The Evaluation of the Relationship Between the Level of Disclosure of Cancer in Terminally Ill Patients With Cancer and the Quality of Terminal Care in These Patients and Their Families Using the Support Team Assessment Schedule

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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Factors Affecting the Improvement of Quality of Dying of Terminally Ill Patients with Cancer through Palliative Care: A Ten-Year Experience

Journal of Palliative Medicine ◽

10.1089/jpm.2012.0033 ◽

2012 ◽

Vol 15 (8) ◽

pp. 854-862 ◽

Cited By ~ 23

Author(s):

Shao-Yi Cheng ◽

Sydney Dy ◽

Wen-Yu Hu ◽

Ching-Yu Chen ◽

Tai-Yuan Chiu

Keyword(s):

Palliative Care ◽

Terminally Ill ◽

Factors Affecting ◽

Patients With Cancer ◽

Quality Of Dying ◽

Terminally Ill Patients

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Comparison of Patient Self-Reported Quality of Life and Health Care Professional-Assessed Symptoms in Terminally ill Patients With Cancer

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120944157 ◽

2020 ◽

pp. 104990912094415

Author(s):

Chikako Matsumura ◽

Nanako Koyama ◽

Morito Sako ◽

Hideo Kurosawa ◽

Takehisa Nomura ◽

...

Keyword(s):

Quality Of Life ◽

Health Care ◽

Palliative Care ◽

Health Care Professionals ◽

Terminally Ill ◽

Patients With Cancer ◽

Terminally Ill Patients ◽

Patient Reported ◽

Exact Agreement

Background: Few studies evaluated whether health care professionals accurately assess several symptoms for patients with cancer in palliative care units. We determined the agreement level for several symptoms related to quality of life (QOL) between patient-reported QOL assessment and health care professional-assessed symptoms based on the Support Team Assessment Schedule (STAS). Method: An observational study was performed with terminally ill patients with cancer hospitalized in the palliative care unit between June 2018 and December 2019. Patients and health care professionals independently assessed 7 symptoms at the time of hospitalization and after 1 week. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C15-PAL). In examining the proportions of exact agreement, “exact agreement” referred to the pairs of the scores (QLQ-C15-PAL vs STAS) being (1 vs 0), (2 vs 1), (3 vs 2 or 3), or (4 vs 4). The relationships of physical functioning between QLQ-C15-PAL and Palliative Performance Scale (PPS) were examined. Results: Of 130 patients, approximately 60% had PPS scores from 40 to 60. The highest mean score on QLQ-C15-PAL was for fatigue (63.8). The exact agreement on symptoms between patients and health care professionals ranged from 15.4% (fatigue) to 57.7% (nausea and vomiting). The mean of the transformed QLQ-C15-PAL and proportions of exact agreement were negatively correlated ( R 2 = 0.949, P < .05). The physical function scores in QLQ-C15-PAL for each PPS group showed no differences. Conclusion: We expect patient-reported outcomes including QLQ-C15-PAL to be added to health care professionals’ assessment of serious symptoms such as fatigue in terminally ill patients with cancer.

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Investigation of Optimal Time for Starting Betamethasone Using Fatigue Scores and Prognostic Nutritional Index in Terminally Ill Patients With Cancer-Related Fatigue

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909116632487 ◽

2016 ◽

Vol 34 (5) ◽

pp. 449-455 ◽

Cited By ~ 2

Author(s):

Nanako Koyama ◽

Chikako Matsumura ◽

Hiroaki Morii ◽

Chiaki Hasegawa ◽

Daiki Hira ◽

...

Keyword(s):

Survival Time ◽

Terminally Ill ◽

Prognostic Nutritional Index ◽

Optimal Time ◽

Clinical Validity ◽

Patients With Cancer ◽

Terminally Ill Patients ◽

Cancer Related Fatigue ◽

Nutritional Index ◽

The Relationship

Background: Corticosteroids are frequently used to treat cancer-related fatigue (CRF), but it is yet to be established as standard care, and few reports have defined the appropriate time to start treatment. Objectives: We investigated the optimal time for starting betamethasone and evaluated the clinical validity of using the prognostic nutritional index (PNI) for this purpose. Methods: Data were retrospectively collected for patients with terminal cancer receiving betamethasone for palliative care. Fatigue strength was evaluated by the daily occurrence of fatigue, using proportion of adequate fatigue, AF(%), defined as the average of the daily score for all treatment days, AF(%)all, the initial 5 days, AF(%)initi5, or the last 5 days, AF(%)last5. We examined (1) the relationship between survival time and adequate fatigue for CRF and (2) the correlation between survival time and PNI (based on serum albumin and lymphocytes). Results: Data from 24 patients were included. The AF(%)all was approximately 50% at 42 days before death and gradually decreased as the survival time shortened ( R2 =.41, P <.001). There was a clear positive correlation between AF(%)all and AF(%)initi5 ( R2 =.84, P <.001). At 42 days before death, PNI was approximately 30 and significantly correlated with the survival time ( R2 = .873, P <.001). Conclusion: The adequate fatigue appears to be dependent on survival time, and PNI might be useful for identifying patients that will benefit from betamethasone use. It is hoped that these results will contribute to individualized pharmacotherapy of terminally ill patients with CRF.

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Advance Care Planning Improves Psychological Symptoms But Not Quality of Life and Preferred End-of-Life Care of Patients With Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7106 ◽

2019 ◽

Vol 17 (4) ◽

pp. 311-320 ◽

Cited By ~ 11

Author(s):

Siew Tzuh Tang ◽

Jen-Shi Chen ◽

Fur-Hsing Wen ◽

Wen-Chi Chou ◽

John Wen-Cheng Chang ◽

...

Keyword(s):

Depressive Symptoms ◽

Terminally Ill ◽

Anxiety Symptoms ◽

Care Planning ◽

Patients With Cancer ◽

Terminally Ill Patients ◽

Advance Care ◽

Eol Care ◽

Care Decision

Background: This study was conducted to examine whether a longitudinal advance care planning (ACP) intervention facilitates concordance between the preferred and received life-sustaining treatments (LSTs) of terminally ill patients with cancer and improves quality of life (QoL), anxiety symptoms, and depressive symptoms during the dying process. Patients and Methods: Of 795 terminally ill patients with cancer from a medical center in Taiwan, 460 were recruited and randomly assigned 1:1 to the experimental and control arms. The experimental arm received an interactive ACP intervention tailored to participants’ readiness to engage in this process. The control arm received symptom management education. Group allocation was concealed, data collectors were blinded, and treatment fidelity was monitored. Outcome measures included 6 preferred and received LSTs, QoL, anxiety symptoms, and depressive symptoms. Intervention effectiveness was evaluated by intention-to-treat analysis. Results: Participants providing data had died through December 2017. The 2 study arms did not differ significantly in concordance between the 6 preferred and received LSTs examined (odds ratios, 0.966 [95% CI, 0.653–1.428] and 1.107 [95% CI, 0.690–1.775]). Participants who received the ACP intervention had significantly fewer anxiety symptoms (β, −0.583; 95% CI, −0.977 to −0.189; P= .004) and depressive symptoms (β, −0.533; 95% CI, −1.036 to −0.030; P= .038) compared with those in the control arm, but QoL did not differ. Conclusions: Our ACP intervention facilitated participants’ psychological adjustment to the end-of-life (EoL) care decision-making process, but neither improved QoL nor facilitated EoL care honoring their wishes. The inability of our intervention to improve concordance may have been due to the family power to override patients’ wishes in deeply Confucian doctrine–influenced societies such as Taiwan. Nevertheless, our findings reassure healthcare professionals that such an ACP intervention does not harm but improves the psychological well-being of terminally ill patients with cancer, thereby encouraging physicians to discuss EoL care preferences with patients and involve family caregivers in EoL care decision-making to eventually lead to patient value–concordant EoL cancer care.

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Correction to: The relationship between comorbidity medication adherence and health related quality of life among patients with cancer

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-021-00300-6 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Dana Drzayich Antol ◽

Adrianne Waldman Casebeer ◽

Raya Khoury ◽

Todd Michael ◽

Andrew Renda ◽

...

Keyword(s):

Quality Of Life ◽

Medication Adherence ◽

Health Related Quality ◽

Patients With Cancer ◽

Related Quality ◽

Health Related ◽

The Relationship

An amendment to this paper has been published and can be accessed via the original article.

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The role of EORTC QLQ-C15-PAL scores and inflammatory biomarkers in predicting survival in terminally ill patients with cancer

BMC Cancer ◽

10.1186/s12885-021-08049-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nanako Koyama ◽

Chikako Matsumura ◽

Yoshihiro Shitashimizu ◽

Morito Sako ◽

Hideo Kurosawa ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Cox Regression ◽

Terminally Ill ◽

Inflammatory Biomarkers ◽

Survival Curves ◽

Patients With Cancer ◽

Terminally Ill Patients ◽

Patient Reported ◽

Eortc Qlq

Abstract Background The clinical use of patient-reported outcomes as compared to inflammatory biomarkers for predicting cancer survival remains a challenge in palliative care settings. We evaluated the role of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative scores (EORTC QLQ-C15-PAL) and the inflammatory biomarkers C-reactive protein (CRP), albumin (Alb), and neutrophil-lymphocyte ratio (NLR) for survival prediction in patients with advanced cancer. Methods This was an observational study in terminally ill patients with cancer hospitalized in a palliative care unit between June 2018 and December 2019. Patients’ data collected at the time of hospitalization were analyzed. Cox regression was performed to examine significant factors influencing survival. A receiver operating characteristic (ROC) analysis was performed to estimate cut-off values for predicting survival within 3 weeks, and a log-rank test was performed to compare survival curves between groups divided by the cut-off values. Results Totally, 130 patients participated in the study. Cox regression suggested that the QLQ-C15-PAL dyspnea and fatigue scores and levels of CRP, Alb, and NLR were significantly associated with survival time, and cut-off values were 66.67, 66.67, 3.0 mg/dL, 2.5 g/dL, and 8.2, respectively. The areas under ROC curves of these variables were 0.6–0.7. There were statistically significant differences in the survival curves between groups categorized using each of these cut-off values (p < .05 for all cases). Conclusion Our findings suggest that the assessment of not only objective indicators for the systemic inflammatory response but also patient-reported outcomes using EORTC QLQ-C15-PAL is beneficial for the prediction of short-term survival in terminally ill patients with cancer.

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Symptom clusters and their influence on prognosis using EORTC QLQ-C15-PAL scores in terminally ill patients with cancer

Supportive Care in Cancer ◽

10.1007/s00520-021-06380-w ◽

2021 ◽

Author(s):

Nanako Koyama ◽

Chikako Matsumura ◽

Yuuna Tahara ◽

Morito Sako ◽

Hideo Kurosawa ◽

...

Keyword(s):

Palliative Care ◽

Terminally Ill ◽

Symptom Clusters ◽

Rank Test ◽

Appetite Loss ◽

Patients With Cancer ◽

Terminally Ill Patients ◽

Log Rank Test ◽

Eortc Qlq ◽

Cluster 2

Abstract Purpose The aims of the present study were to investigate the symptom clusters in terminally ill patients with cancer using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL), and to examine whether these symptom clusters influenced prognosis. Methods We analyzed data from 130 cancer patients hospitalized in the palliative care unit from June 2018 to December 2019 in an observational study. Principal component analysis was used to detect symptom clusters using the scored date of 14 items in the QLQ-C15-PAL, except for overall QOL, at the time of hospitalization. The influence of the existence of these symptom clusters and Palliative Performance Scale (PPS) on survival was analyzed by Cox proportional hazards regression analysis, and survival curves were compared between the groups with or without existing corresponding symptom clusters using the log-rank test. Results The following symptom clusters were identified: cluster 1 (pain, insomnia, emotional functioning), cluster 2 (dyspnea, appetite loss, fatigue, and nausea), and cluster 3 (physical functioning). Cronbach’s alpha values for the symptom clusters ranged from 0.72 to 0.82. An increased risk of death was significantly associated with the existence of cluster 2 and poor PPS (log-rank test, p = 0.016 and p < 0.001, respectively). Conclusion In terminally ill patients with cancer, three symptom clusters were detected based on QLQ-C15-PAL scores. Poor PPS and the presence of symptom cluster that includes dyspnea, appetite loss, fatigue, and nausea indicated poor prognosis.

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