The Role of Palliative Care in Oncology

AbstractPalliative care is a powerful adjunct to oncology that adds distinct value to the physical, mental, and psychosocial well-being of patients living with cancer. Its expanding role and integration with standard oncologic care has proven clinical benefit, as the practice of palliative care can help alleviate symptom burden, enhance illness and prognostic understanding, and improve both the quality of life and overall survival for patients. The primary aim of this review article is to highlight the significant interplay between palliative care and oncology and, in doing so, shed light on the areas for improvement and modern challenges that exist to meet the complex palliative care needs of patients with cancer.

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Psychiatric symptoms in palliative care

Oxford Handbook of Palliative Care ◽

10.1093/med/9780198745655.003.0022 ◽

2019 ◽

pp. 637-656

Keyword(s):

Palliative Care ◽

Psychiatric Symptoms ◽

Emotional Health ◽

Well Being ◽

Emotional Reactions ◽

Care Needs ◽

The Common ◽

Palliative Care Needs ◽

Health And Well Being

This chapter covers the common psychiatric symptoms experienced in people with palliative care needs. It covers the challenges of diagnosis in this particular population and the need to take account of both the patients’ own coping mechanisms and the health challenges that they are facing as they approach the end of life. Palliative care is the provision of holisitic management to individuals and their carers/families who are facing issues associated with life-limiting illness. It embraces a biopsychosociocultural and spiritual approach with emphasis on quality of life. Consequently, the maintenance of psychological and emotional health and well-being is an essential component in the provision of comprehensive care. Initial diagnosis—and the circumstances surrounding this—is a time of great challenge for most patients, and the potential for strong emotional reactions and intense feelings of distress is heightened.

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The effectiveness of hope-fostering interventions in palliative care: A systematic review and meta-analysis

Palliative Medicine ◽

10.1177/0269216321994728 ◽

2021 ◽

pp. 026921632199472

Author(s):

Natalia Salamanca-Balen ◽

Thomas V Merluzzi ◽

Man Chen

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Palliative Care ◽

Meta Analysis ◽

Symptom Burden ◽

Well Being ◽

Medium Effect ◽

Spiritual Well Being ◽

Quasi Experimental

Background: The concept of hope is an important theme in chronic illness and palliative care and has been associated with increased psycho-spiritual well-being and quality of life. Psycho-spiritual interventions have been described in this population, but no systematic review of hope-enhancing interventions or hopelessness-reducing interventions has been conducted for persons with palliative care diseases. Aim: To describe and assess the effectiveness of interventions in palliative care that measure hope and/or hopelessness as an outcome. Design: This systematic review and meta-analysis was pre-registered (Prospero ID: CRD42019119956). Data sources: Electronic databases, journals, and references were searched. We used the Cochrane criteria to assess the risk of bias within studies. Results: Thirty-five studies (24 randomized controlled trials, 5 quasi-experimental, 6 pre-post studies) involving a total of 3296 palliative care patients were included. Compared with usual/standard cancer care alone, interventions significantly increased hope levels at a medium effect size ( g = 0.61, 95% confidence interval (CI) = 0.28–0.93) but did not significantly reduce hopelessness ( g = −0.08, 95% CI = −0.18 to 0.02). It was found that interventions significantly increase spirituality ( g = 0.70, 95% CI = 0.02–1.37) and decrease depression ( g = −0.29, 95% CI = −0.51 to −0.07), but had no significant effect over anxiety, quality of life, and symptom burden. Overall, quality of evidence across the included studies was rated as low. Conclusions: Evidence suggests that interventions can be effective in increasing hope in palliative care patients.

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Identifying Palliative Care Needs in Assisted Living

Innovation in Aging ◽

10.1093/geroni/igaa057.2854 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 788-788

Author(s):

Daniel David ◽

Abraham Brody ◽

Tina Sadarangani ◽

Bei Wu ◽

Tara Cortez

Keyword(s):

Palliative Care ◽

Assisted Living ◽

Unmet Needs ◽

Care Needs ◽

Code Status ◽

Care Services ◽

Palliative Care Services ◽

Advance Care ◽

Palliative Care Needs

Abstract Many residents of Assisted Living (AL) confront serious illness and therefore might benefit from greater access to Palliative Care Services to improve quality of life. We surveyed resident records and AL nursing staff to identify patients in need of Palliative Care. Preliminary findings showed that nurses predicted 23% would not be alive and 49% would no longer live in AL. A majority of residents were over the age of 90, yet 30% did not have a reported code status. These findings suggest that a substantial portion of AL residents may have unmet needs with respect to palliative care. Future interventions are needed to support advance care planning conversations and make palliative care more accessible to this population.

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E10-B Palliative Care Needs at Different Phases in the Illness Trajectory: A Survey Study in Patients with Cancer

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2016.10.120 ◽

2016 ◽

Vol 52 (6) ◽

pp. e45

Author(s):

Kim Beernaert ◽

Koen Pardon ◽

Lieve Van den Block ◽

Dirk Devroey ◽

Martine De Laat ◽

...

Keyword(s):

Palliative Care ◽

Survey Study ◽

Care Needs ◽

Illness Trajectory ◽

Patients With Cancer ◽

Palliative Care Needs

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Pilot Randomized Trial of a Transdisciplinary Geriatric and Palliative Care Intervention for Older Adults With Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2019.7386 ◽

2020 ◽

Vol 18 (5) ◽

pp. 591-598

Author(s):

Ryan D. Nipp ◽

Brandon Temel ◽

Charn-Xin Fuh ◽

Paul Kay ◽

Sophia Landay ◽

...

Keyword(s):

Older Adults ◽

Palliative Care ◽

Usual Care ◽

Pilot Trial ◽

Symptom Burden ◽

Medium Effect ◽

Care Needs ◽

Care Intervention ◽

Cancer Types

Background: Oncologists often struggle with managing the unique care needs of older adults with cancer. This study sought to determine the feasibility of delivering a transdisciplinary intervention targeting the geriatric-specific (physical function and comorbidity) and palliative care (symptoms and prognostic understanding) needs of older adults with advanced cancer. Methods: Patients aged ≥65 years with incurable gastrointestinal or lung cancer were randomly assigned to a transdisciplinary intervention or usual care. Those in the intervention arm received 2 visits with a geriatrician, who addressed patients’ palliative care needs and conducted a geriatric assessment. We predefined the intervention as feasible if >70% of eligible patients enrolled in the study and >75% of eligible patients completed study visits and surveys. At baseline and week 12, we assessed patients’ quality of life (QoL), symptoms, and communication confidence. We calculated mean change scores in outcomes and estimated intervention effect sizes (ES; Cohen’s d) for changes from baseline to week 12, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect. Results: From February 2017 through June 2018, we randomized 62 patients (55.9% enrollment rate [most common reason for refusal was feeling too ill]; median age, 72.3 years; cancer types: 56.5% gastrointestinal, 43.5% lung). Among intervention patients, 82.1% attended the first visit and 79.6% attended both. Overall, 89.7% completed all study surveys. Compared with usual care, intervention patients had less QoL decrement (–0.77 vs –3.84; ES = 0.21), reduced number of moderate/severe symptoms (–0.69 vs +1.04; ES = 0.58), and improved communication confidence (+1.06 vs –0.80; ES = 0.38). Conclusions: In this pilot trial, enrollment exceeded 55%, and >75% of enrollees completed all study visits and surveys. The transdisciplinary intervention targeting older patients’ unique care needs showed encouraging ES estimates for enhancing patients’ QoL, symptom burden, and communication confidence.

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Pulmonary referrals to specialist palliative medicine: a survey

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003386 ◽

2021 ◽

pp. bmjspcare-2021-003386

Author(s):

Michael Bonares ◽

Kenneth Mah ◽

David Christiansen ◽

John Granton ◽

Andrea Weiss ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Chronic Respiratory Disease ◽

Life Care ◽

Care Needs ◽

Patients With Cancer ◽

Referral Criteria ◽

Referral Practices ◽

Palliative Care Needs

ObjectivesPatients with chronic respiratory disease have significant palliative care needs, but low utilisation of specialist palliative care (SPC) services. Decreased access to SPC results in unmet palliative care needs among this patient population. We sought to determine the referral practices to SPC among respirologists in Canada.MethodsRespirologists across Canada were invited to participate in a survey about their referral practices to SPC. Associations between referral practices and demographic, professional and attitudinal factors were analysed using regression analyses.ResultsThe response rate was 64.7% (438/677). Fifty-nine per cent of respondents believed that their patients have negative perceptions of palliative care and 39% were more likely to refer to SPC earlier if it was renamed supportive care. While only 2.7% never referred to SPC, referral was late in 52.6% of referring physicians. Lower frequency of referral was associated with equating palliative care to end-of-life care (p<0.001), male sex of respirologist (p=0.019), not knowing referral criteria of SPC services (p=0.015) and agreement that SPC services prioritise patients with cancer (p=0.025); higher referral frequency was associated with satisfaction with SPC services (p=0.001). Late referral was associated with equating palliative care to end-of-life care (p<0.001) and agreement that SPC services prioritise patients with cancer (p=0.013).ConclusionsPossible barriers to respirologists’ timely SPC referral include misperceptions about palliative care, lack of awareness of referral criteria and the belief that SPC services prioritise patients with cancer. Future studies should confirm these barriers and evaluate the effectiveness of strategies to overcome them.

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Telemedically Augmented Palliative Care

Advances in Healthcare Information Systems and Administration - Achieving Effective Integrated E-Care Beyond the Silos ◽

10.4018/978-1-4666-6138-7.ch009 ◽

2014 ◽

pp. 185-201

Author(s):

Romina Nemecek ◽

Patrick Huber ◽

Sophie Schur ◽

Eva Masel ◽

Stefanie Porkert ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Family Caregivers ◽

Hospital Admissions ◽

Intervention Group ◽

Symptom Burden ◽

Well Being ◽

Control Group ◽

User Friendly

Patients with advanced cancer have a substantial symptom burden, which deteriorates their quality of life. Palliative care improves well-being of patients and their family caregivers. Within the scope of a controlled pilot study, a user-friendly telepresence system is developed, which enables patients and family caregivers to send a direct request to a palliative care team. Additionally, a specially tailored database is developed, which contains up to date patient information. Twenty patients with advanced non-small cell lung cancer are consecutively assigned in a control and an intervention group. The intervention group receives the telemedically augmented care, whereas the control group receives standard care. The primary goal of this chapter is to determine the usability and feasibility; the secondary goal is the assessment of the intervention's impact on quality of life and the number of unscheduled hospital admissions. To sum up, telemedically supported ambulatory palliative care may synergistically help to improve safety and quality of life.

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1-2-3 Project: A Quality Improvement Initiative to Normalize and Systematize Palliative Care for All Patients With Cancer in the Outpatient Clinic Setting

Journal of Oncology Practice ◽

10.1200/jop.18.00346 ◽

2018 ◽

Vol 14 (12) ◽

pp. e775-e785 ◽

Cited By ~ 7

Author(s):

Anjali V. Desai ◽

Virginia M. Klimek ◽

Kimberly Chow ◽

Andrew S. Epstein ◽

Camila Bernal ◽

...

Keyword(s):

Decision Making ◽

Palliative Care ◽

Outpatient Clinic ◽

Core Values ◽

Newly Diagnosed ◽

Care Needs ◽

Patients With Cancer ◽

Palliative Care Consultation ◽

Care Consultation ◽

Palliative Care Needs

Background: Prior work to integrate early palliative care in oncology has focused on patients with advanced cancer and primarily on palliative care consultation. We developed this outpatient clinic initiative for newly diagnosed patients at any stage, emphasizing primary (nonspecialist) palliative care by oncology teams, with enhanced access to palliative care specialists. Methods: We piloted the project in two medical oncology specialty clinics (for patients with myelodysplastic syndrome and GI cancer, respectively) to establish feasibility. On a visit-based schedule, patients systematically reported symptoms, information/decision-making preferences, and illness understanding. They also participated in discussions of their core values with their oncology nurse. Oncology teams were first responders to palliative care needs, whereas specialists were available for clinician support and direct patient consultation. Results: All 58 eligible patients were enrolled. In both clinics, patient self-reports documented a heavy symptom burden. Information/decision-making preferences and illness understanding levels varied across patients. Patients prepared new advance directives. Oncology nurses documented discussions of core values. Requests for palliative care consultation decreased over time as oncology teams embraced their primary palliative care role with coaching from the specialists. Clinic workflow and patient volume were maintained. Conclusion: Our pilot experience suggests that in outpatient oncology clinics, a structured, scheduled, and systematic approach is feasible to deliver palliative care to newly diagnosed patients with cancer at any stage and throughout their illness trajectory. This novel approach identified important, actionable palliative care needs, relying primarily on oncology teams to respond to these needs, while enhancing access to palliative care specialist input. Expansion to additional clinics will allow evaluation of scalability and generalizability, along with measurement of a broader range of important outcomes.

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