Impact of a Palliative Care Service on In-Hospital Mortality in a Comprehensive Cancer Center

51 Background: Accreditation Canada has adopted four main values for hospice, palliative, and end-of-life services: dignity and respect; information sharing; partnership and participation; and collaboration . These domains, as well as communication and joint decision-making, are important for satisfaction of caregivers for patients with cancer, and can be measured using the FAMCARE questionnaire. We aimed to assess satisfaction of caregivers for patient admitted to an acute palliative care unit at a comprehensive cancer center in Toronto, Canada. Methods: The FAMCARE questionnaire was administered by a trained volunteer to self-identified caregivers of patients who were admitted for more than five days on the acute palliative care unit. A short, anonymous demographic survey accompanied the FAMCARE questionnaire to gather information on relationship to patient, ethnicity, patient length of stay, and location of residence. The survey package either was completed in the presence of the volunteer, or was left to be completed by the caregiver alone and collected later by the volunteer. Results were reviewed regularly at the quality committee of the palliative care service. Results: From September 2014 to March 2017, 90 caregivers completed the questionnaire. Most caregivers were female (69%), identified as Canadian or Caucasian (57%), and lived in Toronto (63%). In all, 57% were spouses while 31% were children of the patient. Most patients had been admitted between a week and a month (67%). Care was rated as “Satisfied” or “Very satisfied” most of the time on all items (range 81-100%). The availability of nurses and doctors (100% satisfied/very satisfied) and the way tests and treatments were followed-up (99%) were rated highest. Information given about side effects (81%) and referral to specialists (83%) were rated lowest. Conclusions: Despite the nature of the acute palliative care unit, where patients admitted tend to be very ill with complex symptoms and psychosocial issues, caregiver satisfaction was high. Future research will examine whether caregivers of different ethnicities value different aspects of cancer care.

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Predictors of outpatients’ request for palliative care service at a medical oncology clinic of a German comprehensive cancer center

Supportive Care in Cancer ◽

10.1007/s00520-018-4245-7 ◽

2018 ◽

Vol 26 (10) ◽

pp. 3641-3647 ◽

Cited By ~ 2

Author(s):

Mitra Tewes ◽

Teresa Rettler ◽

Nathalie Wolf ◽

Jörg Hense ◽

Martin Schuler ◽

...

Keyword(s):

Palliative Care ◽

Medical Oncology ◽

Care Service ◽

Palliative Care Service ◽

Comprehensive Cancer Center ◽

Cancer Center

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Assessing caregiver satisfaction with care on an acute palliative care unit.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.180 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 180-180 ◽

Cited By ~ 1

Author(s):

Ernie Mak ◽

Patricia Murphy-Kane ◽

Camilla Zimmermann

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Palliative Care Unit ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Future Research ◽

Joint Decision ◽

Caregiver Satisfaction ◽

Patients With Cancer

180 Background: Accreditation Canada has adopted four main values for hospice, palliative, and end-of-life services: dignity and respect; information sharing; partnership and participation; and collaboration . These domains, as well as communication and joint decision-making, are important for satisfaction of caregivers for patients with cancer, and can be measured using the FAMCARE questionnaire. We aimed to assess satisfaction of caregivers for patient admitted to an acute palliative care unit at a comprehensive cancer center in Toronto, Canada. Methods: The FAMCARE questionnaire was administered by a trained volunteer to self-identified caregivers of patients who were admitted for more than five days on the acute palliative care unit. A short, anonymous demographic survey accompanied the FAMCARE questionnaire to gather information on relationship to patient, ethnicity, patient length of stay, and location of residence. The survey package either was completed in the presence of the volunteer, or was left to be completed by the caregiver alone and collected later by the volunteer. Results were reviewed regularly at the quality committee of the palliative care service. Results: From September 2014 to May 2018, 116 caregivers completed the questionnaire. Most caregivers were female (66%), identified as Canadian or Caucasian (56%), and lived in Toronto (66%). In all, 52% were spouses while 27% were children of the patient. Most patients had been admitted between a week and a month (68%). Care was rated as “Satisfied” or “Very satisfied” most of the time on all items (range 77-99%). The availability of nurses and doctors (99% satisfied/very satisfied) were rated highest. Information given about side effects (77%) and referral to specialists (84%) were rated lowest. Conclusions: Despite the nature of the acute palliative care unit, where patients admitted tend to be very ill with complex symptoms and psychosocial issues, caregiver satisfaction was high. Developing adequate support for the spouses of patients is important. Future research will examine whether caregivers of different ethnicities value different aspects of cancer care.

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Quality matters: Patterns of palliative interventions in metastatic colorectal cancer (mCRC) patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.83 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 83-83

Author(s):

Rebecca M. Prince ◽

Shuyin Liang ◽

Mantaj Brar ◽

Stephanie Ramkumar ◽

Adena Scheer ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Care Service ◽

Quality Care ◽

Symptom Relief ◽

Palliative Care Service ◽

Palliative Surgery ◽

Cancer Center ◽

The Mean ◽

Mean Time

83 Background: Increasing recognition that high-quality end of life care is essential has resulted in internationally endorsed metrics allowing assessment of interventions at the end of life. Median survival for mCRC patients has improved to more than 24 months resulting in increased opportunity to undergo interventions for symptom relief at the end of life. We explored patterns of palliative interventions (chemotherapy, radiotherapy, surgery, endoscopy, drainage procedures) and outcomes in mCRC patients. Methods: A retrospective review was undertaken of all mCRC patients referred to the palliative care service from 2000 to 2010 at a tertiary cancer center in Toronto, Canada. Descriptive statistics, survival analysis and regression were employed. Results: A total of 542 patients were included of whom 52.8% were male, mean age was 62.8 years and 44.6% had stage 4 disease at diagnosis. Over the course of their disease 93.9% had an intervention at any time after their diagnosis including 27.5% of patients undergoing palliative surgery, 77% of patients had an intervention in the last year of life and 19.1% had an intervention in the last 30 days of life. The percentage of patients receiving interventions within the last 14 days of life were 1.23% for chemotherapy, 4.6% for radiotherapy, 0.5% for surgery, 10.4% for endoscopy and 23% drainage procedures. The mean time between referral to palliative care and death was 7 months (SD 10.4). For patients who received chemotherapy, the mean time between last chemotherapy and death was 9.5 months (SD 14.9). Overall survival for patients who did not receive chemotherapy was 28 months (SD 33) compared with 40 months (SD 32) for those who received chemotherapy. Regression analysis for risks of dying within 30 days of chemotherapy was limited by a low event rate. Increasing age was significantly associated with a lower risk of dying within 30 days of chemotherapy. Conclusions: In their final months of life, palliative mCRC patients undergo a significant number of interventions aiming to improve quality of life. These require considerable multi-disciplinary input with ramifications for quality care, planning for service provision and funding.

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The outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.131 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 131-131

Author(s):

Si Won Lee ◽

Hye Jin Choi

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Group Performance ◽

Care Service ◽

Symptom Control ◽

Palliative Care Service ◽

Cancer Center ◽

Anticancer Treatment ◽

Tertiary Cancer Center

131 Background: The importance of palliative care in cancer patients continues to be emphasized and studies are proving its importance. Several studies proved the improvement of quality of life in advanced cancer patients. The efficacy of symptom control based on outpatient palliative care service has not yet been reported in Korea. The objective of this study is to review the outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea. Methods: We retrospectively reviewed 155 cancer patients who used outpatient clinic at Yonsei Cancer Center in Korea between April 2014 and December 2014. Symptom severity was measured by modified Korean version of Edmonton Symptom Assessment System. Twelve symptoms were assessed: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, anorexia, constipation, wellbeing, financial distress. Higher score means worse symptom. ESAS scores at baseline and follow-up assessments were analyzed. Results: The 155 patients had following characteristics: female 52.3%, median age 65 years (range 58-75), Hepatobiliary-pancreatic cancer and lung cancer patients accounted for the largest portion (n = 37, 23.9%; n = 36, 23.2% respectively). Most patients were Eastern Cooperative Oncology Group performance status 1 (n = 28, 18.1%) or 2 (n = 24, 15.5%). Ninety-two (59.4%) patients were referred to the palliative care team after anti-cancer treatments were all finished. Overall the symptoms did not change significantly from baseline to 2 consecutive follow up assessment except anorexia ( p value = 0.0195). Patients who were on active anticancer treatment had tendency of higher ESAS score than those finished with the anticancer treatment. However, all symptoms except nausea were not statistically significant. Conclusions: Most patients in this study did not have severe symptom scores that would show the differences of the symptom changes. Nevertheless, although not statistically significant, we found that patients on active anticancer treatment had higher symptom burden than those who were finished with the anticancer treatment. More meticulous symptom management is necessary to improve the symptom control.

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Home Palliative Care for Advanced Cancer: PC Can Be Introduced at Diagnosis or at Relapse in Thai Society, Independent of Oncology Service

Journal of Global Oncology ◽

10.1200/jgo.18.76800 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 112s-112s

Author(s):

I. Nuchprayoon

Keyword(s):

Palliative Care ◽

Cancer Therapy ◽

Advanced Cancer ◽

Care Service ◽

Palliative Care Service ◽

Metastatic Breast ◽

Cancer Center ◽

Ageing Population ◽

Oncology Service ◽

At Home

Background: Thailand is a resource-limited country with universal health care. Cancer services are available for everyone for free, but the system has been overloaded due to limited number of qualified specialist physicians, nurses, radiology technicians, and growing demand from ageing population. Patients with advanced cancer are often not referred to a palliative care (PC) service until multiple treatment failure. Aim: To provide a better access to PC, we initiated an independent palliative care counseling and home service, focusing on families of patients with advanced cancer. Methods: The families of patients with advanced cancer were referred to our home palliative care service through cancer patient support groups, self-referral or from other physicians. Eligibility for PC was guided through a Thai national guideline of cancer treatment as well as by NCCN guideline. Early stage cancer were excluded from the service and referred to oncology service of patient's choice. For each family, we arranged a family meeting/counseling session at patient's home or a designated place and introduce palliative care as well as cancer therapy options. If the patient choose palliative care, then we provide home PC. Patients are followed at home by home visits, and continually communicated online and by phone. Family members visits palliative clinic for morphine and other medications. Results: In the first 3 years of operation, 53 adult patients with advanced or recurrent cancer and their families were counseled. Fifty chose home palliative care service, exclusively (30) or along with a hospital oncology service (20), while 3 patients preferred life-prolonging cancer therapy. The average age (±SD) of patients were 60 (±16) years. The most common cancers were stage IV or metastatic breast (7), lung (6), colorectal (6), and leukemia/lymphoma (6). The median survival time of this PC cohort was 3.1 months, with 16 (32%) living > 6 months, and 10 (20%) > 1 year. Of 36 patients who had died, 22 (61%) died at home, 13 (36%) at a local hospital, and 1 (3%) at a cancer center. Conclusion: For advanced cancer patients, palliative care can be introduced early and efficiently by PC team and most people would prefer PC. PC counseling may serve as an entry point to cancer care system. For patients who choose early palliative care, it can reduce burden on the existing busy oncology service, while providing satisfaction on patients and family.

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The use of opioids in the last month of life in a tertiary cancer center in Jordan.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.54 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 54-54

Author(s):

Omar M. Shamieh ◽

Sewar S Salmany ◽

Odai Khamash ◽

Stella Dawood ◽

Mustafa Alkhreisat ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Care Service ◽

Tertiary Care ◽

Palliative Care Service ◽

Cancer Center ◽

Major Barrier ◽

Survival Difference ◽

Daily Dose ◽

Higher Doses

54 Background: The low rates of utilization of opioids is a major barrier to optimal pain control in cancer patients in developing countries. The presence of a palliative care service may improve opioid utilization. In our study we assessed opioid utilization in the last month of life for patients admitted to our tertiary care cancer center in Jordan, and compared the use of opioids with and without palliative care involvement. Methods: We conducted a retrospective chart review to examine opioid use for all adult patients who died at King Hussein Cancer Center between January 1st, 2012 until December 31st, 2012. Patient demographics, cancer diagnosis, type of opioid and total daily dose of opioids in morphine oral equivalent (OME) were collected in the last 30 days of life while admitted to the hospital. Results: Among the 297 patients included, the median age was 58 years (range, 19- 95), 134 (45%) were males, and 186 (62.6%) died under the palliative care service. The median admission length was 7 days. The average daily doses of opioids were 187mg, 214mg, 222mg (OME) in the last 24 hours, 48 hours, and 30 days of life, respectively, In the last 24 and 48 hours before death, 140 (47%) and 228 (77%) patients were on opioids, respectively. Younger age was associated with higher doses of opioids (P= 0.0001). We found no significant differences in patient characteristics between palliative and non-palliative care patients; however, patients under palliative care received significantly higher doses of opioids compared to non-palliative care patients in the last 30 days of life, the average daily dose of opioids (OME) was 249.4mg vs. 11.2mg (P< 0.001). There was no survival difference between palliative and non-palliative patients (P= 0.2244), or between patients who were on opioids or patients who were not (p= 0.57). Conclusions: A large minority of patients did not receive opioids at the end-of-life. Palliative care service was associated with higher utilization of opioids. Palliative care service may assist in pain management at the end-of-life.

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Effect of patient education on palliative care knowledge and acceptability of outpatient palliative care service among gynecologic oncology patients.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11583 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11583-11583 ◽

Cited By ~ 1

Author(s):

Ashley Graul ◽

Ashley Ford Haggerty ◽

Carolyn Stickley ◽

Pallavi Kumar ◽

Knashawn Morales ◽

...

Keyword(s):

Palliative Care ◽

Care Service ◽

Gynecologic Oncology ◽

Tertiary Care ◽

Palliative Care Service ◽

Cancer Center ◽

Educational Video ◽

Oncology Patients ◽

Care Services ◽

Palliative Care Services

11583 Background: This was a randomized control trial to estimate the effect of an interventional video on improving palliative care knowledge and acceptability of outpatient services in gynecologic oncology patients. Methods: Women receiving active treatment for gynecologic malignancy (persistent or progressive disease despite primary treatment) were recruited at an academic tertiary care center from 2/2018 to 1/2019 and randomized to: palliative care educational video or non-directive cancer center informational video (control). The primary outcome was desire for referral to palliative care. Function and knowledge were assessed using the Functional Assessment of Cancer Therapy (FACT-G) and the Palliative Care Knowledge Scales. Data analyses were performed using t-tests, Wilcoxon rank sum or Fisher’s exact tests with significance level of α=0.05. Results: 111 women were enrolled. Demographic characteristics were equally distributed between groups (mean age 63.4 vs 65.4 years; 78% vs 82% Caucasian, 58% vs 68% stage III, 71% vs 64% ovarian cancer, 65% vs 72% platinum-sensitive). There was no statistical difference in knowledge scores or in desire for referral to palliative care (29% vs 27%; p=0.79). Secondary analysis showed a statistically significant increase in utilization of palliative care services compared to historic institutional data (8.8% to 29.7%; p=<0.001). Further, those that desired referral had significantly worse FACT-G scores at time of referral choice (table). Conclusions: Use of a palliative care educational video did not increase knowledge or acceptability of palliative care services within this RCT. However, the rate of patients seeking palliative care referral tripled compared to historic rates. Further studies should investigate whether discussion regarding palliative care services alone may increase desire for referral, and if use of Fact-G scores may identify patients in greatest need of services. [Table: see text]

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