Role of palliative care department in modifying ICU admissions for patients with advanced cancer: A study.

e19517 Background: Admission of cancer patients are on the rise in the Intensive Care Unit due to advancement in healthcare facilities. But limited number of ICU beds, health resources and lack of structured Palliative Care services are a matter of concern. Methods: A retrospective study was conducted in an Indian tertiary cancer centre from Jan – Jun 2010 to find out total number and cause of ICU admission of advanced cancer patients when a Palliative Care Department did not exist. Information source were case files and interviews after appropriate consent. Exclusion criteria - age < 18 years, post operative care, complications arising from a major surgery, established oncological emergencies, patients with curative intent. With a 24 hr Palliative Care department under operation from Aug 2010 - another similar study was performed from Jan – Jun 2011. Results: Jan – Jun 2010: Total admissions 542. 297 patients matched the exclusion criteria. Of the remaining 245 patients (45.2%) considered for the study 35 patients (14.2%) died. 11 patients (4.4%) were put on ventilator. Average occupancy of bed 5 days. Commonest cause was respiratory distress. Review of the case notes revealed 54 patients (22%) were admitted due to lack of Palliative Care service. Study was repeated from Jan – Jun 2011 after the initiation of a Palliative care Department from Aug 2010. Out of 487 patients, 195 patients (40%) were considered for study. 18 (9.2%) died. 6 patients (3%) were put on ventilator. The average duration of stay was 4 days. Components of Palliative Care like good communication, early consent from patients as to where they wish to die, do not resuscitate policy for some patients in the background of ethical issues, 24 hour Palliative care service, emergency helpline, home based care, good psychological counselling etc were identified as the key reasons for reduced admissions. Conclusions: Effective round the clock Palliative care service can increase ICU bed turnover, reduce misery of the patients and their family members, save resources, giving patients with longer survival chances a hope to live longer.

Download Full-text

Documentation of Assessment of Spiritual Concerns of Adult Advanced Cancer Patients: An Audit in a Hospital-based Specialist Palliative Care Service

Indian Journal of Palliative Care ◽

10.25259/ijpc_49_21 ◽

2021 ◽

Vol 0 ◽

pp. 1-8

Author(s):

Jayita Deodhar ◽

Naveen Salins ◽

Mary Ann Muckaden

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Care Service ◽

Palliative Care Service ◽

Practice Change ◽

Care Staff ◽

Specialist Palliative Care ◽

Patient Assessment ◽

Advanced Cancer Patients

Objectives: Spirituality is a significant dimension of quality palliative care service provision. The purpose of our audit was to assess current practice and improve documentation of spiritual concerns of adult advanced cancer patients in a specialist palliative care (SPC) service in a tertiary care cancer centre. Materials and Methods: In a standard-based audit, we measured the percentage of patient assessment forms with documentation of assessed spiritual concerns at a baseline and reaudit after practice change measures. We set the optimum standard that at least 60% of the case forms would have patients’ spiritual concerns recorded. We implemented the following measures – (1) engaging our palliative care staff in team discussions on existing practice and identifying problems and (2) conducting a structured 2 h training module for assessment and documentation of patients’ spiritual concerns. Results: About 70.8% and 93.4% of the patient assessment forms included had documentation of assessed spiritual concerns which is higher than the standard we set at 60% and 90% at baseline and after implementing practice change, respectively. In the reaudit, we found that documentation specific to spirituality and overall psychological assessment improved. We identified that a persisting problem was the lack of recording of spiritual assessment in the patients’ follow-up notes. Conclusion: We achieved the benchmark of a standard-based audit on documentation of assessed spiritual concerns of advanced cancer patients in our SPC service. Regular audits in clinical service delivery and documentation should be integrated into quality improvement measures in palliative care.

Download Full-text

Late referrals to home palliative care service affecting death at home in advanced cancer patients in Japan: a nationwide survey

Annals of Oncology ◽

10.1093/annonc/mdq719 ◽

2011 ◽

Vol 22 (9) ◽

pp. 2113-2120 ◽

Cited By ~ 32

Author(s):

S. Fukui ◽

J. Fujita ◽

M. Tsujimura ◽

Y. Sumikawa ◽

Yayoi Hayashi ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Care Service ◽

Palliative Care Service ◽

Nationwide Survey ◽

Advanced Cancer Patients ◽

At Home

Download Full-text

Palliative Prognostic Index application at an inpatient palliative care service from a Brazilian tertiary Hospital: A prospective observational study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11537 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11537-11537

Author(s):

Tiago Pugliese Branco ◽

Alze Pereira dos Santos Tavares ◽

Mariana Sarkis Braz ◽

Mariana Ribeiro Monteiro ◽

Ana Beatriz Kinupe Abrahao ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Care Service ◽

Prognostic Index ◽

Palliative Care Service ◽

Tertiary Hospital ◽

Care Physician ◽

Survival Prediction ◽

Advanced Cancer Patients

11537 Background: Palliative Care Index (PPI) has been proposed to improve the accuracy of survival prediction for advanced cancer patients. The aim of this study is to investigate the feasibility and real-world prognosis survival of oncology inpatients from a Brazilian tertiary hospital using PPI. Methods: Hospitalized advanced cancer patients who have been referred to the Palliative Care Team were enrolled from May 2011 to December 2018. The PPI was collected within 24 hours of the referral by the palliative care physician. Primary endpoint was median overall survival (OS), estimated with the use of the Kaplan–Meier method, in three groups: PPI < 4.0; 4.0 ≤ PPI > 6.0 and PPI ≥ 6.0. Secondary endpoints were OS rate at 3-week for patients with PPI ≥ 6.0, and the most accurate PPI value to predict 6 and 3-week survival, calculated by ROC curve. Results: Total of 1.381 patients were included in this cohort with a median age of 68-year-old, and 51.3% of females. The most frequent primary cancer sites were lung/chest (17,2%), colorectal (14,3%), breast (11,2%), and biliopancreatic (10,9%). Among 454 patients with PPI < 4.0, median OS was 44 days (95% CI: 35,5-52,4); 20 days (95% CI: 15,4-24,5) for 260 patients with 4.0≤ PPI < 6.0 and 8 days (95% CI: 7-8,9) between 655 patients with PPI ≥ 6. Differences in OS among the groups adjusted for primary site, age and gender were significant (p < 0,001). OS rate at 3 weeks for PPI≥ 6.0 was 28.1% (OR 5,39 p < 0.001). PPI value of < 5,5 best predicted 6-week OS (79% sensibility, 55% specificity, AUC 0,714) and the PPI value of ≥ 5,5 predicted 3-week OS (67% sensibility, 73% specificity, AUC 0,753). Conclusions: PPI is feasible and suitable for routine clinical practice to predict survival among Brazilian patients with advanced cancer. In our study, PPI 5.5 seems to be the most accurate value to predict survival within 3 weeks.

Download Full-text

Effect of Music on Pain in Cancer Patients in Palliative Care Service: A Randomized Controlled Study

OMEGA - Journal of Death and Dying ◽

10.1177/00302228211059891 ◽

2021 ◽

pp. 003022282110598

Author(s):

Gönül Düzgün ◽

Ayfer Karadakovan

Keyword(s):

Palliative Care ◽

Music Therapy ◽

Cancer Patients ◽

Functional Capacity ◽

Classical Music ◽

Care Service ◽

Palliative Care Service ◽

Palliative Care Unit ◽

Pain Anxiety ◽

Randomized Controlled

This study aimed to investigate the effect of music on pain, anxiety, comfort, and functional capacity of cancer patients who received care in a palliative care unit. The population of this randomized controlled trial consisted of cancer patients hospitalized in the palliative care service between July 2018 and July 2019. The study included 60 patients (30 interventions/30 controls). The patients in the intervention group were given a total of six music sessions, 10 minutes each with the Turkish classical music in maqams of their choice (Hejaz or Rast accompanied by an expert tambour (drum) player). There was a significant difference between the mean total pain scores, anxiety, comfort, and functional capacity scores of the patients in the intervention and control groups before and after music therapy. Music therapy decreased the level of pain. It is demonstrated that Turkish classical music therapy improved the pain, anxiety, comfort, and functional capacity in the palliative care unit.

Download Full-text

Easing of Suffering in Children With Cancer at the End of Life: Is Care Changing?

Journal of Clinical Oncology ◽

10.1200/jco.2007.14.0277 ◽

2008 ◽

Vol 26 (10) ◽

pp. 1717-1723 ◽

Cited By ~ 189

Author(s):

Joanne Wolfe ◽

Jim F. Hammel ◽

Kelly E. Edwards ◽

Janet Duncan ◽

Michael Comeau ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Care Service ◽

Geometric Mean ◽

Symptom Control ◽

Palliative Care Service ◽

Do Not Resuscitate ◽

Children With Cancer ◽

Adjusted Risk

Purpose In the past decade studies have documented substantial suffering among children dying of cancer, prompting national attention on the quality of end-of-life care and the development of a palliative care service in our institutions. We sought to determine whether national and local efforts have led to changes in patterns of care, advanced care planning, and symptom control among children with cancer at the end of life. Methods Retrospective cohort study from a US tertiary level pediatric institution. Parent survey and chart review data from 119 children who died between 1997 and 2004 (follow-up cohort) were compared with 102 children who died between 1990 and 1997 (baseline cohort). Results In the follow-up cohort, hospice discussions occurred more often (76% v 54%; adjusted risk difference [RD], 22%; P < .001) and earlier (adjusted geometric mean 52 days v 28 days before death; P = .002) compared with the baseline cohort. Do-not-resuscitate orders were also documented earlier (18 v 12 days; P = .031). Deaths in the intensive care unit or other hospitals decreased significantly (RD, 16%; P = .024). Parents reported less child suffering from pain (RD, 19%; P = .018) and dyspnea (RD, 21%; P = .020). A larger proportion of parents felt more prepared during the child's last month of life (RD, 29%; P < .001) and at the time of death (RD, 24%; P = .002). Conclusion Children dying of cancer are currently receiving care that is more consistent with optimal palliative care and according to parents, are experiencing less suffering. With ongoing growth of the field of hospice and palliative medicine, further advancements are likely.

Download Full-text

A comparison of liver cancer and lung cancer patients at two Veteran Affairs Medical Centers.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21642 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e21642-e21642

Author(s):

Sejal Kothadia ◽

Zhen Wang ◽

Sarah Lee ◽

Victor Tsu-Shih Chang ◽

Yucai Wang ◽

...

Keyword(s):

Lung Cancer ◽

Palliative Care ◽

Liver Cancer ◽

Cancer Patients ◽

Care Service ◽

Palliative Care Service ◽

Pooled Analysis ◽

Lung Cancer Patients ◽

Medical Centers ◽

Symptom Prevalence

e21642 Background: Little is known about palliative care for liver cancer. In this study, we examined palliative care for liver cancer and lung cancer patients. Methods: In an IRB approved protocol, we reviewed medical records of patients diagnosed with liver cancer who were seen by the palliative care service between 2006 and 2012 at 2 VA medical centers, and matched them to patients with lung cancer by year, KPS, and stage. Veterans were compared by symptom prevalence with the CMSAS and by palliative care interventions. Statistical analyses were performed with SAS Studio Version 3.5. Results: We analyzed a total of 138 male patients at 2 VA centers; 69 with lung cancer and 69 with liver cancer. The mean age in both groups was 65 years and 60% of patients self-identified as a minority. There was a high prevalence of symptoms in both groups. Symptom prevalence differed significantly between liver and lung cancer pts for weight loss and dyspnea at one site, and for feeling drowsy, constipation, at the other site. These differences disappeared in a pooled analysis. During palliative care evaluation, more lung cancer patients received treatment for constipation (n = 44 in lung, 29 in liver, p = 0.0107) and dyspnea treatment (n = 37 in lung, 22 in liver, p = 0.0167). More patients with lung cancer were evaluated by physical therapy (n = 41 in lung, n = 28 in liver, p = 0.0276) and psychiatry (n = 31 in lung, n = 20 in liver, p = 0.032). Conclusions: Differences between lung and liver cancer patients’ symptom prevalence and treatment by palliative care can vary by site. This reinforces the importance of local surveys of symptom prevalence . Further studies should be replicated in other sites.

Download Full-text

The outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.131 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 131-131

Author(s):

Si Won Lee ◽

Hye Jin Choi

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Group Performance ◽

Care Service ◽

Symptom Control ◽

Palliative Care Service ◽

Cancer Center ◽

Anticancer Treatment ◽

Tertiary Cancer Center

131 Background: The importance of palliative care in cancer patients continues to be emphasized and studies are proving its importance. Several studies proved the improvement of quality of life in advanced cancer patients. The efficacy of symptom control based on outpatient palliative care service has not yet been reported in Korea. The objective of this study is to review the outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea. Methods: We retrospectively reviewed 155 cancer patients who used outpatient clinic at Yonsei Cancer Center in Korea between April 2014 and December 2014. Symptom severity was measured by modified Korean version of Edmonton Symptom Assessment System. Twelve symptoms were assessed: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, anorexia, constipation, wellbeing, financial distress. Higher score means worse symptom. ESAS scores at baseline and follow-up assessments were analyzed. Results: The 155 patients had following characteristics: female 52.3%, median age 65 years (range 58-75), Hepatobiliary-pancreatic cancer and lung cancer patients accounted for the largest portion (n = 37, 23.9%; n = 36, 23.2% respectively). Most patients were Eastern Cooperative Oncology Group performance status 1 (n = 28, 18.1%) or 2 (n = 24, 15.5%). Ninety-two (59.4%) patients were referred to the palliative care team after anti-cancer treatments were all finished. Overall the symptoms did not change significantly from baseline to 2 consecutive follow up assessment except anorexia ( p value = 0.0195). Patients who were on active anticancer treatment had tendency of higher ESAS score than those finished with the anticancer treatment. However, all symptoms except nausea were not statistically significant. Conclusions: Most patients in this study did not have severe symptom scores that would show the differences of the symptom changes. Nevertheless, although not statistically significant, we found that patients on active anticancer treatment had higher symptom burden than those who were finished with the anticancer treatment. More meticulous symptom management is necessary to improve the symptom control.

Download Full-text