Return-to-work issues in outpatient palliative care.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 35-35
Author(s):  
Paul A. Glare ◽  
Tanya Nikolova ◽  
Alberta Alickaj ◽  
Victoria Susana Blinder ◽  
Sujata Patil
Keyword(s):  
Palliative Care ◽  
Side Effects ◽  
Return To Work ◽  
Work Ability ◽  
Definitive Treatment ◽  
Comprehensive Cancer Center ◽  
Work Place ◽  
Extensive Literature ◽  
Full Time ◽  
Active Disease

35 Background: Early integration of palliative care (PC) with oncologic care means return to work (RTW) issues will apply to some patients. There is an extensive literature on RTW after completing definitive treatment but much less is known about RTW in patients with active disease and on treatment. Methods: Cross-sectional survey of patients in two Pain & Palliative Care (PC) clinics at a comprehensive cancer center. Respondents were aged 25-65 and had been in paid employment prior to or during their treatment. The survey consisted of 37 items covering three domains: clinical details and demographics; work status, occupation, and work ability; importance of work and factors interfering with work. Results: 105 surveys were completed. 54% respondents were females, median age 53. 79% had been working at the time diagnosis. The commonest primaries were breast, colorectal, lung, GYN, and melanoma/sarcoma. 80% reported having active disease, median 2 years since diagnosis, and 73% were currently on treatment. In patients with active disease (n=86), 47% were currently working, 63% of them full time, typically RTW after taking < 6 months off. Work was important to 80% them, making 83% "feel normal", and 58% feel like they are “beating the cancer”. 35% would have liked to work more hours. Fatigue interfered with work in 49%, pain in 38%, and side effects of pain medicines in 31%. Almost ¼ were anxious or depressed about their work situation. More than 20% experienced discrimination in the work place, although usually minor. Conclusions: It is not uncommon for patients with advanced cancer to RTW even when they are on treatment and are sick enough to need to be followed in a PC clinic. Work is important to them and many would like to work more. Symptoms and side effects may interfere with their work ability. Some may be experiencing discrimination in the work place. Interventions to overcome these problems should be part of comprehensive, interdisciplinary PC.

Survey of palliative care patients WHO work.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20677-e20677
Author(s):  
Paul A. Glare ◽  
Alberta Alickaj ◽  
Victoria Susana Blinder ◽  
Tanya Nikolova ◽  
Carey Ramirez ◽  
...  
Keyword(s):  
Palliative Care ◽  
Side Effects ◽  
Work Ability ◽  
Comprehensive Cancer Center ◽  
Work Place ◽  
Full Time ◽  
Care Clinic ◽  
Comfort Care ◽  
Missing Responses ◽  
Active Disease

e20677 Background: There is an extensive literature on patients who return to work (RTW) after completing definitive cancer treatment. Much less is known about patients who work while on treatment. At a time of economic uncertainty as cancer becomes more of a chronic disease and palliative care is seen as offering much more than comfort care, issues affecting the working cancer patient needed to be explored. Methods: Cross sectional, anonymous survey completed once in two pain and palliative care clinics at a comprehensive cancer center by patients aged 25-65 who had been in paid employment prior to or during their treatment. Survey covered 37 items in three areas: cancer details (diagnosis, date of diagnosis, prior treatments, current disease status); occupation, work status and work ability; importance of work and factors interfering with work. Results: 97 surveys have been completed but up to 20% items missing responses. Cancer details: 54% females, median age 53, 79% working at diagnosis. Common primaries: Breast 26; CRC 14; lung 6; pancreas 4; prostate 2. 80% (67/84) reported having active disease, median 2 years since diagnosis, and 80% of them on treatment currently.Work status and attitudes of the 67 patients with active disease: 42% (29/68) are currently working, mostly full time, and typically will RTW after < 6 months off. 39% would like to work more hours. Work is important to 73% them, making 78% "feel normal", and 53% that they are “beating the cancer”. Fatigue interfered with work in 49%, pain in 38%, and side effects of pain medicines in 31%. Almost ¼ were anxious or depressed about their work situation. More than 20% experienced discrimination in the work place, but usually minor. Conclusions: Many of these patients with advanced cancer were trying to remain in the work force, even when they are on treatment and are sick enough to need to be followed in a Pain & Palliative Care clinic. Work is important to them and almost half would like to work more. Symptoms and side effects are interfering with their work ability. Some are experiencing discrimination in the work place. Interventions need to be developed to overcome some of these problems.

Embedding palliative care (pc) in a community-based cancer center: Benefits and barriers.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 153-153
Author(s):  
Jennifer Bayne ◽  
John Weems ◽  
Robert D. Siegel ◽  
Teresa N. Bowen ◽  
Leigh Stinnett ◽  
...  
Keyword(s):  
Palliative Care ◽  
South Carolina ◽  
Symptom Management ◽  
Hospital Admissions ◽  
Disease Process ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Full Time ◽  
Community Based ◽  
Oncology Patients

153 Background: The importance of involving PC early in the disease process of oncology patients is well documented. Decreased symptom burden, increased quality of life, and extended survival are proven outcomes; however, the provision of PC has largely been limited to the acute care setting in most institutions. Bon Secours St. Francis Health System, a community based healthcare system in Greenville, South Carolina, opened a comprehensive cancer center in late 2014. Our established inpatient PC team began seeing outpatients at the cancer center shortly after its opening. Methods: PC at the cancer center is provided in an “embedded” model of care. PC appointments were initiated at 20 hours/week and have been expanded to 28 hours/week, currently provided by NPs 24 hrs, MD 4 hrs, all of whom are certified in hospice and palliative care. Patients are seen during medical oncology, radiation oncology, or infusion appointments. In August 2015, the PC team began to participate in an interdisciplinary team meeting, reviewing new oncology patients and their expected or known needs. Results: Total visits for 2015: 559/158 new patients seen. Informal interviews from patients, oncology, and PC staff revealed the following benefits: better communication regarding treatment plans; improved symptom management; flexibility and convenience in meeting patients anywhere in the cancer center and; providing resources for staff regarding pain and symptom management and communication techniques. Barriers identified were: scheduling conflicts for patients with multiple appointments; less than full-time coverage by PC prohibits some patients from being seen during their oncology appointments; PC and oncology being separate administrative entities has required creative solutions in billing and staffing. Conclusions: Despite some barriers, the benefits of embedding a PC clinic in a community-based oncology center are clear and worthwhile. This clinic improves coordination of care between inpatient and outpatient services, which results in positive patient experiences. It is hoped that the early integration of PC in the ambulatory setting will result in a decrease in avoidable emergency room visits and hospital admissions.

Book Review: AMA Guides to the Evaluation of Work Ability and Return to Work, Second Edition

2011 ◽  
Vol 16 (4) ◽  
pp. 12-12
Author(s):  
James Talmage ◽  
J. Mark Melhorn ◽  
Mark H. Hyman
Keyword(s):  
Return To Work ◽  
Work Ability

scholarly journals Rescue pre-operative treatment with Lugol’s solution in uncontrolled Graves’ disease

2017 ◽  
Vol 6 (4) ◽  
pp. 200-205 ◽  
Author(s):  
Jan Calissendorff ◽  
Henrik Falhammar
Keyword(s):  
Heart Rate ◽  
Thyroid Hormone ◽  
Side Effects ◽  
Definitive Treatment ◽  
Graves Disease ◽  
Free T4 ◽  
Hormone Levels ◽  
Free T3 ◽  
Adherence To Medication ◽  
Thyroid Hormone Levels

Background Graves’ disease is a common cause of hyperthyroidism. Three therapies have been used for decades: pharmacologic therapy, surgery and radioiodine. In case of adverse events, especially agranulocytosis or hepatotoxicity, pre-treatment with Lugol’s solution containing iodine/potassium iodide to induce euthyroidism before surgery could be advocated, but this has rarely been reported. Methods All patients hospitalised due to uncontrolled hyperthyroidism at the Karolinska University Hospital 2005–2015 and treated with Lugol’s solution were included. All electronic files were carefully reviewed manually, with focus on the cause of treatment and admission, demographic data, and effects of iodine on thyroid hormone levels and pulse frequency. Results Twenty-seven patients were included. Lugol’s solution had been chosen due to agranulocytosis in 9 (33%), hepatotoxicity in 2 (7%), other side effects in 11 (41%) and poor adherence to medication in 5 (19%). Levels of free T4, free T3 and heart rate decreased significantly after 5–9 days of iodine therapy (free T4 53–20 pmol/L, P = 0.0002; free T3 20–6.5 pmol/L, P = 0.04; heart rate 87–76 beats/min P = 0.0007), whereas TSH remained unchanged. Side effects were noted in 4 (15%) (rash n = 2, rash and vomiting n = 1, swelling of fingers n = 1). Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications. Conclusion Treatment of uncontrolled hyperthyroidism with Lugol’s solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. Side effects were limited. Lugol’s solution could be recommended pre-operatively in Graves’ disease with failed medical treatment, especially if side effects to anti-thyroid drugs have occurred.

scholarly journals P159 Factors associated between SLE and work amongst South Asian people: an explorative qualitative study

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Mandeep Ubhi ◽  
Shirish Dubey ◽  
John Reynolds ◽  
Caroline Gordon ◽  
Tochukwu Adizie ◽  
...  
Keyword(s):  
South Asian ◽  
Work Ability ◽  
Lupus Erythematosus ◽  
Full Time ◽  
Structured Interviews ◽  
Related Factors ◽  
Asian Origin ◽  
South Asian Origin ◽  
The Impact ◽  
Minority Ethnic

Abstract Background/Aims  Systemic lupus erythematosus (SLE) affect patients from minority ethnic backgrounds, with many patients experiencing symptoms that affect their daily lives despite receiving long-term controller medication. Work is a large part of most people’s lives, yet little has been explored into how people from minority ethnic backgrounds cope at work whilst living with SLE. We conducted a study to understand the impact of SLE on working lives of South Asian patients. The aim was to identify and develop support mechanisms that could assist them with remaining at work. Methods  Semi-structured interviews were conducted with ten patients of South Asian origin with SLE to explore their work experiences. Patients were recruited from three rheumatology centres in the West Midlands, UK and were interviewed between November 2019 and March 2020. Interviews were audio-recorded and typed by an independent transcribing company. Returned transcripts were analysed using thematic analysis and QSR NVivo 12 software was used to organise and manage the data. Results  The majority (n = 8) of patients were female. Eight patients were from an Indian background, and two were from a Pakistani background. Half of all patients were educated to degree level. The age range of patients was 23 - 58 years old (S.D = 10.79), and disease duration varied between 3 months-33 years (S.D = 9.52). All patients had permanent jobs; six were in full-time employment, and four were in part-time employment. Four main themes emerged from the data: 1) Disease related factors; impacting work ability; 2) Employment related factors; impacting work ability; 3) Personal and cultural related factors; impacting work ability; 4) Recommendations for improvement were made by patients. Conclusion  In this novel study we highlight patients’ experiences of being at work. This study reports low awareness of SLE and mixed support in the workplace. Patients discussed work to varying degrees with their clinicians and needed further information for employers that was not available nor provided by their clinicians. The study reports cultural barriers in understanding SLE that could lead to lack of family support to remain in employment. Moreover, recommendations made in this study require further investigation and could be used by clinicians and Lupus UK to support patients of South Asian origin at work. Disclosure  M. Ubhi: None. S. Dubey: None. J. Reynolds: None. C. Gordon: None. T. Adizie: None. T. Sheeran: None. K. Allen: None. R. Jordan: None. S. Sadhra: None. J. Adams: None. R. Daji: None. K. Kumar: None.

scholarly journals Antineoplastic therapy use in patients with advanced cancer admitted to an acute palliative care unit at a comprehensive cancer center

Cancer ◽  
2010 ◽  
Vol 116 (8) ◽  
pp. 2036-2043 ◽  
Author(s):  
David Hui ◽  
Ahmed Elsayem ◽  
Zhijun Li ◽  
Maxine De La Cruz ◽  
J. Lynn Palmer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Antineoplastic Therapy ◽  
Advanced Cancer ◽  
Palliative Care Unit ◽  
Comprehensive Cancer Center ◽  
Cancer Center

Disease-modifying therapies in advanced cancer

2021 ◽  
pp. 800-807
Author(s):  
Olav Dajani ◽  
Karin Jordan
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Side Effects ◽  
Well Being ◽  
Patient Comfort ◽  
Optimal Care ◽  
Disease Modifying ◽  
Critical Components ◽  
Improve Patient

In many situations, anticancer therapies may be critical components when optimizing patient comfort, function, quality of life, and duration of survival. Optimal care requires the integration of oncological and palliative care and it is very important for palliative care clinicians to be familiar with oncological approaches to improve patient well-being, and also the limitations of such approaches. This integrative role requires that palliative care clinicians have a basic literacy regarding anticancer therapies and the expectations and side effects of their treatments. Together with anticancer therapies, medical oncology should encompass patient-centred care by providing supportive and palliative interventions at all stages of the disease, from the time of diagnosis.

Interval between first palliative care consultation and death among patients in a comprehensive cancer center in Saudi Arabia

2015 ◽  
Vol 3 (2) ◽  
pp. 61 ◽  
Author(s):  
SamiAyed Alshammary ◽  
Abdullah Alsuhail ◽  
BalajiP Duraisamy ◽  
Savithiri Ratnapalan ◽  
SaadHamad Alabdullateef
Keyword(s):  
Palliative Care ◽  
Saudi Arabia ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Palliative Care Consultation ◽  
Care Consultation
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