Difficulties in Addressing Artificial Hydration and Nutrition Therapy for Terminal Cancer Patients: What to do if Patients/Families’ Wishes Differ From the Medically Appropriate Treatment Plans?

2021 ◽  
pp. 104990912110580
Author(s):  
Nobuhisa Nakajima
Keyword(s):  
Cancer Patients ◽  
Symptom Assessment ◽  
Nutrition Therapy ◽  
Assessment System ◽  
Medical Professionals ◽  
Team Assessment ◽  
Appropriate Treatment ◽  
Treatment Plans ◽  
Support Team ◽  
Physical Findings

Purpose: Artificial hydration and nutrition therapy (AHNT) initiated by patients/families sometimes differs from medically appropriate treatment plans. We aimed to identify the causes of these differences and examine the ensuing responses and outcomes. Methods: Of 133 adult cancer patients receiving end-of-life care in the last 2 years, these discrepancies occurred in 41 patients. We retrospectively examined the following issues: (1) The reason why these discrepancies occurred. (2) Based on the causes identified in (1), the following actions were taken: 1) If the consent to change to medically appropriate AHNT was obtained, physical findings using Japan Palliative Oncology Study (JPOS) group and Edmonton Symptom Assessment System (ESAS) were compared before and 1 week after the intervention. 2) If consent was not obtained, time-limited trial (TLT) was conducted, and these results were compared. (3) The communication between patients/families and medical professionals was compared using Support Team Assessment Schedule. Results. (1) Causes: a) the lack of understanding of the disease condition in 26 cases and b) faulty expectation of AHNT in 15 cases. (2) In 30 cases of 1) (20 of a) and 10 of b)) and 11 of 2) in which TLT was performed, JPOS and ESAS improved significantly. (3) The communication above was improved significantly in 1) and 2) ( P = .0027 and .0039, respectively). Conclusion. Providing medically appropriate AHNT with the consent of patients/families is expected to not only alleviate distressing symptoms but also improve the communication between patients/families and medical professionals, as well as improve the quality of palliative care.

Assessing hope at the end of life: Validation of an experience of hope scale in advanced cancer patients

2004 ◽  
Vol 2 (3) ◽  
pp. 243-253 ◽  
Author(s):  
CHERYL L. NEKOLAICHUK ◽  
EDUARDO BRUERA
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
Well Being ◽  
Assessment System ◽  
Validity Evidence ◽  
Advanced Cancer Patients ◽  
Factor I ◽  
Factor Ii

Objective:The purpose of this study was to gather validity evidence for an innovative experience of hope scale, theHope Differential-Short (HDS), and evaluate its clinical utility for assessing hope in advanced cancer patients.Methods:A consecutive sampling approach was used to recruit 96 patients from an inpatient tertiary palliative care unit and three hospice settings. Each participant completed an in-person survey interview, consisting of the following measures: HDS (nine items), Herth Hope Index (HHI), hope visual analog scale (Hope-VAS) and Edmonton Symptom Assessment System (ESAS).Results:Using factor analytic procedures, a two-factor structure for the HDS was identified, consisting ofauthentic spirit(Factor I) andcomfort(Factor II). The HDS factors had good overall internal consistency (α = 0.83), with Factor I (α = 0.83) being higher than Factor II (α = 0.69). The two factors positively correlated with the HHI, Hope-VAS, and one of the ESAS visual analog scales, well-being (range: 0.38 to 0.64) and negatively correlated with depression and anxiety, as measured by the ESAS (range: −0.25 to −0.42).Significance of results:This is the first validation study of the HDS in advanced cancer patients. Its promising psychometric properties and brief patient-oriented nature provide a solid initial foundation for its future use as a clinical assessment measure in oncology and palliative care. Additional studies are warranted to gather further validity evidence for the HDS before its routine use in clinical practice.

Utility of the revised Edmonton Symptom Assessment System (ESAS-r) and the Patient-Reported Functional Status (PRFS) in lung cancer patients

2017 ◽  
Vol 26 (3) ◽  
pp. 767-775 ◽  
Author(s):  
M. N. Yogananda ◽  
Valliappan Muthu ◽  
Kuruswamy Thurai Prasad ◽  
Adarsh Kohli ◽  
Digambar Behera ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Functional Status ◽  
Cancer Patients ◽  
Symptom Assessment ◽  
Assessment System ◽  
Edmonton Symptom Assessment System ◽  
Lung Cancer Patients ◽  
Patient Reported

Developing pathways for cancer rehabilitation in tertiary oncology centers: Initial observations at the McGill University Health Centre.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 17-17
Author(s):  
Sabrina Cesare ◽  
Irina Uscatescu ◽  
Jonathan di Tomasso ◽  
Lorella Ciutto ◽  
Kevin Yu-Chueh ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Handgrip Strength ◽  
Health Centre ◽  
Symptom Assessment ◽  
Well Being ◽  
Assessment System ◽  
Cancer Rehabilitation ◽  
Targeted Interventions ◽  
Mcgill University ◽  
Clinically Significant

17 Background: No definitive rehabilitation pathways exist for cancer patients. To address this gap, the Cancer Rehabilitation interdisciplinary team at the McGill University Health Centre has developed three program paths (e.g., Restorative, Supportive, and Cachexia) to meet the various specialized and personalized needs of cancer patients. Methods: A consecutive cohort of patients referred to the Cancer Rehabilitation Clinic between January 1st and June 30th, 2014 was considered. We examined the following baseline characteristics: handgrip strength (HGS), the abridged Patient Generated-Subjective Global Assessment (aPG-SGA) and Edmonton Symptom Assessment System (ESAS) self-reported questionnaires. Results: Of the 54 patients evaluated (57.4% male), 20 (mean age: 47.4 yrs), 8 (59.9 yrs) and 26 (64.6 yrs) were assigned to the restorative, supportive and cachexia streams, respectively. The most common cancer diagnoses were gastrointestinal (15%), gynecological (13%), breast (12%) and lung (12%). Table 1 contains baseline aPG-SGA, ESAS and HGS scores. Conclusions: Our preliminary data confirm clinically significant differences in muscle strength across the 3 streams for both males and females, as well as significant differences in nutritional, appetite and well-being scores between the patients in the restorative and cachexia pathways. Our data confirm the need of personalized and targeted interventions to achieve or maintain optimal performance and quality of life in cancer survivors with different disease and treatment characteristics. [Table: see text]

The impact of routine ESAS use on overall survival: Results of a population-based retrospective matched cohort analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6509-6509 ◽  
Author(s):  
Lisa Catherine Barbera ◽  
Rinku Sutradhar ◽  
Craig Earle ◽  
Nicole Mittmann ◽  
Hsien Seow ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cancer Patients ◽  
Cox Regression ◽  
Cohort Analysis ◽  
Symptom Assessment ◽  
Assessment System ◽  
Cancer Type ◽  
Matched Cohort ◽  
Study Objective ◽  
The Impact

6509 Background: The study objective was to examine the impact of routine Edmonton Symptom Assessment System (ESAS) use on overall survival among adult cancer patients. We hypothesized that patients exposed to ESAS would have better overall survival rates than those who didn’t have ESAS. Methods: The effect of ESAS screening on survival was evaluated in a retrospective matched cohort study. The cohort included all Ontario patients aged 18 or older who were diagnosed with cancer between 2007 and 2015. Patients completing at least one ESAS assessment during the study were considered exposed. The index date was the day of their first ESAS assessment. Follow up time for each patient was segmented into one of three phases: initial, continuing, or palliative care. Exposed and unexposed patients were matched 1:1 using hard (birth year ± 2 years, cancer diagnosis date ± 1 year, cancer type and sex) and propensity-score matching (14 measures including cancer stage, treatments received, and comorbidity). Matched patients were followed until death or the end of study at Dec 31, 2015. Kaplan-Meier curves and multivariable Cox regression were used to evaluate the impact of ESAS on survival. Results: There were 128,893 pairs well matched on all baseline characteristics (standardized difference < 0.1). The probability of survival within the first 5 years was higher among those exposed to ESAS compared to those who were not (73.8% vs. 72.0%, P-value < 0.0001). In the multivariable Cox regression model, ESAS assessment was significantly associated with a decreased mortality risk (HR: 0.49, 95% CI: 0.48-0.49) and this protective effect was seen across all phases. Conclusions: ESAS exposure is associated with improved survival in cancer patients, in all phases of care. To the extent possible, extensive matching methods have mitigated biases inherent to observational data. This provides real world evidence of the impact of routine symptom assessment in cancer care.

Symptom burden and characteristics of patients who die in the acute palliative care unit of a tertiary cancer center.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 53-53
Author(s):  
YuJung Kim ◽  
Grace S. Ahn ◽  
Hak Ro Kim ◽  
Beodeul Kang ◽  
Sung Soun Hur ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Tertiary Care ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Assessment System ◽  
Cancer Center ◽  
Advanced Cancer Patients ◽  
Tertiary Cancer Center

53 Background: Acute Palliative Care Units (ACPUs) are novel inpatient programs in tertiary care centers that provide aggressive symptom management and assist transition to hospice. However, patients often die in the APCU before successfully transferring to hospice. The aim of this study was to evaluate the symptom burden and characteristics of advanced cancer patients who die in the APCU. Methods: We retrospectively reviewed the medical records of all advanced cancer patients admitted to the APCU between April, 2015 and March, 2016 at a tertiary cancer center in Korea. Basic characteristics and symptom burden assessed by the Edmonton Symptom Assessment System (ESAS) were obtained from consultation upon APCU admission. Statistical analyses were conducted to compare patients who died in the APCU with those who were discharged alive. Results: Of the 267 patients analyzed, 87 patients (33%) died in the APCU. The median age of patients was 66 (range, 23-97). Patients who died in the APCU had higher ESAS scores of drowsiness (6 vs 5, P = 0.002), dyspnea (4 vs 2, P = 0.001), anorexia (8 vs 6, P = 0.014) and insomnia (6 vs 4, P = 0.001) compared to patients who discharged alive. Total symptom distress scores (SDS) were also significantly higher (47 vs 40, P = 0.001). Patients who died in the APCU were more likely to be male (odds ratio [OR] for female patients 0.38, 95% confidence interval [CI] 0.22-0.67, P < 0.001) and have higher ESAS scores of drowsiness (OR 2.08, 95% CI, 1.08-3.99, P = 0.029) and dyspnea (OR 2.19, 95% CI 1.26-3.80, P = 0.005). These patients showed significantly shorter survival after APCU admission (7 days vs 31 days, P < 0.001). Conclusions: Advanced cancer patients who die in the APCU are more likely to be male and have significantly higher symptom burden that include drowsiness and dyspnea. These patients show rapid clinical deterioration after APCU admission. More proactive and timely end-of-life care is needed for these patients.

scholarly journals Symptom and Anxiety Assessment in Gynecologic Cancer Patients Receiving Chemotherapy

2020 ◽  
Vol 5 (2) ◽  
pp. 95-100
Author(s):  
Pongsaton Viriyasiri ◽  
Phatthanan Phutthikiat ◽  
Phatthawan Phonmak ◽  
Phurinut Krutjaikla ◽  
Sittichai Ongtip ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Cancer Patients ◽  
Uterine Cancer ◽  
Gynecologic Cancer ◽  
Personal Data ◽  
Symptom Assessment ◽  
Assessment System ◽  
Antiemetic Drugs

Background: Side effects of chemotherapy usually disturbed the daily life of patients. During chemotherapy, quality of life of patients is affected by the severity of symptoms experienced. Objective: To evaluate the side effects experienced by gynecologic cancer patients receiving chemotherapy.Methods: Gynecologic cancer patients receiving chemotherapy (at least 1 cycle with standard premedication that included antiemetic drugs) between 18 June and 25 September 2019 were invited to this study. Participants were interviewed by our team for personal data and attitudes toward their disease and treatment. In addition, the Edmonton Symptom Assessment System (ESAS-Thai version) tool, and Multinational Association for Supportive Care in Cancer (MASCC) antiemetic tool were used to assess the symptoms during chemotherapy. Results: One hundred sixty-five participants entered this study. The mean age was 53.5. The three most common type of cancer were ovarian (37.6%), cervical (37.6%) and uterine cancer (21.8%). Most common chemotherapy was carboplatin plus paclitaxel (64.8%). Two-thirds of the participants believed they could be cured. The most common severe symptom from the ESAS tool was pain (20.6%), followed by fatigue (18.8%), appetite change (16.4%) and numbness (10.3%). In addition, 10.9% of patients experienced nausea/vomiting in acute phase, while 20.6% experienced it in the delayed phase. Conclusion: Our participants revealed positive attitudes toward cancer and treatment. Some patients experienced nausea and vomiting despite using antiemetic drugs. The most frequent self-reported symptom was pain. Therefore, pain control was necessary to improve their quality of life.

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