Frequency of concomitant use of opioids and psychoactive medications among cancer patients referred to outpatient palliative care at a comprehensive cancer center.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 240-240
Author(s):  
Ahsan Azhar ◽  
Ali Haider ◽  
Angelique Wong ◽  
Maria Agustina Cerana ◽  
Madhuri Adabala ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Care Center ◽  
Symptom Assessment ◽  
Comprehensive Cancer Center ◽  
Categorical Variables ◽  
Cancer Center ◽  
Continuous Variables ◽  
Exact Test ◽  
Psychoactive Medications

240 Background: There are potential severe effects when patients taking opioids receive other psychoactive medications. However, such combinations are sometimes necessary in palliative care. The purpose of this study was to determine the frequency of concomitant use of opioids + psychoactive medications in cancer patients referred to our outpatient palliative care center. Methods: Retrospective data obtained from consecutive consults was analyzed to determine the frequency of patients on opioids alone versus concomitant opioids + psychoactive medications at first presentation to our clinic. Association of type of medication with demographics and baseline characteristics was evaluated by Wilcoxon rank sum test for continuous variables and Chi-square (Fisher's exact) test for categorical variables. Results: Among 541 consecutive consult visits, 365 (67%) patients were taking opioids at the time of referral to our clinic: 209 (57%) were on opioids alone while 156 (43%) were on concomitant opioids + psychoactive medications [69 (44%) were on Opioid + Benzodiazepine, 46 (30%) were Opioid + Antidepressants, 41(26%) were on both). Patients in the concomitant groups were on higher Morphine Equivalent Daily Dose (MEDD, p = 0.007), had higher Edmonton Symptom Assessment Scores (ESAS) for pain (p = 0.017), anxiety (p < 0.001), depression (p < 0.001) and spiritual pain (p = 0.03). Conclusions: A large proportion (156, 43%) of cancer patients referred to outpatient palliative care was on concomitant opioids + psychoactive medications. These patients were on higher doses of opioids with higher levels of pain and psycho-social distress at the time of first presentation. Further studies are required to better understand the clinical implications of concomitant use of opioids + psychoactive medications in such patients.

scholarly journals A descriptive report of outcomes of primary mucinous ovarian cancer patients receiving either an adjuvant gynecologic or gastrointestinal chemotherapy regimen

2019 ◽  
Vol 29 (5) ◽  
pp. 904-909
Author(s):  
Brooke A Schlappe ◽  
Qin C Zhou ◽  
Roisin O'Cearbhaill ◽  
Alexia Iasonos ◽  
Robert A Soslow ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Progression Free Survival ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Free Survival ◽  
Exact Test ◽  
Clinical Criteria ◽  
Kaplan Meier

ObjectiveWe described progression-free survival and overall survival in patients with primary mucinous ovarian cancer receiving adjuvant gynecologic versus gastrointestinal chemotherapy regimens.MethodsWe identified all primary mucinous ovarian cancer patients receiving adjuvant gynecologic or gastrointestinal chemotherapy regimens at a single institution from 1994 to 2016. Gynecologic pathologists using strict pathologic/clinical criteria determined diagnosis. Adjuvant therapy was coded as gynecologic or gastrointestinal based on standard agents and schedules. Clinical/pathologic/treatment characteristics were recorded. Wilcoxon rank-sum test was used for continuous variables, and Fisher’s exact test for categorical variables. Progression-free and overall survival were calculated using the Kaplan-Meier method, applying landmark analysis.ResultsOf 62 patients identified, 21 received adjuvant chemotherapy: 12 gynecologic, 9 gastrointestinal. Median age (in years) at diagnosis: 58 (range 25–68) gynecologic cohort, 38 (range 32–68) gastrointestinal cohort (p=0.13). Median body mass index at first post-operative visit: 25 kg/m2(range 18–31) gynecologic cohort, 23 kg/m2(range 18–31) gastrointestinal cohort (p=0.23). History of smoking: 6/12 (50%) gynecologic cohort, 3/9 (33%) gastrointestinal cohort (p=0.66). Stage distribution in gynecologic and gastrointestinal cohorts, respectively: stage I: 9/12 (75%) and 3/9 (33%); stage II: 2/12 (17%) and 1/9 (11%); stage III: 1/12 (8%) and 5/9 (56%) (p=0.06). Grade distribution in gynecologic and gastrointestinal cohorts, respectively: grade 1: 8/12 (67%) and 1/9 (13%); grade 2/3: 4/12 (33%) and 7/9 (88%) (p=0.03). Three-year progression-free survival: 90.9% (95% CI 50.8% to 98.7 %) gynecologic, 53.3% (95% CI 17.7% to 79.6%) gastrointestinal. Three-year overall survival: 90.9% (95% CI 50.8% to 98.7%) gynecologic, 76.2% (95% CI 33.2% to 93.5%) gastrointestinal.ConclusionOngoing international collaborative research may further define associations between chemotherapy regimens and survival.

Utilization of antineoplastic therapy (ANT) in advanced cancer patients admitted to an acute palliative care unit (APCU) at a comprehensive cancer center

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9590-9590
Author(s):  
D. Hui ◽  
E. Bruera ◽  
Z. Li ◽  
J. L. Palmer ◽  
M. de la Cruz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Univariate Analysis ◽  
Palliative Care Unit ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Targeted Agents ◽  
Cox Regression Analysis ◽  
Younger Age

9590 Background: Cancer patients admitted to a palliative care unit generally have a poor prognosis. The role of ANT (chemotherapy and targeted agents) in these patients is unclear. We examined the frequency, trends, factors and survival associated with ANT use in hospitalized patients who required an APCU stay. Methods: All patients admitted to APCU between September 1, 2003 and August 31, 2008 were included. Demographics, cancer diagnosis and ANTs utilization from day of hospitalization to discharge, and survival information were retrieved retrospectively. Results: 2604 cancer patients had the following characteristics: median age 59 (range 18–101), male 51%, hematologic malignancy 11%, median hospital stay 11 (Q1-Q3 8–17) days, median APCU stay 7 (Q1-Q3 4–10) days and median survival 22 days. During hospitalization, 393 patients (15%) received ANTs, including chemotherapy (N=297, 11%) and targeted therapy (N=155, 6%). No significant change in frequency of ANTs was detected over the 5 year period. Multivariate logistic regression analysis ( Table ) revealed that younger age, cancer primaries and longer admissions were associated with ANT use. Patients with hematologic malignancies received more chemotherapy (38% vs. 8%, p<0.001) and targeted agents (18% vs. 4%, p<0.001) compared to patients with solid tumors. ANT use was associated with longer overall survival in univariate analysis (median 25 days vs. 21 days, p=0.001); however, this was no longer significant in multivariate Cox regression analysis. Conclusions: The use of ANT during hospitalization that included an APCU stay was limited to a highly selected group of patients, and did not increase overtime. ANT use was associated with younger age, specific cancer primaries, longer admissions, and no significant improvement in survival. The APCU at our cancer center facilitates simultaneous care where patients access palliative care while on ANT. [Table: see text] No significant financial relationships to disclose.

Access to palliative care before death among patients treated at a comprehensive cancer center.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 25-25
Author(s):  
David Hui ◽  
Sun Hyun Kim ◽  
Jung Hye Kwon ◽  
Kimberson Cochien Tanco ◽  
Tao Zhang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Disease Process ◽  
Hematologic Malignancies ◽  
Median Number ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Medical Team ◽  
Missed Opportunities

25 Background: Palliative care (PC) access is a critical component of quality cancer care. Previous studies on PC access have mostly examined the timing of PC referral. The proportion of patients who actually received PC is unclear. We determined the proportion of cancer patients who received PC at our comprehensive cancer center, and the predictors of PC referral. Methods: We reviewed the charts ofconsecutive patients with advanced cancer from the Houston region seen at MD Anderson Cancer Center and died between September 2009 and February 2010. We compared patients who received PC services with those who did not receive PC services before death using univariate and multivariate logistic regression. Results: A total of 366/816 (45%) decedents had a PC consultation. The median interval between PC consultation and death was 1.4 months (interquartile range (0.5-4.2) and the median number of medical team encounters before PC was 20 (6-45). In multivariate analysis, older age, being married, and specific cancer types (gynecology, lung and head and neck) were significantly associated with a PC referral (Table). Patients with hematologic malignancies had significantly fewer PC referrals (33%), the longest interval between advanced cancer diagnosis and PC consultation (median 16 months), the shortest interval between PC consultation and death (median 0.4 month), and one of the largest number of medical team encounters (median 38) before PC. Conclusions: We found that a majority of cancer patients at our cancer center did not access PC before they die. PC referral occurs late in the disease process with many missed opportunities for referral. Further effort is needed to improve quality of end-of-life care. [Table: see text]

Snapshot of an outpatient supportive care center at a comprehensive cancer center.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 145-145
Author(s):  
Lindsey E Pimentel ◽  
Maxine Grace De la Cruz ◽  
Angelique Wong ◽  
Debra Castro ◽  
Eduardo Bruera
Keyword(s):  
End Of Life ◽  
Care Center ◽  
Case Manager ◽  
Symptom Assessment ◽  
Assessment Tools ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Early Integration ◽  
Team Members ◽  
Outpatient Supportive Care

145 Background: Integration of Palliative Care (PC) in oncology has been found to improve symptom distress, quality of life and survival in patients with advanced cancer. Early integration is most appropriate in the outpatient (OP) setting. However, most PC services in the U.S. do not have an OP component. Our study aims to provide a snapshot of the type of patients that are referred to this novel setting for the delivery of early PC. Methods: We reviewed a day in the SCC to illustrate the structure and process involved in the delivery of outpatient PC. We highlighted 9 patients seen that day to show the variety of patients, scope of services, and the unique roles that PC interdisciplinary team members perform. Results: 41 patients were seen that day in the SCC: 10 scheduled consults, 22 scheduled follow-ups, 9 (22%) same-day unscheduled patients: 4 follow-ups, 1 consult and 4 nurse triages. There were also 31 telephone encounters. Most patients seen were for routine follow-up and symptom assessment. However, 10 presented with worsening symptoms with one needing hospital admission. 21 patients required additional counseling: 2 for hospice transitioning, 12 for psychosocial distress, 7 for opioid education. PC was delivered predominantly by physicians and nurses with collaboration with our pharmacist, counselors, and case manager. Conclusions: Traditionally, PC has been delivered predominantly to patients with advanced disease and to aid in transition to end of life. In recent years, OP centers have dramatically changed the nature of PC work as in our snapshot. In addition to patients regarded as traditional PC patients, such as those transitioning to end of life, there are now patients who come in soon after arrival to a cancer center requiring specialized care to address a variety of symptom and educational needs, thus requiring adaptation of structure and processes to allow access for frequent follow ups and counseling and flexibility for walk-in visits. Our findings suggest that SCC needs to practice in a very different way which requires certain skills and assessment tools that are not conventionally present in traditional oncology clinic setting. More research is needed to identify the type of patients that would benefit most from a PC referral.

scholarly journals Sudden cardiac death in cancer patients: results from the Paris-Sudden Death Expertise Centre

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Mirabel ◽  
J.S Hulot ◽  
A Lillo-Lelouet ◽  
X Jouven ◽  
E Marijon
Keyword(s):  
Sudden Cardiac Death ◽  
Cancer Patients ◽  
Cardiac Death ◽  
Univariate Analysis ◽  
Population Based ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Multiple Sources ◽  
Exact Test ◽  
Respiratory Causes

Abstract Background Sudden cardiac death (SCD) in cancer patients regardless of their therapies has not been addressed. Methods Population-based registry (2011) via multiple sources to collect every case of SCD in Paris and its suburbs, covering a population of 6.6 million. Data of SCD patients (2011–2017) were analysed by identifying patients with known cancer or past medical history of cancer. Categorical variables were compared using chi-square test or Fisher's exact test; continuous variables using Student t-test or Wilcoxon rank sum test, as appropriate. Results Of 22,570 out of hospital cardiac arrests, 3,311 SCD patients (124 cancer patients and 3,187 non cancer patients) were admitted alive to the hospital and were included in the analysis. Characteristics of patients and cardiac arrest circumstances differed on univariate analysis (Table). The final aetiology of SCD varied: more respiratory causes to SCD (pulmonary embolism and hypoxia) among cancer patients and less acute coronary artery syndromes. Conclusions SCD in cancer patients differs significantly when compared to non-cancer patients. Coronary events are less prominent whereas respiratory causes are common aetiologies in cancer. Funding Acknowledgement Type of funding source: None

Patients’ characteristics and outcomes of palliative care inpatient consults at a comprehensive cancer center

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8524-8524 ◽  
Author(s):  
B. El Osta ◽  
F. S. Braiteh ◽  
S. Reddy ◽  
H. El Osta ◽  
E. Bruera
Keyword(s):  
Palliative Care ◽  
Symptom Assessment ◽  
Disease Diagnosis ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Limited Information ◽  
Opioid Rotation ◽  
Cancer Data ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

8524 Background: There is limited information about the characteristics and outcomes of inpatient palliative care consults in cancer centers. Two mobile teams (MT) each with a physician, fellow, and a nurse, provide consultation to hospitalized patients (pts) with complex symptoms. Methods: We analyzed the pts characteristics and outcomes during a two-month period. The charts were reviewed for demographics, cancer data, reason for consultation, symptoms, interventions, and outcomes. Results: Sixty-one pts were analyzed. Pain was the main reason for a consult request in 46 pts (75%), delirium in 10 (16%), anxiety in 4 (7%) and constipation in 5 (8 %). Some pts had more than one reason. 56(92%) pts had metastatic disease, diagnosis for ≤1 year in 26 (42%) and ≤2 years in 44 (72%) (Median =17 months). The Edmonton Symptom Assessment Scale (ESAS), 0–10, is summarized in the table. We uncovered new issues at consultation, such as 20 pts (38%) screened positive for alcoholism with CAGE questionnaire and the 34 pts (56%) had clinical delirium. Features of opioids toxicity such as constipation (N=43;70%), confusion (N=35;57%) (Mean MMSE = 23 ± 5), hallucinations (N=21;34%), myoclonus (N=16;26%) and miosis (N=18;29%) were frequently identified. The MT interventions included imaging studies (23%), enema (43%), laxatives (49%), neuroleptics (54%), metoclopramide (39%), corticosteroids (25%). Half (N=30;50%) of the pts had opioid rotation and/or had counseling (N=27;46%). One out of two pts (N=30;49%) required transfer to the palliative care unit. Conclusions: Most pts had previously undiagnosed opioid toxicity, delirium, and other symptoms. Opioid toxicity occurred secondary to rapid opioid escalation, possibly linked to chemical coping, and psychosocial distress. The outcome of these pts improved by opioid rotation, adding laxatives, metoclopramide, neuroleptics, and steroids. [Table: see text] No significant financial relationships to disclose.

The Opioid Rotation Ratio (ORR) from transdermal fentanyl (TDF) to strong opioids in cancer patients.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 182-182
Author(s):  
Akhila Sunkepally Reddy ◽  
Sriram Yennu ◽  
Suresh K. Reddy ◽  
Jimin Wu ◽  
Diane D Liu ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Care Center ◽  
Linear Regression Analysis ◽  
Symptom Assessment ◽  
Cancer Center ◽  
Transdermal Fentanyl ◽  
Opioid Rotation ◽  
Edmonton Symptom Assessment Scale ◽  
Strong Opioids

182 Background: Despite being the most frequently prescribed strong opioid by oncologists, there is a lack of knowledge of the accurate the opioid rotation ratio (ORR) from transdermal fentanyl (TDF) to other strong opioids in cancer patients. Opioid rotation (OR) from TDF to other strong opioids is performed very frequently in cancer patients for uncontrolled pain or opioid induced neurotoxicity (OIN). The aim of our study was to determine the ORR of TDF to other strong opioids, as measured by morphine equivalent daily dose (MEDD). Methods: In this ad hoc analysis, we reviewed 2471 consecutive patient visits to the supportive care center of a tertiary cancer center in 2008 for an OR from TDF to other strong opioids by a palliative medicine specialist. Information regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and MEDD were collected in patients who followed-up within 6 weeks. Linear regression analysis was used to estimate the ORR between TDF dose and net MEDD (MEDD after OR minus MEDD of breakthrough opioid used along with TDF before OR). Successful OR was defined as 2-point or 30% reduction in pain score and continuation of the new opioid at follow up. Results: 47/2471 patients underwent OR from TDF to other opioids and followed-up within 6 weeks. The median age was 54 years, 53% were male, and 77% had advanced cancer. The median time between OR and follow up was 14 days. Uncontrolled pain (83%) followed by OIN (15%) were the most frequent reasons for OR and 77% had a successful OR with significant improvement in ESAS pain and symptom distress scores. In patients with OR and no worsening of pain at follow-up (n = 41), the median ORR (range) from TDF mg/day to net MEDD was 100 (12.5-217), TDF mcg/hour to net MEDD was 2.4 (0.3-5.2), and correlation of TDF dose to net MEDD was .60 (P < 0.0001). Conclusions: The median ORR from TDF mg/day to MEDD is 100 and from TDF mcg/hour to MEDD is 2.4. Further validation studies are needed.

Symptom burden and characteristics of patients who die in the acute palliative care unit of a tertiary cancer center.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 53-53
Author(s):  
YuJung Kim ◽  
Grace S. Ahn ◽  
Hak Ro Kim ◽  
Beodeul Kang ◽  
Sung Soun Hur ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Tertiary Care ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Assessment System ◽  
Cancer Center ◽  
Advanced Cancer Patients ◽  
Tertiary Cancer Center

53 Background: Acute Palliative Care Units (ACPUs) are novel inpatient programs in tertiary care centers that provide aggressive symptom management and assist transition to hospice. However, patients often die in the APCU before successfully transferring to hospice. The aim of this study was to evaluate the symptom burden and characteristics of advanced cancer patients who die in the APCU. Methods: We retrospectively reviewed the medical records of all advanced cancer patients admitted to the APCU between April, 2015 and March, 2016 at a tertiary cancer center in Korea. Basic characteristics and symptom burden assessed by the Edmonton Symptom Assessment System (ESAS) were obtained from consultation upon APCU admission. Statistical analyses were conducted to compare patients who died in the APCU with those who were discharged alive. Results: Of the 267 patients analyzed, 87 patients (33%) died in the APCU. The median age of patients was 66 (range, 23-97). Patients who died in the APCU had higher ESAS scores of drowsiness (6 vs 5, P = 0.002), dyspnea (4 vs 2, P = 0.001), anorexia (8 vs 6, P = 0.014) and insomnia (6 vs 4, P = 0.001) compared to patients who discharged alive. Total symptom distress scores (SDS) were also significantly higher (47 vs 40, P = 0.001). Patients who died in the APCU were more likely to be male (odds ratio [OR] for female patients 0.38, 95% confidence interval [CI] 0.22-0.67, P < 0.001) and have higher ESAS scores of drowsiness (OR 2.08, 95% CI, 1.08-3.99, P = 0.029) and dyspnea (OR 2.19, 95% CI 1.26-3.80, P = 0.005). These patients showed significantly shorter survival after APCU admission (7 days vs 31 days, P < 0.001). Conclusions: Advanced cancer patients who die in the APCU are more likely to be male and have significantly higher symptom burden that include drowsiness and dyspnea. These patients show rapid clinical deterioration after APCU admission. More proactive and timely end-of-life care is needed for these patients.

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