Depression Moderates the Positive Impact of Early Palliative Care on Survival Among Advanced Cancer Patients (FR467-E)

Background: Timely identification of palliative care needs can reduce hospitalizations and improve quality of life. The Supportive & Palliative Care Indicators Tool (SPICT) identifies patients with advanced medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting. SPICT and RI among cancer patients were utilized in this study to evaluate their potential roles in palliative care referrals. Methods: Advanced cancer patients admitted to an institution in Baltimore, Maryland in 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), palliative care referrals, RI scores, and SPICT scores were obtained. Patients were divided into SPICT positive or negative and RI > 60 or RI < 60.Unpaired t-tests and chi-square tests were utilized to determine the associations between SPICT and RI and early palliative care needs and mortality. Results: 227 patients were included, with a mean age of 68 years, 63% Black, 59% female, with the majority having lung and GI malignancies. Sixty percent were SPICT +, 21% had RI < 60. SPICT + patients were more likely to have RI < 60 (p = 0.001). SPICT + and RI < 60 patients were more likely to have longer LOS, change in code status, more palliative/hospice referrals, and increased mortality (p <0.05). Conclusions: SPICT and RI are valuable tools in predicting mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer.

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An early palliative care intervention can be confronting but reassuring: A qualitative study on the experiences of patients with advanced cancer

Palliative Medicine ◽

10.1177/0269216319847884 ◽

2019 ◽

Vol 33 (7) ◽

pp. 783-792 ◽

Cited By ~ 4

Author(s):

Monica Fliedner ◽

Sofia Zambrano ◽

Jos MGA Schols ◽

Marie Bakitas ◽

Christa Lohrmann ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Cancer Patients ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

End Of Life Decisions ◽

Early Palliative Care ◽

Network Support ◽

Care Intervention ◽

Life Decisions

Background: Intervention trials confirm that patients with advanced cancer receiving early palliative care experience a better quality of life and show improved knowledge about and use of palliative care services. To involve patients in future health-care decisions, health professionals should understand patients’ perspectives. However, little is known about how patients’ experience such interventions. Aim: To explore advanced cancer patients’ experiences with a structured early palliative care intervention, its acceptability and impact on the patients’ life including influencing factors. Design: Qualitative content analysis of in-depth, semi-structured interviews. Setting/participants: Patients with various advanced cancer diagnoses were enrolled in a multicenter randomized controlled trial (NCT01983956), which investigated the impact of “Symptoms, End-of-life decisions, Network, Support,” a structured early palliative care intervention, on distress. Of these, 20 patients who underwent the intervention participated in this study. Results: Participants received the intervention well and gained a better understanding of their personal situation. Patients reported that the intervention can feel “confronting” but with the right timing it can be confirming and facilitate family conversations. Patients’ personal background and the intervention timing within their personal disease trajectory influenced their emotional and cognitive experiences; it also impacted their understanding of palliative care and triggered actions toward future care planning. Conclusion: Early palliative care interventions like “Symptoms, End-of-life decisions, Network, Support” may provoke emotions and feel “confrontational” often because this is the first time when issues about one’s end of life are openly discussed; yet, advanced cancer patients found it beneficial and felt it should be incorporated into routine care.

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palliative care Evaluation of effects of early palliative care on quality of life of advanced cancer patients. A multicenter controlled randomised clinical trial

Annals of Oncology ◽

10.1093/annonc/mdw435.48 ◽

2016 ◽

Vol 27 ◽

pp. vi584

Author(s):

V. Franciosi ◽

G. Caruso ◽

G. Maglietta ◽

Cgli De Esposti ◽

L. Cavanna ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Trial ◽

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Randomised Clinical Trial ◽

Advanced Cancer Patients ◽

Early Palliative Care ◽

Care Evaluation

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Predictive model of complexity in early palliative care: a cohort of advanced cancer patients (PALCOM study)

Supportive Care in Cancer ◽

10.1007/s00520-017-3840-3 ◽

2017 ◽

Vol 26 (1) ◽

pp. 241-249 ◽

Cited By ~ 12

Author(s):

Albert Tuca ◽

Mónica Gómez-Martínez ◽

Aleix Prat

Keyword(s):

Palliative Care ◽

Predictive Model ◽

Cancer Patients ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

Early Palliative Care

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A phase II randomized study to evaluate a new psychosocial intervention (PI) plus early palliative care (PC) in the reduction of depression of advanced cancer patients (ACP): The PREPArE trial.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.e21626 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. e21626-e21626 ◽

Cited By ~ 1

Author(s):

Carlos Eduardo Paiva ◽

Thamires Monteiro do Carmo ◽

Cleyton Zanardo de Oliveira ◽

Maria Salete de Angelis Nascimento ◽

Milena Ruas de Siqueira ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Phase Ii ◽

Psychosocial Intervention ◽

Randomized Study ◽

Advanced Cancer Patients ◽

Early Palliative Care

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Mindfulness-based stress reduction in early palliative care for advanced cancer patients: An Italian single-centre study. MINDEEP

Annals of Oncology ◽

10.1093/annonc/mdz273.007 ◽

2019 ◽

Vol 30 ◽

pp. v823-v824

Author(s):

E. Gianotti ◽

G. Razzini ◽

A. righi ◽

M. bini ◽

C. crivellaro ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Stress Reduction ◽

Advanced Cancer Patients ◽

Single Centre ◽

Early Palliative Care ◽

Centre Study ◽

Single Centre Study ◽

Mindfulness Based Stress Reduction

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Early versus delayed palliative/supportive care in advanced cancer: an observational study

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-001794 ◽

2019 ◽

Vol 10 (4) ◽

pp. e32-e32 ◽

Cited By ~ 2

Author(s):

Elena Bandieri ◽

Federico Banchelli ◽

Fabrizio Artioli ◽

Claudia Mucciarini ◽

Giorgia Razzini ◽

...

Keyword(s):

Observational Study ◽

Supportive Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Positive Impact ◽

Performance Status ◽

Real Life ◽

Advanced Cancer Patients ◽

Early Palliative Care ◽

Edmonton Symptom Assessment Scale

ObjectiveThe positive impact of early palliative care interventions in advanced cancer patients has so far been largely evaluated in randomised controlled trials. This study aimed at providing information on the value of early palliative/supportive care, integrated with standard oncologic care, in a real-life setting.MethodsThis was a retrospective observational study of 292 advanced cancer patients consecutively admitted at Carpi Hospital in Modena, Italy, between 2014 and 2017. For the purpose of this analysis, patients were classified into two groups (early and delayed palliative/supportive care patients), and analysed for different clinical indicators. Early and delayed palliative/supportive care were classified according to the time elapsed from advanced cancer diagnosis until palliative/supportive care start.ResultsA total of 200 patients (68%), with at least three visits, were included in the analyses. The frequency of chemotherapy use in the last 60 days of life was 3.4% and 24.6% in the early and delayed groups, respectively (adjusted OR=0.1; 95% CI 0.0 to 0.4; p=0.002). The estimated survival probability at 1 year was 74.5% (95% CI 65.0% to 85.4%) and 45.5% (95% CI 37.6% to 55.0%), in the early and delayed groups, respectively. Performance status, pain and all the Edmonton Symptom Assessment Scale items, assessed at baseline and at 1 to 12 weeks after the intervention, showed significant improvement over time. However, no between-group differences were found with regard to symptom outcomes.ConclusionsAn earlier palliative/supportive care intervention was associated with reduced aggressiveness of therapy, in patients receiving community oncology care. Symptom burden was improved by early palliative/supportive care, independently of the timing of patient referral.

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