Advanced Cancer Patients’ Perceptions of Dignity

2018 ◽  
Vol 33 (2) ◽  
pp. 88-94 ◽  
Author(s):  
Sotiria Kostopoulou ◽  
Efi Parpa ◽  
Eleni Tsilika ◽  
Stylianos Katsaragakis ◽  
Irene Papazoglou ◽  
...  
Keyword(s):  
Body Image ◽  
Psychological Distress ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Depression Scale ◽  
Physical Symptoms ◽  
Role Identity ◽  
Advanced Cancer Patients ◽  
And Performance

Purpose: The present study assesses the relationship between patient dignity in advanced cancer and the following variables: psychological distress, preparatory grief, and sociodemographic and clinical characteristics. Methods: The sample consisted of 120 patients with advanced cancer. The self-administered questionnaires were as follows: the Preparatory Grief in Advanced Cancer Patients (PGAC), the Patient Dignity Inventory–Greek (PDI-Gr), the Greek Schedule for Attitudes toward Hastened Death (G-SAHD), and the Greek version of the Hospital Anxiety and Depression Scale (G-HADS). Results: Moderate to strong statistically significant correlations were found between the 4 subscales of PDI-Gr (psychological distress, body image and role identity, self-esteem, and social support) with G-HADS, G-SAHD, and PGAC ( P < .005), while physical distress and dependency was moderately correlated with depression. Multifactorial analyses showed that preparatory grief, depression, and age influenced psychological distress, while preparatory grief, depression, and performance status influenced body image and role identity. Conclusions: Preparatory grief, psychological distress, and physical symptoms had significant associations with perceptions of dignity among patients with advanced cancer. Clinicians should assess and attend to dignity-distressing factors in the care of patients with advanced cancer.

Insecure attachment predicts depression and death anxiety in advanced cancer patients

2017 ◽  
Vol 16 (3) ◽  
pp. 308-316 ◽  
Author(s):  
Katharina Scheffold ◽  
Rebecca Philipp ◽  
Susan Koranyi ◽  
Dorit Engelmann ◽  
Frank Schulz-Kindermann ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Cancer Patients ◽  
Attachment Style ◽  
Advanced Cancer ◽  
Attachment Styles ◽  
Death Anxiety ◽  
Healthcare Providers ◽  
Physical Symptoms ◽  
Insecure Attachment ◽  
Advanced Cancer Patients

ABSTRACTObjective:The prevalence of depression as well as adjustment and anxiety disorders is high in advanced cancer patients, and research exploring intraindividual factors leading to high psychological distress is underrepresented. Cancer patients' feelings about security and trust in their healthcare providers have a significant influence on how they deal with their disease. The perception of social support is affected by patients' attachment styles and influences their reactions to feelings of dependency and loss of control. We therefore aimed to explore attachment and its association with psychological distress in patients with advanced cancer.Method:We obtained data from the baseline measurements of a randomized controlled trial in advanced cancer patients. Patients were sampled from the university medical centers of Hamburg and Leipzig, Germany. The main outcome measures included the Patient Health Questionnaire, the Death and Dying Distress Scale, the Memorial Symptom Assessment Scale, and the Experience in Close Relationships Scale for assessing attachment insecurity.Results:A total of 162 patients were included. We found that 64% of patients were insecurely attached (fearful-avoidant 31%, dismissing 17%, and preoccupied 16%). A dismissing attachment style was associated with more physical symptoms but did not predict psychological distress. A fearful-avoidant attachment style significantly predicted higher death anxiety and depression, whereas preoccupied attachment predicted higher death anxiety only. Overall, insecure attachment contributed to the prediction of depression (10%) and death anxiety (14%).Significance of results:The concept of attachment plays a relevant role in advanced cancer patients' mental health. Healthcare providers can benefit from knowledge of advanced cancer patients' attachment styles and how they relate to specific mental distress. Developing a better understanding of patients' reactions to feelings of dependency and distressing emotions can help us to develop individually tailored advanced cancer care programs and psychotherapeutic interventions.

A picture of early death after admission in patients with advanced cancer at the end-of-life.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 80-80
Author(s):  
Shuji Hiramoto ◽  
Ayako Kikuchi ◽  
Hori Tetsuo ◽  
Akira Yoshioka ◽  
Tomoko Tamaki
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Early Death ◽  
Advanced Cancer Patients ◽  
Metastatic Site ◽  
Consciousness Level ◽  
Continuous Sedation ◽  
And Performance

80 Background: Little is unknown about a picture of early death after admission in terminal phase of advanced cancer patients. Previous studies have reported that approximately 14.3% of patients with cancer enroll in hospice in the last 3days of life. Methods: We retrospectively analyzed data for 510 advanced cancer patients at the end of life between August 2011 and August 2016, and contained deceased 83 (16.3%) patients within 3days after admission in our institute. We divided into deceased patients within 3days and more than 4days after admission. Primary endpoints are to compare each symptom (delirium, cancer pain, dyspnea, nausea and vomiting, fatigue) and intervention (hydration, continuous sedation, opioid) at the end of life. Secondary endpoints are association between prognostic factor and early death (within 3days) after admission. Results: Symptoms about delirium, cancer pain, dyspnea, nausea and vomiting were no significant difference between deceased patients within 3days and more than 4days after admission. Mean hydration at the end of life was more significantly volume of infusion for patients in within 3days (0.34 Litters/day) than in over 4 days (0.20 Litters/day). Continuous sedation was significantly less for patients within 3days (4.82%) than in over 4 days (28.64%). Mean of opioid use was significantly less for patients within 3days (Oral morphine dose 23.54mg/day) than in over 4 days (41.11mg/day). In univariate analysis primary site of cancer was tend to (p = 0.086), and number of metastatic site (p = 0.018) and consciousness level ( < 0.0001) and performance status ( < 0.0001) were significantly associated with early death. In multivariate analysis number of metastatic site (p = 0.057) and consciousness level ( < 0.0001) and performance status (p = 0.0004) were significantly associated with early death. Conclusions: We reports a picture of early death after admission in advanced cancer patients at the end-of-life, and number of metastatic site and consciousness level and performance status might be predictors for short-term prediction model.

scholarly journals Palliative Care and COVID-19 Pandemic: Retrospective Study of Factors Associated With Infection and Death at an Oncological Palliative Care Reference Center

2021 ◽  
pp. 104990912098696
Author(s):  
Livia Costa de Oliveira ◽  
Karla Santos da Costa Rosa ◽  
Ana Luísa Durante ◽  
Luciana de Oliveira Ramadas Rodrigues ◽  
Daianny Arrais de Oliveira da Cunha ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Tumor Type ◽  
Advanced Cancer Patients ◽  
Factors Associated ◽  
Reactive Protein

Background: Advanced cancer patients are part of a group likely to be more susceptible to COVID-19. Aims: To describe the profile of advanced cancer inpatients to an exclusive Palliative Care Unit (PCU) with the diagnosis of COVID-19, and to evaluate the factors associated with death in these cases. Design: Retrospective cohort study with data from advanced cancer inpatients to an exclusive PCU, from March to July 2020, with severe acute respiratory syndrome. Diagnostic of COVID-19 and death were the dependent variables. Logistic regression analyses were performed, with the odds ratio (OR) and 95% confidence interval (CI). Results: One hundred fifty-five patients were selected. The mean age was 60.9 (±13.4) years old and the most prevalent tumor type was breast (30.3%). Eighty-three (53.5%) patients had a diagnostic confirmation of COVID-19. Having diabetes mellitus (OR: 2.2; 95% CI: 1.1-6.6) and having received chemotherapy in less than 30 days before admission (OR: 3.8; 95% CI: 1.2-12.2) were associated factors to diagnosis of COVID-19. Among those infected, 81.9% died and, patients with Karnofsky Performance Status (KPS) < 30% (OR: 14.8; 95% CI 2.7-21.6) and C-reactive protein (CRP) >21.6mg/L (OR: 9.3; 95% CI 1.1-27.8), had a greater chance of achieving this outcome. Conclusion: Advanced cancer patients who underwent chemotherapy in less than 30 days before admission and who had diabetes mellitus were more likely to develop Coronavirus 2019 disease. Among the confirmed cases, those hospitalized with worse KPS and bigger CRP were more likely to die.

Validation of the Brief Edinburgh Depression Scale (BEDS) in a Mexican population with advanced cancer in a palliative care service

2018 ◽  
Vol 17 (04) ◽  
pp. 436-440 ◽  
Author(s):  
Oscar Rodríguez-Mayoral ◽  
Bárbara Rodríguez-Ortíz ◽  
Leticia Ascencio-Huertas ◽  
Adriana Peña-Nieves ◽  
Emma Verástegui ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Depression Scale ◽  
Case Finding ◽  
Spanish Language ◽  
Advanced Cancer Patients ◽  
Major Depressive ◽  
Palliative Patients

AbstractObjectiveDepression in palliative advanced cancer patients is common, but often goes unrecognized. One of the first steps toward improving detection is the development of tools that are valid in the specific language and setting in which they are to be used. The Brief Edinburgh Depression Scale (BEDS) is a sensitive case-finding tool for depression in advanced cancer patients that was developed in the United Kingdom. There are no validated instruments to identify depression in Mexican palliative patients. Our aim was to validate the Spanish-language version of the BEDS in Mexican population with advanced cancer.MethodWe conducted a cross-sectional study with outpatients from the palliative care unit at the Instituto Nacional de Cancerología in Mexico City. The Mexican BEDS was validated against a semistructured psychiatric clinical interview according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, classification criteria for major depressive disorder. The interviewer was blind to the BEDS score at the time of the assessment.ResultSeventy subjects completed the scale and interview. Women represented 71.4% of the sample and median age of subjects was 56.5 years (range, 20–85 years). The prevalence of major depressive disorder according to the psychiatric interview was 20%. The most valid cutoff for defining a case of depression was a score ≥5 of 18 on the Mexican BEDS, which gave a sensitivity of 85.7% and specificity of 62.5%. The scale's Cronbach's alpha was 0.71.Significance of resultsMajor depressive disorder is frequent in Mexican palliative patients. The Spanish-language Mexican version of the BEDS is the first valid case-finding tool in advanced cancer patients in this setting.

scholarly journals Home Artificial Nutrition in Advanced Cancer

1997 ◽  
Vol 90 (11) ◽  
pp. 597-603 ◽  
Author(s):  
Loris Pironi ◽  
Enrico Ruggeri ◽  
Stephan Tanneberger ◽  
Stefano Giordani ◽  
Franco Pannuti ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Artificial Nutrition ◽  
Utilization Rate ◽  
Karnofsky Performance Score ◽  
Advanced Cancer Patients ◽  
At Home

Attitudes to home artificial nutrition (HAN) in cancer vary greatly from country to country. A 6-year prospective survey of the practice of HAN in advanced cancer patients applied by a hospital-at-home programme in an Italian health district was performed to estimate the utilization rate, to evaluate efficacy in preventing death from cachexia, maintaining patients at home without burdens and distress and improving patients' performance status, and to obtain information about costs. Patients were eligible for HAN when all the following were present: hypophagia; life expectancy 6 weeks or more, suitable patient and family circumstances; and verbal informed consent. From July 1990 to June 1996, 587 patients were evaluated; 164 were selected for HAN (135 enteral and 29 parenteral) and were followed until 31 December 1996. The incidence of HAN per million inhabitants was 18.4 in the first year of activity and 33.2–36.9 in subsequent years, being 4–10 times greater than rates reported by the Italian HAN registers. On 31 December 1996, 158 patients had died because of the disease and 6 were on treatment. Mean survival was 17.2 weeks for those on enteral nutrition and 12.2 weeks for those on parenteral nutrition. Prediction of survival was 72% accurate. 95 patients had undergone 155 readmissions to hospital, where they spent 15–23% of their survival time. Burdens due to HAN were well accepted by 124 patients, an annoyance or scarcely tolerable in the remainder. The frequency of major complications of parenteral nutrition was 0.67 per year for catheter sepsis and 0.16 per year for deep vein thrombosis. Karnofsky performance score increased in only 13 patients and body weight increased in 43. The fixed direct costs per patient-day (in European Currency Units) were 14.2 for the nutrition team, 18.2 for enteral nutrition and 61 for parenteral nutrition. The results indicate that definite entry criteria and local surveys are required for the correct use of HAN in advanced cancer patients, that HAN can be applied without causing additional burdens and distress, and that its costs are not higher than hospital costs.

The Importance of a Home Care Program for Patients with Advanced Cancer Pain

1985 ◽  
Vol 71 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Vittorio Ventafridda ◽  
Marcello Tamburini ◽  
Silvana Selmi ◽  
Luigi Valera ◽  
Franco De Conno
Keyword(s):  
Home Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Care Program ◽  
Pain Clinic ◽  
Advanced Cancer Patients ◽  
Sample Group ◽  
Significant Difference ◽  
Quality Of Life Index

At the Pain Clinic of the National Cancer Institute of Milan, a special Home Care Program has been set up to assist advanced cancer patients with pain and their families during their remaining survival. The Home Care Unit comprises a team of physicians, nurse clinicians, psychologists and many volunteers who are active both in the hospital and at the patient's home. This entire operation provides a continuous relationship between the family, the patient and the Home Care Unit. This Home Care Program, which is one of a kind with other forms of treatment for advanced cancer patients (i.e. hospices), has produced interesting results. Out of a sample group of 50 patients, 33 were monitored at home by the Home Care Unit while 17 had their families to do the monitoring. Over a six-week period the following results were reported: a) Improvement of psycho-emotional factors such as anxiety, weakness and mood for both patients and their families who entered the Home Care Program. b) The Quality of Life Index remained unchanged for the sample group that entered the Home Care Program whereas it deteriorated for patients monitored by their families. c) A decrease in the Integrated Pain Score for both groups; however, results showed a statistically significant difference in favor of patients on the Home Care Program. d) The Performance Status decreased by very little over the study period, and there was little difference between the two groups. These results confirm the need for a Home Care Program which must go hand in hand with the Pain Clinic as an effective way to control Total Pain.

Use of parenteral nutrition in patients with advanced cancer

2008 ◽  
Vol 33 (1) ◽  
pp. 102-106 ◽  
Author(s):  
Isaac Soo ◽  
Leah Gramlich
Keyword(s):  
Parenteral Nutrition ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Bowel Obstruction ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Intestinal Failure ◽  
Advanced Cancer Patients ◽  
End Stage ◽  
Northern Alberta

The purpose of this study is to describe patient-related variables in a cohort of advanced cancer patients (ACPs) enrolled in a home parenteral nutrition (HPN) program. This study reviewed the cohort of ACPs enrolled in the Northern Alberta Home Total Parenteral Nutrition Program (NAHTPNP). Thirty-eight ACPs received HPN during the study period, 24% of all patients admitted for PN. Of these, 27 (71%) were female. Mean age was 48.76 y (SD 13.8 y). Bowel obstruction was the most common indication for initiating HPN (84%, 32) and ovarian cancer was the most common malignancy (34%, 13). Patients who began HPN with a Karnofsky performance status (KPS) of greater than 50 (median of 70) were found to have a longer duration of life (median: 6 months) compared with patients who began HPN with a KPS of 50 or below (median = 50; median 3 months; p = 0.01; two-tailed). There was no difference in survival between malignancy type (p = NS). Advanced cancer is the fastest growing indication for enrollment in the HPN program. ACP demonstrated a 3% average annual increase proportionate to all indications for HPN starts, accounting for 7%–48% of HPN starts from 1999–2006. HPN is an increasingly used therapy for patients with advanced cancer, most commonly for intestinal failure in the setting of bowel obstruction. Initiation of HPN at a higher KPS was associated with a longer duration of life. Further studies are needed to validate the use of TPN in end-stage cancer patients.

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