Changes in Quality of Care and Quality of Life of Outpatients With Advanced Cancer After a Regional Palliative Care Intervention Program

Background: International oncology societies recommend early palliative care. Specific models to integrate early palliative care efficiently into clinical practice are debated. The authors designed a study to look at the quantitative and qualitative outcomes of an early palliative care intervention in oncological care to decrease stress and improve quality of life. Aims: To compare a single structured early palliative care intervention added to a usual oncology care in terms of distress and health-related quality of life at baseline compared to 6 months after enrollment. Design: This multicenter randomized controlled trial (NCT01983956) enrolled adult patients with advanced cancer. Participants were either randomly assigned to usual oncology care alone or usual care plus a structured early palliative care intervention. Setting/participants: One hundred fifty adult patients with a variety of advanced cancer diagnoses were randomized. Seventy-four participants were in the intervention and 76 participants in the control group. The primary outcome was the change in patient distress assessed by the National Comprehensive Cancer Network distress thermometer at 6 months. Health-related quality of life, the secondary outcome, was assessed by the Functional Assessment of Cancer Therapy–General Questionnaire. Results: The results showed no significant effect of the early palliative care intervention neither on patient distress nor on health-related quality of life. Conclusion: The addition of an early intervention to usual care for patients with advanced cancer did not improve distress or quality of life. Thus, patients may need more intensive early palliative care with continuous professional support to identify and address their palliative needs early.

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Impact on caregiver burden of a patient-focused palliative care intervention for patients with advanced cancer

Palliative & Supportive Care ◽

10.1017/s1478951510000258 ◽

2010 ◽

Vol 8 (4) ◽

pp. 395-404 ◽

Cited By ~ 65

Author(s):

Ross E. O'Hara ◽

Jay G. Hull ◽

Kathleen D. Lyons ◽

Marie Bakitas ◽

Mark T. Hegel ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Usual Care ◽

Advanced Cancer ◽

Caregiver Burden ◽

Depressed Mood ◽

Care Intervention ◽

Symptom Intensity ◽

Objective Burden

AbstractObjective:Caregivers of patients with advanced cancer experience physical and emotional strain that can raise their own risk for morbidity and mortality. This analysis was performed to determine whether ENABLE II, a patient-focused palliative care intervention that increased patients' quality of life, reduced symptom intensity, and lowered depressed mood compared to usual care, would affect caregiver burden.Method:Caregivers of patients with advanced cancer from the parent study completed a caregiver burden scale and patients completed quality of life, symptom intensity, and depressed mood measures. Data were collected at baseline, 1 month, and every 3 months thereafter until patient death or the study ended. Decedents' caregivers were asked to complete an after-death interview regarding the quality of care that the patient received.Results:There were no significant differences in caregiver burden between intervention and usual care conditions. Follow-up analyses showed that higher caregiver objective burden and stress burden were related to lower patient quality of life, higher symptom intensity, and higher depressed mood. Caregivers who perceived that patients had unmet needs at end of life reported higher objective burden, and those who perceived that patients were not treated with respect reported higher demand burden.Significance of results:The results indicate that a successful patient-focused intervention did not have a similar beneficial effect on caregiver burden. Future interventions should focus on caregivers as well as patients, with particular attention to caregivers' perceptions of patient care, and seek to change both negative and positive effects of informal caregiving.

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Shifting Palliative Care Paradigm in Primary Care From Better Death to Better End-of-Life : A Swiss Pilot Study

10.21203/rs.3.rs-153919/v1 ◽

2021 ◽

Author(s):

Johanna Sommer ◽

Christopher Chung ◽

Dagmar M. Haller ◽

Sophie Pautex

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Palliative Care ◽

Pilot Study ◽

End Of Life ◽

Cancer Patients ◽

Advanced Cancer ◽

Communication Skills ◽

Advanced Cancer Patients

Abstract Background: Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late.The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients’ quality of life. Methods: Observational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues.3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis.Results: 8 PCPs were trained. PCPs failed to recruit patients for fear of imposing additional loads on their patients. PCPs changed their approach of advanced cancer patients. They became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient’s cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life.Conclusions: PCPs failed to recruit advanced cancer patients, but reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life.Trial registration : The ethics committee of the canton of Geneva approved the study (2018-00077 Pilot Study) in accordance with the Declaration of Helsinki

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Financial Hardship and Quality of Life Among Patients With Advanced Cancer Receiving Outpatient Palliative Care

Cancer Nursing ◽

10.1097/ncc.0000000000001052 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Sarah M. Belcher ◽

Haerim Lee ◽

Janet Nguyen ◽

Kimberly Curseen ◽

Ashima Lal ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Advanced Cancer ◽

Financial Hardship

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Chemotherapy use and quality of life in cancer patients at the end of life: an integrative review

Health and Quality of Life Outcomes ◽

10.1186/s12955-020-01580-0 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Elham Akhlaghi ◽

Rebecca H. Lehto ◽

Mohsen Torabikhah ◽

Hamid Sharif Nia ◽

Ahmad Taheri ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

End Of Life ◽

Cancer Patients ◽

Advanced Cancer ◽

Palliative Chemotherapy ◽

Palliative Therapy ◽

Related Quality ◽

Health Related

Abstract Background When curative treatments are no longer available for cancer patients, the aim of treatment is palliative. The emphasis of palliative care is on optimizing quality of life and provided support for patients nearing end of life. However, chemotherapy is often offered as a palliative therapy for patients with advanced cancer nearing death. The purpose of this review was to evaluate the state of the science relative to use of palliative chemotherapy and maintenance of quality of life in patients with advanced cancer who were at end of life. Materials and methods Published research from January 2010 to December 2019 was reviewed using PRISMA guidelines using PubMed, Proquest, ISI web of science, Science Direct, and Scopus databases. MeSH keywords including quality of life, health related quality of life, cancer chemotherapy, drug therapy, end of life care, palliative care, palliative therapy, and palliative treatment. Findings 13 studies were evaluated based on inclusion criteria. Most of these studies identified that reduced quality of life was associated with receipt of palliative chemotherapy in patients with advanced cancer at the end of life. Conclusion Studies have primarily been conducted in European and American countries. Cultural background of patients may impact quality of life at end of life. More research is needed in developing countries including Mideastern and Asian countries.

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Changes in and correlates of individual quality of life in advanced cancer patients admitted to an academic unit for palliative care

Palliative Medicine ◽

10.1177/1352458507077404 ◽

2007 ◽

Vol 21 (3) ◽

pp. 199-205 ◽

Cited By ~ 11

Author(s):

Michael A Echteld ◽

Lia van Zuylen ◽

Marjolein Bannink ◽

Erica Witkamp ◽

Carin CD Van der Rijt

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Individual Quality ◽

Academic Unit ◽

Advanced Cancer Patients ◽

Individual Quality Of Life

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Prevalence and Predictors of Distress, Anxiety, Depression, and Quality of Life in Bereaved Family Caregivers of Patients With Advanced Cancer

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119872755 ◽

2019 ◽

Vol 37 (3) ◽

pp. 201-213 ◽

Cited By ~ 6

Author(s):

Karin Oechsle ◽

Anneke Ullrich ◽

Gabriella Marx ◽

Gesine Benze ◽

Feline Wowretzko ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Depressive Symptoms ◽

Family Caregivers ◽

Advanced Cancer ◽

Anxiety Symptoms ◽

Bereaved Family ◽

Severe Anxiety ◽

Item Scale

Objective: To investigate prevalence and predictors of postloss distress, depressive and anxiety symptoms, and quality of life among bereaved family caregivers of patients with advanced cancer. Methods: Prospective multicenter study. Family caregivers (N = 160, mean age 56.8 years, 66% female) completed validated outcome measures (Distress Thermometer, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire depression module 9-item scale, SF-8 Health Survey Questionnaire) 6 months after patient’s discharge or death at specialist inpatient palliative care ward. Results: Clinically relevant distress was observed in 82% with sadness (89%), exhaustion (74%), sleeping problems (68%), loneliness (53%), and sorrows (52%) being the most common distress-causing problems. Moderate/severe anxiety and depressive symptoms were observed in 27% and 35%, respectively. Compared to an adjusted norm sample, quality of life was significantly impaired with exception of “bodily pain” and physical component score. Preloss caregiving (odds ratio [OR] 2.195) and higher preloss distress (OR 1.345) predicted high postloss distress. Utilization of psychosocial support services (OR 2.936) and higher preloss anxiety symptoms (OR 1.292) predicted moderate/severe anxiety symptoms, lower preloss physical quality of life (OR 0.952), and higher preloss depressive symptoms (OR 1.115) predicted moderate/severe depressive symptoms. Conclusion: Preloss mental burden showed to be a consistent predictor for postloss burden and should be addressed during palliative care. Future research should examine specific caregiver-directed interventions during specialist palliative care.

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Severe symptoms and very low quality-of-life among outpatients newly diagnosed with advanced cancer: data from a multicenter cohort study

Supportive Care in Cancer ◽

10.1007/s00520-020-05388-y ◽

2020 ◽

Vol 28 (11) ◽

pp. 5547-5555

Author(s):

Waldemar Siemens ◽

Stefan S. Schönsteiner ◽

Claudia Lorena Orellana-Rios ◽

Ulrike Schaekel ◽

Jens Kessler ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Cohort Study ◽

Advanced Cancer ◽

Physical Symptoms ◽

Newly Diagnosed ◽

Multicenter Cohort Study ◽

European Organization ◽

Multicenter Cohort

Abstract Purpose The aim of this study was to identify symptoms of severe intensity or very low scores for quality of life (QoL) domains in newly diagnosed outpatients with advanced cancer. Methods This multicenter cohort study from a state-wide palliative care network included adult outpatients with advanced cancer diagnosed within the preceding 8 weeks from four comprehensive cancer centers (DRKS00006162, registered on 19 May 2014). We used the Palliative Outcome Scale (POS), Hospital Anxiety and Depression Scale, and European Organization for Research and Treatment of Cancer QoL Questionnaire-C30. For each questionnaire, cut-off scores defined symptoms and QoL domains that were considered “severe” or “very low.” Results Of 3155 patients screened, 481/592 (81.3%) were analyzed (mean age 62.4; women n = 245, 50.9%). We identified 324/481 (67.4%) patients experiencing at least one severe symptom or a very low QoL domain (median 2; range 0 to 16). Role functioning (n = 180, 37.4%), fatigue (n = 162, 33.7%), and social functioning (n = 126, 26.2%) were most commonly affected. QoL was very low in 89 patients (18.5%). Women experienced more anxiety symptoms, fatigue, and had lower POS scores. Patients often mentioned physical symptoms and fears of adverse events resulting from disease-modifying therapies (e.g., chemotherapy) as most relevant problems. Conclusions Already within the first 8 weeks after diagnosis, the majority of patients reported at least one severe symptom or a very low QoL domain. Gender differences were evident. The findings illustrate the value of early routine assessment of patient burden and the development of multi-professional and interdisciplinary palliative care.

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