Choosing wisely in oncology: necessity and obstacles

In the last decades, the survival of many patients with cancer improved thanks to modern diagnostic methods and progresses in therapy. Still for several tumours, especially when diagnosed at an advanced stage, the benefits of treatment in terms of increased survival or quality of life are at best modest when not marginal, and should be weighed against the potential discomfort caused by medical procedures. As in other specialties, in oncology as well the dialogue between doctor and patient should be encouraged about the potential overuse of diagnostic procedures or treatments. Several oncological societies produced recommendations similar to those proposed by other medical disciplines adhering to the Choosing Wisely (CW) campaign. In this review, we describe what was reported in the medical literature concerning adequacy of screening, diagnostic, treatment and follow-up procedures and the potential impact on them of the CW. We only marginally touch on the more complex topic of treatment appropriateness, for which several evaluation methods have been developed (including the European Society for Medical Oncology—magnitude of clinical benefit scale). Finally, we review the possible obstacles for the development of CW in the oncological setting and focus on the strategies which could allow CW to evolve in the cancer field, so as to enhance the therapeutic relationship between medical professionals and patients and promote more appropriate management.

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Sleep Pattern and Predictors of Sleep Disturbance Among Family Caregivers of Terminal Ill Patients With Cancer in Taiwan: A Longitudinal Study

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118755453 ◽

2018 ◽

Vol 35 (8) ◽

pp. 1109-1117 ◽

Cited By ~ 4

Author(s):

Kwo-Chen Lee ◽

Ya-Ling Hsieh ◽

Pi-Chu Lin ◽

Yun-Ping Lin

Keyword(s):

Longitudinal Study ◽

Sleep Quality ◽

Sleep Disturbance ◽

Family Caregivers ◽

Terminally Ill ◽

Patients With Cancer ◽

Terminally Ill Patients ◽

Prospective Longitudinal

Background: Sleep disturbance commonly has a negative impact on the well-being of family caregivers (FCs) of terminally ill patients with cancer. The effect of sleep disturbance on FCs has not been explored through long-term follow-up studies in Taiwan. Objective: The purposes of this study were to (1) identify the trajectory of sleep quality of FCs of terminally ill patients with cancer in Taiwan and (2) examine the determinants of sleep disturbance through a longitudinal follow-up until patient death. Methods: A prospective, longitudinal study was conducted among 95 FCs of terminally ill patients with cancer. The FCs’ sleep quality was measured subjectively by using the Pittsburgh Sleep Quality Index and objectively by wearing a wrist actigraphy for 48 hours each month during the 6-month follow-up assessments. The trajectory and determinants of sleep quality were identified using a generalized estimation equation approach. Results: The FCs’ sleep quality significantly decreased as the patient’s death approached. Family caregivers who were women or older, had a relative with a longer survival period after diagnosis, reported higher levels of depression and fatigue, and provided lower levels of assistance to their relatives experienced more sleep disturbance. Conclusion: The sleep quality of Taiwanese FCs significantly deteriorated as the death of the terminally ill patients with cancer approached. Early detection of the FCs’ sleep disturbance, increasing their self-awareness of sleep problems, and providing nonpharmacological interventions and psychosocial support may be helpful for FCs to improve their quantity and quality of sleep.

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Interventional radiology in the palliation of cancer

10.1093/med/9780198821328.003.0082 ◽

2021 ◽

pp. 861-871

Author(s):

Tarun Sabharwal ◽

Nicos I. Fotiadis ◽

Andy Adam

Keyword(s):

Palliative Care ◽

Interventional Radiology ◽

Diagnostic Procedures ◽

Venous Access ◽

Patients With Cancer ◽

Therapeutic Procedures ◽

Potential Benefits ◽

Diagnosis Of Cancer ◽

Interventional Radiology Procedures

Interventional radiology uses image guidance to perform minimally invasive therapeutic and diagnostic procedures. It is an integral part of the multidisciplinary team managing patients with cancer. Interventional radiology is involved in all stages of the cancer patient’s journey starting from performing image-guided biopsies for the diagnosis of cancer, venous access procedures, and therapeutic procedures, and focuses on the palliation of symptoms and improvement in the quality of life. All interventional procedures carry some risk, which is related to the underlying condition, the nature of the procedure, and the experience of the radiologist. Therefore, it is important in patients with advanced malignant disease receiving palliative care to contemplate only those procedures that will alleviate symptoms, and in which the potential benefits outweigh the risks. This chapter presents the drainage, stenting, feeding, embolization, ablation, and supportive interventional radiology procedures which could potentially benefit patients undergoing palliative care. The focus will be on the indications, contraindications, and likely outcomes, rather than on detailed technical descriptions.

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Managing Pain in Patients With Cancer: The Chinese Good Pain Management Experience

Journal of Global Oncology ◽

10.1200/jgo.2016.005686 ◽

2017 ◽

Vol 3 (5) ◽

pp. 583-595 ◽

Cited By ~ 5

Author(s):

Shi-Ying Yu ◽

Jie-Jun Wang ◽

Yu-guang Huang ◽

Bing Hu ◽

Kun Wang ◽

...

Keyword(s):

Quality Of Life ◽

Pain Management ◽

High Standard ◽

Management Training ◽

Drug Dose ◽

Dose Titration ◽

Patients With Cancer ◽

Opioid Drugs

Purpose The number of cancer cases in China has increased rapidly from 2.1 million in 2000 to 4.3 million in 2015. As a consequence, pain management as an integral part of cancer treatment became an important health care issue. In March 2011, the Good Pain Management (GPM) program was launched to standardize the treatment of cancer pain and improve the quality of life for patients with cancer. With this work, we will describe the GPM program, its implementation experience, and highlight key lessons that can improve pain management for patients with cancer. Methods We describe procedures for the selection, implementation, and assessment procedures for model cancer wards. We analyzed published results in areas of staff training and patient education, pain management in practice, analgesic drugs administration, and patient follow-up and satisfaction. Results Pain management training enabled medical staff to accurately assess the level of pain and to provide effective pain relief through timely dispensation of medication. Patients with good knowledge of treatment of pain were able to overcome their aversion to opioid drugs and cooperate with nursing staff on pain assessment to achieve effective drug dose titration. Consumption of strong opioid drugs increased significantly; however, there was no change for weaker opioids. Higher pain remission rates were achieved for patients with moderate-to-severe pain levels. Proper patient follow-up after discharge enabled improved outcomes to be maintained. Conclusion The GPM program has instituted a consistent and high standard of care for pain management at cancer wards and improved the quality of life for patients with cancer.

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Efficacy of naloxegol on symptoms and quality of life related to opioid-induced constipation in patients with cancer: a 3-month follow-up analysis

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002249 ◽

2020 ◽

pp. bmjspcare-2020-002249

Author(s):

Manuel Cobo Dols ◽

Carmen Beato Zambrano ◽

Luis Cabezón Gutiérrez ◽

Rodolfo Chicas Sett ◽

María Isabel Blancas López-Barajas ◽

...

Keyword(s):

Quality Of Life ◽

Karnofsky Performance Status ◽

Moderate Intensity ◽

Life Questionnaire ◽

Inadequate Response ◽

Patient Assessment ◽

Patients With Cancer ◽

Bowel Movements

ObjectivesOpioid-induced constipation (OIC) can affect up to 63% of all patients with cancer. The objectives of this study were to assess quality of life as well as efficacy and safety of naloxegol, in patients with cancer with OIC.MethodsAn observational study was made of a cohort of patients with cancer and with OIC exhibiting an inadequate response to laxatives and treated with naloxegol. The sample consisted of adult outpatients with a Karnofsky performance status score ≥50. The Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) and the Patient Assessment of Constipation Symptoms (PAC-SYM) were applied for 3 months.ResultsA total of 126 patients (58.2% males) with a mean age of 61.3 years (range 34–89) were included. Clinically relevant improvements (>0.5 points) were recorded in the PAC-QOL and PAC-SYM questionnaires (p<0.0001) from 15 days of treatment. The number of days a week with complete spontaneous bowel movements increased significantly (p<0.0001) from 2.4 to 4.6 on day 15, 4.7 after 1 month and 5 after 3 months. Pain control significantly improved (p<0.0001) during follow-up. A total of 13.5% of the patients (17/126) presented some gastrointestinal adverse reaction, mostly of mild (62.5%) or moderate intensity (25%).ConclusionsClinically relevant improvements in OIC-related quality of life, number of bowel movements and constipation-related symptoms were recorded as early as after 15 days of treatment with naloxegol in patients with cancer and OIC, with a good safety profile.

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Quality of life in thyroid cancer patients: a literature review

Medicine and Pharmacy Reports ◽

10.15386/cjmed-703 ◽

2017 ◽

Vol 90 (2) ◽

pp. 147-153 ◽

Cited By ~ 6

Author(s):

Elena Bãrbuş ◽

Claudiu Peştean ◽

Maria Iulia Larg ◽

Doina Piciu

Keyword(s):

Quality Of Life ◽

Thyroid Cancer ◽

Literature Review ◽

Psychological Impact ◽

Solid Base ◽

Emotional Impact ◽

Free Access ◽

Patients With Cancer

Introduction. Quality of life (QoL) has received increasing interest in the last years, especially in patients with cancer. This article aims to analyze a selection of medical research papers regarding the quality of life in patients with thyroid carcinoma. We overviewed the main QoL aspects derived from several studies and highlighted those less researched issues, which could represent a solid base for future clinical studies.Method. We used an integrative selection method of medical literature, choosing mostly "free access" studies, as it was considered that they could be easily viewed, searched and researched including by patients.Results. After an integrative literature review, we selected 16 relevant studies. Patients with thyroid cancer have several factors influencing their QoL, with both physical and psychological impact. The decisive factors are the quality of the surgical act, radioiodine therapy, follow-up using rh-TSH vs. hormonal withdrawal, access to behavioral help and the relationship with their physician.Conclusion. We must understand the emotional impact of the cancer diagnosis on the patient and we must collaborate in order to help the patient restore the psychosomatic balance and to recover the quality of life.

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Pulmonary lymphangitis and cancer: Prospective series of 37 patients in palliative care

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.18600 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 18600-18600 ◽

Cited By ~ 1

Author(s):

A. A. Dettino ◽

E. M. Negri ◽

T. Pagano

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Short Form ◽

Primary Tumors ◽

Patients With Cancer ◽

The Moment ◽

In The Beginning ◽

Minor Criteria

18600 Background: Lymphangitis of the lungs is an uncommon type of metastasis, mainly in breast, lung and gastric cancers, and has major impact in quality of life and an unfavorable prognosis. Survival is very poor: 50% in 3 and 15% in 6 months. Our objective was to evaluate prospectively quality of life in cancer patients with pulmonary lymphangitis, under palliative care. Methods: Patients with pulmonary lymphangitis, diagnosed either by lung biopsy (major criteria) or 3 minor criteria (cyto or histotologically proven cancer, clinical picture and image exam) were followed in 3 tertiary services, in a cohort series study. Primary end point was quality of life (QoL), measured with questionnaires in the beginning of the study and monthly afterwards (Saint George Respiratory Questionnaire -SGRQ- and Medical Outcomes Study 36-Item Short-Form Health Survey -SF36). Clinical and complementary aspects were also followed, in addition to treatment and outcome. Results: Thirty-seven patients were included from Aug/2004 to Jan/2006 - 23 female and 14 male; age from 41 to 84 (mean: 62) years. Primary tumors were: lung (20), breast (11), esophagus (2), pancreas, rectum and bone. Of those patients, 33 were able to respond QoL questionnaires in the beginning of follow-up and monthly thereafter. Median follow-up was of one month (range: 0–13); at the moment, 9 patients are still alive. Median survival was 2.5 months (range: 0,1–33), with 38% with a survival of at least 6 months. In general, QoL was poor, but improved after palliative care. Notice that values get higher as QoL improves in SF-36; however, they get lower as QoL improves in SGRQ - values were 61.5, 50.5, 61.7, and 47.5% for SGRQ and 38.1, 32.1, 32.8, 61.6 for SF36 in 0, 1, 3 and 6 months, respectively. Palliative care included: corticosteroids (65%), oxygen (51%), opioids (51%), diuretics (47%), inhalations with beta2-agonists and/or ipatropium (57%), chemo and/or hormonotherapy (51%), physical therapy (43%), antidepressants and benzodiazepines (37% each), thoracocentesis (35%), and blood transfusions. Conclusions: Even though QoL is poor and survival is short for patients with cancer lymphangitis in lungs, some improvement is possible with active palliative care. No significant financial relationships to disclose.

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PRIVATE PEDIATRIC PRACTICE: PERFORMANCE AND PROBLEMS

PEDIATRICS ◽

10.1542/peds.52.3.344 ◽

1973 ◽

Vol 52 (3) ◽

pp. 344-351

Author(s):

Barbara Starfield ◽

Henry Seidel ◽

Gertrude Carter ◽

William Garvin ◽

Johanna Seddon

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Medical Records ◽

Health Management ◽

Diagnostic Procedures ◽

Pediatric Practice ◽

American Academy Of Pediatrics ◽

Practice Performance

All 96 physicians in pediatric practice in the Baltimore area were invited to join in a study assessing the quality of health management. The 15 practitioners who participated helped to set the criteria which were modifications of the standards set by the American Academy of Pediatrics. Medical records of 5-year-olds were audited for recording of preventive procedures, throat cultures for suspected pharyngitis, and urine cultures for suspected urinary tract infection. Some procedures were uniformly well performed; the performance of others varied widely. None of the practices had high rates of recording for all procedures. Existing records proved inadequate to assess the sequence of performance of activities and the relationships between problems, diagnostic procedures, responses, and follow-up. Data from questionnaires sent to all 96 physicians indicated that the performance of the 15 participants was probably higher than that which would be obtained if all the practitioners in the area had participated. This study has implications for the way in which peer review activities are organized and carried out.

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Measuring Financial Distress and Quality of Life Over Time in Patients With Gynecologic Cancer—Making the Case to Screen Early in the Treatment Course

JCO Oncology Practice ◽

10.1200/op.20.00907 ◽

2021 ◽

pp. OP.20.00907

Author(s):

Margaret I. Liang ◽

Sarah S. Summerlin ◽

Christina T. Blanchard ◽

Teresa K. L. Boitano ◽

Warner K. Huh ◽

...

Keyword(s):

Quality Of Life ◽

Financial Distress ◽

Gynecologic Cancer ◽

Correlation Coefficients ◽

Estimating Equation ◽

Patients With Cancer ◽

Repeated Analysis ◽

Over Time

PURPOSE: Our objective was to measure the trajectory of financial distress and to determine its relationship with quality of life (QOL) among patients with cancer. MATERIALS AND METHODS: We conducted a longitudinal survey of patients with gynecologic cancer starting a new line of systemic therapy at baseline, 3 months, and 6 months. Financial distress was measured using a Comprehensive Score for Financial Toxicity (COST) < 26, and QOL was measured using Functional Assessment of Cancer Therapy-General (FACT-G) with lower scores indicating worse responses. One-way repeated analysis of variances, generalized estimating equation models, and correlation coefficients were used to evaluate financial distress and QOL over time. RESULTS: There were 90 of 121 (74%) baseline participants with a 6-month follow-up. The average age was 60 years, 29% were African-American, 57% had an annual income < $40,000 in US dollars, and 6% were uninsured. At baseline, 54% of patients screened positive for financial distress, which was unchanged at 3 months (50%, P = .27) but decreased at 6 months (46%, P = .04) compared with baseline. There was no change in average COST (23.6, 25.1, 25.6; P = .33) or FACT-G (70.8, 71.0, 72.8; P = .68) over time. Less financial distress was moderately correlated with better QOL (r = 0.63, 0.61, 0.60) at each time point. The presence of financial distress was associated with a 16-point decrease in FACT-G QOL score over time. CONCLUSION: Upfront screening with COST identified 90% of patients who experienced financial distress, and COST did not change significantly over time. More severe financial distress was moderately correlated with worse QOL, and its presence was associated with a clinically meaningful 16-point decrease in QOL.

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Text Messaging in Oncology: A Review of the Landscape

JCO Clinical Cancer Informatics ◽

10.1200/cci.17.00162 ◽

2018 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Sarah S. Mougalian ◽

Cary P. Gross ◽

E. Kevin Hall

Keyword(s):

Text Messaging ◽

Care Delivery ◽

The United States ◽

Patients With Cancer ◽

Barriers To Implementation ◽

Text Messaging Intervention ◽

E Mail ◽

Improve Health Care Delivery

Text messaging via short messaging service (SMS) is a common route of communication in the United States and offers many advantages to improve health care delivery compared with other forms of mHealth. Text messaging is easy to use, is convenient, is more likely to be viewed than e-mail, and can be tailored to an individual recipient’s needs. Despite evidence that patients with cancer desire more mobile-based communication, there are few examples of successful text messaging interventions in the literature. This narrative review examines the current landscape of SMS-based interventions across the continuum of cancer care, including addressing behavioral change, attendance to screening and follow-up appointments, adherence to treatment, and assessment of symptoms and quality of life. Finally, we explore some of the barriers to implementation of a successful text messaging intervention.

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