Results Recently there has been increased interest in the effects of PC and brain tumor patients. The origins, methodology, and conceptual models of delivering PC and how it might be applied to the field of neuro-oncology were reviewed. Patterns of referral and utilization in neuro-oncology are described based on the findings of a recent survey. Conclusions Despite a very high symptom burden, many HGG patients do not receive the same level of PC and have fewer interactions with PC services than other cancer populations. Early PC interventions and structured advance-care planning might improve symptom control and quality of life for brain tumor patients.

scholarly journals Impact of deprescribing dual-purpose medications on patient-related outcomes for older adults near end-of-life: a systematic review and meta-analysis

2021 ◽  
Vol 12 ◽  
pp. 204209862110523
Author(s):  
Shakti Shrestha ◽  
Arjun Poudel ◽  
Magnolia Cardona ◽  
Kathryn J. Steadman ◽  
Lisa M. Nissen
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Disease Prevention ◽  
End Of Life ◽  
Acute Care ◽  
Symptom Control ◽  
Risk Of Bias ◽  
Care Facilities ◽  
Acute Care Facilities

Introduction: The decision to deprescribe medications used for both disease prevention and symptom control (dual-purpose medications or DPMs) is often challenging for clinicians. We aim to establish the impact of deprescribing DPMs on patient-related outcomes for older adults near end-of-life (EOL). Methods: This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Literature was searched on PubMed, EMBASE, CINAHL, PsycINFO and Google Scholar until December 2019 for studies on deprescribing intervention with a control group (with or without randomisation); targeting ⩾65-year olds, at EOL, with at least one life-limiting illness and at least one potentially inappropriate DPM. We were interested in any patient-related outcomes. Studies with similar outcome assessment criteria were subjected to meta-analysis and narrative synthesis otherwise. The risk of bias was assessed using Cochrane Risk of Bias and ROBINS-I tools for randomised controlled trials (RCTs) and quasi-experimental non-randomised controlled studies, respectively. Results: Five studies covering 689 participants with mean age 81.6–85.7 years, the majority (74.6–100%) with dementia were included. The risk of bias was moderate to low. The deprescribing of DPMs lowered the risk of mortality (risk ratio (RR) = 0.59, 95% confidence interval (CI) = 0.44–0.79) and referral to acute care facilities (RR = 0.40, 95% CI = 0.22–0.73), but did not have a significant impact on the risk of falls, non-vertebral fracture, emergency presentation, unplanned hospital admission, or general practitioner visits. No significant difference was observed in the quality of life, physical and cognitive functions between the intervention and control groups. Conclusion: There is some evidence that deprescribing of DPMs for older adults near the EOL can lower the risk of mortality and referral to acute care facilities, but there are insufficient good-quality studies powered to confirm a benefit in terms of quality of life, physical or cognitive function, health service utilisation and adverse events. Plain Language Summary What is the health impact of withdrawal or dose reduction of medication used for disease prevention and symptom control in older adults near end-of-life? Introduction: Older adults (aged ⩾ 65 years) with advanced diseases such as cancer, dementia, and organ failure tend to have a limited life expectancy. With the progression of these diseases towards the end-of-life, the intensity for day-to-day supportive care becomes increasingly necessary. The use of medications for symptom management is a critical part of such care, but the use of medications for long-term disease prevention can become irrelevant due to the already shortened life expectancy and may become harmful due to alterations in physiology and pharmacology associated with age and frailty. This necessitates the withdrawal or dose reduction of inappropriate medications, the process called deprescribing. The decision to deprescribe medications used for both disease prevention and symptom control (DPMs) in this population is often challenging for clinicians. In this context, whether deprescribing of DPMs can improve patient-related health outcomes is unknown. Methods: Evidence from the literature was reviewed and analysed, and the quality of studies was assessed. Five studies were identified, which had 689 participants with an average age above 80 years and mostly suffering from dementia. Results: The analysis of these studies showed deprescribing of DPMs lowered the risk of death and referral to acute care facilities at 12 months but had no significant impact on falls, non-vertebral fractures, emergency presentations, unplanned hospital admission, general practitioner visits, quality of life, physical and mental functions. Conclusion: In conclusion, there were insufficient numbers of high-quality studies powered to confirm whether deprescribing of DPMs reduces adverse events, health service use, or improves the quality of life or functioning in older adults near the end of life.

Health-related quality of life (HRQOL) in patients with glioblastoma (GBM) and their caregivers in the end-of-life phase: A retrospective study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 2071-2071
Author(s):  
Birgit Flechl ◽  
Cornelia Sax ◽  
Michael Ackerl ◽  
Richard Crevenna ◽  
Alexander Gaiger ◽  
...  
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Common Symptom ◽  
Loved One ◽  
Life Phase ◽  
Related Quality ◽  
Health Related ◽  
Need For Support ◽  
Medical University

2071 Background: Glioblastoma multiforme (GBM) still harbours an inevitably fatal prognosis. The specially course of this disease poses unique challenges in care provision to the relatives. We still lack data about the end-of-life phase of GBM patients to improve counseling and supporting GBM patients and their proxies. Methods: In this retrospecitve study we included 52 caregivers of deceased GBM patients treated in two hospitals in Vienna, Austria. We used a specially developed questionnaire by the Medical University of Amsterdam to explore and document the last three months of living of GBM patients. Results: Most of the included caregivers were the partners of the patients (88%) and two thirds were female. The most common symptom in GBM patients was fatigue (87%), followed by reduced consciousness (81%) and aphasia (77%). 22% of the patients were bedbound during their last three months increasing to 80% in the last week of life. 30% of the caregivers told that they felt incompletely informed for their task and about the illness of their loved one. They stated the quality of life (QOL) of the patients with 2.2 and their own with 2.8 on a scale of 1 to 7 whereas 7 displays the best possible answer. The majority of the patients (46%) died in hospitals and 38% at home, which was the most often expressed wish for place of death (45%)by patients. Regarding the caregivers’ symptoms, sadness (90%), fear (69%), burnout (60%), less interest in others (54%) and irritation (42%) were the leading ones and did not differ significantly in-between the places of death. Conclusions: The end-of-life phase of GBM patients is different from that of patients dying from other cancers. Most alarmingly, one thirds of their caregivers feels poorly informed. About two thirds of the caregivers fell overstrained and stresses thereby the urgent need for support and dedicated educational programs.

scholarly journals Caring for Older Patients on Peritoneal Dialysis at End of Life

2015 ◽  
Vol 35 (6) ◽  
pp. 667-670 ◽  
Author(s):  
Frédérique Meeus ◽  
Edwina A. Brown
Keyword(s):  
Quality Of Life ◽  
Peritoneal Dialysis ◽  
End Of Life ◽  
Older Patients ◽  
Psychosocial Support ◽  
Life Phase ◽  
Dialysis Withdrawal ◽  
Do So

End of life is the last phase of life, not merely the last few days. For many older patients on peritoneal dialysis (PD), the end-of-life phase commences with the start of dialysis. The principal aim of management of this phase should be optimizing the quality of life of the patient. Evidence suggests that patients on dialysis mostly want involvement in decisions at this stage, but most do not have the opportunity to do so. Management should therefore include discussions with the patient and their family to determine lifestyle goals, treatment wishes, and ceilings of care (including resuscitation and dialysis withdrawal). Care should also include symptom identification and management, psychosocial support, and adaptation of dialysis to the ability and needs of the patient. By doing this, quality of life at end of life is achievable.

scholarly journals Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review

2019 ◽  
Vol 97 (1) ◽  
pp. 113-175 ◽  
Author(s):  
CATHERINE J. EVANS ◽  
LUCY ISON ◽  
CLARE ELLIS‐SMITH ◽  
CAROLINE NICHOLSON ◽  
ALESSIA COSTA ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Service Delivery ◽  
Older People ◽  
End Of Life ◽  
Rapid Review ◽  
Service Delivery Models ◽  
Delivery Models

scholarly journals Last Place of Care and End-of-Life Quality of Life in the United States: Evidence From a National Representative Data Set

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 17-17
Author(s):  
Yifan Lou ◽  
Nan Jiang ◽  
Katherine Ornstein
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
End Of Life ◽  
End Of Life Care ◽  
The United States ◽  
Life Care ◽  
Person Centered Care ◽  
Centered Care ◽  
The Relationship

Abstract Background: Quality of life (QoL) during last stage of life has raised expanded interests as an important aspect of person-centered care. Last place of care (LPC), refer to the last place decedents received their formal end-of-life care (EOLC), has been identified as a key indicator of older adults’ end-of-life QoL, but the relationship was understudied. This study explores the association between LPC and end-of-life QoL among American older adults. Methods: Data used seven waves of Last Month of Life data with a total sample of 3068 Medicare decedents in NHATS. Outcome is end-of-life QoL assessed by eleven measures on four domains: pain and symptoms management (SP), quality of healthcare encounter (HE), person-centered care (PC), and overall quality of care (QC). LPC was categorized into home, hospital, nursing home, and residential hospice. Multivariate logistic regression analyses were used to examine the relationship with covariates. Results: LPC varied by most demographic characteristics, except immigration status and education. Older adults whose LPC is hospital, compared to those who had home-care, were less likely to have great experiences on HE, PC, and QC. People dying at nursing homes are more likely to receive care meeting their dyspnea and spiritual needs. Residential hospice is negatively related to respected care, clear coordination, and keeping family informed, but are more likely to provide PS and spiritual care. Discussion: Home-based end-of-life care has certain advantages but still has room to improve on SP and religious concerns. Hospitals should keep reforming their service delivery structure to improve patients’ QoL.

Parental report of cognitive difficulties, quality of life and rehabilitation in children with epilepsy or treated for brain tumour

2008 ◽  
Vol 11 (4) ◽  
pp. 268-275 ◽  
Author(s):  
Carmen Soria ◽  
Delphine Callu ◽  
Delphine Viguier ◽  
Sandra El Sabbagh ◽  
Christine Bulteau ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Brain Tumour ◽  
Parental Report ◽  
Cognitive Difficulties
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