Palliative Care of Cancer Survivors

Being told you are cancer-free does not mean you are free of the consequences of the disease. Seventy-six percent of cancer survivors are over age 60 years and have coexisting medical conditions that complicate posttreatment recovery to maximum health. Childhood cancer survivors also carry a heavy burden of medical and psychological problems resulting from their experience with cancer. Cancer diagnosis and treatment affects the family as well as the patient. Improvements are needed in the coordination of care for cancer survivors to assure optimal quality of life.

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Patterns of comorbidities in hospitalised cancer survivors for palliative care and associated in-hospital mortality risk: A latent class analysis of a statewide all-inclusive inpatient data

Palliative Medicine ◽

10.1177/0269216319860705 ◽

2019 ◽

Vol 33 (10) ◽

pp. 1272-1281 ◽

Cited By ~ 2

Author(s):

Lan Luo ◽

Wei Du ◽

Shanley Chong ◽

Huibo Ji ◽

Nicholas Glasgow

Keyword(s):

Risk Factors ◽

Palliative Care ◽

Hospital Mortality ◽

Cancer Survivors ◽

Latent Class Analysis ◽

Cancer Patients ◽

Mortality Risk ◽

Latent Class ◽

Class Analysis ◽

Hospital Deaths

Background: At the end of life, cancer survivors often experience exacerbations of complex comorbidities requiring acute hospital care. Few studies consider comorbidity patterns in cancer survivors receiving palliative care. Aim: To identify patterns of comorbidities in cancer patients receiving palliative care and factors associated with in-hospital mortality risk. Design, Setting/Participants: New South Wales Admitted Patient Data Collection data were used for this retrospective cohort study with 47,265 cancer patients receiving palliative care during the period financial year 2001–2013. A latent class analysis was used to identify complex comorbidity patterns. A regression mixture model was used to identify risk factors in relation to in-hospital mortality in different latent classes. Results: Five comorbidity patterns were identified: ‘multiple comorbidities and symptoms’ (comprising 9.1% of the study population), ‘more symptoms’ (27.1%), ‘few comorbidities’ (39.4%), ‘genitourinary and infection’ (8.7%), and ‘circulatory and endocrine’ (15.6%). In-hospital mortality was the highest for ‘few comorbidities’ group and the lowest for ‘more symptoms’ group. Severe comorbidities were associated with elevated mortality in patients from ‘multiple comorbidities and symptoms’, ‘more symptoms’, and ‘genitourinary and infection’ groups. Intensive care was associated with a 37% increased risk of in-hospital deaths in those presenting with more ‘multiple comorbidities and symptoms’, but with a 22% risk reduction in those presenting with ‘more symptoms’. Conclusion: Identification of comorbidity patterns and risk factors for in-hospital deaths in cancer patients provides an avenue to further develop appropriate palliative care strategies aimed at improving outcomes in cancer survivors.

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Health behaviors and coping among informal caregivers of lung and colorectal cancer survivors: Distribution and interrelationships.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.229 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 229-229

Author(s):

Erin E. Kent ◽

Kristin Litzelman ◽

Julia Howe Rowland

Keyword(s):

Physical Activity ◽

Palliative Care ◽

Health Behaviors ◽

Cancer Survivors ◽

Coping Strategies ◽

Binge Drinking ◽

Coping Styles ◽

Self Care ◽

Positive Health ◽

And Coping

229 Background: Family/informal caregivers play a critical role in the palliative care and support of cancer survivors, yet are at risk of poorer health outcomes than non-caregivers. Self-care, including positive health behaviors and coping, are important for long-term caregiver well-being, and potentially that of care recipients. This study sought to evaluate the distribution of and interrelationships among health behaviors and coping strategies among cancer caregivers. Methods: This study used data from the Cancer Care Outcomes Research & Surveillance Consortium (CanCORS). Caregivers reported by survey their health behaviors, coping, and sociodemographic and caregiving characteristics. Descriptive statistics assessed the distribution of caregivers’ health and coping behaviors, and multivariable linear regressions assessed the associations between health behaviors and coping styles. Results: Many caregivers reported positive health behaviors (i.e., moderate physical activity, adequate sleep, low rates of binge drinking). Caregivers most frequently reported using emotion-focused coping styles (religion, acceptance, positive reframing, emotional support). Caregivers reporting higher levels of physical activity or feeling less well-rested used problem-focused coping styles more frequently (Effect sizes [ES] up to 0.21, p < 0.05) . Those with some physical activity (1-149 minutes/week vs none) scored higher on emotion-focused coping, while drinkers (1+ drink in the past 30 days vs 0) and binge drinkers (5+ drinks in a row vs 0) scored lower on this subscale (ES = 0.16, 0.12, and 0.25; p < 0.05). Caregivers reporting current smoking (ES = 0.21), binge drinking (ES = 0.49), and feeling less well-rested (ES up to 0.48) scored higher on dysfunctional coping (p < 0.05). Conclusions: Caregivers’ health behaviors and coping strategies were interrelated. Interventions targeting both factors concurrently may be particularly efficacious at improving family caregiver self-care, potentially improving caregiving quality and patient-centered palliative care. Future research is needed to design and test such interventions and the potential impact on palliative care.

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Survivor pain: Experience at an oncology palliative care clinic.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.260 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 260-260

Author(s):

Cristian Zanartu ◽

Lisa Emond ◽

Ann Wojtaszczyk

Keyword(s):

Palliative Care ◽

Cancer Survivors ◽

Risk Mitigation ◽

Opioid Analgesics ◽

The United States ◽

Care Clinic ◽

Pain Scores ◽

Average Pain ◽

Average Pain Score ◽

Opioid Medications

260 Background: As of January 2014 there are an estimated 14.5 million cancer survivors in the United States. In observational studies of cancer survivors up to 40% report chronic pain. Opioids remain an important and effective treatment for active cancer pain. For survivors, however, we must take into account the paucity of data supporting long term benefits of opioids on pain and functional outcomes, and extensive evidence of potential harms. We present data from our palliative care clinic where we have established a nuanced approach to pain management in this population, which includes risk mitigation, consistent education, emphasis on non-pharmacological and non-opiate medications, and attempts to down-taper opioid analgesics when feasible. Methods: Retrospective, observational chart review of 62 patients identified as cancer survivors, who have been managed for pain, at an academically affiliated palliative care clinic embedded in the oncology department. Demographic information, baseline and latest visit pain scores and functional assessments, as well as pain regimen data were collected. Means for pain and functionality scores were compared for those patient’s with differing opioid regimens and nonpharmacological treatments. Results: Of the 62 patients reviewed, 48 were tapered off opioid medication. In the patients who were tapered off opioid medications, 8 (16%) showed an increase in average pain scores, 11 (22%) showed no change in average pain scores, and 29 (60%) showed improvement in average pain score. Conclusions: In 82% of the patients whose opioid medications were decreased, average pain scores either remained the same or actually improved over time. This is encouraging data to support the theory that decreasing opioids in cancer survivors does not worsen pain control in the majority of that population.

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