scholarly journals Differential effects of early palliative care based on the age and sex of patients with advanced cancer from a randomized controlled trial

2018 ◽  
Vol 32 (4) ◽  
pp. 757-766 ◽  
Author(s):  
Ryan D Nipp ◽  
Areej El-Jawahri ◽  
Lara Traeger ◽  
Jamie M Jacobs ◽  
Emily R Gallagher ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Palliative Care ◽  
Gastrointestinal Cancer ◽  
Advanced Lung Cancer ◽  
Early Palliative Care ◽  
Oncology Care ◽  
And Coping ◽  
Age And Sex

Background: Early palliative care interventions enhance patient outcomes, including quality of life, mood, and coping, but it remains unclear whether certain subgroups of patients are more likely to benefit from early palliative care. We explored whether age and sex moderate the improved outcomes seen with early palliative care. Methods: We performed a secondary analysis of data from a randomized trial of 350 patients with advanced lung and non-colorectal gastrointestinal cancer. Patients received an early palliative care intervention integrated with oncology care or usual oncology care alone. We used linear regression to determine if age (older or younger than 65) and sex moderated the effects of the intervention on quality of life (Functional Assessment of Cancer Therapy–General (FACT-G)), depression symptoms (Patient Health Questionnaire 9 (PHQ-9)), and coping (Brief COPE) within lung and gastrointestinal subgroups. Results: At 24 weeks, younger patients with lung cancer receiving early palliative care reported increased use of active coping ( B = 1.74; p = 0.02) and decreased use of avoidant coping ( B = –0.97; p = 0.02), but the effects of early palliative care on these outcomes were not significant for older patients. Male patients with lung cancer assigned to early palliative care reported better quality of life (FACT-G: B = 9.31; p = 0.01) and lower depression scores (PHQ-9: B = –2.82; p = 0.02), but the effects of early palliative care on these outcomes were not significant for female patients. At 24 weeks, we found no age or sex moderation effects within the gastrointestinal cancer subgroup. Conclusion: Age and sex moderate the effects of early palliative care for patients with advanced lung cancer. Early palliative care may need to be tailored to individuals’ unique sociodemographic and clinical characteristics.

scholarly journals Nurse-led, screening-triggered, early specialised palliative care intervention programme for patients with advanced lung cancer: study protocol for a multicentre randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e037759
Author(s):  
Daisuke Fujisawa ◽  
Shigeki Umemura ◽  
Ayumi Okizaki ◽  
Eriko Satomi ◽  
Takuhiro Yamaguchi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Palliative Care ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Advanced Lung Cancer ◽  
Intervention Programme ◽  
Care Intervention ◽  
Randomised Controlled

IntroductionIt has been suggested that palliative care integrated into standard cancer treatment from the early phase of the disease can improve the quality of life of patients with cancer. In this paper, we present the protocol for a multicentre randomised controlled trial to examine the effectiveness of a nurse-led, screening-triggered, early specialised palliative care intervention programme for patients with advanced lung cancer.Methods and analysisA total of 206 patients will be randomised (1:1) to the intervention group or the control group (usual care). The intervention, triggered with a brief self-administered screening tool, comprises comprehensive need assessments, counselling and service coordination by advanced-level nurses. The primary outcome is the Trial Outcome Index of the Functional Assessment of Cancer Therapy (FACT) at 12 weeks. The secondary outcomes include participants’ quality of life (FACT-Lung), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), illness perception (Prognosis and Treatment Perceptions Questionnaire), medical service use and survival. A mixed-method approach is expected to provide an insight about how this intervention works.Ethics and disseminationThis study has been approved by the Institutional Review Board of the National Cancer Center Japan (approval number: 2016-235). The findings will be disseminated through peer-reviewed publications and conference presentations and will be reflected on to the national healthcare policy.Trial registration numberUMIN000025491.

Evaluating the Time to Palliative Care Referrals in Patients With Small-Cell Lung Cancer: A Single-Centre Retrospective Review

2018 ◽  
Vol 35 (11) ◽  
pp. 1426-1432
Author(s):  
Geoffrey Alan Watson ◽  
Jean Saunders ◽  
Linda Coate
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Palliative Care ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Tertiary Hospital ◽  
Small Cell ◽  
Small Cell Lung ◽  
Early Palliative Care

Introduction: Lung cancer is a leading cause of morbidity and mortality worldwide. Patients with lung cancer may experience a plethora of symptoms, which can be debilitating and affect their quality of life. Palliative care input to manage their physical and psychological well-being is a crucial component of their oncological care. The benefit of early palliative care input has been shown in patients with non-small cell lung cancer; however, data pertaining to patients with small-cell lung cancer are scarce. Nevertheless, early palliative care input is recommended by several national and international guidelines. Thus, we aimed to assess the time to palliative care referrals in patients diagnosed with small-cell lung cancer in an Irish tertiary hospital and to determine what impact this had on overall survival. Methods: We performed a retrospective, single-center audit of all patients diagnosed with extensive stage small-cell lung cancer over a 6-year period in an Irish tertiary hospital. Results: Overall, 91 patients were identified. Median age at diagnosis was 66 years (range: 38-83 years). The median Eastern Cooperative Oncology Group Performance Status at diagnosis was 1 (range: 0-3); 24 (26%) patients had multiple sites of distant metastasis at diagnosis; 45 (49.5%) patients were alive at 6 months, and 15 (16.5%) patients were alive at 12 months. One hundred percent of patients received palliative care input in our center over the course of their care. In the patients alive at 6 months after diagnosis, there was no survival advantage in those receiving palliative care within 1 month ( P = .002, odd ratio: 0.23, 95% confidence interval: 0.09-0.59). Conclusion: Palliative care treatment is a critical aspect in the oncological treatment of all patients diagnosed with advanced cancer, and this study highlights good compliance with existing national guidelines. Further research focusing on quality-of-life issues with the use of questionnaires to assess physical and psychological symptoms should be performed to further understand the impact of palliative care in these patients.

Early palliative care for lung cancer: improving quality of life and increasing survival

2010 ◽  
Vol 16 (9) ◽  
pp. 420-423 ◽  
Author(s):  
Constance Dahlin ◽  
John M Kelley ◽  
Vicki A Jackson ◽  
Jennifer S Temel
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Palliative Care ◽  
Early Palliative Care

Quality of Life in Patients With Advanced Lung Cancer Treated at Home and at a Palliative Care Unit

2011 ◽  
Vol 29 (5) ◽  
pp. 379-387 ◽  
Author(s):  
Wojciech Leppert ◽  
Anna Turska ◽  
Mikolaj Majkowicz ◽  
Sylwia Dziegielewska ◽  
Piotr Pankiewicz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Palliative Care ◽  
Palliative Care Unit ◽  
Advanced Lung Cancer ◽  
Lung Cancer Patients ◽  
Assess Quality ◽  
Eortc Qlq ◽  
At Home

Background: To assess quality of life (QOL) in patients with advanced lung cancer. Patients and Methods: A prospective study of 78 patients cared at home and at a palliative care unit (PCU) with 2 QOL assessments was conducted. Results: Fifty patients completed the study. In the EORTC QLQ-C30 role, cognitive, social functioning, global QOL, fatigue, pain, dyspnea, and appetite deteriorated; nausea/vomiting improved; dyspnea was more intense in the case of in-home patients. In the EORTC QLQ-LC13 hemoptysis improved; pain in other parts was more intense in the PCU patients. Pain (Visual Analogue scale) was more intense in the PCU patients; the level of activity (Karnofsky) decreased in the case of patients treated at home. Conclusions: QOL deteriorated with few differences between home and the PCU patients.

Preparation for the end of life and life completion during late-stage lung cancer: An exploratory analysis

2017 ◽  
Vol 15 (5) ◽  
pp. 554-564 ◽  
Author(s):  
Gail Adorno ◽  
Cara Wallace
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Older Adults ◽  
Palliative Care ◽  
Depressive Symptoms ◽  
End Of Life ◽  
Late Stage ◽  
Advanced Lung Cancer ◽  
Stage Lung Cancer

ABSTRACTObjective:Our aim was to explore preparation for the end of life (EoL) and life closure among persons with advanced metastatic lung cancer. Understanding quality of life through the lens of preparation and completion is important since the trajectory of lung cancer can be relatively short, often leading to application of cancer-directed therapies near death without the opportunity for advance planning or palliative care. Clinical research is needed to understand the kinds of distress specific to older adults with advanced lung cancer that are amendable to palliative care interventions.Method:We employed an exploratory cross-sectional design to examine psychosocial and existential concerns among a purposive sample (N = 30) of advanced lung cancer patients using the “end-of-life preparation” and “life completion” subscales of the Quality of Life at the End of Life (QUAL–E) questionnaire. Nonparametric methods were employed to analyze preparation, completion, global quality of life (QoL), and the associations among depressive symptoms, preparation, completion, and global QoL.Results:Higher scores on life completion were associated with better global QoL, and with items related to transcendence, communicative acts, and interpersonal relationships demonstrating important contributions. The perception of being a future burden on family members was the greatest concern within the preparation domain. Depressive symptoms were not associated with preparation, completion, or global QoL.Significance of Results:Psychosocial and existential issues contribute to QoL at the EoL among older adults with late-stage lung cancer during cancer-directed therapy, concurrent care, and hospice. The role of preparation, especially self-perceived burden, merits further research early on in the oncological setting. The preparation and life completion subscales of the QUAL–E are feasible clinical tools for facilitating dyadic communication about sensitive topics in the palliative care setting.

Single early palliative care intervention added to usual oncology care for patients with advanced cancer: A randomized controlled trial (SENS Trial)

2021 ◽  
pp. 026921632110053
Author(s):  
Steffen Eychmüller ◽  
Susanne Zwahlen ◽  
Monica C Fliedner ◽  
Peter Jüni ◽  
Daniel M Aebersold ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Health Related Quality ◽  
Early Palliative Care ◽  
Care Intervention ◽  
Related Quality ◽  
Health Related ◽  
Oncology Care

Background: International oncology societies recommend early palliative care. Specific models to integrate early palliative care efficiently into clinical practice are debated. The authors designed a study to look at the quantitative and qualitative outcomes of an early palliative care intervention in oncological care to decrease stress and improve quality of life. Aims: To compare a single structured early palliative care intervention added to a usual oncology care in terms of distress and health-related quality of life at baseline compared to 6 months after enrollment. Design: This multicenter randomized controlled trial (NCT01983956) enrolled adult patients with advanced cancer. Participants were either randomly assigned to usual oncology care alone or usual care plus a structured early palliative care intervention. Setting/participants: One hundred fifty adult patients with a variety of advanced cancer diagnoses were randomized. Seventy-four participants were in the intervention and 76 participants in the control group. The primary outcome was the change in patient distress assessed by the National Comprehensive Cancer Network distress thermometer at 6 months. Health-related quality of life, the secondary outcome, was assessed by the Functional Assessment of Cancer Therapy–General Questionnaire. Results: The results showed no significant effect of the early palliative care intervention neither on patient distress nor on health-related quality of life. Conclusion: The addition of an early intervention to usual care for patients with advanced cancer did not improve distress or quality of life. Thus, patients may need more intensive early palliative care with continuous professional support to identify and address their palliative needs early.

scholarly journals Feasibility and preliminary efficacy of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer

2020 ◽  
Author(s):  
Manuel Ester ◽  
S. Nicole Culos-Reed ◽  
Amane Abdul-Razzak ◽  
Julia Daun ◽  
Delaney Duchek ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Lung Cancer ◽  
Palliative Care ◽  
Symptom Burden ◽  
Advanced Lung Cancer ◽  
Post Intervention ◽  
Management Intervention ◽  
Exercise Classes

Introduction: Advanced lung cancer patients face significant physical and psychological burden leading to reduced quality of life. Physical activity, nutrition, and palliative care interventions may enhance quality of life, however no study has combined these modalities in a multimodal intervention. Therefore, we assessed the feasibility and preliminary efficacy of an exercise, nutrition, and palliative symptom management intervention to improve quality of life in advanced lung cancer. Methods: Participants received an individually-tailored 12-week intervention featuring in-person group-based exercise classes, at-home physical activity prescription, and nutritional and palliative care consults. Patients reported symptom burden and quality of life pre-/post-class, as well as pre-/post-intervention, along with self-reported physical activity and a physical function assessment. Post-intervention interviews examined participant perspectives. Results: The multimodal program was feasible, with 44% recruitment, 75% class attendance, 89% nutrition and palliative consult attendance, and 85% assessment completion. Participants perceived the intervention as feasible and valuable. Physical activity, symptom burden, and quality of life were maintained, while tiredness decreased significantly. Exercise classes prompted acute clinically meaningful reductions in fatigue, tiredness, depression, pain, and increases in energy and well-being. Conclusion: A multimodal exercise, nutrition, and palliative symptom management intervention is feasible and shows potential benefits on quality of life that warrant further investigation.

Sign in / Sign up

Export Citation Format

Share Document