Cancer Survivorship

2019 ◽  
pp. 530-538
Author(s):  
Anne Reb ◽  
Denice Economou
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Cancer Survivors ◽  
Advanced Cancer ◽  
Cancer Survivorship ◽  
Symptom Management ◽  
Symptom Burden ◽  
Physical Symptoms ◽  
Fear Of Recurrence ◽  
Care Approach

Cancer survivors are living longer as a result of treatment advances, and, for those with advanced cancer, there is more uncertainty regarding prognosis and future needs. Survivors will need support to manage long-term side effects including physical and emotional concerns such as fear of recurrence and uncertainty. The palliative care approach to cancer survivors includes assessment of physical, psychological, social, family, and spiritual concerns. Psychosocial, emotional, and spiritual concerns may contribute to physical symptoms, a fact that supports the importance of a holistic and comprehensive approach to symptom management. Referrals to palliative or supportive care should be based on patient and caregiver needs rather than on prognosis. Survivors with advanced cancer or high symptom burden should be referred to interdisciplinary palliative care teams. Survivors in transition from active treatment and those in remission may benefit from early referrals to rehabilitation services to help improve function and manage common symptoms. A comprehensive geriatric assessment can help to identify health concerns and the need for supportive care interventions. This chapter will discuss considerations for incorporating palliative care during the cancer survivorship trajectory; common symptoms and assessment strategies; communication challenges; and a brief overview of nonpharmacologic approaches to symptom management.

Palliative Care For Patients with Advanced COPD in Primary Care

Praxis ◽  
2021 ◽  
Vol 110 (15) ◽  
pp. 902-906
Author(s):  
Tanja Fusi-Schmidhauser
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Symptom Management ◽  
Quality Care ◽  
Symptom Burden ◽  
High Quality ◽  
High Quality Care ◽  
Care And Support ◽  
Care Approach ◽  
Advance Planning

Abstract. Patients with advanced COPD have a high symptom burden that is often multidimensional. Identification of patients who might benefit from palliative care through validated identification tools, multidimensional symptom management, and timely discussion of advance planning are elements of a palliative care approach for these patients and their families. Coordination among stakeholders providing care and support to these patients is central to ensuring high-quality care and meeting all of their needs.

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

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.

Web and mobile-based symptom management interventions for physical symptoms of people with advanced cancer: A systematic review and meta-analysis

2021 ◽  
pp. 026921632110063
Author(s):  
Seyedehtanaz Saeidzadeh ◽  
Vijayvardhan Kamalumpundi ◽  
Nai-Ching Chi ◽  
Rajeshwari Nair ◽  
Stephanie Gilbertson-White
Keyword(s):  
Systematic Review ◽  
Advanced Cancer ◽  
Symptom Management ◽  
Meta Analysis ◽  
Symptom Burden ◽  
Physical Symptom ◽  
Physical Symptoms ◽  
Risk Of Bias ◽  
Delivery Mode ◽  
Management Interventions

Background: Symptom management is a critical aspect of comprehensive palliative care for people with advanced cancer. Web and mobile-based applications are promising e-Health modalities that can facilitate timely access to symptom management interventions for this population Aim: To evaluate the efficacy of web and mobile-based symptom management interventions in alleviating physical symptom burden in people with advanced cancer. Design: A systematic review and meta-analysis was conducted. PROSPERO ID = CRD42020155295. Data sources: We searched databases including PubMed, PsycINFO, and CINAHL from 1991 until 2019. Inclusion criteria were: adults with advanced cancer, web or mobile-based interventions targeting symptom management, and report of physical symptom data. Risk of bias was assessed using the ROBINS-I and RoB2. Using RevMan, standardized mean difference (SMD) and 95% confidence intervals were calculated. Heterogeneity was assessed using the I2 statistic. An assessment of interventions was conducted by evaluating the delivery mode, duration, and evaluation of application feature and theoretical elements. Results: A total of 19 studies are included in the systematic review and 18 in the meta-analysis. Majority of the studies were deemed to have high risk of bias. Most of the interventions used a web-application for delivering their education ( n = 17). While the interventions varied regarding duration and content, they were mainly guided by a symptom management theory. Web and mobile-based interventions significantly improved the overall physical symptom burden (SMD = −0.18; 95% CI = −0.28 to −0.09; I2 = 0%; p = 0.0002). Conclusions: Web and mobile-based intervention are efficacious in decreasing the overall physical symptom burden in people with advanced cancer.

A home-based palliative care pilot program for patients with advanced cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 164-164
Author(s):  
Rae Seitz ◽  
Charles F. Miller ◽  
Michael Duick ◽  
Robert Eubanks
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Symptom Management ◽  
Pilot Program ◽  
Care Services ◽  
Home Based ◽  
Palliative Care Services ◽  
Acute Care Services

164 Background: Advanced cancer care often lacks a comprehensive approach; in Hawaii most oncology practices do not have access to palliative care teams. This causes high use of acute care services and suboptimal symptom management. Hawaii Medical Service Association (HMSA) created a pilot program called Supportive Care in which home-based palliative care services are offered to members with advanced cancer with goals of improved clinical outcomes and decrease utilization of acute care services Methods: Patients must have stage III or IV malignancy and ECOG PS of 2 or greater. Palliative care services are provided by Medicare-certified hospice agencies, with interdisciplinary teams, 24/7 on-call capacity, and expertise in symptom management. Hospice agencies are paid by HMSA to provide intermittent home visits. DME and pharmaceuticals. Care is coordinated with the patient's treating oncologist and other care providers. Each patient may receive 90 days of Supportive Care services in a 12 month period. Services are suspended during hospitalization or placement in a skilled nursing facility. Results: Patients enrolled in this program utilized hospital services significantly less than other Medicare Beneficiaries during the end-of-life period, suggesting that complex medical and psychosocial needs can be met in the home environment. The table compares findings from cancer patients enrolled in Supportive Care during 2014 with the most recent data available from The Dartmouth Atlas of Health Care. Conclusions: Multiple studies show improved quality of life for cancer patients receiving palliative care. Supportive Care resulted in improved clinical outcomes. Anecdotal feedback indicates high satisfaction among patients, families, and providers. Research to collect data and quantify satisfaction continues. [Table: see text]

Unmet supportive care needs of older adults with advanced cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10040-10040 ◽  
Author(s):  
Brandon Temel ◽  
Margaret Ruddy ◽  
Emily Olson ◽  
Samantha M.C. Moran ◽  
Charn-Xin Fuh ◽  
...  
Keyword(s):  
Older Adults ◽  
Linear Regression ◽  
Supportive Care ◽  
Advanced Cancer ◽  
Psychological Symptom ◽  
Symptom Burden ◽  
Physical Symptoms ◽  
Supportive Care Needs ◽  
Care Needs ◽  
Gi Cancer

10040 Background: Cancer disproportionately affects older adults, yet research defining the supportive care needs of these patients is lacking. We sought to examine associations between geriatric impairments, quality of life (QOL), and physical and psychological symptom burden in older adults with newly diagnosed incurable gastrointestinal (GI) cancer. Methods: We prospectively enrolled patients age ≥70 within 8 weeks of diagnosis of incurable GI cancer at Massachusetts General Hospital from 10/2015-11/2016. We used surveys to assess geriatric impairments (Vulnerable Elders Survey-13 [range 0-10, scores ≥3 identify patients with impairments), QOL (EORTC QLQ-C30 [range 0-100, higher scores indicate better QOL]), physical symptoms (Edmonton Symptom Assessment System [range 0-10, higher scores indicate greater symptom burden]) and psychological symptoms (Geriatric Depression Scale, [range 0-15, higher scores indicate greater depression symptoms]). We used descriptive statistics to determine differences in patient characteristics by the presence or absence of geriatric impairments. We used linear regression adjusted for age, employment, cancer type, and comorbidity to examine associations between geriatric impairments, QOL, and physical and psychological symptom burden. Results: We enrolled 50 of 58 (86%) patients approached (mean age = 78.7; 52% with pancreatic cancer). Nearly half (46%) screened positive for geriatric impairments; these patients were older (81.7 vs 76.1, p < .01) and had more comorbid conditions (2.4 vs 1.2, p = .01). On linear regression, patients with geriatric impairments reported worse QOL across all domains (General QOL: B = -28.3, p < .01; Physical: B = -36.8, p < .01; Role: B = -36.8, p < .01; Emotional: B = -30.1, p < .01; Cognitive: B = -17.8, p = .03; Social: B = -39.7, p < .01), higher depression scores (B = 5.1, p < .01) and worse fatigue (B = 4.6, p < .01), drowsiness (B = 4.0, p < .01), appetite (B = 3.8, p < .01), and pain (B = 2.7, p = .02). Conclusions: Older adults with advanced cancer experience considerable unmet supportive care needs, particularly those with geriatric impairments. Future research is needed to assess older patients for geriatric impairments and address their unique palliative and supportive care needs.

Symptom burden in hospitalized patients with curable and incurable cancers.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 190-190
Author(s):  
Lauren Waldman ◽  
Richard Newcomb ◽  
Ryan David Nipp ◽  
Ephraim P. Hochberg ◽  
Vicki Jackson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Psychological Distress ◽  
Supportive Care ◽  
Psychological Symptoms ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Physical Symptoms ◽  
Hospitalized Patients ◽  
Assessment System ◽  
Care Utilization

190 Background: Inpatient supportive care interventions are targeted to patients with advanced solid tumors due to perceived higher symptom burden. Yet, few studies have characterized symptom prevalence in hospitalized patients with curable cancers. We aimed to describe and compare symptom burden and palliative care utilization in hospitalized patients with curable and incurable cancers to determine the allocation of such supportive care resources. Methods: We conducted a single center study of 1549 patients (238 curable hematologic, 239 curable solid, 123 incurable hematologic, 949 incurable solid cancers) who experienced an unplanned hospitalization between 9/14 - 4/17. On admission, we assessed patients’ physical symptoms (Edmonton Symptom Assessment System) and psychological distress (Patient Health Questionnaire - 4 and Primary Care PTSD Screen). Results: The median number of moderate to severe symptoms reported by patients with curable hematologic, curable solid, incurable hematologic, and incurable solid cancers were 5 [3-6], 5 [3-7], 5 [4-6], and 6 [4-7], respectively. Most patients reported moderate to severe fatigue (83.6%, 82.9%, 81.3%, 86.9%). Table 1 depicts rates of psychological distress. In adjusted analyses patients with incurable solid cancers reported higher symptom burden (β = 7.6, p < 0.01), depression (β = 0.4, p = 0.01), and anxiety (β = 0.3, p = 0.03) symptoms, but no difference in PTSD symptoms. Among patients in top quartile of symptom burden, palliative care was consulted in 16.2%, 7.9%, 23.8%, and 49.6% (p < 0.01) of patients with curable hematologic, curable solid, incurable hematologic, and incurable solid cancers, respectively. Conclusions: Hospitalized patients with solid and hematologic cancers experience substantial physical and psychological symptoms regardless of the curability of their illness. Palliative care is rarely consulted for highly symptomatic patients with curable cancers. Inpatient supportive care interventions should target the needs of all highly symptomatic patients with cancer. [Table: see text]

scholarly journals Impact of Palliative Care in Evaluating and Relieving Symptoms in Patients with Advanced Cancer. The DEMETRA Study

2020 ◽  
Author(s):  
Oscar Corli ◽  
Giacomo Pellegrini ◽  
Cristina Bosetti ◽  
Luca Riva ◽  
Matteo Crippa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Physical Symptoms ◽  
Assessment System ◽  
Symptom Intensity ◽  
Almost All ◽  
Patients Experience

Abstract Background: Cancer patients experience a number of symptoms throughout the course of the disease. We aimed to provide a comprehensive analysis of the symptom burden in patients with advanced cancer at admission to specialist palliative care (PC) services and seven days later, to estimate the immediate impact of PC intervention.Patient and methods: The analysis was based on an observational, prospective, multicenter study (named DEMETRA) conducted in Italy to outline the profile of patients, families and PC services in different care settings (hospital, hospice and home care). The prevalence and intensity of symptoms were assessed using three tools, including the Edmonton Symptom Assessment System (ESAS).Results: Five PC centers recruited 865 cancer patients. Thirty-three different symptoms were observed at baseline, the most frequent being asthenia (85%) and lack of appetite (71%). Two-thirds of patients experienced six to twelve simultaneous symptoms. The intensity of the most frequent symptoms according to ESAS varied from 5.5 for asthenia to 3.9 for nausea. The presence and intensity of physical symptoms increased with increasing levels of anxiety and depression. After seven days, prevalence decreased significantly only for nausea and breathlessness, while intensity diminished significantly for almost all symptoms. At admission we noted a correlation between patients' symptoms and the care setting. After one week, the symptom intensity was uniformly reduced in all settings.Conclusions: The study confirmed the considerable symptom burden of patients with advanced cancer. PC intervention significantly lessened the severity of symptoms, despite the patients’ advanced disease and short survival.

scholarly journals Impact of Palliative Care in Evaluating and Relieving Symptoms in Patients with Advanced Cancer. Results from the DEMETRA Study

2020 ◽  
Vol 17 (22) ◽  
pp. 8429
Author(s):  
Oscar Corli ◽  
Giacomo Pellegrini ◽  
Cristina Bosetti ◽  
Luca Riva ◽  
Matteo Crippa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Well Being ◽  
Physical Symptoms ◽  
Assessment System ◽  
Intervention Patient ◽  
Almost All

Background: Cancer patients experience multiple symptoms throughout the course of the disease. We aimed to provide a comprehensive analysis of the symptom burden in patients with advanced cancer at admission to specialist palliative care (PC) services and seven days later to estimate the immediate impact of PC intervention. Patient and methods: The analysis was based on an observational, prospective, multicenter study (named DEMETRA) conducted in Italy on new patients accessing network specialist PC centers during the period May 2017–November 2017. The prevalence and intensity of symptoms were assessed at baseline and after seven days using three tools including the Edmonton Symptom Assessment System (ESAS). Results: Five PC centers recruited 865 cancer patients. Thirty-three different symptoms were observed at the baseline, the most frequent being asthenia (84.9%) and poor well-being (71%). The intensity of the most frequent symptoms according to ESAS ranged from 5.5 for asthenia to 3.9 for nausea. The presence and intensity of physical symptoms increased with increasing levels of anxiety and depression. After seven days, prevalence of nausea and breathlessness as well as intensity of almost all symptoms significantly decreased. Conclusions: The study confirmed the considerable symptom burden of patients with advanced cancer. PC intervention has significantly reduced the severity of symptoms, despite the patients’ advanced disease and short survival.

Palliative care referral practices and perceptions: The divide between metropolitan and non-metropolitan general practitioners

2011 ◽  
Vol 9 (2) ◽  
pp. 181-189 ◽  
Author(s):  
Claire E. Johnson ◽  
Afaf Girgis ◽  
Christine L. Paul ◽  
David C. Currow
Keyword(s):  
Palliative Care ◽  
General Practitioners ◽  
Advanced Cancer ◽  
Terminal Illness ◽  
Symptom Control ◽  
Physical Symptoms ◽  
Care Physician ◽  
Self Report ◽  
Psychosocial Needs ◽  
Consultative Service

AbstractObjective:Late or non-referral of patients to specialist palliative care (SPC) services may affect patients' and their carers' quality of care. General practitioners (GPs) are key professionals in linking people with SPC. The aim of this article is to assess GPs' perceptions and SPC referrals for their patients with advanced cancer and differences between metropolitan (M GPs) and non-metropolitan GPs (NM GPs).Method:Self-report survey mailed to a stratified random sample of 1,680 Australian GPs was used.Results:Thirty-one percent (469) of eligible GPs returned surveys. More M GPs than NM GPs reported referring >60% of their patients for SPC (p = 0.014); and that a more comprehensive range of SPC services was available. The most frequently reported referral prompts were: presence of terminal illness (M GPs, 71%, NM GPs, 66%, ns (not significant)); future need for symptom control (69% vs. 59%, ns) and uncontrolled physical symptoms (63% vs. 54%, ns). Reasons for not referring were: doctor's ability to manage symptoms (62% vs. 68%, ns) and the absence of symptoms (29% vs. 18%, p = 0.025). Higher referral was associated with: having a palliative care physician or consultative service available; agreeing that all patients with advanced cancer should be referred, and agreeing that with SPC, the needs of the family are better met.Significance of results:Referrals for SPC were primarily disease-related rather than for psychological and emotional concerns. Measures are needed to encourage referrals based upon psychosocial needs as well as for physical concerns, and to support GPs caring for people with advanced cancer in areas with fewer comprehensive SPC services.

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