scholarly journals External Validation of the Number of Risk Factors Score in a Palliative Care Outpatient Clinic at a Comprehensive Cancer Center

2014 ◽  
Vol 17 (7) ◽  
pp. 797-802 ◽  
Author(s):  
Paul Glare ◽  
Imran Shariff ◽  
Howard T. Thaler
Keyword(s):  
Risk Factors ◽  
Palliative Care ◽  
Outpatient Clinic ◽  
External Validation ◽  
Comprehensive Cancer Center ◽  
Cancer Center

External validation of the simple prognostic score in a palliative care clinic at a comprehensive cancer center.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19566-e19566
Author(s):  
Brinder Vij ◽  
Stacy Marie Stabler ◽  
Howard T. Thaler ◽  
Paul A. Glare
Keyword(s):  
Palliative Care ◽  
Karnofsky Performance Status ◽  
Prognostic Score ◽  
External Validation ◽  
Comprehensive Cancer Center ◽  
Rank Test ◽  
Cancer Center ◽  
Cancer Type ◽  
Care Clinic ◽  
Percentage Difference

e19566 Background: Accurate survival predictions are essential for the optimal delivery of palliative care (PC). Clinical predictions of survival are notoriously inaccurate. Tools for making objective survival estimates in ambulatory cancer patients, who have months or years to live, are lacking. The Simple Prognostic Score (SPS) separated Canadian palliative radiotherapy patients into three groups with 12, 6 and 3 months median survivals, respectively. The aim of this study was to test the SPS in an outpatient PC clinic at a U.S. comprehensive cancer center. Methods: Retrospective chart review of 300 consecutive patients referred to one PC clinic at Memorial Sloan-Kettering Cancer Center (MSKCC). Cancer type, metastatic sites and Karnofsky performance status (KPS) score were used to calculate SPS (1 point each for non-breast cancer; non-osseous metastases; KPS score <70%). Outcome was date of death, obtained from the MSKCC institutional data base. Survival analysis was performed. Discrimination (non-overlap between groups) and calibration (percentage difference between estimated and observed survival) were measures of accuracy. Results: 79% (236 of 300) patients had advanced disease. Of them, 90% had cancers other than breast; 76% had metastases in sites other than bone; 27% had a low KPS score. The SPS score was 2 or 3 in 80%. By 10/31/11, 85% had died (median survival 4.9 months). SPS categorized the sample into four prognostic subgroups (see Table), with median survivals of 15, 9, 5 and 2 months respectively (log rank test χ2=38.71, d.f .3, p<0.0001). SPS was not very accurate, with poor discrimination (extensive intergroup overlap) but reasonable calibration (6-15% for the different groups). Conclusions: The SPS is user-friendly and helpful at the group level, but inaccurate at the individual level. Additional variables may narrow the prediction intervals, but will make the tool more complex. [Table: see text]

scholarly journals Antineoplastic therapy use in patients with advanced cancer admitted to an acute palliative care unit at a comprehensive cancer center

Cancer ◽  
2010 ◽  
Vol 116 (8) ◽  
pp. 2036-2043 ◽  
Author(s):  
David Hui ◽  
Ahmed Elsayem ◽  
Zhijun Li ◽  
Maxine De La Cruz ◽  
J. Lynn Palmer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Antineoplastic Therapy ◽  
Advanced Cancer ◽  
Palliative Care Unit ◽  
Comprehensive Cancer Center ◽  
Cancer Center

Interval between first palliative care consultation and death among patients in a comprehensive cancer center in Saudi Arabia

2015 ◽  
Vol 3 (2) ◽  
pp. 61 ◽  
Author(s):  
SamiAyed Alshammary ◽  
Abdullah Alsuhail ◽  
BalajiP Duraisamy ◽  
Savithiri Ratnapalan ◽  
SaadHamad Alabdullateef
Keyword(s):  
Palliative Care ◽  
Saudi Arabia ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Palliative Care Consultation ◽  
Care Consultation

scholarly journals Work Experiences of Patients Receiving Palliative Care at a Comprehensive Cancer Center: Exploratory Analysis

2017 ◽  
Vol 20 (7) ◽  
pp. 770-773 ◽  
Author(s):  
Paul A. Glare ◽  
Tanya Nikolova ◽  
Alberta Alickaj ◽  
Sujata Patil ◽  
Victoria Blinder
Keyword(s):  
Palliative Care ◽  
Exploratory Analysis ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Work Experiences

The impact of a palliative care service on overall hospital mortality in a comprehensive cancer center

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 8034-8034
Author(s):  
A. F. Elsayem ◽  
R. Jenkins ◽  
L. Parmley ◽  
M. L. Smith ◽  
J. L. Palmer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hospital Mortality ◽  
Care Service ◽  
Palliative Care Service ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
The Impact

The use of palliative sedation for intractable symptoms in a palliative care unit (PCU) in a comprehensive cancer center

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8577-8577 ◽  
Author(s):  
A. Elsayem ◽  
E. Curry ◽  
J. Boohene ◽  
H. Ibrahim ◽  
E. Pace ◽  
...  
Keyword(s):  
Palliative Care ◽  
Head And Neck ◽  
Poor Prognosis ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Pharmacy Records ◽  
Progressive Dyspnea ◽  
Midazolam Infusion

8577 Background: There is wide variation in the frequency of reported use of palliative sedation (PS) to control intractable and refractory symptoms. Institutions have established policies for midazolam infusion in cases of PS. The indications and outcomes of this procedure have not been well characterized Methods: Our midazolam policy for PS requires 1:1 nursing for the first 24 hours and documentation of discussions regarding sedation. We reviewed our PCU database for all admissions for the first 11 months of 2005. We used pharmacy records for all patients who received medications used for sedation (chlorpromazine, lorazepam, midazolam). We reviewed all charts of pts who received any of these drugs to establish if the indication had been PS. Results: 148/484 admissions died in the PCU [31%]. 65/484 admissions (13%), and 47/ 148 patients who died (32%) received PS. Median age of patients (pts) was 58, 42 pts were male [65%], and the most frequent primaries observed were lung 24 [37%], hematologic 12 [18%], head and neck 7 [11%], and gastrointestinal 7 [11%]. Results are indicated in the table. * 2 patients had more than one indication for sedation The main causes for PS in our patients were delirium 57 [88%], dyspnea 6 [9%], and bleeding 4 [6%]. 18/65 patients who received PS [35%] were discharged alive, versus 318/419 [76%] who did not receive PS [p< 0.001]. Midazolam was used in 11/65 episodes [17%]. 4/6 pts with PS for dyspnea received midazolam [66%], versus 8/57 with PS for delirium or bleeding [14%], p=0.01]. 18/54 pts who received PS using other drug were discharged alive [33%], versus 0/11 pts who received midazolam [p=0.02]. Conclusions: Palliative sedation was required in 32% of pts who died in the hospital. Reporting midazolam utilization rates for monitoring overall PS outcomes, results in significant under reporting. Midazolam was used more frequently in cases of progressive dyspnea and poor prognosis. Less restrictive policies in the use of midazolam may result in more use for PS. Data accrual continues. [Table: see text] No significant financial relationships to disclose.

Utilization of antineoplastic therapy (ANT) in advanced cancer patients admitted to an acute palliative care unit (APCU) at a comprehensive cancer center

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9590-9590
Author(s):  
D. Hui ◽  
E. Bruera ◽  
Z. Li ◽  
J. L. Palmer ◽  
M. de la Cruz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Univariate Analysis ◽  
Palliative Care Unit ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Targeted Agents ◽  
Cox Regression Analysis ◽  
Younger Age

9590 Background: Cancer patients admitted to a palliative care unit generally have a poor prognosis. The role of ANT (chemotherapy and targeted agents) in these patients is unclear. We examined the frequency, trends, factors and survival associated with ANT use in hospitalized patients who required an APCU stay. Methods: All patients admitted to APCU between September 1, 2003 and August 31, 2008 were included. Demographics, cancer diagnosis and ANTs utilization from day of hospitalization to discharge, and survival information were retrieved retrospectively. Results: 2604 cancer patients had the following characteristics: median age 59 (range 18–101), male 51%, hematologic malignancy 11%, median hospital stay 11 (Q1-Q3 8–17) days, median APCU stay 7 (Q1-Q3 4–10) days and median survival 22 days. During hospitalization, 393 patients (15%) received ANTs, including chemotherapy (N=297, 11%) and targeted therapy (N=155, 6%). No significant change in frequency of ANTs was detected over the 5 year period. Multivariate logistic regression analysis ( Table ) revealed that younger age, cancer primaries and longer admissions were associated with ANT use. Patients with hematologic malignancies received more chemotherapy (38% vs. 8%, p<0.001) and targeted agents (18% vs. 4%, p<0.001) compared to patients with solid tumors. ANT use was associated with longer overall survival in univariate analysis (median 25 days vs. 21 days, p=0.001); however, this was no longer significant in multivariate Cox regression analysis. Conclusions: The use of ANT during hospitalization that included an APCU stay was limited to a highly selected group of patients, and did not increase overtime. ANT use was associated with younger age, specific cancer primaries, longer admissions, and no significant improvement in survival. The APCU at our cancer center facilitates simultaneous care where patients access palliative care while on ANT. [Table: see text] No significant financial relationships to disclose.

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