Early integration of supportive oncology consultation for hospitalized cancer patients.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 136-136
Author(s):  
Kellie Woodfield ◽  
Kerin B. Adelson ◽  
Jay Horton ◽  
Cardinale B. Smith
Keyword(s):  
Cancer Patients ◽  
Transition Planning ◽  
Quality Care ◽  
Symptom Control ◽  
Stage Iv ◽  
Disease Stage ◽  
Inpatient Setting ◽  
Early Integration ◽  
Oncology Service ◽  
Pain Symptoms

136 Background: Integration of Palliative Care (PC) for patients with cancer is associated with improved symptom control, clearer understanding of prognosis, lower utilization of health care resources, and increased hospice use. Yet few studies identify which elements of a PC consultation are most associated with improved outcomes, particularly in the inpatient setting. This study describes the processes of a specialized, interdisciplinary, inpatient PC consultation service that utilized standardized referral criteria and demonstrated improved 30-day readmission, oncology service mortality, and hospice utilization. Methods: We implemented a 3-month intervention on the solid tumor oncology service requiring an automatic PC consultation for patients with one or more of the following criteria: stage IV disease, Stage III lung or pancreatic cancer, hospitalization within 30 days, > 7 day hospitalization, or uncontrolled symptoms. Descriptive statistics were used to identify specific processes associated with the consultation. Results: A total of 52 patients were evaluated. The median time of initial consult was on hospital day 2 and patients were followed for an average of 9 days (±11). The majority of patient encounters were by a physician (47%) or advanced practice nurse (42%), with 48% of encounters lasting 35-60 minutes. Integrative services (massage, yoga etc.) were offered in 72% of consults. The most common issues addressed throughout the consultation were pain (85%), non-pain symptoms (85%), transition planning (85%), and plan of care (82%). Overall, consulting teams addressed more PC needs than were initially identified by chart review. Conclusions: Implementing standardized PC consultations in patients with solid malignancies requires the full support of an interdisciplinary team. PC consultations are time-consuming undertakings, often addressing needs broader in scope than initially identified and requiring the use of specialty level PC in the majority of cases. Future efforts to implement similar interventions can use these data to identify specific staffing needs and to ensure cancer patients receive quality care.

Comparative analysis of internal medicine physicians’ perspectives and attitudes when addressing palliative care needs in heart failure and cancer patients.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 7-7
Author(s):  
Vatsala Katiyar ◽  
Tiago Araujo ◽  
Ishaan Vohra ◽  
Rayli Pichardo ◽  
Vijaya Venkatasubbaraya Pavan Kedar Vijaya Venkatasubbar Mukthinuthalapati ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Heart Failure ◽  
Palliative Care ◽  
Cancer Patients ◽  
Symptom Burden ◽  
Stage Iv ◽  
Care Needs ◽  
Early Integration ◽  
Survey Tool ◽  
Level Of Training

7 Background: Palliative care (PC) is heavily centered on patients with advanced and often incurable malignancies. Despite having a comparable symptomatic burden and worse mortality rates than some types of cancer, heart failure (HF) patients have decreased rate of palliative service referral of approximately 7%, as opposed to 48% in those with malignancies. We aim to understand the differences in the attitudes of physicians when addressing the PC needs for patients with advanced HF and malignancies. Methods: All the internal medicine residents at our institute were asked to fill out a structured paper-based questionnaire. The survey tool consisted of both Likert-type scales and open-ended questions focused on their attitude and perceptions while managing patients with advanced HF and Stage IV malignancy. Descriptive statistics and intergroup comparisons were then made for all quantifiable variables (Table). Results: Of the 137 medicine residents, 120 (87.6%) completed the survey. 70% were males and 96.6% residents were in the age group of 25-34 years. 62.5% residents had done a PC rotation prior to answering the survey and they were more comfortable in initiating goals of care (GOC) discussion for these patients. More residents were comfortable communicating the prognosis of patients with HF as compared to cancer patients irrespective of the level of training. Of the 26 residents interested in pursuing cardiology as a subspecialty, only 5 (19.2%) thought that the 5-year mortality of advanced HF ≥50%. Conclusions: Physicians often underestimate the symptom burden and mortality of HF patients and are less likely to consult PC for them. Early integration of PC in the management of HF patients is recommended and physicians need to be educated on these guidelines. [Table: see text]

Standardized criteria for required palliative care consultation on the solid tumor oncology service.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 37-37 ◽  
Author(s):  
Kerin Adelson ◽  
Julia Paris ◽  
Cardinale B. Smith ◽  
Jay Horton ◽  
R. Sean Morrison
Keyword(s):  
Palliative Care ◽  
Solid Tumor ◽  
Readmission Rate ◽  
Symptom Control ◽  
Disease Stage ◽  
Hospital Death ◽  
Oncology Service ◽  
Palliative Care Consultation ◽  
Mortality Index ◽  
Care Consultation

37 Background: Studies have shown that routine integration of Palliative Care (PC) for patients with advanced cancer is associated with improved symptom control, clearer understanding of prognosis, lower utilization of health care resources, and increased hospice use. The 2012 ASCO guidelines call for incorporation of PC for any patient with metastatic cancer and/or high symptom burden. Despite a top-rated PC division at Mount Sinai, our Solid Tumor (ST) Division utilized PC and hospice less than other medical centers. Our inpatient ST service consistently demonstrated poor quality metrics. Our 2011-2012 UHC statistics were: mortality index, 1.35 (target <1), 30-day readmission rate, 21.7%, (target < 10.3%) and length of stay (LOS) index, 1.23 (target <1). We hypothesized that implementing standardized criteria for PC consultation would improve these metrics. Methods: During this 3-month pilot, criteria for PC consultation included patients with one or more of the following: stage IV disease, Stage III lung or pancreatic cancer, hospitalization within prior 30 days, >7 day hospitalization, uncontrolled symptoms (pain, nausea, dyspnea, delirium, distress). We looked at two baseline groups for comparison: 1) patients who met eligibility in a six week period prior to the intervention 2) For UHC index data, we used the hospital dashboard average over a 1-year period prior to the intervention. This included all ST patients who were eligible for the intervention (60%) and those who were not (40%). Primary outcomes were: hospice utilization, ST mortality index, 30-day readmission rate and LOS. Results: Comparing Group 1 to the Pilot Group, palliative care consultation doubled from 41% to 82%, 30-day readmission decreased from 36% to 17% (p= .022), and hospice utilization increased from 14% to 25% (p=.146). UHC data (Group 2 vs. Pilot) showed: mortality index improved (1.35 to .59) and 30-day readmission rates decreased (21.7% to 13.5%, p=.026). LOS was unchanged (1.23 to 1.25). Conclusions: Mandating palliative care consults for patients at the highest risk for in hospital death and readmission improved hospice utilization, 30-day readmission, oncology service mortality and adherence with ASCO guidelines.

Il livello di speranza nei pazienti oncologici in cura chemioterapica. Un’indagine sperimentale / The level of hope in the cancer patients receiving chemotherapy. An experimental investigation

2018 ◽  
Vol 67 (5) ◽  
pp. 525-543
Author(s):  
Melissa Maioni
Keyword(s):  
Cancer Patients ◽  
Clinical Sample ◽  
Age Groups ◽  
Stage Iv ◽  
Sono State ◽  
Human Dimensions ◽  
Disease Stage ◽  
Experimental Sample ◽  
Stage Iv Cancer ◽  
The Impact

La speranza è una caratteristica multidimensionale che coinvolge diverse dimensioni umane, il cui costrutto è stato più volte studiato in molteplici ambiti disciplinari. Il presente studio si propone di: valutare l’impatto della patologia in relazione al livello di speranza; comparare il livello di speranza con altre variabili cliniche e socio-demografiche, attraverso lo studio di 83 pazienti oncologici del Policlinico Campus Bio-Medico di Roma in cura chemioterapica, e di 83 soggetti sani, con caratteristiche socio-demografiche comparabili al campione clinico, a cui sono state sottoposte due scale: l’HHI (Herth Hope Scale) e la SF-12 (Questionario sullo stato di salute). L’analisi statistica utilizzata è finalizzata a valutare l’interdipendenza lineare tra le due variabili considerate (la speranza e lo stato di salute) sulla popolazione in generale e nelle sottopopolazioni considerate, tramite il calcolo dell’indice R2. I risultati mostrano che: a) il campione sperimentale composto per l’84,3% da pazienti affetti da cancro al IV stadio, ha mediamente un medio livello di speranza (media ± es = 35.47 ± 0.78); b) non emerge una correlazione significativa tra lo stato di salute e il livello di speranza; c) non emergono differenze significative riguardo il livello di speranza, mentre emergono delle differenze significative relativamente alla PCS (stato di salute fisica). I dati raccolti indicherebbero come la speranza sia una dimensione indipendente dalla diagnosi, dalla stadiazione della patologia, dal sesso, dal tipo di ospedalizzazione, dallo stato civile e non si modifichi nelle varie fasce d’età. Sembrerebbe un costrutto che si mantiene stabile nel tempo e che viene scarsamente influenzato da altre variabili. ---------- Hope is a multidimensional characteristic that involves different human dimensions, the construction of which has been studied several times in multiple disciplinary fields. The present study aims to: assess the impact of the pathology in relation to the level of hope; compare the level of hope with other clinical and socio-demographic variables, through the study of 83 cancer patients receiving chemotherapy at the Policlinico Campus Bio-Medico in Rome, and 83 healthy subjects, with socio-demographic characteristics comparable to the clinical sample, who were given two scales: the HHI (Herth Hope Index) and the SF-12 (SF-12 Health Survey). The statistical analysis used is aimed at assessing the linear interdependence between the two variables under consideration (hope and health) for the general population and the subpopulations under consideration, by calculating the R2 index. The results show that: a) the experimental sample, 84.3% of which was composed of stage IV cancer patients, had an average hope level (mean ± es = 35.47 ± 0.78); b) there was no significant correlation between health and hope; c) there were no significant differences in hope levels, while there were significant differences in physical health (PCS). The data collected would indicate that hope is a dimension independent of diagnosis, disease stage, sex, type of hospitalization, marital status and does not change in the various age groups. It would seem to be a construct that remains stable over time and is poorly influenced by other variables.

scholarly journals Interleukin-6 Differential Expression in Cancer Patients of Different Clinical Stages; a Possible Biomarker of Cancer Progression

2021 ◽  
Author(s):  
Abosede Obafunke Bello ◽  
John Abiodun Obadipe ◽  
Oluwabanke Temitope Adewusi ◽  
Anthony Oluwamuyiwa Ayanshina
Keyword(s):  
Cancer Patients ◽  
Differential Expression ◽  
Cancer Progression ◽  
Interleukin 6 ◽  
Clinical Stage ◽  
Stage Iv ◽  
Disease Stage ◽  
Enzyme Linked Immunosorbent Assay ◽  
Cancer Stage ◽  
Advanced Clinical Stage

Abstract PurposeThe study investigated interleukin-6 expression pattern across all stages of cancer. The research questions raised in the study were: Is there differential expression of Interleukin-6 across all cancer stages? and what relationship exists between serum interleukin-6 level and cancer stage?Methods The prospective case-control study comprised sixty two (62) purposively selected cancer participants across all stages and age range 18 years to 72years as well equal number of healthy volunteers from two medical centres in Nigeria. Three milliliters (3mls) of blood samples was collected intravenously from the participants and centrifuged after 30 minutes of collection at 3000rpm for 10 minutes to obtain serum. The serum level of Interleukin-6 was determined spectrophotometrically by Enzyme linked immunosorbent assay (ELISA). Data obtained were expressed as mean and standard error of the mean. One way Analysis of variance and t-test were employed to test for significance difference between the groups and the significant level was considered at P< 0.05. ResultsFindings from the study revealed significant (P< 0.05) higher mean serum interleukin-6 levels in stage IV cancer participants as compared to other disease stages. In the same way, significant higher mean Interleukin-6 level of stage III cancer participants as compared to that of stage I cancer participants was observed. Furthermore, the study revealed a significant correlation (P< 0.01) between serum Interleukin 6 concentration and cancer stage.Conclusion Serum interleukin-6 had differential expression in cancer patients at advanced clinical stage as compared to that of early disease stage.

CLINICAL SIGNIFICANCE OF SERUM CAVEOLIN-1 LEVELS IN GASTRIC CANCER PATIENTS

2018 ◽  
Vol 40 (4) ◽  
pp. 323-327 ◽  
Author(s):  
F Tas ◽  
S Karabulut ◽  
K Erturk ◽  
D Duranyildiz
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Histological Grade ◽  
Clinical Importance ◽  
Disease Stage ◽  
Control Group ◽  
Tissue Samples ◽  
Caveolin 1 ◽  
Study Results ◽  
Gastric Cancer Patients

Aim: Caveolin-1 plays a significant role in the pathogenesis of various carcinomas and its expression affects the survival of cancer patients. However, the molecular function of caveolin-1 and its possible clinical importance has remained uncertain in gastric cancer. No clinical trial has examined serum caveolin-1 levels in gastric cancer patients so far, instead all available results were provided from studies conducted on tissue samples. In the current study, we analyzed the soluble serum caveolin-1 levels in gastric cancer patients, and specified its associations with the clinical factors and prognosis. Material and Methods: Sixty-three patients with pathologically confirmed gastric cancer were enrolled into the trial. Serum caveolin-1 concentrations were detected by ELISA method. Thirty healthy subjects were also included in the study. Results: The median age of patients was 62 years, ranging from 28 to 82 years. The serum caveolin-1 levels in gastric cancer patients were significantly higher than those in control group (p < 0.001). The common clinical parameters including patient age, sex, lesion localization, histopathology, histological grade, disease stage, and various serum tumor markers (e.g. LDH, CEA, and CA 19.9) were not found to be associated with serum caveolin-1 levels (p > 0.05). Similarly, no correlation existed between serum caveolin-1 concentration and chemotherapy responsiveness (p = 0.93). Furthermore, serum caveolin-1 level was not found to have a prognostic role (p = 0.16). Conclusion: Even though it is neither predictive nor prognostic, serum caveolin-1 level may be a valuable diagnostic indicator in patients with gastric cancer. Key

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