Safety Aspects of Acupuncture in Palliative Care

2001 ◽  
Vol 19 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Jacqueline Filshie
Keyword(s):  
Palliative Care ◽  
Symptom Management ◽  
Tumour Progression ◽  
Clinical Stage ◽  
Symptom Control ◽  
Alternative Therapies ◽  
Current Status ◽  
Neutropenic Patients ◽  
Full Knowledge ◽  
Clotting Disorder

Acupuncture can mask symptoms of cancer and tumour progression. It is not safe to use such a therapy without full knowledge of the clinical stage of the disease, and the current status of orthodox therapy. Contraindications to acupuncture needling include an unstable spine, severe clotting disorder, neutropenia and lymphoedema. Whilst semi-permanent needles are used increasingly in symptom control and pain management they should not be used in patients with valvular heart disease or in vulnerable neutropenic patients. Acupuncture has an increasing role in support for pain and symptom management, but patients should not be advised to abandon conventional treatments in favour of complementary or alternative therapies alone, and should not have their hopes raised inappropriately, or have any guilt projected on to them for the cause of their cancer.

scholarly journals Experience of symptom control, anxiety and associating factors in a palliative care unit evaluated with Support Team Assessment Schedule Japanese version

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tetsuya Ito ◽  
Emi Tomizawa ◽  
Yuki Yano ◽  
Kiyozumi Takei ◽  
Naoko Takahashi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Laboratory Data ◽  
Japanese Version ◽  
Palliative Care Unit ◽  
Current Status ◽  
Physical Factors ◽  
Patient Anxiety ◽  
Team Assessment ◽  
Support Team

AbstractVarious physical and psychosocial difficulties including anxiety affect cancer patients. Patient surroundings also have psychological effects on caregiving. Assessing the current status of palliative care intervention, specifically examining anxiety and its associated factors, is important to improve palliative care unit (PCU) patient quality of life (QOL). This study retrospectively assessed 199 patients admitted to a PCU during August 2018–June 2019. Data for symptom control, anxiety level, disease insight, and communication level obtained using Support Team Assessment Schedule Japanese version (STAS-J) were evaluated on admission and after 2 weeks. Palliative Prognostic Index (PPI) and laboratory data were collected at admission. Patient anxiety was significantly severer and more frequent in groups with severer functional impairment (p = 0.003) and those requiring symptom control (p = 0.006). Nevertheless, no relation was found between dyspnea and anxiety (p = 0.135). Patients with edema more frequently experienced anxiety (p = 0.068). Patient survival was significantly shorter when family anxiety was higher after 2 weeks (p = 0.021). Symptoms, edema, and disabilities in daily living correlate with patient anxiety. Dyspnea is associated with anxiety, but its emergence might be attributable mainly to physical factors in this population. Family members might sensitize changes reflecting worsened general conditions earlier than the patients.

Integration of oncology palliative care in a regional health care system.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 34-34
Author(s):  
Connie Edelen ◽  
Nicole Koesel
Keyword(s):  
Palliative Care ◽  
Healthcare System ◽  
Symptom Management ◽  
Symptom Control ◽  
Family Satisfaction ◽  
Cancer Center ◽  
Care Utilization ◽  
Full Time ◽  
Treatment Pathways ◽  
Regional Health Care

34 Background: Early incorporation of palliative medicine in cancer care has been shown to be associated with improved symptom control, quality of life, and patient and family satisfaction however integration in the outpatient setting remains deficient nationwide. Regional healthcare systems carry the additional challenge of providing consistent quality care across a diverse geographic area. We performed a retrospective review of oncology palliative care utilization in a regional healthcare system following the implementation of a fully integrated model of palliative care. Methods: In 2012, Levine Cancer Institute (LCI) and Carolinas Palliative Care collaborated to establish palliative care access across its 12-site regional cancer center. This was a transition from a vendor service to a fully embedded clinic at multiple LCI locations. The new model offered full time outpatient multidisciplinary services in addition to an inpatient oncology palliative care consult service. Standardization of care and early integration were augmented by the creation of symptom management guidelines and tumor treatment pathways with built in recommendations for palliative/supportive care. Results: New oncology palliative care referrals increased from 150 annually to over 475 in the first 12 months. The top diagnoses were lung (16%), breast (11%), and head and neck cancer (7.2%) with pain and symptom management as the primary reason for consultation. Ten symptom management pathways have been published for regional utilization, enabling primary palliative care and serving as a trigger for palliative specialist consultation. A toolkit was created to identify operational needs, clinical tools, and staffing at each site. Conclusions: The growth of oncology palliative care utilization by 317% demonstrates the success of a fully embedded program. This multidisciplinary model is being standardized across regional sites to ensure access to primary and secondary palliative care. Additional clinic sites and the application of telemedicine for rural areas are in development. Future research is needed to document outcomes associated with palliative care integration across the cancer trajectory in a regional healthcare system.

Genitourinary Issues in Palliative Care

2021 ◽  
pp. 198-213
Author(s):  
Min Ji Kim ◽  
Kimberson Tanco
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Symptom Management ◽  
Urinary Tract Obstruction ◽  
Performance Status ◽  
Treatment Options ◽  
Symptom Control ◽  
Kidney Injury ◽  
Management Options

Genitourinary problems in palliative care can be very distressing to patients and require prompt management and alleviation of symptoms. Examples include urinary tract obstruction, which can lead to pain and kidney injury, as well as infection, hematuria, renal colic, and bladder spasm-related pain. This chapter addresses relevant aspects of palliative care in patients with genitourinary issues, including consideration for context of symptoms and subsequent practical management. Options for symptom management may range from medications to procedural interventions. In deciding between treatment options, factors such as the patient’s preexisting comorbidities, performance status, goals of care, and anticipated benefit in symptom control and in quality of life versus potential burden of treatment must be considered.

scholarly journals COVID-19 and Hospital Palliative Care – A service evaluation exploring the symptoms and outcomes of 186 patients and the impact of the pandemic on specialist Hospital Palliative Care

2020 ◽  
Vol 34 (9) ◽  
pp. 1256-1262 ◽  
Author(s):  
Lucy Hetherington ◽  
Bridget Johnston ◽  
Grigorios Kotronoulas ◽  
Fiona Finlay ◽  
Paul Keeley ◽  
...  
Keyword(s):  
Palliative Care ◽  
Symptom Management ◽  
Demographic Data ◽  
Symptom Control ◽  
Service Evaluation ◽  
Health Board ◽  
Symptom Profile ◽  
Palliative Care Teams ◽  
The Impact ◽  
Care Demands

Background: Patients hospitalised with COVID-19 have increased morbidity and mortality, which requires extensive involvement of specialist Hospital Palliative Care Teams. Evaluating the response to the surge in demand for effective symptom management can enhance provision of Palliative Care in this patient population. Aim: To characterise the symptom profile, symptom management requirements and outcomes of hospitalised COVID-19 positive patients referred for Palliative Care, and to contextualise Palliative Care demands from COVID-19 against a ‘typical’ caseload from 2019. Design: Service evaluation based on a retrospective cohort review of patient records. Setting/participants: One large health board in Scotland. Demographic data, patient symptoms, drugs/doses for symptom control, and patient outcomes were captured for all COVID-19 positive patients referred to Hospital Palliative Care Teams between 30th March and 26th April 2020. Results: Our COVID-19 cohort included 186 patients (46% of all referrals). Dyspnoea and agitation were the most prevalent symptoms (median 2 symptoms per patient). 75% of patients were prescribed continuous subcutaneous infusion for symptom control, which was effective in 78.6% of patients. Compared to a ‘typical’ caseload, the COVID-19 cohort were on caseload for less time (median 2 vs 5 days; p < 0.001) and had a higher death rate (80.6% vs 30.3%; p < 0.001). The COVID-19 cohort replaced ‘typical’ caseload; overall numbers of referrals were not increased. Conclusions: Hospitalised COVID-19 positive patients referred for Palliative Care may have a short prognosis, differ from ‘typical’ caseload, and predominantly suffer from dyspnoea and agitation. Such symptoms can be effectively controlled with standard doses of opioids and benzodiazepines.

scholarly journals Development of a model of Home-based Cancer Palliative Care Services in Mumbai - Analysis of Real-world Research Data over 5 Years

2021 ◽  
Vol 0 ◽  
pp. 1-31
Author(s):  
Sunil Rameshchandra Dhiliwal ◽  
Arunangshu Ghoshal ◽  
Manjiri Pushpak Dighe ◽  
Anuja Damani ◽  
Jayita Deodhar ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Symptom Management ◽  
Symptom Control ◽  
Care Process ◽  
Model Of Care ◽  
Patient Assessment ◽  
Care Services ◽  
Home Based ◽  
Management Protocol

Objectives: Patients needing palliative care prefer to be cared for in the comfort of their homes. Although private home health-care services are entering the health-care ecosystem in India, for the majority it is still institution-based. Here, we describe a model of home-based palliative care developed by the Tata Memorial Hospital, a government tertiary care cancer hospital. Materials and Methods: Data on patient demographics, services provided and outcomes were collected prospectively for patients for the year November 2013 - October 2019. In the 1st year, local general physicians were trained in palliative care principles, bereavement services and out of hours telephone support were provided. In the 2nd year, data from 1st year were analysed and discussed among the study investigators to introduce changes. In the 3rd year, the updated patient assessment forms were implemented in practice. In the 4th year, the symptom management protocol was implemented. In the 5th and 6th year, updated process of patient assessment data and symptom management protocol was implemented as a complete model of care. Results: During the 6 years, 250 patients were recruited, all suffering from advanced cancer. Home care led to good symptom control, improvement of quality of life for patients and increased satisfaction of caregivers during the care process and into bereavement. Conclusion: A home-based model of care spared patients from unnecessary hospital visits and was successful in providing client centred care. A multidisciplinary team composition allowed for holistic care and can serve as a model for building palliative care capacity in low- and middle-income countries.

scholarly journals The Use of Neuromodulation for Symptom Management

2019 ◽  
Vol 9 (9) ◽  
pp. 232 ◽  
Author(s):  
Farrell ◽  
Green ◽  
Aziz
Keyword(s):  
Palliative Care ◽  
Symptom Management ◽  
Symptom Control ◽  
Viable Option ◽  
Autonomic Dysregulation ◽  
Treatment Protocols ◽  
Care Treatment ◽  
Conventional Methods

Pain and other symptoms of autonomic dysregulation such as hypertension, dyspnoea and bladder instability can lead to intractable suffering. Incorporation of neuromodulation into symptom management, including palliative care treatment protocols, is becoming a viable option scientifically, ethically, and economically in order to relieve suffering. It provides further opportunity for symptom control that cannot otherwise be provided by pharmacology and other conventional methods.

Efficacy of an oncology palliative care clinic for improving symptom management and patient satisfaction

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19552-19552
Author(s):  
M. Follwell ◽  
D. Burman ◽  
K. Wakimoto ◽  
D. Seccareccia ◽  
J. Bryson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Patient Satisfaction ◽  
Symptom Management ◽  
Symptom Control ◽  
Symptom Distress ◽  
Assessment System ◽  
Care Clinic ◽  
Distress Score ◽  
Symptom Scores ◽  
The Mean

19552 Background: Previous studies to assess symptom control in a palliative care clinic setting have largely been retrospective. This study prospectively assesses the efficacy of an Oncology Palliative Care Clinic (OPCC) for improving symptom management and satisfaction with cancer care. Methods: All consenting patients newly referred to the OPCC completed the Edmonton Symptom Assessment System (ESAS) and the FAMCARE Scale (modified for patient use) at baseline, one week, and one month. The primary outcomes were the ESAS distress and FAMCARE total scores, for which one-week analyses are presented (paired t-test). Individual ESAS symptom scores were also assessed in an exploratory analysis, with the p-value set at 0.01 to provide some protection from multiple comparisons. Results: 118 patients, all with metastatic cancer, have completed the one-week assessment. The mean ESAS symptom distress score at baseline was 38.31±18.34. One week after the initial OPCC assessment there was a mean decrease in the distress score of 7.94 units (95%CI 5.11–10.76, p<0.0001). The mean baseline score for patient satisfaction was 66.31±13.23, with a mean increase of 7.22 points at one week (95%CI 4.51–9.94, p<0.0001). Individual symptom scores that showed the greatest improvement were anxiety (improved 1.40 units; p<0.0001), nausea (1.16 units, p = 0.0001), dyspnea (1.08 units; p = 0.0003), insomnia (0.97 units, p = 0.0003), pain (1.01 units, p = 0.0018), drowsiness (0.93 units, p = 0.0083), appetite (0.86 units, p = 0.0023) and fatigue (0.77 units p = 0.0039). The only symptoms that did not reach statistical significance were constipation (improved by 0.71, p = 0.053) and depression (0.6 units, p = 0.018). Conclusions: One week after assessment in an OPCC, there were significant improvements in symptom distress and satisfaction with care. It remains to be determined whether or not these results will be sustained at one month. Randomized controlled trials of the effectiveness of an OPCC are needed. No significant financial relationships to disclose.

scholarly journals Relevance of monitoring transmural disease activity in patients with Crohn’s disease: current status and future perspectives

2021 ◽  
Vol 14 ◽  
pp. 175628482110066
Author(s):  
Rune Wilkens ◽  
Kerri L. Novak ◽  
Christian Maaser ◽  
Remo Panaccione ◽  
Torsten Kucharzik
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Symptom Control ◽  
Current Status ◽  
Clinical Relapse ◽  
Cross Sectional ◽  
Treatment Targets ◽  
Endoscopic Remission ◽  
Transmural Inflammation

Treatment targets of inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn’s disease (CD) have evolved over the last decade. Goals of therapy consisting of symptom control and steroid sparing have shifted to control of disease activity with endoscopic remission being an important endpoint. Unfortunately, this requires ileocolonoscopy, an invasive procedure. Biomarkers [C-reactive protein (CRP) and fecal calprotectin (FCP)] have emerged as surrogates for endoscopic remission and disease activity, but also have limitations. Despite this evolution, we must not lose sight that CD involves transmural inflammation, not fully appreciated with ileocolonoscopy. Therefore, transmural assessment of disease activity by cross-sectional imaging, in particular with magnetic resonance enterography (MRE) and intestinal ultrasonography (IUS), is vital to fully understand disease control. Bowel-wall thickness (BWT) is the cornerstone in assessment of transmural inflammation and BWT normalization, with or without bloodflow normalization, the key element demonstrating resolution of transmural inflammation, namely transmural healing (TH) or transmural remission (TR). In small studies, achievement of TR has been associated with improved long-term clinical outcomes, including reduced hospitalization, surgery, escalation of treatment, and a decrease in clinical relapse over endoscopic remission alone. This review will focus on the existing literature investigating the concept of TR or residual transmural disease and its relation to other existing treatment targets. Current data suggest that TR may be the next logical step in the evolution of treatment targets.

Pain and Symptom Management in Palliative Care

1996 ◽  
Vol 3 (3) ◽  
pp. 204-213 ◽  
Author(s):  
Carla Ripamonti ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
Cancer Pain ◽  
Control Strategy ◽  
Symptom Management ◽  
Pain Control ◽  
Advanced Disease ◽  
Patients With Cancer ◽  
Pharmacologic Management

Background Pain, dyspnea, and anorexia are common symptoms experienced by patients with cancer and often are poorly managed. Methods The incidence and causes of these symptoms are described, as well as factors that exacerbate or ameliorate their impact. Results Pharmacologic management of cancer pain is based on the use of a sequential “ladder” that incorporates nonopioid, opioid, and adjuvant drugs, depending on the severity of the pain. This approach usually is effective. Other symptoms of advanced disease may be more difficult to control. Conclusions Adherence to an adequate pain-control strategy will significantly enhance palliation of pain in patients with cancer.

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