Intensity of palliative care and its impact on the aggressiveness of end-of-life care in patients with advanced pancreatic cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9518-9518 ◽  
Author(s):  
Raymond Woo-Jun Jang ◽  
Monika K. Krzyzanowska ◽  
Camilla Zimmermann ◽  
Nathan Taback ◽  
Shabbir M.H. Alibhai
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Quality Indicators ◽  
Advanced Pancreatic Cancer ◽  
Population Based ◽  
Administrative Databases ◽  
Icu Admission ◽  
Ed Visits ◽  
Aggressive Care ◽  
The Impact

9518 Background: Quality indicators have been developed to avoid overly aggressive care in patients with advanced cancer. Specialized palliative care (PC) may reduce overly aggressive care in patients with advanced pancreatic cancer. Our objective was to examine the impact of the intensity of specialized PC (defined as a physician consultation focusing on PC needs, lasting at least 40 minutes) on (a) use of chemotherapy within 14 days of death; (b) more than one emergency department (ED) visit; (c) more than one hospitalization; and (d) at least one intensive care unit (ICU) admission, all within 30 days of death. Methods: A retrospective population-based cohort study using linked administrative databases in Ontario, Canada was conducted with patients diagnosed with advanced pancreatic cancer from Jan 1 2005 to Dec 31 2010. Multivariable logistic regression analyses were performed with the above quality indicators as the outcomes of interest and the intensity of PC visits as the exposure, adjusting for other variables (age, sex, comorbidity, rurality, and health region). Intensity of PC was defined in both absolute numbers (ie 0, 1, 2, 3+ visits) and rate of visits per month. Results: Of 6076 patients with advanced pancreatic cancer, 5381 had died at last followup. 2816 (52%) received a PC consultation, 218 (4%) received chemotherapy near death, 234 (4%) patients went to the ICU near death, 993 (18%) had multiple ED visits near death, and 447 (8%) had multiple hospitalizations near death. 2565 (48%) had 0 PC visits, 513 (10%) had 1, 555 (10%) had 2, and 1748 (32%) had 3 or more. In multivariable analyses, having had one PC consultation was associated with a lower odds of ICU admission near death (odds ratio (OR) 0.25; 95% CI 0.13-0.46), multiple ED visits near death (OR 0.44; 95% CI 0.33-0.58), and multiple hospitalizations near death (OR 0.47; 95% CI 0.33-0.69). Two PC visits were associated with a lower OR for chemotherapy near death (OR 0.26; 95% CI 0.14-0.51). Using the monthly PC visit rate, a higher rate was associated with less aggressive care for each outcome. Conclusions: In patients with advanced pancreatic cancer, more intensive PC involvement is associated with less frequent overly aggressive care.

The impact of early palliative care on the quality of life of patients with advanced pancreatic cancer: The IMPERATIVE study.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. TPS777-TPS777
Author(s):  
Stephanie Lelond ◽  
Harvey Chochinov ◽  
Paul Joseph Daeninck ◽  
Benjamin Adam Goldenberg ◽  
Lisa Lix ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pancreatic Cancer ◽  
Palliative Care ◽  
Patient Experience ◽  
Symptom Control ◽  
Advanced Pancreatic Cancer ◽  
Nurse Specialist ◽  
Early Palliative Care ◽  
The Impact

TPS777 Background: Pancreatic cancer is lethal. Chemotherapy can improve survival by months; however, many patients experience an overwhelming burden of cancer-associated symptoms and poor quality of life (QOL). Early palliative care (EPC) alongside standard oncologic care results in improved QOL and survival in patients with lung cancer. Although international guidelines recommend EPC for patients with advanced pancreatic cancer (PANC), the benefit is not known. Objectives: The primary objective is to test for change in QOL between baseline (BL) and 16 weeks (wk). Secondary objectives are to test for change between BL and 16 wk in (a) symptom control; and (b) depression and anxiety. Methods: This prospective case-crossover study of patients with PANC provides EPC plus standard oncologic care. Primary oncology clinics refer patients to an EPC team led by a palliative care physician and a clinical nurse specialist. BL questionnaires are completed prior to initial EPC assessment, then every 4 wk until wk 16. EPC visits are every 2 wk for the first month, every 4 wk until wk 16, and then as needed. QOL, symptom control, anxiety and depression are measured using the FACT-Hep tool, ESAS-r, HADS and PHQ-9, respectively. A generalized linear model will test for statistically significant change in scores between BL and 16 wk; chemotherapy (yes/no) is included as a confounding covariate; model fit will be assessed. A sample size of 20 patients provides 80% power after controlling for covariate effects. 40 patients will be enrolled to account for missing data. To date, 28 patients have enrolled and 17 have completed the intervention. Significance: The benefit of EPC for patients with PANC is not known, however, EPC is increasingly recognized internationally by patients and stakeholders as a critical intervention which may improve both QOL and satisfaction with care. The Canadian Partnership Against Cancer’s report on the patient experience states “the best possible patient experience means all people with cancer have equitable access to high-quality person-centered palliative care”. This study offers access to EPC and provides an environment in which the benefit of an integrated approach is evaluated.

Predictors of specialized pediatric palliative care involvement and impact on patterns of end-of-life care in children with cancer: A population-based study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10573-10573
Author(s):  
Sumit Gupta ◽  
Rinku Sutradhar ◽  
Adam Rapoport ◽  
Katherine Nelson ◽  
Ying Liu ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Population Based ◽  
Small Sample ◽  
Pediatric Palliative Care ◽  
Income Quintile ◽  
Hospital Death ◽  
Children With Cancer ◽  
Icu Admission ◽  
The Impact

10573 Background: Children with cancer are at risk of receiving high-intensity (HI) care at the end-of-life (EOL) and associated high symptom burden. The impact of palliative care (PC) delivered by generalists or of specialized pediatric palliative care (SPPC) on patterns of EOL care is unknown, with previous studies limited by small sample sizes or low response rates. Methods: Using a provincial registry, we assembled a retrospective cohort of Ontario children with cancer who died between 2000-2012 and who received care through a pediatric institution with a SPPC team and a clinical PC database. Patients were linked to population-based healthcare data capturing inpatient, outpatient, and emergency visits. Clinical PC databases were used to identify patients receiving SPPC. Remaining patients were categorized as having received either general PC (GPC) or no PC depending on the presence of PC associated physician billing or inpatient codes. We determined predictors of SPPC involvement, and whether either SPPC or GPC was associated with HI-EOL outcomes: ICU admission < 30 days from death, mechanical ventilation < 14 days from death, or in hospital death. Sensitivity analyses excluded treatment-related mortality (TRM) cases. Results: 572 patients met inclusion criteria. Children less likely to receive SPPC services included those with hematologic cancers [odds ratio (OR) 0.33, 95th confidence interval (CI) 0.30-0.37; p < 0.001)], in the lowest income quintile (OR 0.44, 95CI 0.23-0.81; p = 0.009), and living at increased distance from the treatment center (OR 0.46, 95CI 0.40-0.52; p < 0.0001). In multivariate analysis, SPPC was associated with a 3-fold decrease in the odds of an EOL ICU admission (OR 0.32, 95CI 0.18-0.57), while GPC had no impact. Similar associations were seen with all other HI-EOL indicators. Excluding TRM had little impact. Conclusions: SPPC, but not GPC, is associated with lower intensity care at EOL. Access to such care however remains uneven. In the absence of randomized trials, these results provide the strongest evidence to date supporting the creation of SPPC teams. These results can be used to support PC advocacy and policy efforts.

scholarly journals Palliative care consultation and aggressive care at end of life in unresectable pancreatic cancer

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
C. Lees ◽  
S. Weerasinghe ◽  
N. Lamond ◽  
T. Younis ◽  
Ravi Ramjeesingh
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
End Of Life ◽  
Potential Effect ◽  
Unresectable Pancreatic Cancer ◽  
Palliative Care Consultation ◽  
Integral Role ◽  
Care Consultation ◽  
Aggressive Care ◽  
Key Indicators

Background Palliative care (pc) consultation has been associated with less aggressive care at end of life in a number of malignancies, but the effect of the consultation timing has not yet been fully characterized. For patients with unresectable pancreatic cancer (upcc), aggressive and resource-intensive treatment at the end of life can be costly, but not necessarily of better quality. In the present study, we investigated the association, if any, between the timing of specialist pc consultation and indicators of aggressive care at end of life in patients with upcc.Methods This retrospective cohort study examined the potential effect of the timing of specialist pc consultation on key indicators of aggressive care at end of life in all patients diagnosed with upcc in Nova Scotia between 1 January 2010 and 31 December 2015. Statistical analysis included univariable and multivariable logistic regression.Results In the 365 patients identified for inclusion in the study, specialist pc consultation was found to be associated with decreased odds of experiencing an indicator of aggressive care at end of life; however, the timing of the consultation was not significant. Residency in an urban area was associated with decreased odds of experiencing an indicator of aggressive care at end of life. We observed no association between experiencing an indicator of aggressive care at end of life and consultation with medical oncology or radiation oncology.Conclusions Regardless of timing, specialist pc consultation was associated with decreased odds of experiencing an indicator of aggressive care at end of life. That finding provides further evidence to support the integral role of pc in managing patients with a life-limiting malignancy.

scholarly journals P-152 The impact of 2nd-line treatment after 1st-line gemcitabine plus nab-paclitaxel in advanced pancreatic cancer patients

2020 ◽  
Vol 31 ◽  
pp. S139
Author(s):  
M. Bensi ◽  
B. Di Stefano ◽  
M. Chiaravalli ◽  
M. Ribelli ◽  
A. Spring ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Advanced Pancreatic Cancer ◽  
Line Treatment ◽  
The Impact
Sign in / Sign up

Export Citation Format

Share Document