Morphine, constipation and performance status in advanced cancer patients

Purpose: The present study assesses the relationship between patient dignity in advanced cancer and the following variables: psychological distress, preparatory grief, and sociodemographic and clinical characteristics. Methods: The sample consisted of 120 patients with advanced cancer. The self-administered questionnaires were as follows: the Preparatory Grief in Advanced Cancer Patients (PGAC), the Patient Dignity Inventory–Greek (PDI-Gr), the Greek Schedule for Attitudes toward Hastened Death (G-SAHD), and the Greek version of the Hospital Anxiety and Depression Scale (G-HADS). Results: Moderate to strong statistically significant correlations were found between the 4 subscales of PDI-Gr (psychological distress, body image and role identity, self-esteem, and social support) with G-HADS, G-SAHD, and PGAC ( P < .005), while physical distress and dependency was moderately correlated with depression. Multifactorial analyses showed that preparatory grief, depression, and age influenced psychological distress, while preparatory grief, depression, and performance status influenced body image and role identity. Conclusions: Preparatory grief, psychological distress, and physical symptoms had significant associations with perceptions of dignity among patients with advanced cancer. Clinicians should assess and attend to dignity-distressing factors in the care of patients with advanced cancer.

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A picture of early death after admission in patients with advanced cancer at the end-of-life.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.80 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 80-80

Author(s):

Shuji Hiramoto ◽

Ayako Kikuchi ◽

Hori Tetsuo ◽

Akira Yoshioka ◽

Tomoko Tamaki

Keyword(s):

End Of Life ◽

Cancer Patients ◽

Advanced Cancer ◽

Performance Status ◽

Early Death ◽

Advanced Cancer Patients ◽

Metastatic Site ◽

Consciousness Level ◽

Continuous Sedation ◽

And Performance

80 Background: Little is unknown about a picture of early death after admission in terminal phase of advanced cancer patients. Previous studies have reported that approximately 14.3% of patients with cancer enroll in hospice in the last 3days of life. Methods: We retrospectively analyzed data for 510 advanced cancer patients at the end of life between August 2011 and August 2016, and contained deceased 83 (16.3%) patients within 3days after admission in our institute. We divided into deceased patients within 3days and more than 4days after admission. Primary endpoints are to compare each symptom (delirium, cancer pain, dyspnea, nausea and vomiting, fatigue) and intervention (hydration, continuous sedation, opioid) at the end of life. Secondary endpoints are association between prognostic factor and early death (within 3days) after admission. Results: Symptoms about delirium, cancer pain, dyspnea, nausea and vomiting were no significant difference between deceased patients within 3days and more than 4days after admission. Mean hydration at the end of life was more significantly volume of infusion for patients in within 3days (0.34 Litters/day) than in over 4 days (0.20 Litters/day). Continuous sedation was significantly less for patients within 3days (4.82%) than in over 4 days (28.64%). Mean of opioid use was significantly less for patients within 3days (Oral morphine dose 23.54mg/day) than in over 4 days (41.11mg/day). In univariate analysis primary site of cancer was tend to (p = 0.086), and number of metastatic site (p = 0.018) and consciousness level ( < 0.0001) and performance status ( < 0.0001) were significantly associated with early death. In multivariate analysis number of metastatic site (p = 0.057) and consciousness level ( < 0.0001) and performance status (p = 0.0004) were significantly associated with early death. Conclusions: We reports a picture of early death after admission in advanced cancer patients at the end-of-life, and number of metastatic site and consciousness level and performance status might be predictors for short-term prediction model.

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Palliative Care and COVID-19 Pandemic: Retrospective Study of Factors Associated With Infection and Death at an Oncological Palliative Care Reference Center

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120986962 ◽

2021 ◽

pp. 104990912098696

Author(s):

Livia Costa de Oliveira ◽

Karla Santos da Costa Rosa ◽

Ana Luísa Durante ◽

Luciana de Oliveira Ramadas Rodrigues ◽

Daianny Arrais de Oliveira da Cunha ◽

...

Keyword(s):

Diabetes Mellitus ◽

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Karnofsky Performance Status ◽

Performance Status ◽

Tumor Type ◽

Advanced Cancer Patients ◽

Factors Associated ◽

Reactive Protein

Background: Advanced cancer patients are part of a group likely to be more susceptible to COVID-19. Aims: To describe the profile of advanced cancer inpatients to an exclusive Palliative Care Unit (PCU) with the diagnosis of COVID-19, and to evaluate the factors associated with death in these cases. Design: Retrospective cohort study with data from advanced cancer inpatients to an exclusive PCU, from March to July 2020, with severe acute respiratory syndrome. Diagnostic of COVID-19 and death were the dependent variables. Logistic regression analyses were performed, with the odds ratio (OR) and 95% confidence interval (CI). Results: One hundred fifty-five patients were selected. The mean age was 60.9 (±13.4) years old and the most prevalent tumor type was breast (30.3%). Eighty-three (53.5%) patients had a diagnostic confirmation of COVID-19. Having diabetes mellitus (OR: 2.2; 95% CI: 1.1-6.6) and having received chemotherapy in less than 30 days before admission (OR: 3.8; 95% CI: 1.2-12.2) were associated factors to diagnosis of COVID-19. Among those infected, 81.9% died and, patients with Karnofsky Performance Status (KPS) < 30% (OR: 14.8; 95% CI 2.7-21.6) and C-reactive protein (CRP) >21.6mg/L (OR: 9.3; 95% CI 1.1-27.8), had a greater chance of achieving this outcome. Conclusion: Advanced cancer patients who underwent chemotherapy in less than 30 days before admission and who had diabetes mellitus were more likely to develop Coronavirus 2019 disease. Among the confirmed cases, those hospitalized with worse KPS and bigger CRP were more likely to die.

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Home Artificial Nutrition in Advanced Cancer

Journal of the Royal Society of Medicine ◽

10.1177/014107689709001103 ◽

1997 ◽

Vol 90 (11) ◽

pp. 597-603 ◽

Cited By ~ 30

Author(s):

Loris Pironi ◽

Enrico Ruggeri ◽

Stephan Tanneberger ◽

Stefano Giordani ◽

Franco Pannuti ◽

...

Keyword(s):

Enteral Nutrition ◽

Parenteral Nutrition ◽

Cancer Patients ◽

Advanced Cancer ◽

Performance Status ◽

Artificial Nutrition ◽

Utilization Rate ◽

Karnofsky Performance Score ◽

Advanced Cancer Patients ◽

At Home

Attitudes to home artificial nutrition (HAN) in cancer vary greatly from country to country. A 6-year prospective survey of the practice of HAN in advanced cancer patients applied by a hospital-at-home programme in an Italian health district was performed to estimate the utilization rate, to evaluate efficacy in preventing death from cachexia, maintaining patients at home without burdens and distress and improving patients' performance status, and to obtain information about costs. Patients were eligible for HAN when all the following were present: hypophagia; life expectancy 6 weeks or more, suitable patient and family circumstances; and verbal informed consent. From July 1990 to June 1996, 587 patients were evaluated; 164 were selected for HAN (135 enteral and 29 parenteral) and were followed until 31 December 1996. The incidence of HAN per million inhabitants was 18.4 in the first year of activity and 33.2–36.9 in subsequent years, being 4–10 times greater than rates reported by the Italian HAN registers. On 31 December 1996, 158 patients had died because of the disease and 6 were on treatment. Mean survival was 17.2 weeks for those on enteral nutrition and 12.2 weeks for those on parenteral nutrition. Prediction of survival was 72% accurate. 95 patients had undergone 155 readmissions to hospital, where they spent 15–23% of their survival time. Burdens due to HAN were well accepted by 124 patients, an annoyance or scarcely tolerable in the remainder. The frequency of major complications of parenteral nutrition was 0.67 per year for catheter sepsis and 0.16 per year for deep vein thrombosis. Karnofsky performance score increased in only 13 patients and body weight increased in 43. The fixed direct costs per patient-day (in European Currency Units) were 14.2 for the nutrition team, 18.2 for enteral nutrition and 61 for parenteral nutrition. The results indicate that definite entry criteria and local surveys are required for the correct use of HAN in advanced cancer patients, that HAN can be applied without causing additional burdens and distress, and that its costs are not higher than hospital costs.

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The Importance of a Home Care Program for Patients with Advanced Cancer Pain

Tumori Journal ◽

10.1177/030089168507100506 ◽

1985 ◽

Vol 71 (5) ◽

pp. 449-454 ◽

Cited By ~ 30

Author(s):

Vittorio Ventafridda ◽

Marcello Tamburini ◽

Silvana Selmi ◽

Luigi Valera ◽

Franco De Conno

Keyword(s):

Home Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Performance Status ◽

Care Program ◽

Pain Clinic ◽

Advanced Cancer Patients ◽

Sample Group ◽

Significant Difference ◽

Quality Of Life Index

At the Pain Clinic of the National Cancer Institute of Milan, a special Home Care Program has been set up to assist advanced cancer patients with pain and their families during their remaining survival. The Home Care Unit comprises a team of physicians, nurse clinicians, psychologists and many volunteers who are active both in the hospital and at the patient's home. This entire operation provides a continuous relationship between the family, the patient and the Home Care Unit. This Home Care Program, which is one of a kind with other forms of treatment for advanced cancer patients (i.e. hospices), has produced interesting results. Out of a sample group of 50 patients, 33 were monitored at home by the Home Care Unit while 17 had their families to do the monitoring. Over a six-week period the following results were reported: a) Improvement of psycho-emotional factors such as anxiety, weakness and mood for both patients and their families who entered the Home Care Program. b) The Quality of Life Index remained unchanged for the sample group that entered the Home Care Program whereas it deteriorated for patients monitored by their families. c) A decrease in the Integrated Pain Score for both groups; however, results showed a statistically significant difference in favor of patients on the Home Care Program. d) The Performance Status decreased by very little over the study period, and there was little difference between the two groups. These results confirm the need for a Home Care Program which must go hand in hand with the Pain Clinic as an effective way to control Total Pain.

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Use of parenteral nutrition in patients with advanced cancer

Applied Physiology Nutrition and Metabolism ◽

10.1139/h07-152 ◽

2008 ◽

Vol 33 (1) ◽

pp. 102-106 ◽

Cited By ~ 31

Author(s):

Isaac Soo ◽

Leah Gramlich

Keyword(s):

Parenteral Nutrition ◽

Cancer Patients ◽

Advanced Cancer ◽

Bowel Obstruction ◽

Karnofsky Performance Status ◽

Performance Status ◽

Intestinal Failure ◽

Advanced Cancer Patients ◽

End Stage ◽

Northern Alberta

The purpose of this study is to describe patient-related variables in a cohort of advanced cancer patients (ACPs) enrolled in a home parenteral nutrition (HPN) program. This study reviewed the cohort of ACPs enrolled in the Northern Alberta Home Total Parenteral Nutrition Program (NAHTPNP). Thirty-eight ACPs received HPN during the study period, 24% of all patients admitted for PN. Of these, 27 (71%) were female. Mean age was 48.76 y (SD 13.8 y). Bowel obstruction was the most common indication for initiating HPN (84%, 32) and ovarian cancer was the most common malignancy (34%, 13). Patients who began HPN with a Karnofsky performance status (KPS) of greater than 50 (median of 70) were found to have a longer duration of life (median: 6 months) compared with patients who began HPN with a KPS of 50 or below (median = 50; median 3 months; p = 0.01; two-tailed). There was no difference in survival between malignancy type (p = NS). Advanced cancer is the fastest growing indication for enrollment in the HPN program. ACP demonstrated a 3% average annual increase proportionate to all indications for HPN starts, accounting for 7%–48% of HPN starts from 1999–2006. HPN is an increasingly used therapy for patients with advanced cancer, most commonly for intestinal failure in the setting of bowel obstruction. Initiation of HPN at a higher KPS was associated with a longer duration of life. Further studies are needed to validate the use of TPN in end-stage cancer patients.

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Differences in performance status assessments between palliative care specialists, nurses, and oncologists.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.19 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 19-19

Author(s):

YuJung Kim ◽

Yi Zhang ◽

Ji Chan Park ◽

David Hui ◽

Gary B. Chisholm ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Performance Status ◽

Well Being ◽

Assessment Tools ◽

Advanced Cancer Patients ◽

Care Clinic ◽

Edmonton Symptom Assessment Scale ◽

Ecog Ps

19 Background: The Eastern Cooperative Oncology Group (ECOG) performance status (PS) is one of the most commonly used assessment tools among oncologists and palliative care specialists caring advanced cancer patients. However, the inter-observer difference between the oncologist and palliative care specialist has never been reported. Methods: We retrospectively reviewed the medical records of all patients who were first referred to an outpatient palliative care clinic in 2013 and identified 278 eligible patients. The ECOG PS assessments by palliative care specialists, nurses, and oncologists, and the symptom burden measured by Edmonton Symptom Assessment Scale (ESAS) were analyzed. Results: According to the pairwise comparisons using Sign tests, palliative care specialists rated the ECOG PS grade significantly higher than oncologists (median 0.5 grade, P<0.0001) and nurses also rated significantly higher (median 1.0 grade, P<0.0001). The assessments of palliative care specialists and nurses were not significantly different (P=0.10). Weighted kappa values for inter-observer agreement were 0.26 between palliative care specialists and oncologists, and 0.61 between palliative care specialists and nurses. Palliative care specialists’ assessments showed a moderate correlation with fatigue, dyspnea, anorexia, feeling of well-being, and symptom distress score measured by ESAS. The ECOG PS assessments by all three groups were significantly associated with survival (P<0.001), but the assessments by oncologists could not distinguish survival of patients with PS 2 from 3. Independent predictors of discordance in PS assessments between palliative care specialists and oncologists were the presence of an effective treatment option (odds ratio [OR] 2.39, 95% confidence interval [CI] 1.09-5.23) and poor feeling of well-being (≥4) by ESAS (OR 2.38, 95% CI 1.34-4.21). Conclusions: ECOG PS assessments by the palliative care specialists and nurses were significantly different from the oncologists. Systematic efforts to increase regular interdisciplinary meetings and communications might be crucial to bridge the gap and establish a best care plan for each advanced cancer patients.

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Digitally captured step counts for evaluating performance status in advanced cancer patients: A single cohort, prospective trial (Digi-STEPS).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.tps6651 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. TPS6651-TPS6651

Author(s):

Gillian Gresham ◽

Andrew Eugene Hendifar ◽

Jun Gong ◽

Arash Asher ◽

Christine S. Walsh ◽

...

Keyword(s):

Adverse Events ◽

Cancer Patients ◽

Advanced Cancer ◽

Performance Status ◽

Advanced Cancer Patients ◽

Step Counts ◽

Wide Range ◽

Ecog Ps ◽

Single Cohort

TPS6651 Background: Advanced cancer patients undergo dynamic changes in their functionality and physical activity over the course of their treatment. Monitoring patient function is important because it can inform treatment decisions and allow for timely and appropriate intervention. Current scales that assess patient function, such as the ECOG Performance Status (PS), are limited in their ability to capture the wide range in activity that cancer patients can experience on a daily basis outside of the clinic setting. Given recent technological advances in wearable activity monitors, we can collect real-time, objective information about a patient’s daily activity including steps, stairs, heart rate, sleep, and activity intensity. Thus, the primary objective of this study is to determine whether longitudinal changes in objectively-assessed activity are associated with change in physician-rated ECOG PS. Methods: This is a prospective, single cohort trial being conducted at Cedars-Sinai Medical Center. Stage 3/4 cancer patients who are English or Spanish-speaking, ambulatory (assistive walking devices are allowed) and expected to be seen for treatment or follow-up with their oncologist at least every 8 weeks are eligible for study. Consenting patients will be asked to wear a Fitbit Charge HR continuously for 8 weeks during the study period and for one week prior to the 6 month and 1 year follow-up visits. Primary outcomes are change in average daily step counts and ECOG PS at 8 weeks from baseline. Secondary outcomes include: 1) Change in NIH PROMIS patient-reported outcomes (physical function, pain, sleep, emotional distress, and fatigue), 2) Change in frailty status at 8 weeks, 3) Occurrence of adverse events, and 4) 6-month and 1-year survival outcomes. Baseline assessments include a physical exam, medical history, and frailty assessment. The attending oncologist will rate the patient's ECOG PS at baseline and at the end-of-study visit. Weekly NIH PROMIS questionnaires will be administered online over the 8-week study and again at 6 months and 1 year follow-up. The occurrence of serious cancer-related adverse events, chemotherapy-associated toxicities, and hospitalizations will be documented up to 12 weeks from baseline. Survival will be assessed at 6 months and 1 year. Accrual is ongoing with 20 patients currently enrolled of a target sample size of 60 patients. Clinical trial information: NCT03757182.

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