“At home without pain”: a national project on real time pain monitoring system in advanced cancer patients assisted at home by the ANT Foundation

Attitudes to home artificial nutrition (HAN) in cancer vary greatly from country to country. A 6-year prospective survey of the practice of HAN in advanced cancer patients applied by a hospital-at-home programme in an Italian health district was performed to estimate the utilization rate, to evaluate efficacy in preventing death from cachexia, maintaining patients at home without burdens and distress and improving patients' performance status, and to obtain information about costs. Patients were eligible for HAN when all the following were present: hypophagia; life expectancy 6 weeks or more, suitable patient and family circumstances; and verbal informed consent. From July 1990 to June 1996, 587 patients were evaluated; 164 were selected for HAN (135 enteral and 29 parenteral) and were followed until 31 December 1996. The incidence of HAN per million inhabitants was 18.4 in the first year of activity and 33.2–36.9 in subsequent years, being 4–10 times greater than rates reported by the Italian HAN registers. On 31 December 1996, 158 patients had died because of the disease and 6 were on treatment. Mean survival was 17.2 weeks for those on enteral nutrition and 12.2 weeks for those on parenteral nutrition. Prediction of survival was 72% accurate. 95 patients had undergone 155 readmissions to hospital, where they spent 15–23% of their survival time. Burdens due to HAN were well accepted by 124 patients, an annoyance or scarcely tolerable in the remainder. The frequency of major complications of parenteral nutrition was 0.67 per year for catheter sepsis and 0.16 per year for deep vein thrombosis. Karnofsky performance score increased in only 13 patients and body weight increased in 43. The fixed direct costs per patient-day (in European Currency Units) were 14.2 for the nutrition team, 18.2 for enteral nutrition and 61 for parenteral nutrition. The results indicate that definite entry criteria and local surveys are required for the correct use of HAN in advanced cancer patients, that HAN can be applied without causing additional burdens and distress, and that its costs are not higher than hospital costs.

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Factors Associated with Length of Stay at Home in the Final Month of Life among Advanced Cancer Patients: A Retrospective Chart Review

Journal of Palliative Medicine ◽

10.1089/jpm.2016.0455 ◽

2017 ◽

Vol 20 (8) ◽

pp. 884-889 ◽

Cited By ~ 2

Author(s):

Masatomo Otsuka

Keyword(s):

Length Of Stay ◽

Cancer Patients ◽

Advanced Cancer ◽

Chart Review ◽

Retrospective Chart Review ◽

Advanced Cancer Patients ◽

Factors Associated ◽

At Home

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Palliative Sedation in Advanced Cancer Patients Followed at Home: A Retrospective Analysis

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2011.06.027 ◽

2012 ◽

Vol 43 (6) ◽

pp. 1126-1130 ◽

Cited By ~ 25

Author(s):

Sebastiano Mercadante ◽

Giampiero Porzio ◽

Alessandro Valle ◽

Flavio Fusco ◽

Federica Aielli ◽

...

Keyword(s):

Retrospective Analysis ◽

Cancer Patients ◽

Advanced Cancer ◽

Palliative Sedation ◽

Advanced Cancer Patients ◽

At Home

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Breakthrough Pain in Advanced Cancer Patients Followed at Home: A Longitudinal Study

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2008.12.008 ◽

2009 ◽

Vol 38 (4) ◽

pp. 554-560 ◽

Cited By ~ 27

Author(s):

Sebastiano Mercadante ◽

Benedetta Veruska Costanzo ◽

Flavio Fusco ◽

Valeria Buttà ◽

Valentina Vitrano ◽

...

Keyword(s):

Longitudinal Study ◽

Cancer Patients ◽

Advanced Cancer ◽

Breakthrough Pain ◽

Advanced Cancer Patients ◽

At Home

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Impact of a dedicated supportive care center telephone triaging program (SCCTP) for patients with advanced cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.54 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 54-54

Author(s):

Lindsey E Pimentel ◽

Sriram Yennurajalingam ◽

Gary B. Chisholm ◽

Tonya Edwards ◽

Maria Guerra-Sanchez ◽

...

Keyword(s):

Palliative Care ◽

Supportive Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Symptom Management ◽

Care Center ◽

Assessment Scale ◽

Cancer Type ◽

Advanced Cancer Patients ◽

At Home

54 Background: Due to high symptom burden in advanced cancer patients, ongoing symptom management for outpatient palliative care patients is vital. More patients are receiving outpatient care; Yet, most palliative care patients receive less than 2 follow ups. Nurse telephone care can improve quality of life in these patients. Our aim was to determine frequency and care provided by Supportive Care Center Telephone Program (SCCTP) in advanced cancer patients. Methods: 400 consecutive patients who utilized palliative care service, 200 from outpatient Supportive Care Center (SCC) and 200 from inpatient Palliative Care (IPC), were followed for 6 months starting 3/2012 to examine call frequency and reason and outcomes including pain and other symptoms [Edmonton Symptom Assessment Scale (ESAS) and Memorial Delirium Assessment Scale (MDAS)] associated with utilization of SCCTP. We also examined the effect of SCCTP interventions on pain, ESAS and counseling needs. Results: 375 patients were evaluable. Median age 59 years, 53% female, 70% white. Most frequent cancer type were gastrointestinal (20%, p < 0.0001) for IPC and thoracic (23%, p <0.0001) for SCC. SCC patients had higher prevalence of CAGE positivity (28% SCC vs 11% IPC, p <0.0001), ESAS SDS(p=0.0134), depression(p=0.0009), anxiety(p=0.0097) and sleep(p=0.0015); MDAS scores were significantly higher in IPC (p<0.0001).115/400 patients (29%) utilized SCCTP. 96/115 outpatients (83%) used the SCCTP vs 19/115 IPC (17%). Common reasons for calls were pain (24%), pain medication refills (24%) and counseling (12%). Of 115 phone calls, 340 recommendations were made; 43% (145/340) were regarding care at home; 56% of these recommendations were regarding opioids. Patients who utilized SCCTP had worse pain(p=0.0059), fatigue(p=0.0448), depression(p=0.0410), FWB(p=0.0149) and better MDAS scores(p=0.0138) compared to non-utilizers. Conclusions: There was more frequent SCCTP use by outpatients than inpatients. Most common reason for utilization was pain control. Frequently, recommendations were made to continue symptom management at home. Patients who utilized SCCTP had worse pain, fatigue, depression, well-being scores and better delirium scores.

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