Do hospitalized cancer patients requiring palliative care consultation discharged to subacute rehabilitation ever get anticancer therapy again?

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 62-62
Author(s):  
Muhammad Azeem Khan ◽  
Clint S. Pettit ◽  
Hunter Groninger
Keyword(s):  
Palliative Care ◽  
Cancer Therapy ◽  
Cancer Treatment ◽  
Advanced Cancer ◽  
Functional Decline ◽  
Goals Of Care ◽  
Discharge Disposition ◽  
Patients With Cancer ◽  
Palliative Care Consultation ◽  
Anti Cancer

62 Background: Patients with advanced cancer inevitably experience a functional decline that is often associated with notable symptom burden and/or indications for clarification of goals. Palliative care (PC) services frequently engage such patients during hospital stays. For many of these patients, discharge plans to sub-acute rehabilitation facilities (SAR) in order to ‘gain strength’ for future cancer treatment is a common practice. We wished to examine if inpatients with advanced cancer receiving PC consultation who are discharged to SAR are ever able to follow up with their oncology team and receive anti-cancer therapy. Methods: A search was conducted in our institution’s electronic medical system for hospitalized patients with cancer who received inpatient PC consultation and were subsequently discharged to SAR. Patients were excluded if they did not follow with an oncologist at MWHC as an out patient prior to the admission being reviewed or if they had never received anti cancer therapy before. Results: From 2015-2017, 16 patients meeting our criteria were identified. For 14 (82.4%) patients Palliative Care was consulted to either discuss goals of care and/or assist with pain management.13 (76%) patients were discharged to SAR to ‘improve strength’. However only 7 (44%) patients saw their oncologist after discharge from SAR. Of those 7 only 3 (19%) received further anti cancer therapy. 4 of the 7 (57%) patients that saw their oncologist after SAR had an ECOG of 1 on admission, the other 3 had an ECOG of 2. No patient with an ECOG of 2 or greater ever received cancer treatment again. Exactly half of the 16 patients were eventually readmitted to our hospital. Conclusions: SAR may not be an appropriate discharge disposition for patients with cancer who have a decline in functional status. Less than half the patients with cancer discharged to SAR from our institute with the intention to gain strength for future chemotherapy saw their oncologist again and the overwhelming majority (particularly those with an ECOG performance score of 2 and greater) never received anti cancer therapy again. This data can be considered to make informed decisions when discussing goals of care.

Systemic Anti-Cancer Therapy Use in Palliative Care Outpatients With Advanced Cancer

2020 ◽  
pp. 082585972097594
Author(s):  
Deepa Wadhwa ◽  
David Hausner ◽  
Gordana Popovic ◽  
Ashley Pope ◽  
Nadia Swami ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Therapy ◽  
Advanced Cancer ◽  
Multinomial Logistic Regression ◽  
Multivariable Analysis ◽  
Related Factors ◽  
Factors Associated ◽  
Palliative Care Consultation ◽  
Anti Cancer ◽  
Care Consultation

Purpose: To evaluate factors associated with continuation of systemic anti-cancer therapy (SACT) after palliative care consultation, and SACT administration in the last 30 days of life, in outpatients with cancer referred to palliative care. Timing of referral was of particular interest. Methods: Patient, disease, and treatment-related factors associated with SACT before and after palliative care, and in the last 30 days of life, were identified using 3-level multinomial logistic regression. Referral to palliative care was categorized by time from death as early (>12 months), intermediate (6-12 months), and late (≤6 months). Results: Of the 337 patients, 240 (71.2%) received SACT for advanced cancer; of these, 126 (52.5%) received SACT only prior to palliative care while 114 (47.5%) also received SACT afterward. Only 35/337 (10.4%) received SACT in the last 30 days of life. On multivariable analysis, factors associated with continuing SACT after palliative care consultation were a cancer diagnosis for <1 year (OR 3.09, p = 0.01), breast primary (OR 11.88, p = 0.0008), and early (OR 28.8, p < 0.001) or intermediate (OR 6.67, p < 0.001) referral timing. No factors were significantly associated with receiving SACT in the last 30 days versus earlier, but the median time from palliative care referral to death in those receiving SACT in the last 30 days versus stopping SACT earlier was 1.78 versus 4.27 months. Conclusion: Patients who received SACT following palliative care consultation were more likely to be referred early; however, patients receiving SACT in their last 30 days tended to be referred late.

scholarly journals Inpatients with neurologic disease referred for palliative care consultation

Neurology ◽  
2019 ◽  
Vol 92 (17) ◽  
pp. e1975-e1981 ◽  
Author(s):  
Breana L. Taylor ◽  
David L. O'Riordan ◽  
Steven Z. Pantilat ◽  
Claire J. Creutzfeldt
Keyword(s):  
Palliative Care ◽  
Odds Ratio ◽  
Primary Diagnosis ◽  
Care Quality ◽  
Care Planning ◽  
Neurologic Disease ◽  
Discharge Disposition ◽  
Patients With Cancer ◽  
Outcomes Of Care ◽  
Palliative Care Consultation

ObjectivesTo compare characteristics and needs of inpatients with neurologic disease to those with cancer referred for palliative care (PC) consultation.MethodsThis prospective cohort study used data collected by the Palliative Care Quality Network from January 2013 until December 2016. We compared demographics, reasons for consultation, discharge disposition, Palliative Performance Scale (PPS) score, and outcomes of care among patients with a primary diagnosis of neurologic disease vs cancer.ResultsThe most common reason for PC consultation in all patients was assistance with goals of care and advanced care planning. PC consultation was less often requested for pain and symptom management in patients with neurologic disease compared to patients with cancer (13.7% vs 43%, odds ratio 0.3) and more often for assistance with transition to comfort measures only and withdrawal of life-sustaining treatment (19.1% vs 7.1%, odds ratio 1.3). Patients with cancer had higher PPS scores (42.1% vs 23.4%) and were more likely to be discharged home from the hospital, while patients with neurologic disease were more likely to die in hospital.ConclusionsPatients with neurologic disease as a reason for PC consultation are more in need of end-of-life care planning and more likely to die in the hospital than those with cancer, suggesting that targeted approaches may best address the needs of each patient population. Our results can direct further research and education in neuropalliative care.

Racial Disparities in Utilization of Palliative Care Among Patients Admitted With Advanced Solid Organ Malignancies

2020 ◽  
pp. 104990912092277
Author(s):  
Kimberley Lee ◽  
Faiz Gani ◽  
Joseph K. Canner ◽  
Fabian M. Johnston
Keyword(s):  
Palliative Care ◽  
Racial Disparities ◽  
Advanced Cancer ◽  
The United States ◽  
Patients With Cancer ◽  
Care Services ◽  
Palliative Care Consultation ◽  
Black Patients ◽  
Palliative Care Services ◽  
Care Consultation

Background: There is increasing recognition of the importance of early incorporation of palliative care services in the care of patients with advanced cancers. Hospice-based palliative care remains underutilized for black patients with cancer, and there is limited literature on racial disparities in use of non-hospice-based palliative care services for patients with cancer. Objective: The primary objective of this study is to describe racial differences in the use of inpatient palliative care consultations (IPCC) for patients with advanced cancer who are admitted to a hospital in the United States. Design: This retrospective cohort study analyzed 204 175 hospital admissions of patients with advanced cancers between 2012 and 2014. The cohort was identified through the National Inpatient Dataset. International Classification of Disease, Ninth Revision codes were used to identify receipt of a palliative care consultation. Results: Of this, 57.7% of those who died received IPCC compared to 10.5% who were discharged alive. In multivariable logistic regression models, black patients discharged from the hospital, were significantly less likely to receive a palliative care consult compared to white patients (odds ratio [OR] black: 0.69, 95% CI: 0.62-0.76). Conclusions: Death during hospitalization was a significant modifier of the relationship between race and receipt of palliative care consultation. There are significant racial disparities in the utilization of IPCC for patients with advanced cancer.

scholarly journals Microbes as Medicines: Harnessing the Power of Bacteria in Advancing Cancer Treatment

2020 ◽  
Vol 21 (20) ◽  
pp. 7575 ◽  
Author(s):  
Shruti S. Sawant ◽  
Suyash M. Patil ◽  
Vivek Gupta ◽  
Nitesh K. Kunda
Keyword(s):  
Cancer Therapy ◽  
Cancer Treatment ◽  
Treatment Options ◽  
Current Treatment ◽  
Genetically Engineered ◽  
Cancer Therapies ◽  
Anti Cancer ◽  
Tumor Environment ◽  
Systemic Side Effects ◽  
Hypoxic Tumor

Conventional anti-cancer therapy involves the use of chemical chemotherapeutics and radiation and are often non-specific in action. The development of drug resistance and the inability of the drug to penetrate the tumor cells has been a major pitfall in current treatment. This has led to the investigation of alternative anti-tumor therapeutics possessing greater specificity and efficacy. There is a significant interest in exploring the use of microbes as potential anti-cancer medicines. The inherent tropism of the bacteria for hypoxic tumor environment and its ability to be genetically engineered as a vector for gene and drug therapy has led to the development of bacteria as a potential weapon against cancer. In this review, we will introduce bacterial anti-cancer therapy with an emphasis on the various mechanisms involved in tumor targeting and tumor suppression. The bacteriotherapy approaches in conjunction with the conventional cancer therapy can be effective in designing novel cancer therapies. We focus on the current progress achieved in bacterial cancer therapies that show potential in advancing existing cancer treatment options and help attain positive clinical outcomes with minimal systemic side-effects.

scholarly journals Patterns of Opioid Prescription, Use, and Costs Among Patients With Advanced Cancer and Inpatient Palliative Care Between 2008 and 2014

2019 ◽  
Vol 15 (1) ◽  
pp. e74-e83 ◽  
Author(s):  
Sriram Yennurajalingam ◽  
Zhanni Lu ◽  
Suresh K. Reddy ◽  
EdenMae C. Rodriguez ◽  
Kristy Nguyen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
Patient Characteristics ◽  
Opioid Prescription ◽  
Patients With Cancer ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
Symptom Changes

PURPOSE: An understanding of opioid prescription and cost patterns is important to optimize pain management for patients with advanced cancer. This study aimed to determine opioid prescription and cost patterns and to identify opioid prescription predictors in patients with advanced cancer who received inpatient palliative care (IPC). MATERIALS AND METHODS: We reviewed data from 807 consecutive patients with cancer who received IPC in each October from 2008 through 2014. Patient characteristics; opioid types; morphine equivalent daily dose (MEDD) in milligrams per day of scheduled opioids before, during, and after hospitalization; and in-admission opioid cost per patient were assessed. We determined symptom changes between baseline and follow-up palliative care visits and the in-admission opioid prescription predictors. RESULTS: A total of 714 (88%) of the 807 patients were evaluable. The median MEDD per patient decreased from 150 mg/d in 2008 to 83 mg/d in 2014 ( P < .001). The median opioid cost per patient decreased and then increased from $22.97 to $40.35 over the 7 years ( P = .03). The median MEDDs increased from IPC to discharge by 67% ( P < .001). The median Edmonton Symptom Assessment Scale pain improvement at follow-up was 1 ( P < .001). Younger patients with advanced cancer (odds ratio [OR[, 0.95; P < . 001) were prescribed higher preadmission MEDDs (OR, 1.01; P < .001) more often in the earlier study years (2014 v 2009: OR, 0.18 [ P = .004] v 0.30 [ P = .02]) and tended to use high MEDDs (> 75 mg/d) during hospitalization. CONCLUSION: The MEDD per person decreased from 2008 to 2014. The opioid cost per patient decreased from 2008 to 2011 and then increased from 2012 to 2014. Age, prescription year, and preadmission opioid doses were significantly associated with opioid doses prescribed to patients with advanced cancer who received IPC.

scholarly journals 1-2-3 Project: A Quality Improvement Initiative to Normalize and Systematize Palliative Care for All Patients With Cancer in the Outpatient Clinic Setting

2018 ◽  
Vol 14 (12) ◽  
pp. e775-e785 ◽  
Author(s):  
Anjali V. Desai ◽  
Virginia M. Klimek ◽  
Kimberly Chow ◽  
Andrew S. Epstein ◽  
Camila Bernal ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Outpatient Clinic ◽  
Core Values ◽  
Newly Diagnosed ◽  
Care Needs ◽  
Patients With Cancer ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Palliative Care Needs

Background: Prior work to integrate early palliative care in oncology has focused on patients with advanced cancer and primarily on palliative care consultation. We developed this outpatient clinic initiative for newly diagnosed patients at any stage, emphasizing primary (nonspecialist) palliative care by oncology teams, with enhanced access to palliative care specialists. Methods: We piloted the project in two medical oncology specialty clinics (for patients with myelodysplastic syndrome and GI cancer, respectively) to establish feasibility. On a visit-based schedule, patients systematically reported symptoms, information/decision-making preferences, and illness understanding. They also participated in discussions of their core values with their oncology nurse. Oncology teams were first responders to palliative care needs, whereas specialists were available for clinician support and direct patient consultation. Results: All 58 eligible patients were enrolled. In both clinics, patient self-reports documented a heavy symptom burden. Information/decision-making preferences and illness understanding levels varied across patients. Patients prepared new advance directives. Oncology nurses documented discussions of core values. Requests for palliative care consultation decreased over time as oncology teams embraced their primary palliative care role with coaching from the specialists. Clinic workflow and patient volume were maintained. Conclusion: Our pilot experience suggests that in outpatient oncology clinics, a structured, scheduled, and systematic approach is feasible to deliver palliative care to newly diagnosed patients with cancer at any stage and throughout their illness trajectory. This novel approach identified important, actionable palliative care needs, relying primarily on oncology teams to respond to these needs, while enhancing access to palliative care specialist input. Expansion to additional clinics will allow evaluation of scalability and generalizability, along with measurement of a broader range of important outcomes.

scholarly journals Polymeric Co-Delivery Systems in Cancer Treatment: An Overview on Component Drugs’ Dosage Ratio Effect

Molecules ◽  
2019 ◽  
Vol 24 (6) ◽  
pp. 1035 ◽  
Author(s):  
Jiayi Pan ◽  
Kobra Rostamizadeh ◽  
Nina Filipczak ◽  
Vladimir Torchilin
Keyword(s):  
Cancer Therapy ◽  
Cancer Treatment ◽  
Therapeutic Agent ◽  
Polymeric Nanoparticles ◽  
Therapeutic Agents ◽  
Delivery Systems ◽  
Individual Therapy ◽  
Multiple Factors ◽  
Therapeutic Outcomes ◽  
Anti Cancer

Multiple factors are involved in the development of cancers and their effects on survival rate. Many are related to chemo-resistance of tumor cells. Thus, treatment with a single therapeutic agent is often inadequate for successful cancer therapy. Ideally, combination therapy inhibits tumor growth through multiple pathways by enhancing the performance of each individual therapy, often resulting in a synergistic effect. Polymeric nanoparticles prepared from block co-polymers have been a popular platform for co-delivery of combinations of drugs associated with the multiple functional compartments within such nanoparticles. Various polymeric nanoparticles have been applied to achieve enhanced therapeutic efficacy in cancer therapy. However, reported drug ratios used in such systems often vary widely. Thus, the same combination of drugs may result in very different therapeutic outcomes. In this review, we investigated polymeric co-delivery systems used in cancer treatment and the drug combinations used in these systems for synergistic anti-cancer effect. Development of polymeric co-delivery systems for a maximized therapeutic effect requires a deeper understanding of the optimal ratio among therapeutic agents and the natural heterogenicity of tumors.

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