scholarly journals Summarizing the Evidence Base for Palliative Oncology Care: A Critical Evaluation of the Meta-analyses

2020 ◽  
Vol 14 ◽  
pp. 117955492091572 ◽  
Author(s):  
James L Rogers ◽  
Laura M Perry ◽  
Michael Hoerger
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Critical Evaluation ◽  
Evidence Base ◽  
Palliative Oncology ◽  
Oncology Care ◽  
Meta Analyses ◽  
The Impact ◽  
Psychological Quality Of Life

Background: Palliative care is a specialized approach to symptom management that focuses on supporting patients’ physical and psychological quality of life throughout the disease course. In oncology, palliative care has been increasing in utilization. The evidence base for such care is also growing through the use of randomized controlled trials (RCTs). In this review, we aim to integrate the findings from 4 meta-analyses of palliative oncology care RCTs to examine the impact of palliative care on physical and psychological quality of life and survival. Method: We considered 4 meta-analyses of palliative oncology care RCTs, which each used slightly different methodologies and analyses. Two of the meta-analyses included both outpatient and inpatient populations, whereas the remaining meta-analyses focused specifically on outpatient palliative oncology care. Results: All 4 meta-analyses reported a robust quality of life advantage for patients randomized to receive palliative care. Two meta-analyses identified a survival advantage, whereas the other 2 detected no survival differences. In 1 meta-analysis that examined high-quality RCTs of outpatient palliative oncology care, it was found that an increased survival probability for palliative care, compared with standard of care, was confined to 6- to 18-month follow-up. Conclusions: There is a growing evidence base for palliative oncology care, as highlighted by the 4 meta-analyses considered. Such care successfully improves both physical and psychological quality of life for patients with serious illnesses, especially cancer. Clinicians should educate patients and their caregivers about the findings of these meta-analyses. Finally, governmental policies should focus on increasing palliative care access.

Proactive, multidisciplinary approach to supportive medicine: Improving health outcomes and care utilization.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6537-6537
Author(s):  
Brooke Worster ◽  
Valerie P Csik ◽  
Jared Minetola ◽  
Gregory D. Garber ◽  
Alison Petok ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Care Plan ◽  
Cancer Center ◽  
Care Plans ◽  
Oncology Care ◽  
The Impact

6537 Background: Evidence suggests that cancer patients who receive palliative care early in their disease have improved quality of life, decreased emergency department (ED) visits, and less aggressive end-of-life care. In 2017, the Sidney Kimmel Cancer Center at Jefferson established the Neu Center for Supportive Medicine and Cancer Survivorship (NCSMCS) as a model for integrated care in the outpatient setting for all cancer patients. A multidisciplinary team consisting of palliative care physicians, social work, psychology, and navigation conducts biopsychosocial screening and initiates a personalized care plan for each patient to clarify treatment goals and offer assistance. Objectives: To use biopsychosocial screening at specified time points to identify needs and evaluate the impact of supportive care as part of standardized oncology care regardless of stage. Methods: This assessment utilized Oncology Care Model (OCM) data for Jefferson Medicare patients between 7/1/16 to 7/31/18. Incidence of ED admits ED/Observation and admissions were evaluated as well as ICU utilization and advanced care planning. Poisson regression was used to generate incidence rate ratios (IRR) and 95% confidence intervals (CI) to facilitate the comparison of post- vs. pre- incidence rates of hospitalization. Results: The post-intervention hospital admissions decreased by 31% in NCSMCS (IRR 0.69; 95% CI 0.48-0.98) and by 10% in Non-NCSMCS (IRR 0.90; 0.84-0.96) and advanced care plans were more likely to be on file for NCSMCS (9.0% vs. 4.9%). The intensive care unit (ICU) admissions were decreased by 17% among Non-NCSMCS (IRR 0.83; 95% CI 0.74-0.93). The utilization rates for ED admissions were not statistically different among both the groups. Conclusions: The preliminary data is promising and impact will be monitored as the intervention is expanded. Reducing admissions has benefits from both a cost savings as well as quality of life perspective. Future analyses will consider the impact of the intervention on a patient’s quality of life.

scholarly journals Healing at the End of Life: The Voice of the Patient

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Cory Ingram
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Lived Experience ◽  
End Of Life ◽  
Life Story ◽  
Patient Centered ◽  
Whole Person ◽  
Centered Care ◽  
The Impact

In palliative care we have the privilege to care for seriously ill people and their families. Some people value capturing their life story or illness journey on film. I have been fortunate to have been invited into the lives of many people close the end of life for a heartfelt conversation.On an interactive iPad incorporated in the poster, the recorded narrative of patients and one bereft spouse the poster audience will experience the lived experience of people close to the end of life as they reflect on their lives. The narratives will demonstrate how each lived with a new found improved quality of life in the face of increasing symptoms, declining functioning and the approaching end of life; otherwise known as healing. Topics of healing and quality of life, patient-centered care, dignity, human development, spirituality and love will be the focus of their stories. The stories lay bare the very practical, emotional, existential, and personal experience central to our provision of whole person care through palliative care. The poster audience will experience a renewed sense of the impact of a dedicated approach to whole person care as experienced through those on the receiving end.

Music therapy effectiveness by duration in patients with cancer: a meta-regression

2021 ◽  
pp. bmjspcare-2021-003163
Author(s):  
Ronald Chow ◽  
Robert Bergner ◽  
Elizabeth Prsic
Keyword(s):  
Quality Of Life ◽  
Music Therapy ◽  
Positive Association ◽  
Well Being ◽  
Patients With Cancer ◽  
Therapy Effectiveness ◽  
Meta Regression ◽  
Meta Analyses ◽  
The Impact

ObjectivesSeveral reviews and meta-analyses have reported on music therapy for physical and emotional well-being among patients with cancer. However, the duration of music therapy offered may range from less than 1 hour to several hours. The aim of this study is to assess whether longer duration of music therapy is associated with different levels of improvement in physical and mental well-being.MethodsTen studies were included in this paper, reporting on the endpoints of quality of life and pain. A meta-regression, using an inverse-variance model, was performed to assess the impact of total music therapy time. A sensitivity analysis was conducted for the outcome of pain, among low risk of bias trials.ResultsOur meta-regression found a trend for positive association between greater total music therapy time and improved better pain control, but it was not statistically significant.ConclusionThere is a need for more high-quality studies examining music therapy for patients with cancer, with a focus on total music therapy time and patient-related outcomes including quality of life and pain.

scholarly journals Impact of Comorbidities on Quality Of Life in Breast Cancer Patients

2016 ◽  
Vol 01 (04) ◽  
pp. 025-028
Author(s):  
Monica Irukulla ◽  
Rama Vaghmare ◽  
Deepa Joseph ◽  
Syed Ahmed ◽  
Jyothi Jonnadula ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Patients ◽  
Physical Functioning ◽  
Bodily Pain ◽  
Evidence Base ◽  
Breast Cancer Patients ◽  
Co Morbidity ◽  
The Impact

AbstractIntroduction: Comorbidities are common among cancer patients and with an aging population are becoming more prevalent. These can potentially affect the stage at diagnosis, treatment and outcomes of people with cancer. Despite the intimate relationship between comorbidity and cancer, there is limited consensus on how to record, interpret or manage comorbidities in the context of cancer. Addressing the impact of comorbid conditions in cancer patients warrants improvement in the evidence base from which to make treatment decisions for those with comorbidities.Methods: In this prospective study, 64 patients with breast cancer, underwent QOL assessment using FACT –B questionnaire at three time points- pre-radiation and three and six months post radiation.Results: 29(46%) patients had comorbidities of which 23 (35%) had cardiovascular comorbidities and 6 had other comorbidities. The co-morbidities were negatively associated with multiple domains of quality of life, including physical functioning, general health, bodily pain. Patients with diabetes and hypertension had significantly lower scores in physical functioning in comparison to patients without diabetes and hypertension, but improved after treatment. In majority of patients the overall scores were less in patients with co-morbidities compared to patients without any co-morbidity.Conclusion: Comorbidities can significantly affect the quality of life in patients with comorbidities. Hence greater research into the QOL issues for better patient care and symptom management especially during the transitioning phase from active care to follow up will help clinicians improve the quality of care and interdisciplinary co-ordination.

scholarly journals P-140 Adapted tai chi in palliative care – the impact on well-being and quality of life

2018 ◽  
Author(s):  
Andrew Bradshaw ◽  
Samantha Greenwood ◽  
Lynne Yeadon ◽  
Kate Eagle
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Tai Chi ◽  
Well Being ◽  
The Impact

Caring for the caregiver: factors associated with the quality of life of family caregivers to palliative care patients

2015 ◽  
Vol 3 (3) ◽  
pp. 352
Author(s):  
Macarena Quesada ◽  
Manuel Madrigal ◽  
Aurelio Luna ◽  
Maria D Perez-Carceles
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Family Caregivers ◽  
Care Patient ◽  
Terminal Phase ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Factors Associated ◽  
The Impact

Purpose: The aim was to investigate the factors associated with the quality of life (QoL) of family caregivers to palliative care patients. Methods: A cross-sectional survey was conducted of 125 family caregivers of patients in the terminal phase of their illness and included in palliative care programs. Data were collected using WHOQOL-BREF, the socio-demographic characteristics of both caregiver and patient, clinical questions and information about caregiving. Results: The QoL of caregivers was lower than that of the national average for healthy people. Significantly lower QoL scores were obtained in the case of caregivers if they were women, over 55 years, uneducated, unemployed or the patient’s spouse. Cancer diagnosis and patients who were dependent for their Activities of Daily Living also lower caregiver QoL. The factors associated with higher caregiver QoL in each domain differed: being employed in the physical domain (OR:3.3; 95% CI:1.47-7.4), the patient receiving palliative care in hospital in the psychological domain (OR:3.05; 95% CI:1.19-7.7), a higher level of caregiver´s education in the social domain (OR:3.3; 95% CI:1.4-9.8) and caregivers between 45-55 years in the environmental domain (OR:5.4; 95% CI:1.6-9.2).Conclusion: Family caregivers of palliative care patients are highly burdened during caregiving. Characteristics of the patient and caregiver and the conditions under which care is performed, significantly affect QoL. We consider it essential to increase health professionals’ awareness of the importance of the role of the caregiver in providing services to the terminally ill, given the impact of the caregiver’s QoL on the QoL of the palliative care patient and its importance for the delivery of person-centered care at the end of life.    

scholarly journals A systematic review of physical activity and quality of life and well-being

2020 ◽  
Vol 10 (5) ◽  
pp. 1098-1109 ◽  
Author(s):  
David X Marquez ◽  
Susan Aguiñaga ◽  
Priscilla M Vásquez ◽  
David E Conroy ◽  
Kirk I Erickson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Systematic Review ◽  
Well Being ◽  
Evidence Base ◽  
Committee Report ◽  
High Quality Research ◽  
Physical Activity Guidelines ◽  
Meta Analyses

Abstract Maintaining or improving quality of life (QoL) and well-being is a universal goal across the lifespan. Being physically active has been suggested as one way to enhance QoL and well-being. In this systematic review, conducted in part for the 2018 U.S. Health and Human Services Physical Activity Guidelines for Americans Scientific Advisory Committee Report, we examined the relationship between physical activity (PA) and QoL and well-being experienced by the general population across the lifespan and by persons with psychiatric and neurologic conditions. Systematic reviews, meta-analyses, and pooled analyses from 2006 to 2018 were used for the evidence base. Strong evidence (predominantly from randomized controlled trials [RCTs]) demonstrated that, for adults aged 18–65 years and older adults (primarily 65 years and older), PA improves QoL and well-being when compared with minimal or no-treatment controls. Moderate evidence indicated that PA improves QoL and well-being in individuals with schizophrenia and Parkinson’s disease, and limited evidence indicated that PA improves QoL and well-being for youth and for adults with major clinical depression or bipolar disorder. Insufficient evidence existed for individuals with dementia because of a small number of studies with mixed results. Future high-quality research designs should include RCTs involving longer interventions testing different modes and intensities of PA in diverse populations of healthy people and individuals with cognitive (e.g., dementia) and mental health conditions (e.g., schizophrenia) to precisely characterize the effects of different forms of PA on aspects of QoL and well-being.

The impact of early palliative care on the quality of life of patients with advanced pancreatic cancer: The IMPERATIVE study.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. TPS777-TPS777
Author(s):  
Stephanie Lelond ◽  
Harvey Chochinov ◽  
Paul Joseph Daeninck ◽  
Benjamin Adam Goldenberg ◽  
Lisa Lix ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pancreatic Cancer ◽  
Palliative Care ◽  
Patient Experience ◽  
Symptom Control ◽  
Advanced Pancreatic Cancer ◽  
Nurse Specialist ◽  
Early Palliative Care ◽  
The Impact

TPS777 Background: Pancreatic cancer is lethal. Chemotherapy can improve survival by months; however, many patients experience an overwhelming burden of cancer-associated symptoms and poor quality of life (QOL). Early palliative care (EPC) alongside standard oncologic care results in improved QOL and survival in patients with lung cancer. Although international guidelines recommend EPC for patients with advanced pancreatic cancer (PANC), the benefit is not known. Objectives: The primary objective is to test for change in QOL between baseline (BL) and 16 weeks (wk). Secondary objectives are to test for change between BL and 16 wk in (a) symptom control; and (b) depression and anxiety. Methods: This prospective case-crossover study of patients with PANC provides EPC plus standard oncologic care. Primary oncology clinics refer patients to an EPC team led by a palliative care physician and a clinical nurse specialist. BL questionnaires are completed prior to initial EPC assessment, then every 4 wk until wk 16. EPC visits are every 2 wk for the first month, every 4 wk until wk 16, and then as needed. QOL, symptom control, anxiety and depression are measured using the FACT-Hep tool, ESAS-r, HADS and PHQ-9, respectively. A generalized linear model will test for statistically significant change in scores between BL and 16 wk; chemotherapy (yes/no) is included as a confounding covariate; model fit will be assessed. A sample size of 20 patients provides 80% power after controlling for covariate effects. 40 patients will be enrolled to account for missing data. To date, 28 patients have enrolled and 17 have completed the intervention. Significance: The benefit of EPC for patients with PANC is not known, however, EPC is increasingly recognized internationally by patients and stakeholders as a critical intervention which may improve both QOL and satisfaction with care. The Canadian Partnership Against Cancer’s report on the patient experience states “the best possible patient experience means all people with cancer have equitable access to high-quality person-centered palliative care”. This study offers access to EPC and provides an environment in which the benefit of an integrated approach is evaluated.

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