Provider and patient gender influence on timing of do-not-resuscitate in hospitalized patients with cancer.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e20500-e20500
Author(s):  
Melissa Crosby ◽  
Lee Cheng ◽  
Alma Yvette DeJesus ◽  
Maria Alma Rodriguez
2016 ◽  
Vol 19 (7) ◽  
pp. 728-733 ◽  
Author(s):  
Melissa A. Crosby ◽  
Lee Cheng ◽  
Alma Y. DeJesus ◽  
Elizabeth L. Travis ◽  
Maria A. Rodriguez

2021 ◽  
Author(s):  
Jonathan C. Yeh ◽  
Arielle R. Urman ◽  
Robert J. Besaw ◽  
Laura E. Dodge ◽  
Kathleen A. Lee ◽  
...  

PURPOSE Palliative care (PC) improves outcomes in advanced cancer, and guidelines recommend early outpatient referral. However, many PC teams see more inpatient than outpatient consults. We conducted a retrospective study of hospitalized patients with cancer to quantify exposure to inpatient and outpatient PC and describe associations between PC and end-of-life (EOL) quality measures. METHODS We identified all decedents admitted to an inpatient oncology unit in 1 year (October 1, 2017-September 30, 2018) and abstracted hospitalization statistics, inpatient and outpatient PC visits, and EOL outcomes. Descriptive statistics, univariate tests, and multivariate analysis evaluated associations between PC and patient outcomes. RESULTS In total, 522 decedents were identified. 50% saw PC; only 21% had an outpatient PC visit. Decedents seen by PC were more likely to enroll in hospice (78% v 44%; P < .001), have do-not-resuscitate status (87% v 55%; P < .001), have advance care planning documents (53% v 31%; P < .001), and die at home or inpatient hospice instead of in hospital (67% v 40%; P < .01). Decedents seen by PC had longer hospital length-of-stay (LOS; 8.4 v 7.0 days; P = .03), but this association reversed for decedents seen by outpatient PC (6.3 v 8.3 days; P < .001), who also had longer hospice LOS (46.5 v 27.1 days; P < .01) and less EOL intensive care (6% v 15%; P < .05). CONCLUSION PC was associated with significantly more hospice utilization and advance care planning. Patients seen specifically by outpatient PC had shorter hospital LOS and longer hospice LOS. These findings suggest different effects of inpatient and outpatient PC, underscoring the importance of robust outpatient PC.


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 24-24
Author(s):  
Arielle R. Urman ◽  
Mary K. Buss ◽  
Robert J. Besaw ◽  
Laura E. Dodge ◽  
Kathleen A. Lee ◽  
...  

24 Background: Palliative care (PC) improves outcomes for patients with advanced cancer, and current ASCO guidelines recommend early outpatient referral. However, recent data show that PC teams at many cancer centers see more inpatient consults than outpatient visits; the comparative impact of inpatient versus outpatient PC is not well-described. For this reason, we conducted a retrospective cohort study of hospitalized cancer patients to quantify exposure to inpatient/outpatient PC, and to describe associations between PC exposure and end-of-life (EOL) quality measures including hospice utilization, advance care planning (ACP), and intensity of care. Methods: We identified all patients admitted to one cancer center’s inpatient oncology unit during one fiscal year (10/1/2017-9/30/2018). Demographics, admission statistics, inpatient/outpatient PC visits, and EOL outcomes were abstracted from the electronic medical record. Decedents were identified through chart review and public obituaries. Results were summarized by descriptive statistics, and standard statistical tests were used to evaluate associations between PC exposure and EOL outcomes. Results: 842 patients were hospitalized in one year. 522 patients died by the study end-date of 10/1/2020 and were included in analysis. 50% of decedents had any PC exposure prior to death, but only 21% had an outpatient PC visit. Patients seen by PC were younger at time of death, (median: 67 vs 72 years; p <.001) and more likely to be female (52% vs 42%; p =.03). Compared to patients never seen by PC, patients with any PC exposure were significantly more likely to enroll in hospice (78% vs 44%; p <.0001), have do-not-resuscitate status (87% vs 55%; p <.0001), have scanned ACP documents (53% vs 31%; p <.0001), and die at home or inpatient hospice instead of in the hospital (67% vs 40%; p <.01). PC exposure was not associated with differences in 30-day re-admissions, systemic cancer therapy in the last 14 days of life, or intensive care (ICU) utilization in the last 30 days of life. Notably, PC exposure was associated with longer hospital length-of-stay (LOS) (8.4 vs 7.2 days), but this association was reversed for patients seen by outpatient PC versus all others (6.3 vs 8.2 days; p <.01). Patients seen by outpatient PC also had longer hospice LOS (46.5 vs 27.1 days; p <.01) and less EOL ICU use (6% vs 15%; p <.05) compared to all others. Conclusions: In this large retrospective study of hospitalized patients with cancer, PC exposure was associated with significant improvements in multiple EOL quality measures. The subset of patients seen by outpatient PC experienced additional benefits, including shorter hospital LOS, longer hospice LOS, and less EOL ICU utilization. These findings point to differential effects between inpatient and outpatient PC, underscoring the importance of early, longitudinal PC involvement.


Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2768
Author(s):  
Bram C. Agema ◽  
Astrid W. Oosten ◽  
Sebastiaan D. T. Sassen ◽  
Wim J. R. Rietdijk ◽  
Carin C. D. van der Rijt ◽  
...  

Oxycodone is frequently used for treating cancer-related pain, while not much is known about the factors that influence treatment outcomes in these patients. We aim to unravel these factors by developing a population-pharmacokinetic model to assess the pharmacokinetics of oxycodone and its metabolites in cancer patients, and to associate this with pain scores, and adverse events. Hospitalized patients with cancer-related pain, who were treated with oral oxycodone, could participate. Pharmacokinetic samples and patient-reported pain scores and occurrence and severity of nine adverse events were taken every 12 h. In 28 patients, 302 pharmacokinetic samples were collected. A one-compartment model for oxycodone and each metabolite best described oxycodone, nor-oxycodone, and nor-oxymorphone pharmacokinetics. Furthermore, oxycodone exposure was not associated with average and maximal pain scores, and oxycodone, nor-oxycodone, and nor-oxymorphone exposure were not associated with adverse events (all p > 0.05). This is the first model to describe the pharmacokinetics of oxycodone including the metabolites nor-oxycodone and nor-oxymorphone in hospitalized patients with cancer pain. Additional research, including more patients and a more timely collection of pharmacodynamic data, is needed to further elucidate oxycodone (metabolite) pharmacokinetic/pharmacodynamic relationships. This model is an important starting point for further studies to optimize oxycodone dosing regiments in patients with cancer-related pain.


2019 ◽  
Vol 30 (2) ◽  
pp. 274-280 ◽  
Author(s):  
R.D. Nipp ◽  
A. El-Jawahri ◽  
M. Ruddy ◽  
C. Fuh ◽  
B. Temel ◽  
...  

2021 ◽  
Author(s):  
Awad I. Javaid ◽  
Dominique J. Monlezun ◽  
Gloria Iliescu ◽  
Phi Tran ◽  
Alexandru Filipescu ◽  
...  

2020 ◽  
Vol 115 (1) ◽  
pp. S68-S68
Author(s):  
Shilpa Grover ◽  
Walker D. Redd ◽  
Joyce C. Zhou ◽  
Cheikh Njie ◽  
Danny Wong ◽  
...  

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