Outpatient palliative care encounters in stage IV lung cancer care: An institutional review.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 128-128
Author(s):  
Sophia Rizk ◽  
Elizabeth Horn Prsic ◽  
William Rafelson ◽  
John Leonard Reagan ◽  
Angela Marie Taber
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Overall Survival ◽  
Stage Iv ◽  
Emergency Department Visits ◽  
Institutional Review ◽  
Significant Difference ◽  
Multidisciplinary Clinic ◽  
Stage Iv Lung Cancer ◽  
To Receive

128 Background: Palliative Care (PC) is becoming increasingly integrated into standard oncologic care (SC). Previous research suggests that patients receiving PC report better quality of life, and may have prolonged survival. This study evaluates the effect of PC integration in patients diagnosed with stage IV non-small cell lung cancer (NSCLC) at a single institution. Methods: All patients diagnosed with Stage IV NSCLC between January 2010 and January 2013 were considered for inclusion and retrospective analysis of their care. Charts were reviewed to identify patients who received outpatient PC with a licensed PC physician in addition to SC. There were no guidelines regarding the nature of the PC intervention. Retrospective analyses of multiple factors were assessed, including: receipt of chemotherapy and/or radiotherapy, utilization of emergency and sick visits, frequency and timing of hospice referral, and duration of hospice utilization. Overall survival was also assessed. Results: 136 patients fulfilled study inclusion criteria. 29 patients received PC in addition to SC, and 107 received SC alone. No statistically significant difference was noted between the groups with respect to age, sex, lines of chemotherapy administered, number of emergency department visits, or number of clinic sick visits. Hospice was offered more frequently in the PC group; however, there was no difference in the amount of time spent on hospice, and no difference in overall survival. There was a trend towards longer survival in the PC group (220 days vs. 254 days). Patients seen in a multidisciplinary clinic were significantly more likely to receive a PC evaluation (RR 1.28 CI 1.073-1.52, p < 0.006). Conclusions: This retrospective study examines how PC is integrated in actual clinical models. Multidisciplinary clinic patients were more likely to receive PC after controlling for comorbidities. There was no significant difference between PC and SC group outcomes. Although this study is small, it demonstrates common practice patterns, and identifies the need to identify the components of the PC encounter that are important in order to maximize the potential benefits of PC interventions.

Improving palliative care integration for patients with stage IV lung cancer at UConn Health by initiating a best practice advisory (BPA) in the electronic medical record (EMR).

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 331-331
Author(s):  
Sarah Loschiavo ◽  
Lisa Holle ◽  
Carolyn Guarino ◽  
Ruth Kalish ◽  
Cheryl Coppola ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Stage Iv ◽  
Palliative Care Team ◽  
Care Team ◽  
Clinical Staging ◽  
Newly Diagnosed ◽  
Care Clinic ◽  
Stage Iv Cancer ◽  
Stage Iv Lung Cancer

331 Background: The American Society of Clinical Oncology (ASCO) practice updates on the integration of palliative care into standard oncology practice provides a key recommendation that patients with advanced cancer should receive palliative care services. Specifically, ASCO recommends that all patients with stage IV cancer receive a referral to an interdisciplinary palliative care team early in their course of disease and within 8 weeks of diagnosis. At UConn Health, it has been previously documented that only 28% of patients with stage IV cancer receive a referral to the palliative care team. To improve the quality of cancer care, a BPA with standardized criteria for palliative care referral was developed and implemented for patients with stage IV lung cancer. In this pilot study, the goal was to get 80-90% of patients a referral to palliative care team within 8 weeks of stage IV lung cancer diagnosis. Methods: The Model for Improvement using Plan-Do-Study-Act Cycles was completed: 1) created an EMR report to identify patients with stage IV lung cancer; 2) completed a retrospective review of patients with stage IV lung cancer referred to palliative care 6 months prior to BPA implementation; 3) created and implemented BPA; 4) educated providers about palliative care referral and BPA; 5) retrospectively reviewed referrals 6 months following BPA implementation; and 6) evaluated potential barriers. The palliative care EMR BPA was developed in collaboration with information technology specialists. The BPA alert populates the EMR when the provider opens a patient chart or visit encounter for all patients with 1) diagnosis of lung cancer; 2) stage IV disease; and 3) does not have a current order for palliative care referral. Results: Prior to BPA implementation (January 1, 2020- July 31, 2020), 8 of 28 patients (32%) with stage IV lung cancer were referred to palliative care service. The BPA became active on 9/15/2020. Within the six months following BPA implementation, 16 patients were newly diagnosed with stage IV lung cancer. Of these 16 patients, 81% of them had a referral to palliative care made within 8 weeks of clinical staging. Several barriers were identified with current process, including lack of staging tool use by all providers; lack of documentation of all data required for staging tool to automatically calculate stage, and inability to track patients who declined palliative care appointment. Conclusions: Incorporating a BPA reminding providers to consider a palliative care referral improved referrals of patients with newly diagnosed stage IV lung cancer to the palliative care clinic within 8 weeks of diagnosis, improving compliance with ASCO’s practice guidance on integration of palliative care. Next steps are to address barriers and expand the use of palliative care referral BPA to all patients with stage IV cancer.

Association of early specialist-delivered palliative care with less aggressive chemotherapy in patients with advanced lung cancr.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20621-e20621
Author(s):  
Austin J. Lammers ◽  
Donald Richard Sullivan
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Demographic Data ◽  
Stage Iv ◽  
Advanced Lung Cancer ◽  
Health Administration ◽  
Palliative Care Consultation ◽  
Comorbidity Index ◽  
To Receive ◽  
Platinum Doublet

e20621 Background:Advanced stage lung cancer has a poor prognosis with high symptom burden. Early specialist-delivered palliative care (ESDPC) has been shown to improve quality of life (QOL) and may even improve survival, but a minority of patients receive this care. Previous studies have found that > 1 regimen of chemotherapy is associated with reduced QOL near death, but it is unknown how palliative care affects aggressive chemotherapy use. We sought to determine if ESDPC impacted aggressive chemotherapy receipt in patients with advanced lung cancer. Methods: A cohort of Veterans with advanced stage IIIB/IV lung cancer in the national Veterans Health Administration network diagnosed between 2007-2013 were included. Demographic data, cancer characteristics, chemotherapy characteristics and early palliative care consultation (within 90 days of diagnosis) were recorded. Aggressive chemotherapy was defined as receipt of a Bevacizumab/Cetuximab triplet, > / = 2 lines of chemotherapy, and more than 4 cycles of a platinum doublet. Descriptive statistics were used to compare demographic data. Unadjusted p-valves were calculated using two-sample t-test. Results: Among 23,660 patients, mean age 68, 98% male, 71% white, 56% current tobacco users. In total, 45% received chemotherapy and 37% received ESDPC. Mean Charlson comorbidity index (CCI) was 4.5 and functional comorbidity index (FCI) was 3. 89% were stage IV, 82% NSCLC. Patients with ESDPC were notably different in CCI (5.4 vs 4) and stage IV (93 vs 86). Of those receiving ESDPC, patients were less likely to receive triple drug therapy (Bevacizumab or Cetuximab combo), less likely to receive > / = 2 lines of chemotherapy and less likely to receive > / = 4 cycles of platinum doublet (all with p-values < 0.001). Conclusions: Our study found that patients who received ESDPC were less likely to receive aggressive chemotherapy. However, comorbidities, cancer stage, and age may have contributed to this difference. We plan to further analyze this data in an adjusted analysis to determine the association between ESDPC and chemotherapy receipt. Future research should focus on identifying patients that will most benefit from aggressive chemotherapy.

scholarly journals Torque Teno Virus load in lung cancer patients correlates with age but not with tumor stage

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252304
Author(s):  
Dirk Stefani ◽  
Balazs Hegedues ◽  
Stephane Collaud ◽  
Mohamed Zaatar ◽  
Till Ploenes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Stage Iv ◽  
Tumor Stage ◽  
Plasma Dna ◽  
Early Stage Lung Cancer ◽  
Lung Cancer Patients ◽  
Stage Iv Lung Cancer ◽  
Stage Lung Cancer

Background Torque teno virus (TTV) is a ubiquitous non-pathogenic virus, which is suppressed in immunological healthy individuals but replicates in immune compromised patients. Thus, TTV load is a suitable biomarker for monitoring the immunosuppression also in lung transplant recipients. Since little is known about the changes of TTV load in lung cancer patients, we analyzed TTV plasma DNA levels in lung cancer patients and its perioperative changes after lung cancer surgery. Material and methods Patients with lung cancer and non-malignant nodules as control group were included prospectively. TTV DNA levels were measured by quantiative PCR using DNA isolated from patients plasma and correlated with routine circulating biomarkers and clinicopathological variables. Results 47 patients (early stage lung cancer n = 30, stage IV lung cancer n = 10, non-malignant nodules n = 7) were included. TTV DNA levels were not detected in seven patients (15%). There was no significant difference between the stage IV cases and the preoperative TTV plasma DNA levels in patients with early stage lung cancer or non-malignant nodules (p = 0.627). While gender, tumor stage and tumor histology showed no correlation with TTV load patients below 65 years of age had a significantly lower TTV load then older patients (p = 0.022). Regarding routine blood based biomarkers, LDH activity was significantly higher in patients with stage IV lung cancer (p = 0.043), however, TTV load showed no correlation with LDH activity, albumin, hemoglobin, CRP or WBC. Comparing the preoperative, postoperative and discharge day TTV load, no unequivocal pattern in the kinetics were. Conclusion Our study suggest that lung cancer has no stage dependent impact on TTV plasma DNA levels and confirms that elderly patients have a significantly higher TTV load. Furthermore, we found no uniform perioperative changes during early stage lung cancer resection on plasma TTV DNA levels.

scholarly journals Palliative thoracoscopic surgery for refractory chronic cough in a patient with stage IV lung cancer

2020 ◽  
Vol 34 (7) ◽  
pp. 678-681
Author(s):  
Nahoko Shimizu ◽  
Yugo Tanaka ◽  
Shuto Sakai ◽  
Sanae Kuroda ◽  
Akito Hata ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chronic Cough ◽  
Thoracoscopic Surgery ◽  
Stage Iv ◽  
Stage Iv Lung Cancer

Factors associated with palliative care (PC) utilization in advanced and metastatic renal cell carcinoma (RCC).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 297-297
Author(s):  
Hiren V. Patel ◽  
Joshua Sterling ◽  
Arnav Srivastava ◽  
Sinae Kim ◽  
Biren Saraiya ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Palliative Care ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Multivariable Analysis ◽  
Stage Iv ◽  
Stage Iii ◽  
Clinical Factors ◽  
Factors Associated ◽  
To Receive

297 Background: Palliative care (PC) offers various benefits for patient with cancer that include, but are not limited to, decrease in disease-specific symptoms and improvement in functional status. Several oncological guidelines have adopted early integration of PC into oncologic care to improve quality of life among patients with advanced malignancies. However, PC utilization patterns and factors associated with its use in advanced renal cell carcinoma (RCC) remain poorly understood. Methods: Using the National Cancer Database (NCDB), we abstracted patients with stage III and IV RCC from 2004-2014 and evaluated PC utilization amongst this cohort. Socioeconomic and clinical factors were compared for patient receiving and not receiving PC for advanced RCC. Multivariable logistic regression identified factors that were associated with receipt of PC. Results: We identified 20,122 and 42,014 patients with stage III and IV RCC, respectively. Among this cohort, 329 and 9,317 patients received PC for stage III and IV RCC, respectively. From 2004 to 2014, PC utilization has been stable at ~1% for stage III RCC and has significantly increased from 17% to 20% for stage IV RCC. Multivariable analysis demonstrated that Blacks, income >$48,000, regions outside of Northeast, stage III RCC, and patients that received surgery were less likely to receive PC. Patients that were female, with more comorbidities, uninsured or with government insurance, lower educational status, treated at academic or integrated cancer program, with sarcomatoid histology, receiving systemic therapy were more likely to receive PC. Conclusions: While PC utilization has significantly increased for stage IV RCC, there are several demographic, socioeconomic, and clinical factors that predict PC usage among patients with advanced RCC. Taken together, this suggests the need for more equitable and systematic use of PC among patients with advanced RCC.

P40.03 Palliative Radiotherapy Decreased Circulating White Blood Cells in Patients With Stage IV Lung Cancer

2021 ◽  
Vol 16 (10) ◽  
pp. S1070
Author(s):  
Z. Liang ◽  
L. Ma ◽  
C. Zhao ◽  
F. Zhang ◽  
W. Xu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Blood Cells ◽  
White Blood Cells ◽  
Stage Iv ◽  
Palliative Radiotherapy ◽  
Stage Iv Lung Cancer

Improved survival for patients with acute myelogenous leukemia.

1995 ◽  
Vol 13 (3) ◽  
pp. 560-569 ◽  
Author(s):  
A J Mitus ◽  
K B Miller ◽  
D P Schenkein ◽  
H F Ryan ◽  
S K Parsons ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Remission Induction ◽  
Term Survival ◽  
Free Survival ◽  
Significant Difference ◽  
Acute Myelogenous ◽  
To Receive

PURPOSE Despite improvement in chemotherapy and supportive care over the past two decades, overall survival for patients with acute myelogenous leukemia (AML) remains poor; only 25% to 30% of individuals with this disorder will be cured. In 1987, we initiated a prospective multiinstitution study designed to improve long-term survival in adults with AML. METHODS We modified the usual 7-day treatment scheme of daunorubicin and cytarabine with high-dose cytarabine (HiDAC) on days 8 through 10 (3 + 7 + 3). Allogeneic or autologous bone marrow transplantation (BMT) was offered to all patients who entered complete remission (CR) to decrease the rate of leukemic relapse. Data were analyzed by intention to treat. RESULTS CRs were achieved in 84 of 94 patients (89%; 95% confidence interval [CI], 83 to 95). Because of the high remission rate, factors previously thought to predict outcome, such as cytogenetics, WBC count, French-American-British (FAB) classification, sex, and age, were not useful prognostic variables. The overall survival rate for the entire cohort of patients from data of diagnosis is 55% at 5 years. Sixty percent of all patients who achieved a CR underwent marrow grafting. There was no significant difference in event-free survival (EFS) at 5 years comparing patients assigned to receive allogeneic BMT with patients assigned to receive autologous BMT (56% v 45%, P = .54). CONCLUSION The long-term disease-free survival observed in this study is excellent compared with historical data. This improvement in survival is probably due to the high rate of remission induction, as well as to the effective nature of the consolidation therapy.

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