Patient expectations of palliative cancer treatment for noncurable malignancies: A pilot study.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 194-194
Author(s):  
Katherine E. Faricy-Anderson ◽  
Susan M. Allen ◽  
Nancy J. Freeman ◽  
Vincent Mor
Keyword(s):  
Pilot Study ◽  
Cancer Treatment ◽  
Structured Interview ◽  
Treatment Goals ◽  
Department Of Veterans Affairs ◽  
Number Of Patients ◽  
Patient Reported ◽  
Anti Cancer ◽  
Clinical Interactions ◽  
Unrealistic Expectations

194 Background: Many people with advanced non-curable malignancies have unrealistic expectations of palliative cancer treatment including a belief that treatment may cure their cancer. However, qualitative data describing how patients define “cure” or other treatment goals are lacking. We initiated a pilot study to assess patient understanding of the goals of palliative anti-cancer treatment. Methods: Patients with advanced non-curable malignancy were eligible. Enrolled patients completed a structured interview with both quantitative and qualitative components to assess their understanding of treatment goals and their perceptions of clinical interactions. Additional data included age, race/ethnicity, education, type of malignancy, co-morbidities, and palliative care involvement. Results: We enrolled 30 patients initiating non-curative anti-cancer treatment. Ages ranged from 58 to 92 years. The most common malignancies were lung (33%) and prostate (17%) cancer. Ninety-three percent reported that their doctors explained things in “a way you can understand” and provided “as much information as you want” about treatment. However, only 53% accurately reported that treatment was “not at all likely” to cure their cancer; 40% reported some chance of cure; and 7% weren’t sure. Patient-reported definitions of “cure” ranged from “make it go away” to “no further symptoms” to “less pain.” Of those who reported some chance of cure, about half defined cure as eradication but half used more traditionally palliative language. Overall, 80% reported that treatment was “very” or “somewhat” likely to help them live longer and their definitions of “live longer” ranged from “wake up the next morning” to “20 more years” to “live to 105.” Conclusions: Patient-reported definitions of “cure” and other treatment goals vary widely and a substantial number of patients report unrealistic expectations. These results suggest the need for an intervention to improve patient-physician communication to ensure that patients fully understand the goals of their palliative treatments. “The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.”

Adoption of patient-reported outcomes (PROs) in clinical practice for older patients receiving active anticancer treatment: Impact on health-related quality of life (QoL).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24014-e24014
Author(s):  
Clizia Zichi ◽  
Elisa Sperti ◽  
Donatella Marino ◽  
Gaetano Lacidogna ◽  
Francesca Vignani ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cancer Treatment ◽  
Effect Size ◽  
Older Patients ◽  
Secondary Analysis ◽  
Patient Reported ◽  
Anti Cancer ◽  
Anticancer Treatment ◽  
Group A ◽  
Group B

e24014 Background: PROs are the gold standard to describe subjective symptoms. In order to improve clinical management of outpatients receiving active anti-cancer treatment at Medical Oncology, Mauriziano Hospital, Turin, Italy, in January 2018 we introduced in routine clinical practice an assessment of patient-reported symptoms and toxicities. We demonstrated that use of PROs in clinical practice was associated with a significant QoL improvement, compared to the traditional visit (Baratelli, Support Care Cancer 2019). In this secondary analysis, we show the results obtained in older pts ( > 70yrs). Methods: Eligible pts were receiving an active anti-cancer treatment, as outpatients. Pts treated in 2017 underwent “usual” visits (group A), while pts treated in 2018 before each visit received a paper questionnaire by a dedicated nurse, in order to provide information about symptoms and toxicities to be discussed during visit (group B). Primary objective was the comparison of QoL changes, measured by EORTC QLQ-C30. Results: Out of 211 pts, 88 were older than 70 yrs (47 group A, 41 group B). Median age was 76 (70-84 yrs). Most common tumors were colorectal (25.0%), lung (22.7%) and pancreatic (17.0%). 68.2% were receiving first-line treatment. Tumors and setting were similar between group A and B. Younger and older pts had comparable baseline QoL scores: mean global QoL score was 59.96 in younger pts vs. 57.39 in older pts. After 1 month, global QoL of older pts was significantly improved in group B compared to group A: mean change from baseline was -0.89 group A vs. +4.47 group B (p = 0.006, effect size 0.23). There were statistically significant differences in mean changes from baseline, in favor of group B, for role functioning (-5.67 group A and -0.81 group B, p = 0.034, effect size 0.20) and emotional functioning (-2.30 group A and +3.25 group B, p = 0.014, effect size 0.36). Mean changes from baseline for pain were significantly better for group B (-3.25) than group A (+6.03, p = 0.01, effect size 0.43). There were no significant differences between the 2 groups in terms of other functional scales or symptoms. There was no significant heterogeneity in the proportion of QoL responders between younger and older pts (p = 0.60). The proportion of older pts obtaining a clinically significant improvement in global QoL was numerically higher in group B (36.6%) compared to group A (19.1%, p = 0.09). Odds Ratio of obtaining an improvement in global QoL for group B vs group A was 1.73 (95%CI 0.75 – 3.99) in younger pts and 2.44 (95%CI 0.93 – 6.40) in older pts. Conclusions: This secondary analysis shows that the use of PROs in clinical practice, thanks to an active role of nurses and discussion of symptoms with physicians during the visit, is associated, also in older patients receiving active anticancer treatment, with a significant improvement in global QoL.

The role of patient-reported outcomes in outpatients receiving active anti-cancer treatment: impact on patients’ quality of life

2019 ◽  
Vol 27 (12) ◽  
pp. 4697-4704 ◽  
Author(s):  
Chiara Baratelli ◽  
Carmela Giovanna Cleopatra Turco ◽  
Gaetano Lacidogna ◽  
Elisa Sperti ◽  
Francesca Vignani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Treatment ◽  
Patient Reported Outcomes ◽  
Patient Reported ◽  
Anti Cancer

Variations in patient-reported outcome (PRO) collection and reporting in novel FDA approved anticancer therapies.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18202-e18202
Author(s):  
Surbhi Singhal ◽  
Evan Thomas Hall ◽  
Brooke Peterson Gabster ◽  
James Dickerson ◽  
Lidia Schapira
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Cancer Treatment ◽  
Treatment Options ◽  
Patient Reported Outcome ◽  
Cancer Therapies ◽  
Clinical Trial Registry ◽  
Fda Approval ◽  
Patient Reported ◽  
Anti Cancer

e18202 Background: Patient-reported outcomes (PROs) are increasingly valued as a key tool in patient-focused treatment decisions. However, a lack of standardization leads to significant variability in PRO collection and reporting in ground-breaking clinical trials of novel agents. We sought to characterize the mechanisms of assessment and variability by which PROs are reported for newly approved anti-cancer therapies. Methods: We reviewed the U.S. Food and Drug Administration (FDA) approvals between 2011 and 2017 for anti-cancer new molecular entities (NMEs) and new biologic approvals (BLAs). For each therapy, the pivotal clinical trial leading to FDA approval was identified using the national clinical trial (NCT) number and assessed for inclusion of PROs. A separate PubMed search was conducted to evaluate for PRO publication distinct from the original trial based on national clinical trial registry number. Results: From 2011 to 2017, the FDA approved 66 NMEs/BLAs based on 74 clinical trials for cancer treatment. Of the 74 clinical trial publications, 21 (28%) of the trials published PRO data in their original clinical publication, 18 (24%) published a separate PRO analysis, and 35 (47%) did not publish PRO data in either format. Among the 32 clinical trials (43%) that listed PROs as pre-specified outcomes, 72% published PROs (23/32). The separate PRO analyses (N = 18) were published considerably later following FDA approval (mean 605 days) than the original clinical trials (mean 20 days, N = 74, P < 0.001). Conclusions: As cancer treatment options expand, therapy decisions become increasingly nuanced. PROs assist decision-making by providing detailed information on important aspects of quality of life and tolerability. Our research has identified a significant lag in the publication of companion studies of PRO data associated with pivotal clinical trials, representing a meaningful gap in information critical to patients and oncologists in the process of making informed decisions.

scholarly journals Incidence of Capillary Leak Syndrome as an Adverse Effect of Drugs in Cancer Patients: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 8 (2) ◽  
pp. 143 ◽  
Author(s):  
Gwang Jeong ◽  
Keum Lee ◽  
I Lee ◽  
Ji Oh ◽  
Dong Kim ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Interleukin 2 ◽  
Capillary Leak Syndrome ◽  
Capillary Leak ◽  
Number Of Patients ◽  
Anti Cancer ◽  
Study Heterogeneity

Capillary leak syndrome (CLS) is a rare disease with profound vascular leakage, which can be associated with a high mortality. There have been several reports on CLS as an adverse effect of anti-cancer agents and therapy, but the incidence of CLS according to the kinds of anti-cancer drugs has not been systemically evaluated. Thus, the aim of our study was to comprehensively meta-analyze the incidence of CLS by different types of cancer treatment or after bone marrow transplantation (BMT). We searched the literatures (inception to July 2018) and among 4612 articles, 62 clinical trials (studies) were eligible. We extracted the number of patients with CLS, total cancer patients, name of therapeutic agent and dose, and type of cancer. We performed a meta-analysis to estimate the summary effects with 95% confidence interval and between-study heterogeneity. The reported incidence of CLS was categorized by causative drugs and BMT. The largest number of studies reported on CLS incidence during interleukin-2 (IL-2) treatment (n = 18), which yielded a pooled incidence of 34.7% by overall estimation and 43.9% by meta-analysis. The second largest number of studies reported on anti-cluster of differentiation (anti-CD) agents (n = 13) (incidence of 33.9% by overall estimation and 35.6% by meta-analysis) or undergoing BMT (n = 7 (21.1% by overall estimation and 21.7% by meta-analysis). Also, anti-cancer agents, including IL-2 + imatinib mesylate (three studies) and anti-CD22 monoclinal antibodies (mAb) (four studies), showed a dose-dependent increase in the incidence of CLS. Our study is the first to provide an informative overview on the incidence rate of reported CLS patients as an adverse event of anti-cancer treatment. This meta-analysis can lead to a better understanding of CLS and assist physicians in identifying the presence of CLS early in the disease course to improve the outcome and optimize management.

A Multicenter Retrospective Review of Systemic Anti-Cancer Treatment and Palliative Care Provided to Solid Tumor Oncology Patients in the 12 Weeks Preceding Death in Ireland

2021 ◽  
pp. 104990912098523 ◽  
Author(s):  
Victoria Mallett ◽  
Anna Linehan ◽  
Orla Burke ◽  
Laura Healy ◽  
Sara Picardo ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Treatment ◽  
End Of Life ◽  
Solid Tumor ◽  
Retrospective Review ◽  
Invasive Procedure ◽  
Hospital Death ◽  
Incurable Cancer ◽  
Number Of Patients ◽  
Anti Cancer

Background: Systemic anti-cancer treatment (SACT) can improve symptoms and survival in patients with incurable cancer but there may be harmful consequences. Information regarding the use of SACT at the end-of-life and its impact on patients has not been described in Ireland. Aims: The study aimed to quantify and describe the use of SACT at end-of-life. The primary outcome of interest was the number of patients who received treatment in the last 12, 4 and 2 weeks of life. Secondary outcomes included the frequency of admissions and procedures, location of death, and timing of specialist palliative care (SPC) referral. Methods: Retrospective review. Fisher exact testing was used for analyses. Patients were included if they died between January 2015 and July 2017 and received at least 1 dose of treatment for a solid tumor malignancy. Results: Five hundred and eighty two patients were included. Three hundred and thirty eight (58%), 128 (22%) and 36 (6%) received treatment in the last 12, 4 and 2 weeks of life respectively. Patients who received chemotherapy in the last 12 weeks of life were more likely to be admitted to hospital, undergo a procedure, and die in hospital than those who did not (P < 0.001 for all). Median time of SPC referral before death was shorter in those patients who received chemotherapy than those who did not (61 v129 days, p = 0.0001). Conclusion: Patients who received chemotherapy had a higher likelihood of hospital admission, invasive procedure, and in-hospital death. They were less likely to have been referred early to SPC services.

scholarly journals Safe Provision of Systemic Anti-Cancer Treatment for Urological Cancer Patients During COVID-19: A Tertiary Centre Experience in the First Wave of COVID-19

2022 ◽  
Author(s):  
Alfred Chung Pui So ◽  
Christina Karampera ◽  
Muhammad Khan ◽  
Beth Russell ◽  
Charlotte Moss ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Urological Cancer ◽  
Single Centre ◽  
Oncology Patients ◽  
Tertiary Centre ◽  
Number Of Patients ◽  
Anti Cancer ◽  
Single Centre Study ◽  
Low Incidence ◽  
Ongoing Concern

Abstract Background Safe provision of systemic anti-cancer treatment (SACT) during the COVID-19 pandemic remains an ongoing concern amongst clinicians. Methods Retrospective analysis on uro-oncology patients who continued or started SACT between 1st March and 31st May 2020 during the pandemic (with 2019 as a comparator). Results 441 patients received SACT in 2020 (292 prostate, 101 renal, 38 urothelial, 10 testicular) compared to 518 patients in 2019 (340 prostate, 121 renal, 42 urothelial, 15 testicular). In 2020, there were 75.00% fewer patients with stage 3 cancers receiving SACT (p<0.0001) and 94.44% fewer patients receiving radical treatment (p=0.0019). The number of patients started on a new line of SACT was similar between both years (118 in 2019 vs 102 in 2020; p=N.S) but with 53.45% fewer patients started on chemotherapy in 2020 (p=0.00067). Overall, 5 patients tested positive for COVID-19 (one asymptomatic, two moderate pneumonitis, one severe pneumonitis). Compared to 2019, 30-day mortality was similar (1.69% in 2019 vs 0.98% in 2020; p=N.S) whereas the 6-month mortality was lower (9.32% in 2019 vs 1.96% in 2020; p=0.023) in 2020. Conclusion This single-centre study demonstrated that uro-oncology patients can safely receive SACT during COVID-19 pandemic with a low incidence of infection and mortality.

scholarly journals Active Participation, Mind–Body Stabilization, and Coping Strategies with Integrative Medicine in Breast Cancer Patients

2021 ◽  
Vol 20 ◽  
pp. 153473542199010
Author(s):  
Anna-Katharin Theuser ◽  
Sophia Antoniadis ◽  
Hanna Langemann ◽  
Sonja Wasner ◽  
Katharina Grasruck ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Coping Strategies ◽  
Cancer Patients ◽  
Integrative Medicine ◽  
Active Participation ◽  
Treatment Goals ◽  
Breast Cancer Patients ◽  
Patient Reported ◽  
And Coping

Purpose: Increasing numbers of breast cancer survivors have led to a growing demand for integrative medicine. When patients have completed treatments associated with severe side effects, attention turns to reducing psychological symptoms, coping behavior, and self-care. The aim of this study was to assess patient-reported benefits in relation to active participation, mind–body stabilization, and coping strategies in breast cancer patients receiving integrative medicine. Methods: In a cross-sectional study, health counseling and treatment provided by a standardized integrative medicine consultancy service at the University Breast Center of Franconia were evaluated in 75 breast cancer patients over a 15-month period. At the baseline, the patients answered a questionnaire on their medical history, symptoms, and the treatment goals they were hoping to achieve with integrative medicine. Patient-reported outcomes relative to active participation, mind–body stabilization, and coping strategies were analyzed. Results: A large majority of the patients had previous experience with integrative medicine (91%). Most reported that they achieved their treatment goals with integrative medicine. Ninety-one percent achieved active participation in cancer treatment, 90% mind–body stabilization, and 79% improvement in coping strategies. Besides active participation, which was greatest in patients with stable disease, the success of integrative therapy was independent of age, concomitant diseases, previous integrative medicine experience, treatment state, and systemic cancer therapy. Conclusion: Breast cancer patients benefit from the counseling and treatment provided with integrative medicine in mind–body stabilization and coping with cancer. Active participation in cancer treatment is important for the patients. Integrative treatment services should form part of routine patient care.

Proportion of type 2 diabetic patients achieving treatment goals and the survey of patient’s attitude towards insulin initiation in patients with inadequate glycaemic control with oral anti-diabetic drugs

2020 ◽  
Vol 16 ◽  
Author(s):  
Shivashankara Bhat ◽  
Mukta Chowta ◽  
Nithyananda Chowta ◽  
Rajeshwari Shastry ◽  
Priyanka Kamath
Keyword(s):  
Glycaemic Control ◽  
Diabetic Patients ◽  
Treatment Goals ◽  
Insulin Initiation ◽  
Type 2 Diabetic Patients ◽  
Number Of Patients ◽  
Patient’S Perception ◽  
Hba1c Target ◽  
Type 2 Diabetic

Background: Type 2 diabetic patients often require insulin therapy for better glycaemic control. However, many of these patients do not receive insulin or do not receive it in a timely manner. Objective: The study was planned to assess the proportion of type 2 diabetic patients attaining treatment goals as per the ADA 2018 guidelines. In addition, patient’s perception on insulin therapy assessed and compared between insulin naïve and insulin initiated type 2 diabetic patients. Methods: The study was conducted in type 2 diabetic patients. Data on their demographics, medical history, duration of diabetes, history of diabetes related complications, the current antidiabetic medication received, most recent glycaemic parameters were noted. Patient’s perception on insulin initiation was recorded through structured interview. Results: A total of 129 patients were included in the study. Around 76.7% patients achieved HbA1c target (<7%). Duration of the disease is much higher in patients who did not meet the HBA1c target. A good number of patients felt that insulin injection would be physically painful (56.5%). Majority of the patients also felt that insulin will make their life less flexible (64.8%). Many patients are having the opinion that insulin is required for life long (73.2%). More number of patients on insulin agreed with the statement ‘Leads to good short-term outcomes as well as long-term benefits’ compared to insulin naïve patients. Conclusion: The results highlight that the proportion of patients achieving recommended glycaemic target is not satisfactory. Many patients who are inadequately controlled with oral antidiabetic drugs were reluctant to initiate insulin.

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