The added value of assessing the ‘most troublesome’ symptom among patients with cancer in the palliative phase

2007 ◽  
Vol 65 (2) ◽  
pp. 223-229 ◽  
Author(s):  
Johanna Hoekstra ◽  
Myrra J.F.J. Vernooij-Dassen ◽  
Rien de Vos ◽  
Patrick J.E. Bindels
Keyword(s):  
Added Value ◽  
Patients With Cancer ◽  
Troublesome Symptom ◽  
Palliative Phase

scholarly journals Integration of Germline Pharmacogenetics Into a Tumor Sequencing Program

2018 ◽  
pp. 1-15 ◽  
Author(s):  
Daniel L. Hertz ◽  
Andrew Glatz ◽  
Amy L. Pasternak ◽  
Robert J. Lonigro ◽  
Pankaj Vats ◽  
...  
Keyword(s):  
Genetic Information ◽  
Clinical Laboratory ◽  
Treatment Decisions ◽  
Added Value ◽  
Treatment Recommendation ◽  
Evidence Based ◽  
Patients With Cancer ◽  
Retrospective Assessment ◽  
Tumor Sequencing ◽  
Evidence Based Guidelines

Purpose Evidence-based guidelines inform treatment decisions for patients for whom germline genetic information is available. Our real-time tumor sequencing program, which makes precision treatment decisions for patients with cancer, produces matched germline information, providing a unique opportunity to efficiently implement pharmacogenetics and benefit patients. Methods The germline genetic database from the Michigan Oncology Sequencing (MI-Oncoseq) program was searched for 21 clinically actionable polymorphisms in five cancer-relevant genes: TPMT, DPYD, CYP2C19, CYP3A5, and UGT1A1. Residual germline DNA was sent to an external Clinical Laboratory Improvement Amendments–approved laboratory for confirmatory genotyping. The medical records of MI-Oncoseq patients with actionable phenotypes were searched for receipt of relevant drugs and to determine whether having genetic information at the time of treatment would have led to a treatment recommendation. Results All nine variants in TPMT, DPYD, and CYP2C19 that were detected in MI-Oncoseq were confirmed by external genotyping. Genotype determinations could not be made for CYP3A5*3, UGT1A1*28, or UGT1A1*80. On the basis of retrospective assessment of 115 adult and pediatric patient records, 4.3% (n = 5) had a potentially clinically actionable phenotype for TPMT, DPYD, or CYP2C19 and received a relevant medication. After accounting for differences in adult and pediatric recommendations, three of these patients could have received a treatment recommendation at the time of prescribing. Conclusion Germline genotype determinations for TPMT, DPYD, and CYP2C19 can be used to make evidence-based treatment recommendations in MI-Oncoseq patients. Although the proportion of patients for whom recommendations can be made is small, this added value to MI-Oncoseq and patient care comes at no additional genotyping cost. Pharmacogenetic assessment should be integrated into tumor sequencing programs that genotype matched germline DNA; however, the complexity and additional cost of implementing pharmacogenetics remain challenging.

scholarly journals How We Care for an Older Patient With Cancer

2017 ◽  
Vol 13 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Armin Shahrokni ◽  
Soo Jung Kim ◽  
George J. Bosl ◽  
Beatriz Korc-Grodzicki
Keyword(s):  
Predictive Models ◽  
Older Patients ◽  
Process Development ◽  
Adverse Outcomes ◽  
Added Value ◽  
Cancer Center ◽  
Multiple Chronic Conditions ◽  
Older Patient ◽  
Improve Patient Survival ◽  
Patients With Cancer

As the number of older patients with cancer is increasing, oncology disciplines are faced with the challenge of managing patients with multiple chronic conditions who have difficulty maintaining independence, who may have cognitive impairment, and who also may be more vulnerable to adverse outcomes. National and international societies have recommended that all older patients with cancer undergo geriatric assessment (GA) to detect unaddressed problems and introduce interventions to augment functional status to possibly improve patient survival. Several predictive models have been developed, and evidence has shown correlation between information obtained through GA and treatment-related complications. Comprehensive geriatric evaluations and effective interventions on the basis of GA may prove to be challenging for the oncologist because of the lack of the necessary skills, time constraints, and/or limited available resources. In this article, we describe how the Geriatrics Service at Memorial Sloan Kettering Cancer Center approaches an older patient with colon cancer from presentation to the end of life, show the importance of GA at the various stages of cancer treatment, and how predictive models are used to tailor the treatment. The patient’s needs and preferences are at the core of the decision-making process. Development of a plan of care should always include the patient’s preferences, but it is particularly important in the older patient with cancer because a disease-centered approach may neglect noncancer considerations. We will elaborate on the added value of co-management between the oncologist and a geriatric nurse practitioner and on the feasibility of adapting elements of this model into busy oncology practices.

CoCanCPG. Coordination of Cancer Clinical Practice in Europe

2008 ◽  
Vol 94 (2) ◽  
pp. 154-159 ◽  
Author(s):  
Bèatrice Fervers ◽  
Magali Remy-Stockinger ◽  
Valèrie Mazeau-Woynar ◽  
Renèe Otter ◽  
Alessandro Liberati ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cancer Survival ◽  
Guideline Development ◽  
Critical Mass ◽  
Added Value ◽  
Evidence Based ◽  
Patients With Cancer ◽  
Use Of Resources ◽  
Common Framework

All European countries are facing common challenges for delivering appropriate, evidence-based care to patients with cancer. Despite tangible improvements in diagnosis and treatment, marked differences in cancer survival exist throughout Europe. The reliable translation of new research evidence into consistent patient-oriented strategies is a key endeavour to overcome inequalities in healthcare. Clinical-practice guidelines are important tools for improving quality of care by informing professionals and patients about the most appropriate clinical practice. Guideline programmes in different countries use similar strategies to achieve similar goals. This results in unnecessary duplication of effort and inefficient use of resources. While different initiatives at the international level have attempted to improve the quality of guidelines, less investment has been made to overcome existing fragmentation and duplication of effort in cancer guideline development and research. To provide added value to existing initiatives and foster equitable access to evidence-based cancer care in Europe, CoCanCPG will establish cooperation between cancer guideline programmes. CoCanCPG is an ERA-Net coordinated by the French National Cancer Institute with 17 partners from 11 countries. The CoCanCPG partners will achieve their goal through an ambitious, step-wise approach with a long-term perspective, involving: 1. implementing a common framework for sharing knowledge and skills; 2. developing shared activities for guideline development; 3. assembling a critical mass for pertinent research into guideline methods; 4. implementing an appropriate framework for cooperation. Successful development of joint activities involves learning how to adopt common quality standards and how to share responsibilities, while taking into account the cultural and organisational diversity of the participating organisations. Languages barriers and different organisational settings add a level of complexity to setting up transnational collaboration. Through its activities, CoCanCPG will make an important contribution towards better access to evidence-based cancer practices and thus contribute to reducing inequalities and improving care for patients with cancer across Europe.

scholarly journals Anxiety, depression, and quality of life in caregivers of patients with cancer in late palliative phase

2005 ◽  
Vol 16 (7) ◽  
pp. 1185-1191 ◽  
Author(s):  
E.K. Grov ◽  
A.A. Dahl ◽  
T. Moum ◽  
S.D. Fosså
Keyword(s):  
Quality Of Life ◽  
Patients With Cancer ◽  
Palliative Phase ◽  
Anxiety Depression

Advance care planning for patients with cancer in the palliative phase in Dutch general practices

2018 ◽  
Vol 36 (5) ◽  
pp. 587-593 ◽  
Author(s):  
Daisy J M Ermers ◽  
Karin J H van Bussel ◽  
Marieke Perry ◽  
Yvonne Engels ◽  
Henk J Schers
Keyword(s):  
Advance Care Planning ◽  
Daily Practice ◽  
Health Care Use ◽  
Care Planning ◽  
Electronic Patient Records ◽  
Medical Interventions ◽  
Patients With Cancer ◽  
Advance Care ◽  
General Practices ◽  
Palliative Phase

Abstract Background Advance care planning (ACP) is a crucial element of palliative care. It improves the quality of end-of-life care and reduces aggressive and needless life-prolonging medical interventions. However, little is known about its application in daily practice. This study aims to examine the application of ACP for patients with cancer in general practice. Methods We performed a retrospective cohort study in 11 general practices in the Netherlands. Electronic patient records (EPRs) of deceased patients with colorectal or lung cancer were analysed. Data on ACP documentation, correspondence between medical specialist and GP, and health care use in the last year of life were extracted. Results Records of 163 deceased patients were analysed. In 74% of the records, one or more ACP items were registered. GPs especially documented patients’ preferences for euthanasia (58%), palliative sedation (46%) and preferred place of death (26%). Per patient, GPs received on average six letters from medical specialists. These letters mainly contained information regarding medical treatment and rarely ACP items. In the last year of life, patients contacted the GP over 30 times, and 51% visited the emergency department at least once, of whom 54% in the last month. Conclusions Registration of ACP items in GPs’ EPRs appeared to be limited. ACP elements were rarely subject of communication between primary and secondary care, which may impact the continuity of patient care during the last year of life. More emphasis on registration of ACP items and better exchange of information regarding patients’ preferences are needed.

scholarly journals Caregiver reactions and social provisions among family members caring for home-dwelling patients with cancer in the palliative phase: A cross-sectional study

2019 ◽  
Vol 7 (4) ◽  
pp. 1
Author(s):  
Marianne Fjose ◽  
Grethe Eilertsen ◽  
Marit Kirkevold ◽  
Ellen K. Grov
Keyword(s):  
Older Adult ◽  
Advanced Cancer ◽  
Family Caregiver ◽  
Family Members ◽  
Adult Patients ◽  
Patients With Cancer ◽  
The Family ◽  
Palliative Phase ◽  
The Impact ◽  
Social Provisions

Objective: Studies focusing on the impact of caregiving for older adult home-dwelling patients with cancer in the palliative phase, particularly the burdens on different family caregiver groups, are limited. The objective of this study was to assess and compare caregiver reactions and social provisions among different family caregiver groups in Norway.Methods: The sample consisted of 58 family members caring for 26 home-dwelling older adult patients with advanced cancer. The Caregiver Reaction Assessment and Social Provisions Scale were used to assess the caregiver reactions and social support, respectively. The analyses were performed using descriptive statistics.Results: Significant differences were revealed between the family caregiver groups in the following three dimensions of the Caregiver Reaction Assessment: impact on schedule, lack of family support and impact on health. Significant differences were revealed between the family caregiver groups in the following two dimensions of the Social Provisions Scale: nurturance and attachment.Conclusions: In our study, children and children-in-law caring for widowed patients and spouses were the most vulnerable family caregivers. We recommend assessing the caregiver situation of all available family members caring for older adult patients with advanced cancer to identify the most vulnerable caregivers.

scholarly journals Development and Evaluation of an Integrated Digital Patient Platform During Oncology Treatment

2019 ◽  
Vol 7 (1) ◽  
pp. 53-61 ◽  
Author(s):  
Melissa De Regge ◽  
Elsie Decoene ◽  
Kristof Eeckloo ◽  
Ann Van Hecke
Keyword(s):  
Personal Health Information ◽  
Added Value ◽  
Digital Platforms ◽  
Patients With Cancer ◽  
Oncology Nurse ◽  
Care Approach ◽  
Oncology Treatment ◽  
Survey Interviews ◽  
Active Patients ◽  
Insight Into

Background: Patient platforms are seen as promising technologies in an integrated care approach to involve cancer patients in their own health care and to support them in managing their personal health information. However, few digital platforms have been codesigned with patients and caregivers. Objective: To develop, implement, and evaluate the feasibility and applicability of a digital oncology platform (DOP) for patients with cancer. Method: A mixed-method study was used, employing a survey, interviews, and logged data from caregivers and patients. The DOP was designed in cooperation with Information Technology (IT) staff, caregivers, and patients. Results: The DOP was actively used by half of the patients. These active patients were positive about the DOP. Caregivers acknowledged the added value but also indicate that additional workload was involved. Oncology nurse specialists are the users of the platform. General practitioners have indicated their interest in the platform. Conclusion: Thanks to the codesign process, the DOP could be tailored to the expectations of the end users. This study provides insight into which DOP functionalities the patients were interested in and includes further recommendations for implementation.

scholarly journals The added value of an assessment of the patient's hand grip strength to the comprehensive geriatric assessment in G8-abnormal older patients with cancer in routine practice

2019 ◽  
Vol 10 (6) ◽  
pp. 931-936 ◽  
Author(s):  
Michelle Lycke ◽  
Lore Ketelaars ◽  
Evi Martens ◽  
Tessa Lefebvre ◽  
Hans Pottel ◽  
...  
Keyword(s):  
Grip Strength ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Older Patients ◽  
Hand Grip Strength ◽  
Added Value ◽  
Routine Practice ◽  
Patients With Cancer ◽  
Hand Grip

scholarly journals The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer

Cancer ◽  
2018 ◽  
Vol 124 (18) ◽  
pp. 3753-3763 ◽  
Author(s):  
Cindy Kenis ◽  
Abdelbari Baitar ◽  
Lore Decoster ◽  
Jacques De Grève ◽  
Jean-Pierre Lobelle ◽  
...  
Keyword(s):  
Overall Survival ◽  
Older Patients ◽  
Added Value ◽  
Patients With Cancer ◽  
Geriatric Screening
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