Supportive and palliative care

2016 ◽  
pp. 293-301
Author(s):  
David Hui ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Life Quality ◽  
Symptom Burden ◽  
Cost Of Care ◽  
Care Needs ◽  
Palliative Care Teams ◽  
Information And Communication ◽  
Cancer Experience

Patients with advanced cancer experience significant symptom burden as a result of disease progression, anti-neoplastic therapies and various psychosocial factors. Furthermore, they are often faced with complex decisions regarding information and communication. Palliative care is a professional specialty that specifically addresses patients’ and their families’ supportive care needs through validated assessments, evidence-based interventions, impeccable communication, and collaborative teamwork. Palliative care involvement is associated with improved symptom burden, quality of life, quality of care, satisfaction, and possibly survival and cost of care. In this chapter, we describe the structure, processes, and outcomes of palliative care, and discuss contemporary models of integration between oncology and palliative care. We will also discuss the latest insights into management of cancer pain, fatigue, and depression. Oncologists equipped with basic palliative care skills can deliver effective front-line supportive care. Patients in distress may also benefit from early referral to specialist palliative care teams.

Supportive and Palliative Oncology—A New Paradigm for Comprehensive Cancer Care

2013 ◽  
Vol 09 (01) ◽  
pp. 68 ◽  
Author(s):  
David Hui ◽  
Eduardo Bruera ◽  
◽  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Life Quality ◽  
Symptom Burden ◽  
Tumor Burden ◽  
Cost Of Care ◽  
New Paradigm ◽  
Interprofessional Teamwork

Patients with advanced cancer often experience symptoms related to increasing tumor burden, cancer treatments, and psychosocial stressors. They also have significant social, informational, and decision-making needs. Palliative care practitioners have developed expertise to address many of these supportive care concerns through interprofessional teamwork, validated assessments, multidimensional interventions, and frequent communication. In this article, we aim to provide an evidence-based update on several important palliative care topics, including management of pain, fatigue, anorexia–cachexia, depression, and anxiety, as well as patient–clinician communication and decision-making. Multiple randomized controlled trials have demonstrated that palliative care can improve symptom burden, quality of life, quality of care, satisfaction, and possibly survival and cost of care. To enhance the level of care for patients with advanced cancer, oncologists need to have a good working knowledge of the major palliative care principles, and to refer patients to palliative care programs often and early in the disease trajectory.

scholarly journals Pilot Randomized Trial of a Transdisciplinary Geriatric and Palliative Care Intervention for Older Adults With Cancer

2020 ◽  
Vol 18 (5) ◽  
pp. 591-598
Author(s):  
Ryan D. Nipp ◽  
Brandon Temel ◽  
Charn-Xin Fuh ◽  
Paul Kay ◽  
Sophia Landay ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Usual Care ◽  
Pilot Trial ◽  
Symptom Burden ◽  
Medium Effect ◽  
Care Needs ◽  
Care Intervention ◽  
Cancer Types

Background: Oncologists often struggle with managing the unique care needs of older adults with cancer. This study sought to determine the feasibility of delivering a transdisciplinary intervention targeting the geriatric-specific (physical function and comorbidity) and palliative care (symptoms and prognostic understanding) needs of older adults with advanced cancer. Methods: Patients aged ≥65 years with incurable gastrointestinal or lung cancer were randomly assigned to a transdisciplinary intervention or usual care. Those in the intervention arm received 2 visits with a geriatrician, who addressed patients’ palliative care needs and conducted a geriatric assessment. We predefined the intervention as feasible if >70% of eligible patients enrolled in the study and >75% of eligible patients completed study visits and surveys. At baseline and week 12, we assessed patients’ quality of life (QoL), symptoms, and communication confidence. We calculated mean change scores in outcomes and estimated intervention effect sizes (ES; Cohen’s d) for changes from baseline to week 12, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect. Results: From February 2017 through June 2018, we randomized 62 patients (55.9% enrollment rate [most common reason for refusal was feeling too ill]; median age, 72.3 years; cancer types: 56.5% gastrointestinal, 43.5% lung). Among intervention patients, 82.1% attended the first visit and 79.6% attended both. Overall, 89.7% completed all study surveys. Compared with usual care, intervention patients had less QoL decrement (–0.77 vs –3.84; ES = 0.21), reduced number of moderate/severe symptoms (–0.69 vs +1.04; ES = 0.58), and improved communication confidence (+1.06 vs –0.80; ES = 0.38). Conclusions: In this pilot trial, enrollment exceeded 55%, and >75% of enrollees completed all study visits and surveys. The transdisciplinary intervention targeting older patients’ unique care needs showed encouraging ES estimates for enhancing patients’ QoL, symptom burden, and communication confidence.

scholarly journals The Role of Palliative Care in Oncology

2017 ◽  
Vol 34 (04) ◽  
pp. 307-312 ◽  
Author(s):  
Rajiv Agarwal ◽  
Andrew Epstein
Keyword(s):  
Palliative Care ◽  
Symptom Burden ◽  
Well Being ◽  
Care Needs ◽  
Patients With Cancer ◽  
Living With Cancer ◽  
Palliative Care Needs ◽  
Shed Light

AbstractPalliative care is a powerful adjunct to oncology that adds distinct value to the physical, mental, and psychosocial well-being of patients living with cancer. Its expanding role and integration with standard oncologic care has proven clinical benefit, as the practice of palliative care can help alleviate symptom burden, enhance illness and prognostic understanding, and improve both the quality of life and overall survival for patients. The primary aim of this review article is to highlight the significant interplay between palliative care and oncology and, in doing so, shed light on the areas for improvement and modern challenges that exist to meet the complex palliative care needs of patients with cancer.

scholarly journals Innovative Models for High-Risk Patients Use Care Coordination and Palliative Supports to Reduce End-of-life Utilization and Spending

2017 ◽  
Vol 1 (2) ◽  
Author(s):  
Sarah Ruiz ◽  
Lynne Page Snyder ◽  
Katherine Giuriceo ◽  
Joanne Lynn ◽  
Erin Ewald ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
End Of Life ◽  
Care Coordination ◽  
Cost Of Care ◽  
Care Transition ◽  
Care Planning ◽  
Care Model ◽  
Advance Care

Abstract Background and Objectives Care coordination and palliative care supports are associated with reduced anxiety, fewer hospital admissions, and improved quality of life for patients and their families. Early palliative care can result in savings in the end-of-life period, but there is limited evidence that larger-scale models can improve both utilization and the cost of care. Three models that received Health Care Innovation Awards from the Centers for Medicare & Medicaid Services aimed to improve quality of care and reduce cost through the use of innovative care coordination models. This study explores the total cost of care and selected utilization outcomes at the end-of-life for these innovative models, each of which enrolled adults with multiple chronic conditions and featured care coordination with advance care planning as a component of palliative care. These included a comprehensive at-home supportive care model for persons predicted to die within a year and two models offering advance care planning in nursing facilities and during care transitions. Research Design and Methods We used regression models to assess model impacts on costs and utilization for high-risk Medicare beneficiaries participating in the comprehensive supportive care model (N = 3,339) and the two care transition models (N = 587 and N = 277) who died during the study period (2013–2016), relative to a set of matched comparison patients. Results Comparing participants in each model who died during the study period to matched comparators, two of the three models were associated with significantly lower costs in the last 90 days of life ($2,122 and $4,606 per person), and the third model showed nonsignificant differences. Two of the three models encouraged early hospice entry in the last 30 days of life. For the comprehensive at-home supportive care model, we observed aggregate savings of nearly $19 million over the study period. One care transition model showed aggregate savings of over $500,000 during the same period. Potential drivers of these cost savings include improved patient safety, timeliness of care, and caregiver support. Discussion and Implications Two of the three models achieved significant lower Medicare costs than a comparison group and the same two models also sustained their models beyond the Centers for Medicare & Medicaid Services award period. These findings show promise for achieving palliative care goals as part of care coordination innovation.

scholarly journals Feasibility, acceptability, and efficacy of online supportive care for individuals living with and beyond lung cancer: a systematic review

2021 ◽  
Author(s):  
Jordan Curry ◽  
Michael Patterson ◽  
Sarah Greenley ◽  
Mark Pearson ◽  
Cynthia C. Forbes
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Supportive Care ◽  
Emotional Functioning ◽  
Symptom Burden ◽  
Feasibility Studies ◽  
Symptom Distress ◽  
Care Needs ◽  
Cancer Data

Abstract Purpose To examine the evidence of the feasibility, acceptability, and potential efficacy of online supportive care interventions for people living with and beyond lung cancer (LWBLC). Methods Studies were identified through searches of Medline, EMBASE, PsychINFO, and CINAHL databases using a structured search strategy. The inclusion criteria (1) examined the feasibility, acceptability, and/or efficacy of an online intervention aiming to provide supportive care for people living with and beyond lung cancer; (2) delivered an intervention in a single arm or RCT study pre/post design; (3) if a mixed sample, presented independent lung cancer data. Results Eight studies were included; two randomised controlled trials (RCTs). Included studies reported on the following outcomes: feasibility and acceptability of an online, supportive care intervention, and/or changes in quality of life, emotional functioning, physical functioning, and/or symptom distress. Conclusion Preliminary evidence suggests that online supportive care among individuals LWBLC is feasible and acceptable, although there is little high-level evidence. Most were small pilot and feasibility studies, suggesting that online supportive care in this group is in its infancy. The integration of online supportive care into the cancer pathway may improve quality of life, physical and emotional functioning, and reduce symptom distress. Online modalities of supportive care can increase reach and accessibility of supportive care platforms, which could provide tailored support. People LWBLC display high symptom burden and unmet supportive care needs. More research is needed to address the dearth of literature in online supportive care for people LWBLC.

scholarly journals The Kidney Supportive Care programme: characteristics of patients referred to a new model of care

2018 ◽  
pp. bmjspcare-2018-001630 ◽  
Author(s):  
Louise Purtell ◽  
P Marcin Sowa ◽  
Ilse Berquier ◽  
Carla Scuderi ◽  
Carol Douglas ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Kidney Disease ◽  
Supportive Care ◽  
End Of Life ◽  
Health State ◽  
Model Of Care ◽  
Care Programme ◽  
Palliative Care Teams

ObjectivesFor many people with advanced kidney disease, their physical, psychological and emotional needs remain unmet. Kidney supportive care, fully integrating specialist kidney and palliative care teams, responds to the emotional and symptom distress in this cohort who may be on a non-dialysis care pathway or on dialysis and approaching end of life. We aimed to analyse and describe the operation and patient characteristics of a new kidney supportive care programme (KSCp).MethodsA multidisciplinary KSCp was introduced through a tertiary hospital in Brisbane, Australia. Operational information and characteristics of referred patients were collected from internal databases and electronic medical records and analysed descriptively. Patient data were collected using validated instruments to assess symptom burden, health-related quality of life, health state, functional status and performance at clinic entry and analysed descriptively.Results129 people with advanced kidney disease were referred to the KSCp within the first year (median age 74 (range 27.7–90.5), 48.1% female, median Charlson Comorbidity Index score 7 (IQR 6–8) and mean Integrated Palliative care Outcome Scale Renal score 19.6±9.8). 59% were currently receiving dialysis. The leading reason for referral was symptom management (37%). While quality of life and health state varied considerably among the cohort, in general, these parameters were well below population norms.ConclusionsResults indicate that patients referred to the KSCp were those with a strong need for a patient-centred, integrated model of care. Shifting focus to co-ordinated, multidisciplinary care rather than discrete specialty silos appears key to addressing the challenging clinical problems in end-of-life care.

Symptom burden and palliative care for patients with multiple myeloma: Cancer Experience Registry findings.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 81-81 ◽  
Author(s):  
Joanne S. Buzaglo ◽  
Melissa F Miller ◽  
Clare Karten ◽  
Margaret Longacre ◽  
Thomas William LeBlanc
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Palliative Care ◽  
Sleep Disturbance ◽  
Sleep Disturbances ◽  
Symptom Burden ◽  
Outreach Program ◽  
Cancer Support ◽  
Cancer Experience

81 Background: Multiple myeloma (MM) patients are living longer with treatment advances yet remain challenged by complications and adverse treatment effects. Concurrent oncology/palliative care can improve symptom burden and quality of life for cancer patients, but the benefits of concurrent care for the MM symptom burden is not well described. Methods: From July 2013-2014, the Cancer Support Community (CSC) registered 495 MM patients to the Cancer Experience Registry: MM, an online initiative to study and raise awareness about MM’s psychosocial impact. Registrants were recruited through an outreach program including the CSC and The Leukemia & Lymphoma Society networks of communities and resources. 331 US-based registrants completed surveys about their MM history, treatment, and symptoms. Results: Median respondent age was 64 years; 54% were female, 87% Caucasian. Median time since diagnosis was 4.5 years, and 40% reported experiencing a relapse. Several symptoms interfered (quite a bit or very much) with respondents’ daily life: fatigue (40%), bone pain (22%), peripheral neuropathy (22%) sleep disturbance (21%), GI toxicity (16%), and mood swings (10%). The daily effects of fatigue, pain, sleep disturbance and mood swings were associated (p < 0.05) with distress. 36% did not report all symptoms and side effects (SEs) to their health care team (HCT). The most common reason was “I don’t think anything can be done about these problems.” More than half (58%) reported sleep disturbances related to steroids, and 46% experienced weight gain, 41% mood swings, and 39% edema. One-third (34%) reported their HCT never told them steroids could cause this. 85% felt their HCT prepared them (somewhat, quite a bit, or very much) to manage SEs of MM treatment, yet half (50%) felt little or no control over the physical SEs of MM and its treatment. Conclusions: Patients with MM experience significant symptom burden that interferes with daily living but underreport symptoms to the HCT. Many symptoms are amenable to interventions by palliative care specialists, which may improve MM patients’ quality of life. These findings suggest the need for more integration of palliative care services with oncology and other care for MM patients.

Utilization of an electronic medical record trigger to promote palliative care consultation in ambulatory oncology.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18201-e18201
Author(s):  
Sherri L. Rauenzahn ◽  
Susanne Schmidt ◽  
Nazneen Ali ◽  
Laura LaNiel Tenner
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Cost Of Care ◽  
Ambulatory Oncology ◽  
Edmonton Symptom Assessment Scale ◽  
The Impact

e18201 Background: Research insupportive care demonstrates improvements in overall survival, quality of life, symptom management, and reductions in the cost of care. Despite the American Society of Clinical Oncology recommendation for early concurrent supportive care in patients with advanced cancer and high symptom burden, integrating supportive services is challenging. Our aims were to 1) implement an electronic medical record (EMR) provider alert of high symptom burden based on Edmonton Symptom Assessment Scale (ESAS) criteria and 2) determine the impact an alert has on supportive service referrals. Methods: ESAS scores were implemented in medical ambulatory oncology clinics to quantitatively assess symptom burden. An EMR alert was programmed for a total ESAS score > 30 and any single response of ≥9 to capture approximately 15% of our high symptom burden patient population. The provider could elect to accept the alert placing an order for palliative consultation or decline the prompt. Referral rates and symptom assessment scores were followed as metrics for EMR alert efficiency. Results: Over 10 months, 9,710 patient visits used the ESAS system resulting in 7,707 fully completed ESAS scores (79.4% completion rate). There were 78 total consults to palliative care, a referral rate of less than 1% of the population, which was unchanged from prior to trigger implementation. Of the total completed ESAS forms, the trigger alerted 686 times (8.9% of patient visits) with only 55 of those triggers leading to a supportive care referral (8.0%). Conclusions: This project highlights the challenges of an EMR based alert system and the need for continued efforts to improve supportive care referrals through provider education and tool implementation. [Table: see text]

A randomized, controlled trial of structured palliative care versus standard supportive care for patients enrolled on phase I clinical trials.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 3634-3634
Author(s):  
Michelle Elizabeth Treasure ◽  
Barbara J. Daly ◽  
PingFu Fu ◽  
Shufen Cao ◽  
Neal J. Meropol ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Palliative Care ◽  
Clinical Trials ◽  
Supportive Care ◽  
Usual Care ◽  
Phase 1 ◽  
Symptom Burden ◽  
Care Services

3634 Background: Phase 1 clinical trials are the first step in developing new cancer therapeutics. Patients enrolled in these studies have typically exhausted standard therapies and are at a point in their disease trajectory where they often are choosing between a phase 1 clinical trial and hospice care. These patients may have significant symptom burden, which can result in early trial discontinuation and confound phase 1 trial outcomes, including toxicity profiles, which may influence further drug development. This study aimed to determine the palliative care needs of patients enrolled on phase 1 clinical trials and their caregivers (CGs), along with differences in study duration, adverse event (AE) and symptom profiles, and quality of life (QOL) between those receiving structured palliative care vs usual supportive care. Methods: 68 patients enrolled on phase 1 clinical trials were randomly assigned to receive structured palliative care or usual supportive care. 39 of their CGs were enrolled and assigned to the same arm as the patient. Quality of life metrics were obtained monthly: the Functional Assessment of Cancer Therapy-General and Memorial Symptom Assessment Scale -Short Form for patients, and The Quality of Life in Life Threatening Illness - Family Carer Version and Caregiver Reaction Assessment for CGs. Palliative care resources utilized were assessed for those in the palliative care arm, and referrals to supportive care services assessed in those in the usual care arm. AEs recorded on the Phase 1 trials were evaluated & compared between arms. Results: Mean duration on phase 1 study was 132 days in the palliative care arm vs 114 days in the usual care arm (p = 0.55). Total weighted AE rate (# of AE [x] AE grade per month) was 26.9 in the palliative care arm vs 34.0 in the usual care arm (p = 0.53). Patients in the palliative care arm experienced better QOL and lower symptom burden, as did their CGs, compared to those in the usual care arm. While the differences in outcomes were not statistically significant, all results favored structured palliative care. Conclusions: Phase 1 patients and their CGs have physical and psychosocial needs which warrant palliative care services. Preliminary results suggest structured palliative care is associated with increased duration on study (by nearly 3 weeks), improved patient and CG QOL, and reduced patient symptom and CG burden. A larger study is warranted to confirm these results and further develop the ideal palliative care intervention in these populations. Clinical trial information: NCT02543541 .

The effectiveness of hope-fostering interventions in palliative care: A systematic review and meta-analysis

2021 ◽  
pp. 026921632199472
Author(s):  
Natalia Salamanca-Balen ◽  
Thomas V Merluzzi ◽  
Man Chen
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Palliative Care ◽  
Meta Analysis ◽  
Symptom Burden ◽  
Well Being ◽  
Medium Effect ◽  
Spiritual Well Being ◽  
Quasi Experimental

Background: The concept of hope is an important theme in chronic illness and palliative care and has been associated with increased psycho-spiritual well-being and quality of life. Psycho-spiritual interventions have been described in this population, but no systematic review of hope-enhancing interventions or hopelessness-reducing interventions has been conducted for persons with palliative care diseases. Aim: To describe and assess the effectiveness of interventions in palliative care that measure hope and/or hopelessness as an outcome. Design: This systematic review and meta-analysis was pre-registered (Prospero ID: CRD42019119956). Data sources: Electronic databases, journals, and references were searched. We used the Cochrane criteria to assess the risk of bias within studies. Results: Thirty-five studies (24 randomized controlled trials, 5 quasi-experimental, 6 pre-post studies) involving a total of 3296 palliative care patients were included. Compared with usual/standard cancer care alone, interventions significantly increased hope levels at a medium effect size ( g = 0.61, 95% confidence interval (CI) = 0.28–0.93) but did not significantly reduce hopelessness ( g = −0.08, 95% CI = −0.18 to 0.02). It was found that interventions significantly increase spirituality ( g = 0.70, 95% CI = 0.02–1.37) and decrease depression ( g = −0.29, 95% CI = −0.51 to −0.07), but had no significant effect over anxiety, quality of life, and symptom burden. Overall, quality of evidence across the included studies was rated as low. Conclusions: Evidence suggests that interventions can be effective in increasing hope in palliative care patients.

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