Clinical needs of patients referred early to supportive and palliative care.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9065-9065
Author(s):  
Jung Hye Kwon ◽  
David Hui ◽  
Caroline Ann Ha ◽  
Gary B. Chisholm ◽  
Sriram Yennurajalingam ◽  
...  
Keyword(s):  
Palliative Care ◽  
Service Utilization ◽  
Clinical Characteristics ◽  
Symptom Assessment ◽  
Patient Characteristics ◽  
Median Number ◽  
Curative Intent ◽  
Care Clinic ◽  
Palliative Care Consultation ◽  
Edmonton Symptom Assessment Scale

9065 Background: Palliative care is evolving from delivering care to patients at the end-of-life to those earlier in the disease trajectory. We evaluated the differences in clinical characteristics, symptoms burdens, and service utilization between traditional palliative care patients (late referrals, LR) and the new patients group who are in earlier in their course of disease (early referrals, ER). Methods: We reviewed consecutive cancer patients referred to the Supportive Care Clinic with follow up visit within 30 days between August 2008 and October 2010. Patients were divided into two groups: ER (defined as patients with expected survival ≥ 2 years or receiving treatment for curative intent) and LR (all others). We compared clinical characteristics, symptoms and service utilization between both groups using chi-square test and Wilcoxon rank sum test. Results: 58% (695/1208) patients had a 2nd visit within 30 days. Among them, 100 patients were classified as ER (14.4%) and 100/595 LR were randomly selected as the comparison group. ER patients were younger (median age 54 years vs 60 years, p=0.009), more likely to have head and neck cancer (67% vs 6%, p<0.001) and to have a shorter interval between cancer diagnosis and palliative care consultation (3.8 m vs 16.2 m, <0.001). ER patients were also more likely to be CAGE positive (15% vs 4%, p=.014), referred from radiation oncology (49% vs 3%, p<0.001), referred for treatment related side effects (70% vs 9%, p<0.001), and receiving active anti-cancer treatment at the time of consultation (74% vs 48%, p=0.0002). Baseline symptoms (Edmonton Symptom Assessment Scale) were similar between ER and LR except for insomnia (1.8 vs 2, p=0.004). LR patients experienced greater improvement in the symptom distress score (-5.5 vs -3, p=0.007). Overall median number of medical visits was 24 for ER vs 10.5 for LR (p<0.001); however, median visit per month was 4.3 for LR and 2.1 for ER (p<0.001). Conclusions: ER was associated with different patient characteristics; patients have similar distress but different needs and outcomes as compared to traditional LR patients.

Cannabis use in palliative care: The prevalence and clinical characteristics.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 245-245
Author(s):  
Young Doo Chang ◽  
Joshua S. Smith ◽  
Ritika Oberoi-Jassal ◽  
Vijay Desai ◽  
Stephanie L Winn ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Characteristics ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
P Value ◽  
Spiritual Wellbeing ◽  
Care Clinic ◽  
Palliative Care Setting ◽  
Edmonton Symptom Assessment Scale ◽  
Drug Sample

245 Background: Cannabis has growing attention in palliative care, been used for some cancer related symptom burden, but limited data in terms of prevalence in palliative care setting and clinical characteristics with using it. Purpose: To identify the prevalence of positive rate of cannabis metabolite on urine drug sample (UDS) and compare clinical characteristics focused on symptoms burden on Edmonton Symptom Assessment Scale (ESAS) on the same day of UDS. Methods: We conducted retrospective medical records review of 919 consecutive supportive care clinic patients who were seen at a National Cancer Institute center during a 12-month period between 7/01/2015 to 6/30/2016. Results: 531 out of 919 patients were excluded because UDS was not ordered: either patients were established or had low risk of substance abuse by clinicians’ judgement. 2 patients did not complete ESAS on same day of UDS. 137 patients were excluded because of missing UDS results as well. Finally, 249 out of 919 patients were included for data analysis with their UDS and ESAS at same day of visit. 54 patients were positive for cannabis metabolite (THC: tetrahydrocannabinol) on UDS (22%). We found that positive cannabis group was younger (Mean age 56.1 vs 48.8, p-Value .001), reported higher score of total ESAS (Mean 45.5 vs 38.9, p-value 0.023), pain (Mean 6.13 vs 4.99, p-Value 0.007), and insomnia (6.04 vs 4.44, p-Value 0.001). In addition, positive cannabis group reported poorer overall wellbeing (5.43 vs 4.56, p-Value 0.015) and spiritual wellbeing (6.04 vs 4.44, p Value 0.040) compared to negative cannabis group. Conclusions: The positive results of cannabis on UDS may be a marker of greater symptom burden, in particular, pain, insomnia and poorer overall and spiritual wellbeing as assessed by ESAS patient’s self-reporting.

scholarly journals Patterns of Opioid Prescription, Use, and Costs Among Patients With Advanced Cancer and Inpatient Palliative Care Between 2008 and 2014

2019 ◽  
Vol 15 (1) ◽  
pp. e74-e83 ◽  
Author(s):  
Sriram Yennurajalingam ◽  
Zhanni Lu ◽  
Suresh K. Reddy ◽  
EdenMae C. Rodriguez ◽  
Kristy Nguyen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
Patient Characteristics ◽  
Opioid Prescription ◽  
Patients With Cancer ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
Symptom Changes

PURPOSE: An understanding of opioid prescription and cost patterns is important to optimize pain management for patients with advanced cancer. This study aimed to determine opioid prescription and cost patterns and to identify opioid prescription predictors in patients with advanced cancer who received inpatient palliative care (IPC). MATERIALS AND METHODS: We reviewed data from 807 consecutive patients with cancer who received IPC in each October from 2008 through 2014. Patient characteristics; opioid types; morphine equivalent daily dose (MEDD) in milligrams per day of scheduled opioids before, during, and after hospitalization; and in-admission opioid cost per patient were assessed. We determined symptom changes between baseline and follow-up palliative care visits and the in-admission opioid prescription predictors. RESULTS: A total of 714 (88%) of the 807 patients were evaluable. The median MEDD per patient decreased from 150 mg/d in 2008 to 83 mg/d in 2014 ( P < .001). The median opioid cost per patient decreased and then increased from $22.97 to $40.35 over the 7 years ( P = .03). The median MEDDs increased from IPC to discharge by 67% ( P < .001). The median Edmonton Symptom Assessment Scale pain improvement at follow-up was 1 ( P < .001). Younger patients with advanced cancer (odds ratio [OR[, 0.95; P < . 001) were prescribed higher preadmission MEDDs (OR, 1.01; P < .001) more often in the earlier study years (2014 v 2009: OR, 0.18 [ P = .004] v 0.30 [ P = .02]) and tended to use high MEDDs (> 75 mg/d) during hospitalization. CONCLUSION: The MEDD per person decreased from 2008 to 2014. The opioid cost per patient decreased from 2008 to 2011 and then increased from 2012 to 2014. Age, prescription year, and preadmission opioid doses were significantly associated with opioid doses prescribed to patients with advanced cancer who received IPC.

Comfort Level in Caregivers of Palliative Care Patients and Affecting Factors: What Should We Know?

2021 ◽  
pp. 003022282110147
Author(s):  
Kadriye Sayin Kasar ◽  
Yasemin Yildirim ◽  
Ulku Bulut
Keyword(s):  
Palliative Care ◽  
Nursing Care ◽  
Performance Status ◽  
Symptom Assessment ◽  
Comfort Level ◽  
Affecting Factors ◽  
Holistic Nursing ◽  
Care Clinic ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

Caregivers are an important source of support for patients in palliative care. Comfort is an important concept in nursing care for both patients and their families, and nurses aim to increase comfort. The aim of the study was to determine the comfort level and influencing factors in caregivers of palliative care patients. The research sample consisted of 102 caregivers related to palliative care patients. The data were obtained with an Individual Information Form, the Edmonton Symptom Assessment Scale (ESAS) and the End of Life Comfort Scale (Caregiver/Family). The study was conducted in the palliative care clinic of Aksaray University Training and Research Hospital between October 2018 and April 2019. There was a significant relationship between the total comfort score of the caregivers and the patient's performance status, the caregivers' age, their economic situation, the length of the caregiving period and receiving help in care (social support) ( p < 0.05). Providing comfort is an important function and challenge for holistic nursing care, as comfort is a lifelong need in health and disease. Caregivers in the risk group should be aware of this issue and necessary precautions should be taken.

Phase II Study of an Outpatient Palliative Care Intervention in Patients With Metastatic Cancer

2009 ◽  
Vol 27 (2) ◽  
pp. 206-213 ◽  
Author(s):  
Matthew Follwell ◽  
Debika Burman ◽  
Lisa W. Le ◽  
Kristina Wakimoto ◽  
Dori Seccareccia ◽  
...  
Keyword(s):  
Palliative Care ◽  
Patient Satisfaction ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Metastatic Cancer ◽  
Symptom Control ◽  
Family Satisfaction ◽  
Care Clinic ◽  
Edmonton Symptom Assessment Scale ◽  
The Mean

Purpose Although there is increasing advocacy for timely symptom control in patients with cancer, few studies have assessed outpatient palliative care clinics. This study assessed prospectively the efficacy of an Oncology Palliative Care Clinic (OPCC) in improving patient symptom distress and satisfaction. Patients and Methods Eligible patients were new referrals to an OPCC, had metastatic cancer, were at least 18 years old, and were well enough and able to speak and read English sufficiently to provide informed consent and complete questionnaires. Patients received a consultation by a palliative care team. The primary end points of symptom control and patient satisfaction were assessed using the Edmonton Symptom Assessment Scale (ESAS) and patient-adapted Family Satisfaction with Advanced Cancer Care (FAMCARE) scale at baseline, 1 week, and 1 month. Initial and follow-up scores were compared using paired t tests. Results Of 150 patients enrolled, 123 completed 1-week assessments, and 88 completed 4-week assessments. At baseline, the mean ESAS Distress Score (EDS) was 39.5. The mean improvement in EDS was 8.8 points (P < .0001) at 1 week and 7.0 points (P < .0001) at 1 month. Statistically significant improvements were observed for pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, dyspnea, insomnia, and constipation at 1 week (all P ≤ .005) and 1 month (all P ≤ .05). The mean improvement in FAMCARE score was 6.1 points (P < .0001) at 1 week and 5.0 points (P < .0001) at 1 month. Conclusion This phase II study demonstrates efficacy of an OPCC for improvement of symptom control and patient satisfaction with care. Randomized controlled trials are indicated to further evaluate the effectiveness of specialized outpatient palliative care.

Development and Validation of a Modified Version of the Edmonton Symptom Assessment Scale in a Flemish Palliative Care Population

2011 ◽  
Vol 28 (7) ◽  
pp. 475-482 ◽  
Author(s):  
Patricia Claessens ◽  
Johan Menten ◽  
Paul Schotsmans ◽  
Bert Broeckaert
Keyword(s):  
Palliative Care ◽  
Symptom Assessment ◽  
Assessment Scale ◽  
Face Validity ◽  
Patients With Cancer ◽  
Edmonton Symptom Assessment Scale ◽  
The Face ◽  
Palliative Care Units ◽  
Symptom Assessment Scale ◽  
Development And Validation

Palliative cancer patients are faced with multiple symptoms that threaten their quality of life. To manage these symptoms, a reliable and valid way of registration is crucial. In this study, the Edmonton Symptom Assessment Scale (ESAS) has been translated, modified, and tested on content, face, criterion, construct validity, and internal consistency for patients admitted to Flemish palliative care units. These aspects are tested in a descriptive, comparative, longitudinal study based on 3 convenience samples. The first consisted of 8 palliative care experts. The second sample checked the face validity and consisted of 4 patients, 5 family members, and 5 nurses. The last sample involved 23 patients admitted to 3 Flemish palliative care units. Heedful of the “new-wave” vision on validity, the translated and altered ESAS seemed a suitable instrument for the symptom assessment of patients with cancer admitted to a palliative care unit.

scholarly journals Chronic Non-Malignant Pain in Patients with Cancer Seen at a Timely Outpatient Palliative Care Clinic

Cancers ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 214
Author(s):  
David Hui ◽  
Eman Abdelghani ◽  
Joseph Chen ◽  
Shiva Dibaj ◽  
Donna Zhukovsky ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Task Force ◽  
International Association ◽  
Brief Pain Inventory ◽  
Median Number ◽  
Care Clinic ◽  
Disease Trajectory ◽  
Palliative Care Setting ◽  
Attending Physician

Palliative care is seeing cancer patients earlier in the disease trajectory with a multitude of chronic issues. Chronic non-malignant pain (CNMP) in cancer patients is under-studied. In this prospective study, we examined the prevalence and management of CNMP in cancer patients seen at our supportive care clinic for consultation. We systematically characterized each pain type with the Brief Pain Inventory (BPI) and documented current treatments. The attending physician made the pain diagnoses according to the International Association for the Study of Pain (IASP) task force classification. Among 200 patients (mean age 60 years, 69% metastatic disease, 1-year survival of 77%), the median number of pain diagnosis was 2 (IQR 1–2); 67 (34%, 95% CI 28–41%) had a diagnosis of CNMP; 133 (67%) had cancer-related pain; and 52 (26%) had treatment-related pain. In total, 12/31 (39%) patients with only CNMP and 21/36 (58%) patients with CNMP and other pain diagnoses were on opioids. There was a total of 94 CNMP diagnoses among 67 patients, including 37 (39%) osteoarthritis and 20 (21%) lower back pain; 30 (32%) were treated with opioids. In summary, CNMP was common in the timely palliative care setting and many patients were on opioids. Our findings highlight the need to develop clinical guidelines for CNMP in cancer patients to standardize its management.

scholarly journals Integrating Palliative Care Services in Ambulatory Oncology: An Application of the Edmonton Symptom Assessment System

2017 ◽  
Vol 13 (4) ◽  
pp. e401-e407 ◽  
Author(s):  
Sherri L. Rauenzahn ◽  
Susanne Schmidt ◽  
Ifeoma O. Aduba ◽  
Jessica T. Jones ◽  
Nazneen Ali ◽  
...  
Keyword(s):  
Palliative Care ◽  
Standard Deviation ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Cost Of Care ◽  
Assessment System ◽  
Referral System ◽  
Referral Rates ◽  
Ambulatory Oncology ◽  
Edmonton Symptom Assessment Scale

Purpose: Research in palliative care demonstrates improvements in overall survival, quality of life, symptom management, and reductions in the cost of care. Despite the American Society of Clinical Oncology recommendation for early concurrent palliative care in patients with advanced cancer and high symptom burden, integrating palliative services is challenging. Our aims were to quantitatively describe the palliative referral rates and symptom burden in a South Texas cancer center and establish a palliative referral system by implementing the Edmonton Symptom Assessment Scale (ESAS). Methods: As part of our Plan-Do-Study-Act process, all staff received an educational overview of the ESAS tool and consultation ordering process. The ESAS form was then implemented across five ambulatory oncology clinics to assess symptom burden and changes therein longitudinally. Referral rates and symptom assessment scores were tracked as metrics for quality improvement. Results: On average, one patient per month was referred before implementation of the intervention compared with 10 patients per month after implementation across all clinics. In five sample clinics, 607 patients completed the initial assessment, and 430 follow-up forms were collected over 5 months, resulting in a total of 1,037 scores collected in REDCap. The mean ESAS score for initial patient visits was 20.0 (standard deviation, 18.1), and referred patients had an initial mean score of 39.0 (standard deviation, 19.0). Conclusion: This project highlights the low palliative care consultation rate, high symptom burden of oncology patients, and underuse of services by oncologists despite improvements with the introduction of a symptom assessment form and referral system.

Symptom Assessment and Early Access to Supportive and Palliative Care for Patients With Advanced Solid Tumors in Mexico

2019 ◽  
Vol 35 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Mirza Jacqueline Alcalde-Castro ◽  
Enrique Soto-Perez-de-Celis ◽  
Alfredo Covarrubias-Gómez ◽  
Sofía Sánchez-Román ◽  
Paulina Quiróz-Friedman ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Solid Tumors ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
First Year ◽  
Advanced Solid Tumors ◽  
Care Clinic ◽  
Care Services ◽  
Oncology Care

Background: Early specialized palliative care improves quality of life of patients with advanced cancer, and guidelines encourage its integration into standard oncology care. However, many patients fail to obtain timely palliative/supportive care evaluations, particularly in limited-resource settings. We aimed to determine the proportion of patients with advanced cancer who received an assessment of symptoms and were referred to supportive and palliative care services during the first year after diagnosis in a Mexican hospital. Methods: Individuals with newly diagnosed advanced solid tumors and 1 year of follow-up at the oncology clinics in the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City from October 2015 to April 2016 were included in this retrospective study. Results: Seventy-seven patients were included. Forty-two (54.5%) were referred to the various supportive care services during the first year after diagnosis, and 23 (29.8%) were referred to the palliative care clinic. The most commonly assessed symptoms by oncologists were pain (77.9%), anorexia (74.0%), fatigue (68.8%), and nausea (55.8%), while depression/anxiety were evaluated in 10 (12.9%) patients. The oncologist offered to clarify treatment goals in 39 (50.6%) cases and evaluated the understanding of diagnosis/illness and prognosis in 22 (28.5%). Conclusion: Palliative and supportive care services were widely underutilized, which may be related to a lack of standardized symptom assessments and poor end-of-life communication. Novel strategies are needed to improve the implementation of tools for systematic symptom assessment and to optimize the integration of supportive care interventions into oncology care in developing countries.

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