Predicting life expectancy for pirfenidone and best supportive care (BSC) in idiopathic pulmonary fibrosis (IPF)

2016 ◽  
Author(s):  
Mark Fisher ◽  
Toby M. Maher ◽  
Steven D. Nathan ◽  
Christian Hill ◽  
Jade Marshall ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Life Expectancy ◽  
Pulmonary Fibrosis ◽  
Supportive Care ◽  
Best Supportive Care

scholarly journals Best supportive care for idiopathic pulmonary fibrosis: current gaps and future directions

2018 ◽  
Vol 27 (147) ◽  
pp. 170076 ◽  
Author(s):  
Giovanni Ferrara ◽  
Fabrizio Luppi ◽  
Surinder S. Birring ◽  
Stefania Cerri ◽  
Antonella Caminati ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Supportive Care ◽  
Symptom Control ◽  
Best Supportive Care ◽  
Current Evidence ◽  
Future Directions ◽  
Improve Symptom ◽  
History Of

Best supportive care (BSC) is generally defined as all the interventions and the multiprofessional approach aimed to improve and optimise quality of life (QoL) in patients affected by progressive diseases. In this sense, it excludes and might be complementary to other interventions directly targeting the disease. BSC improves survival in patients with different types of cancer. Patients with idiopathic pulmonary fibrosis (IPF) experience a vast range of symptoms during the natural history of the disease and might have a beneficial effect of BSC interventions. This review highlights the current evidence on interventions targeting QoL and gaps for the clinical assessment of BSC in the treatment of IPF patients. Very few interventions to improve QoL or improve symptom control are currently supported by well-designed studies. Sound methodology is paramount in evaluating BSC in IPF, as well as the use of validated tools to measure QoL and symptom control in this specific group of patients.

scholarly journals THERAPEUTIC OPTIONS FOR PATIENTS WHO ARE NOT ELIGIBLE FOR INTENSIVE CHEMOTHERAPY

2013 ◽  
Vol 5 (1) ◽  
pp. e2013050 ◽  
Author(s):  
Elihu Estey
Keyword(s):  
Life Expectancy ◽  
Supportive Care ◽  
Low Dose ◽  
Best Supportive Care ◽  
Therapeutic Options ◽  
Intensive Chemotherapy ◽  
Principal Problem

Although “less intense” therapies are finding more use in AML, the principal problem in AML remains lack of efficacy rather than toxicity. Hence less intense therapies are of little use if they are not more effective as well as less toxic than standard therapies.. Assignment of patients to less intense therapies should be based on other factors in addition to age. Azacitidine and decitabine, the most commonly used less intense therapies in AML very probably produce better OS than best “supportive care” or “low-dose” ara-C. However improvement is relatively small when compared to expected life expectancy in the absence of disease. Accordingly, while azacitidine or decitabine should be considered the standards against which newer therapies are compared, continued investigation of potentially more effective therapies needs to continue. Better means for evaluating the large number of these therapies (and their combinations) are also needed.   

scholarly journals Acute exacerbations of idiopathic pulmonary fibrosis and the role of corticosteroids

Breathe ◽  
2020 ◽  
Vol 16 (3) ◽  
pp. 200086
Author(s):  
Christopher J. Brereton ◽  
Helen E. Jo
Keyword(s):  
Disease Management ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Supportive Care ◽  
Disease Process ◽  
Evidence Base ◽  
Fatal Complication ◽  
Acute Exacerbations ◽  
International Awareness

An acute exacerbation of idiopathic pulmonary fibrosis (AEIPF) is a potentially fatal complication of an already debilitating disease. Management is currently centred on delivering excellent supportive care and identifying reversible triggers. Despite growing international awareness and collaboration, no effective therapies have been identified. Corticosteroids are often the mainstay of treatment; however, the evidence base for their use is poor. Here, we review our current understanding of the disease process and how to manage it, with a focus on the role of corticosteroid therapy.

Communication of prognostic information between oncologists and patients with advanced lung cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 29-29
Author(s):  
Dilip Sankar Babu ◽  
Nicholas Gerbino ◽  
Kevin Fiscella ◽  
Cleveland Shields ◽  
Jennifer J. Griggs ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Life Expectancy ◽  
Supportive Care ◽  
Statistical Data ◽  
Best Supportive Care ◽  
Metastatic Lung Cancer ◽  
Office Visits ◽  
Prognostic Information ◽  
Management Options ◽  
Metastatic Lung

29 Background: A critical domain of patient-provider communication is helping cancer patients understand their prognosis, as well as the efficacy of treatment options. In this qualitative study, we explored the ways oncology providers approached prognostic discussions during initial office visits with patients with metastatic lung cancer. Methods: Transcripts of initial visits between unannounced standardized patients portraying metastatic non-small cell lung cancer and their oncologists were recorded at multiple practice sites in community and academic settings, as part of a large NIH-funded study. Thematic analysis was conducted on a subset of these recorded visits from one study site. In this secondary analysis, three coders (one medical oncologist, one palliative care physician and one research assistant) reviewed transcripts independently to extract quotes related to prognosis, meeting regularly to review selected quotes and to decide on codes. This process repeated until saturation of themes was achieved (n = 15). Results: Discussions of prognosis were found in all 15 transcripts reviewed. Three main themes were identified: (1) Vagueness, in which best-case/worst-case scenarios were presented without an estimate of life expectancy; (2) Statistical Reliance, in which complex statistical data were presented to the patient; and (3) Emotional Support, in which the discussion was infused with emotional reassurance which was contextually appropriate. A fourth identified theme was (4) Minimizing of Supportive Care, as discussions of management options did not always elaborate on best supportive care. Conclusions: Our qualitative analysis of initial office visits among simulated patients with metastatic lung cancer revealed that providers often frame prognostic information in vague terms without a realistic estimate of life expectancy, sometimes give patients complex statistical data, and tend to accompany their discussions with emotional reassurance. Best supportive care is not always fully explained when management options are reviewed. More work is needed to determine optimal ways to convey prognostic and management information during clinic visits for patients with advanced cancer.

Development of tools to facilitate palliative and supportive care referral for patients with idiopathic pulmonary fibrosis

2017 ◽  
Vol 8 (3) ◽  
pp. 340-346 ◽  
Author(s):  
Charles Sharp ◽  
Heather Lamb ◽  
Nikki Jordan ◽  
Adrienne Edwards ◽  
Rachel Gunary ◽  
...  
Keyword(s):  
Palliative Care ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Supportive Care ◽  
Decision Aid ◽  
Hospice Care ◽  
Supportive Care Needs ◽  
Care Needs ◽  
The Impact ◽  
Care Decision

ObjectivesPalliative care is underused in non-malignant respiratory diseases, including interstitial lung diseases (ILDs). We investigated current practices around palliative and supportive care and explored the impact of a supportive care decision aid tool.MethodsThis was a single centre study in a UK ILD centre. Retrospective analysis of hospice referrals and patients with idiopathic pulmonary fibrosis (IPF) under the Bristol ILD (BILD) service were used to identify unmet palliative and supportive care needs. Using quality improvement methodology, we explored the impact of a supportive care decision aid on clinician behaviours for patients with ILD.Results108 patients with ILD were referred for hospice care between 2010 and 2015, representing 0.15% of all referrals, compared with a population prevalence of IPF of 0.9%. The median interval between referral and death was 124 days.Records were reviewed for 64 deceased and 89 living patients with IPF seen on July–December 2014. The decision aid was prospectively assessed with 73 patients. The deceased patients had greater markers of severity. There were no other differences between the groups.After introduction, the decision aid tool was completed for 49.3% of patients and resulted in significant increases in documented discussion of referral to palliative care (11.2%vs53.6%, p<0.01) and end-of-life discussions (15.7%vs91.8%, p<0.01). Tool completion led to an increase in referral for palliative care (2.7%vs16.7%, p<0.01).ConclusionPalliative care services are underused in ILD and a supportive care decision aid can prompt consideration of palliative and supportive care needs.

scholarly journals Predicting Life Expectancy for Pirfenidone in Idiopathic Pulmonary Fibrosis

2017 ◽  
Vol 23 (3-b Suppl) ◽  
pp. S17-S24 ◽  
Author(s):  
Mark Fisher ◽  
Steven D. Nathan ◽  
Christian Hill ◽  
Jade Marshall ◽  
Fred Dejonckheere ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Life Expectancy ◽  
Pulmonary Fibrosis

scholarly journals Communicating with patients with IPF: can we do it better?

2021 ◽  
pp. 00422-2021
Author(s):  
Marlies S. Wijsenbeek ◽  
Francesco Bonella ◽  
Leticia Orsatti ◽  
Anne-Marie Russell ◽  
Claudia Valenzuela ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Life Expectancy ◽  
Pulmonary Fibrosis ◽  
Poor Prognosis ◽  
Information Needs ◽  
Patient Communication ◽  
Management Options

Communications between clinicians and patients with idiopathic pulmonary fibrosis (IPF) have the potential to be challenging. The variable course and poor prognosis of IPF complicate discussions around life expectancy but should not prevent clinicians from having meaningful conversations about patients’ fears and needs, while acknowledging uncertainties. Patients want information about the course of their disease and management options, but the provision of information needs to be individualised to the needs and preferences of the patient. Communication from clinicians should be empathetic and take account of the patient's perceptions and concerns. Models, tools and protocols are available that can help clinicians to improve their interactions with patients. In this article, we consider the difficulties inherent in discussions with patients with IPF and their loved ones, and how clinicians might communicate with patients more effectively, from breaking the news about the diagnosis to providing support throughout the course of the disease.

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