The utilization and impact of oncology supportive care clinics on patients with metastatic lung cancer.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 123-123
Author(s):  
Yan S Kim ◽  
Esther J Luo ◽  
Matthew T Chin ◽  
Shelley Leong ◽  
Sudhir S Rajan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Supportive Care ◽  
Cancer Treatment ◽  
Statistical Significance ◽  
Hospital Death ◽  
Metastatic Lung Cancer ◽  
Large Patient ◽  
Anti Cancer ◽  
Metastatic Lung

123 Background: The American Society of Clinical Oncology has endorsed early integration of oncology with palliative care. In 2012, Kaiser Permanente Northern California (KPNC) introduced Oncology Supportive Care Clinics (OSCCs). OSCCs are outpatient palliative care clinics designed to incorporate palliative care into standard oncology practice at the time of a patient's cancer diagnosis. This study examines the utilization and impact of OSCCs on patients with metastatic lung cancer. Methods: We identified adult patients with incidental stage IV lung cancer using the KPNC cancer registry from 2012-2015 and followed them for 12 months. We ascertained OSCC utilization using KPNC’s electronic health record. We examined the patterns of OSCC referral/utilization and compared survival, in-hospital death, and treatment received in patients who used and did not use OSCC services. Results: A total of 607 patients were included and 245 (40.4%) were referred to OSCC. The median time from diagnosis to referral was 48 days and ¼ were referred within 15 days. The majority (86%) of the patients referred were seen by OSCC. Only 22 patients (9.0%) refused to be seen. We found no large patient- or facility-level differences between patients referred and not referred to OSCC. At the end of follow up, 398 (65.6%) of the patients died. Patients seen by OSCC were less likely to die (59.2% vs. 68.9%, p < 0.02) at 1 year. Fewer patients who used OSCC died in the hospital compared to those who did not (26 or 12.3% vs. 67 or 16.9%); however, it did not achieve statistical significance (p = 0.13). Among patients who used OSCC, 166 (78.7%) received anti-cancer treatment, compared to 221 (55.8%) among those who did not (p < 0.001). Conclusions: Despite having a robust infrastructure and integrated system in place, over half of the patients diagnosed with metastatic lung cancer did not receive a referral. Future work is needed to understand the reasons why so many patients were not referred. Furthermore, our data showed that receiving OSCC services did not adversely impact survival and the receipt of anti-cancer treatment. These findings serve to reassure patients and providers that the addition of palliative care does not harm patients or limit their treatment.

Retrospective chart review of end-of-life (EOL) care in patients with metastatic lung cancer harboring EGFR mutations.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 126-126 ◽  
Author(s):  
Jessica Ruth Bauman ◽  
Zofia Piotrowska ◽  
Emily Scribner ◽  
Brandon Temel ◽  
Rebecca Suk Heist ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Chart Review ◽  
Median Number ◽  
Egfr Mutations ◽  
Care Utilization ◽  
Metastatic Lung Cancer ◽  
Metastatic Lung ◽  
Egfr Mutant ◽  
Eol Care

126 Background: Metastatic lung cancer is the leading cause of cancer-related death in the US. In the last decade, however, patients (pts) with EGFR mutations have benefitted from improved outcomes with EGFR-directed targeted therapy. We hypothesized that this improvement might impact EOL care. The objective of this chart review was to describe the care of EGFR mutant pts with attention to EOL care, health care utilization, and palliative care use. Methods: With IRB approval, we retrospectively reviewed medical records of pts at our center diagnosed with advanced EGFR-mutant lung cancer from January 2009 to June 2012. We limited the review to pts who had at least one cancer therapy at MGH, and to those who died by June 2014. Results: 44 pts were included. 30 pts (68%) were female. 32 pts (73%) received cancer-directed therapy within 30 days of death. Of these, 30 pts (68%) received oral chemotherapy and 5 (11%) received IV chemotherapy. 30 pts (68%) were hospitalized within 30 days of death. Over their entire disease course, the median number of hospitalizations was 2 (0-8), and the median number of total inpatient days was 12 (0-88). 21 pts (48%) had a palliative care outpatient visit and 34 (77%) had an inpatient palliative care consult at some point during their care. 24 pts (54%) enrolled on hospice prior to death, 15 (34%) were never on hospice, and the hospice status of 5 (11%) was unknown. Of the 39 pts with known hospice status, median length of stay was 6 days (0-206). 23 pts (52%) died at home with hospice or in an inpatient hospice, 16 (36%) died in the hospital, 2 (4%) died at home without hospice, and the location of death was unknown for 3 (7%). Conclusions: Pts with EGFR mutations had high rates of hospitalization and chemotherapy use in the last month of life, and many died in the hospital. Palliative care utilization was high, but it is unclear how this affected EOL care. Designing innovative care models to support this unique population and understand EOL decision-making should be a priority.

Integration of palliative care services into standard oncology practice at diagnosis of metastatic lung cancer at VA New York Harbor Healthcare System.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 165-165
Author(s):  
Felix Manuel Rivera Mercado ◽  
Carol Luhrs ◽  
Alice Beal ◽  
Maura Langdon ◽  
Joan Secrest ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Stage Iv ◽  
Major Advance ◽  
Metastatic Lung Cancer ◽  
Care Services ◽  
National Quality ◽  
Metastatic Lung ◽  
Palliative Care Services ◽  
Oncology Practice

165 Background: The 2012 ASCO provisional clinical opinion addressed the integration of palliative care into standard oncology practice at the time a person is diagnosed with metastatic or advanced cancer. The inclusion of Palliative Care among the National Quality Forum (NQF) framework represented a major advance in palliative care. NQF metrics include chemotherapy administered in the last 14 days of life, hospice less than 3 days before death, ICU or hospital admission, more than one Emergency Room visit in the last 30 days, and death in hospital. Although the use of hospice and other palliative care services has increased, many are enrolled in hospice less than 3 weeks before death. By improving quality of life, cost, and survival in patients with metastatic cancer, palliative care has increasing relevance for the care of patients with cancer. Methods: Retrospective chart review study of lung cancer patients diagnosed at VA from 2010-2013. Inclusion criteria: > 18 years of age with new diagnosis of metastatic lung cancer. Exclusion criteria: < 18 years of age, Stage I-III lung cancer. Results: Total of 125 patients were diagnosed with Stage IV lung cancer. The mean time from diagnosis to death was only 185 days (6.1 months). The VA NYHHS patients were more likely to visit the ED, be admitted to the hospital and ICU in the last 30 days of life, and subsequently die in the hospital. Conclusions: Several confounders were identified, including climate related closure of facilities (2012 Sandy storm), lack of social support, low ICU admission criteria, burial benefits for patients dying in a VA, and delay in transition to Hospice. Currently 392 patients with stage IV solid tumors diagnosed 2010-2014 are being studied. [Table: see text]

Communication of prognostic information between oncologists and patients with advanced lung cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 29-29
Author(s):  
Dilip Sankar Babu ◽  
Nicholas Gerbino ◽  
Kevin Fiscella ◽  
Cleveland Shields ◽  
Jennifer J. Griggs ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Life Expectancy ◽  
Supportive Care ◽  
Statistical Data ◽  
Best Supportive Care ◽  
Metastatic Lung Cancer ◽  
Office Visits ◽  
Prognostic Information ◽  
Management Options ◽  
Metastatic Lung

29 Background: A critical domain of patient-provider communication is helping cancer patients understand their prognosis, as well as the efficacy of treatment options. In this qualitative study, we explored the ways oncology providers approached prognostic discussions during initial office visits with patients with metastatic lung cancer. Methods: Transcripts of initial visits between unannounced standardized patients portraying metastatic non-small cell lung cancer and their oncologists were recorded at multiple practice sites in community and academic settings, as part of a large NIH-funded study. Thematic analysis was conducted on a subset of these recorded visits from one study site. In this secondary analysis, three coders (one medical oncologist, one palliative care physician and one research assistant) reviewed transcripts independently to extract quotes related to prognosis, meeting regularly to review selected quotes and to decide on codes. This process repeated until saturation of themes was achieved (n = 15). Results: Discussions of prognosis were found in all 15 transcripts reviewed. Three main themes were identified: (1) Vagueness, in which best-case/worst-case scenarios were presented without an estimate of life expectancy; (2) Statistical Reliance, in which complex statistical data were presented to the patient; and (3) Emotional Support, in which the discussion was infused with emotional reassurance which was contextually appropriate. A fourth identified theme was (4) Minimizing of Supportive Care, as discussions of management options did not always elaborate on best supportive care. Conclusions: Our qualitative analysis of initial office visits among simulated patients with metastatic lung cancer revealed that providers often frame prognostic information in vague terms without a realistic estimate of life expectancy, sometimes give patients complex statistical data, and tend to accompany their discussions with emotional reassurance. Best supportive care is not always fully explained when management options are reviewed. More work is needed to determine optimal ways to convey prognostic and management information during clinic visits for patients with advanced cancer.

scholarly journals Enhancement of Immune Checkpoint Inhibitor-Mediated Anti-Cancer Immunity by Intranasal Treatment of Ecklonia cava Fucoidan against Metastatic Lung Cancer

2021 ◽  
Vol 22 (17) ◽  
pp. 9125
Author(s):  
Wei Zhang ◽  
Juyoung Hwang ◽  
Dhananjay Yadav ◽  
Eun-Koung An ◽  
Minseok Kwak ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Nk Cells ◽  
Immune Checkpoint ◽  
Intranasal Administration ◽  
Ecklonia Cava ◽  
Metastatic Lung Cancer ◽  
Mucosal Adjuvant ◽  
Cancer Immunity ◽  
Anti Cancer ◽  
Metastatic Lung

Although fucoidan, a well-studied seaweed-extracted polysaccharide, has shown immune stimulatory effects that elicit anticancer immunity, mucosal adjuvant effects via intranasal administration have not been studied. In this study, the effect of Ecklonia cava-extracted fucoidan (ECF) on the induction of anti-cancer immunity in the lung was examined by intranasal administration. In C57BL/6 and BALB/c mice, intranasal administration of ECF promoted the activation of dendritic cells (DCs), natural killer (NK) cells, and T cells in the mediastinal lymph node (mLN). The ECF-induced NK and T cell activation was mediated by DCs. In addition, intranasal injection with ECF enhanced the anti-PD-L1 antibody-mediated anti-cancer activities against B16 melanoma and CT-26 carcinoma tumor growth in the lungs, which were required cytotoxic T lymphocytes and NK cells. Thus, these data demonstrated that ECF functioned as a mucosal adjuvant that enhanced the immunotherapeutic effect of immune checkpoint inhibitors against metastatic lung cancer.

scholarly journals Timing of palliative care needs reporting and aggressiveness of care near the end of life in metastatic lung cancer: A national registry-based study

Cancer ◽  
2018 ◽  
Vol 124 (14) ◽  
pp. 3044-3051 ◽  
Author(s):  
François Goldwasser ◽  
Pascale Vinant ◽  
Régis Aubry ◽  
Philippe Rochigneux ◽  
Yvan Beaussant ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
End Of Life ◽  
National Registry ◽  
Metastatic Lung Cancer ◽  
Care Needs ◽  
Metastatic Lung ◽  
Palliative Care Needs

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 Access to innovative drugs for metastatic lung cancer treatment in a French nationwide cohort: the TERRITOIRE study

BMC Cancer ◽  
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Arnaud Scherpereel ◽  
Isabelle Durand-Zaleski ◽  
François-Emery Cotté ◽  
Jérôme Fernandes ◽  
Didier Debieuvre ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Treatment ◽  
Metastatic Lung Cancer ◽  
Lung Cancer Treatment ◽  
Metastatic Lung ◽  
Innovative Drugs
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