SPECIAL: Standard or Palliative Care in Advanced Lung Cancer - Does early referral of patients with metastatic non-small cell lung cancer to UK specialist palliative care services make a difference in their quality of life or survival?

2015 ◽  
Author(s):  
Ann Pope ◽  
Sam H. Ahmedzai
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Small Cell ◽  
Advanced Lung Cancer ◽  
Specialist Palliative Care ◽  
Small Cell Lung ◽  
Early Referral ◽  
Care Services ◽  
Palliative Care Services

Beyond “Second-Line” in Non–Small Cell Lung Cancer: Therapy and Supportive Care

2015 ◽  
pp. e414-e418 ◽  
Author(s):  
Renato G. Martins ◽  
Craig H. Reynolds ◽  
Gregory J. Riely
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Supportive Care ◽  
Small Cell Lung Cancer ◽  
Cytotoxic Chemotherapy ◽  
Small Cell ◽  
Advanced Lung Cancer ◽  
Care Planning ◽  
Second Line ◽  
Small Cell Lung

Although there once was a single algorithm for the treatment of patients with advanced lung cancer, the modern treatment of advanced lung cancer has multiple treatment pathways that depend on multiple factors, including histology and molecular subtype of disease. New molecular targets, targeted agents, and modes of therapy for patients, including immunotherapy, are being identified at an accelerating pace. These advances are changing outcomes and the treatment landscape, but they also highlight situations with inadequate data to support the use of cytotoxic chemotherapy. In this article, we provide an overview of data regarding cytotoxic chemotherapy and targeted therapy and their value after second line, review the critical role of supportive care and palliative care, and emphasize the importance of advance care planning with our patients. Although this article focuses primarily on NSCLC, the comments about palliative care and advanced care planning also apply to patients with small cell lung cancer.

LuCaS (Lung Cancer Surveillance) study: Surveillance models for advanced lung cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20546-e20546
Author(s):  
Sarah Anne Fraser
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Health Care ◽  
Cancer Patients ◽  
Small Cell ◽  
Advanced Lung Cancer ◽  
Small Cell Lung ◽  
Lung Cancer Patients

e20546 I hope to present the trial protocol as a poster at ASCO with co design work commencing 2017. Background: Lung cancer is the leading cause of cancer death in NZ.1 85% of registrations annually are stage four at diagnosis, presenting a significant burden on resources. Despite novel therapies, survival is poor and quality of life is a key consideration in patient management .2,3 Currently the aim of surveillance is to detect for disease progression and follows a three monthly pattern. There is little literature around benefits of surveillance on survival, and quality of life in these patients. 4-6 Alternative approaches to surveillance should be evaluated to ensure safe, convenient, economical care. Lung cancer outcomes for Maori patients sit significantly lower than those for New Zealand Europeans. Maori patients are twice as likely to present with locally advanced disease and four times less likely to receive curative treatment (multivariate analysis). There are significant barriers for Maori patients to attending health care including time off work, health literacy, costs, child care, language barriers, and transport. 19 Ministry of Health data describes poor outcomes for Maori lung cancer patients with rate of death sitting at 3.4 times that of non-Maori. Co-Primary End Points To determine if there is a reduction in health services utilisation (ED visits, hospital visits, unplanned clinic visits, GP visits, and Nurse Specialist contact) with the end point identified at progression, lost to follow up, or death. To compare the impact of a novel virtual surveillance model (VSM) versus usual follow-up care on patient anxiety measured using the HADS-A tool. Methods: LuCaS is a Randomised Controlled trial in patients with advanced lung cancer randomised to virtual model or standard care. Results: recruitment begins this year. Conclusions: Hypothesis:A virtual follow up model for advanced stage non-small cell lung cancer patients, extensive stage small cell lung cancer patients, and mesothelioma patients will reduce health care utilisation and patient experienced anxiety defined by reduction in Hospital Anxiety and Depression Scale (HADS-A) score, while maintaining effectiveness detecting recurrence and survival.

The Australian Palliative Care Outcomes Collaboration (PCOC) - measuring the quality and outcomes of palliative care on a routine basis

2010 ◽  
Vol 34 (2) ◽  
pp. 186 ◽  
Author(s):  
Kathy Eagar ◽  
Prue Watters ◽  
David C. Currow ◽  
Samar M. Aoun ◽  
Patsy Yates
Keyword(s):  
Palliative Care ◽  
Assessment Tools ◽  
Third Party ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Routine Basis ◽  
Palliative Care Services ◽  
Care Outcomes ◽  
Quality And Outcomes

Australia is leading the way in establishing a national system (the Palliative Care Outcomes Collaboration – PCOC) to measure the outcomes and quality of specialist palliative care services and to benchmark services across the country. This article reports on analysis of data collected routinely at point-of-care on 5939 patients treated by the first fifty one services that voluntarily joined PCOC. By March 2009, 111 services have agreed to join PCOC, representing more than 70% of services and more than 80% of specialist palliative care patients nationally. All states and territories are involved in this unique process that has involved extensive consultation and infrastructure and close collaboration between health services and researchers. The challenges of dealing with wide variation in outcomes and practice and the progress achieved to date are described. PCOC is aiming to improve understanding of the reasons for variations in clinical outcomes between specialist palliative care patients and differences in service outcomes as a critical step in an ongoing process to improve both service quality and patient outcomes. What is known about the topic?Governments internationally are grappling with how best to provide care for people with life limiting illnesses and how best to measure the outcomes and quality of that care. There is little international evidence on how to measure the quality and outcomes of palliative care on a routine basis. What does this paper add?The Palliative Care Outcomes Collaboration (PCOC) is the first effort internationally to measure the outcomes and quality of specialist palliative care services and to benchmark services on a national basis through an independent third party. What are the implications for practitioners?If outcomes and quality are to be measured on a consistent national basis, standard clinical assessment tools that are used as part of everyday clinical practice are necessary.

Mitomycin, Ifosfamide, and Cisplatin in Unresectable Non–Small-Cell Lung Cancer: Effects on Survival and Quality of Life

1999 ◽  
Vol 17 (10) ◽  
pp. 3188-3194 ◽  
Author(s):  
M. H. Cullen ◽  
L. J. Billingham ◽  
C. M. Woodroffe ◽  
A. D. Chetiyawardana ◽  
N. H. Gower ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Palliative Care ◽  
Small Cell Lung Cancer ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Small Cell ◽  
Small Cell Lung

PURPOSE: Chemotherapy for non–small-cell lung cancer (NSCLC) remains controversial. We describe the two largest reported, randomized, parallel trials designed to determine whether the addition of chemotherapy influences duration and quality of life in localized, unresectable (mitomycin, ifosfamide, cisplatin [MIC]1 trial) and extensive (MIC2 trial) disease. PATIENTS AND METHODS: Ambulatory patients with NSCLC, aged 75 years or younger, with localized disease, were randomized in MIC1 to receive up to four cycles of chemotherapy (CT: mitomycin 6 mg/m2, ifosfamide 3 g/m2, and cisplatin 50 mg/m2) every 21 days, followed by radical radiotherapy (CT + RT) or radiotherapy (RT) alone. Extensive-stage patients were randomized in MIC2 to identical chemotherapy plus palliative care (CT + PC) or palliative care (PC) alone. Short-term change in quality of life (QOL) was assessed in a subgroup of patients. Data from the two trials were combined to allow multivariate and stratified survival analyses. RESULTS: Seven hundred ninety-seven eligible patients were randomized, 446 in MIC1 and 351 in MIC2. MIC CT improved survival in both trials (significantly in MIC2). The median survival time in MIC1 was 11.7 months (CT + RT) versus 9.7 months (RT alone) (P = .14); whereas in MIC2, median survival time was 6.7 months (CT + PC) compared with 4.8 months (PC alone) (P = .03). QOL, assessed in 134 patients from start of trial to week 6, showed improvement with chemotherapy and deterioration with standard treatment. In the combined analysis of 797 randomized patients, the positive effect of MIC on survival was significant overall (P = .01) and after adjusting for prognostic factors (P = .01). CONCLUSION: MIC chemotherapy prolongs survival in unresectable NSCLC without compromising QOL.

Evaluating the Time to Palliative Care Referrals in Patients With Small-Cell Lung Cancer: A Single-Centre Retrospective Review

2018 ◽  
Vol 35 (11) ◽  
pp. 1426-1432
Author(s):  
Geoffrey Alan Watson ◽  
Jean Saunders ◽  
Linda Coate
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Palliative Care ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Tertiary Hospital ◽  
Small Cell ◽  
Small Cell Lung ◽  
Early Palliative Care

Introduction: Lung cancer is a leading cause of morbidity and mortality worldwide. Patients with lung cancer may experience a plethora of symptoms, which can be debilitating and affect their quality of life. Palliative care input to manage their physical and psychological well-being is a crucial component of their oncological care. The benefit of early palliative care input has been shown in patients with non-small cell lung cancer; however, data pertaining to patients with small-cell lung cancer are scarce. Nevertheless, early palliative care input is recommended by several national and international guidelines. Thus, we aimed to assess the time to palliative care referrals in patients diagnosed with small-cell lung cancer in an Irish tertiary hospital and to determine what impact this had on overall survival. Methods: We performed a retrospective, single-center audit of all patients diagnosed with extensive stage small-cell lung cancer over a 6-year period in an Irish tertiary hospital. Results: Overall, 91 patients were identified. Median age at diagnosis was 66 years (range: 38-83 years). The median Eastern Cooperative Oncology Group Performance Status at diagnosis was 1 (range: 0-3); 24 (26%) patients had multiple sites of distant metastasis at diagnosis; 45 (49.5%) patients were alive at 6 months, and 15 (16.5%) patients were alive at 12 months. One hundred percent of patients received palliative care input in our center over the course of their care. In the patients alive at 6 months after diagnosis, there was no survival advantage in those receiving palliative care within 1 month ( P = .002, odd ratio: 0.23, 95% confidence interval: 0.09-0.59). Conclusion: Palliative care treatment is a critical aspect in the oncological treatment of all patients diagnosed with advanced cancer, and this study highlights good compliance with existing national guidelines. Further research focusing on quality-of-life issues with the use of questionnaires to assess physical and psychological symptoms should be performed to further understand the impact of palliative care in these patients.

scholarly journals A randomized trial of the electronic Lung Cancer Symptom Scale for quality-of-life assessment in patients with advanced non-small-cell lung cancer

2019 ◽  
Vol 27 (2) ◽  
Author(s):  
J. C. Kuo ◽  
D. M. Graham ◽  
A. Salvarrey ◽  
F. Kassam ◽  
L. W. Le ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Advanced Nsclc ◽  
Small Cell ◽  
Advanced Lung Cancer ◽  
Small Cell Lung ◽  
First Line ◽  
Supportive Interventions ◽  
Line Chemotherapy

Introduction: Improving health-related quality of life (HRQL) is a key goal of systemic therapy in advanced lung cancer although routine assessment remains challenging. We aimed to analyze the impact of a real-time electronic HRQL tool, the eLCSS-QL, on palliative care referral (PCR) rates, patterns of chemotherapy treatment and use of other supportive interventions in patients with advanced non-small cell lung cancer (NSCLC) receiving first-line chemotherapy. Methods: Patients with advanced NSCLC starting first-line chemotherapy were randomized to their oncologist receiving or not receiving their eLCSS-QL data before each clinic visit.  Patients completed the eLCSS-QL scoring at baseline, prior to each chemotherapy cycle, and at subsequent follow-up visits until disease progression. Prospective data on PCR rate, HRQL and use of other supportive interventions were collected. Results: A total of 95 advanced NSCLC patients participated. Oncologists received real-time eLCSS-QL data for 44 patients (eLCSS-QL arm) and used standard clinical assessment only (standard arm) for 51 patients.  The primary end-point, the PCR rate, was numerically higher but statistically similar between patients in the eLCSS-QL and standard arms. HRQL scores over time were not significantly different between the two arms. Conclusions: The eLCSS-QL is feasible as a tool for use in routine clinical practice, although no statistically significant impact was demonstrated in this study. Improving access to supportive care through the collection of patient reported outcomes and HRQL should be an important component of care for advanced lung cancer patients. 

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