Community-based palliative care utilization in elderly pancreatic cancer patients.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 10108-10108
Author(s):  
Zhanni Lu ◽  
Cecilia M Ganduglia Cazaban ◽  
Luis G LeonNovelo ◽  
Sriram Yennu ◽  
Sadie H Conway ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Cancer Patients ◽  
Care Utilization ◽  
Community Based

Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 488-488
Author(s):  
Nizar Bhulani ◽  
Ang Gao ◽  
Arjun Gupta ◽  
Jenny Jing Li ◽  
Chad Guenther ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Cost Of Care ◽  
Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

Palliative care and end-of-life health care utilization of pancreatic cancer patients at an urban safety-net hospital.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 489-489
Author(s):  
Nizar Bhulani ◽  
M. Elizabeth Paulk ◽  
Arjun Gupta ◽  
Kiauna Donnell ◽  
Valorie Harvey ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Safety Net ◽  
Care Utilization ◽  
Safety Net Hospital

489 Background: There has been an increase in Palliative care utilization in cancer patients. We examined trends of palliative care and intensive care utilization in pancreatic cancer patients in an urban setting safety net hospital. Methods: This is a retrospective analysis of pancreatic cancer patients seen at the Parkland Health and Hospital System between January 1999 and September 2016. Cancer cases and receipt of palliative care were identified from prospectively maintained registries. Health care utilization including intensive care unit (ICU) was reviewed. All statistical analysis was done using IBM SPSS version 24. Results: We identified 455 new diagnoses of pancreatic cancer, mean age 61 years, 227 (50%) female and 228 (50%) white. Of these, 277 (61%) received palliative care ever. Patient who received palliative care were more likely to be younger (mean age, 59.3+-12 vs 62.8 +- 12 years) and have stage 4 disease vs stage 1-3 disease (p 0.006, and p 0.003 respectively). There was no statistically significant difference in palliative care utilization between gender and ethnicity groups. 140 patients had a DNR order and 29 required ICU admission at any point. A first contact with palliative care consult was obtained < = 7 days before death for 29 (10%) patients, < = 30 days before death for 86 (31%) patients, 30-60 days before death for 50 (18%) and more than 60 days before death for 141 (51%) patients. Patients receiving palliative care were more likely to have a DNR status (p < 0.001) but had no difference in ICU use within the last 30 days of life (p 0.285). Conclusions: The rate of palliative care in patients with pancreatic cancer in this cohort from a safety net hospital is higher than nationally reported studies. Most patients received palliative care > 30 days before death. While patients received early palliative care, it did not result in reduced ICU care. Factors influencing ICU care utilization near the end of life need further study.

Opioid usage patterns among Medicare pancreatic cancer patients according to palliative care utilization.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 14-14
Author(s):  
Zhanni Lu ◽  
Cecilia M Ganduglia Cazaban ◽  
Luis G. LeonNovelo ◽  
Sriram Yennu ◽  
Sharon H. Giordano ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Cancer Patients ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Care Utilization ◽  
Medicare Beneficiaries ◽  
Opioid Use ◽  
Uptake Rates ◽  
Usage Patterns

14 Background: Opioid pharmacotherapy is used to manage moderate and severe pain in palliative care (PC). Pain affects 80% pancreatic cancer patients older than 65 years. We assessed the opioid utilization patterns in Medicare patients with pancreatic cancer whom did not use PC (NPC), used community-based PC (CBPC) or used hospital-based PC (HBPC). Methods: We assessed opioid use, types, dispensed days, opioid uptake rates, doses (measured by morphine equivalent doses (MEDs)), and related adverse events (AEs) after pancreatic cancer diagnosis in Medicare beneficiaries selected from the SEER-Medicare database between 2007 and 2013 using the log-binomial, generalized linear mixed, and Cox proportional hazards modeling. Results: 16,106 patients were identified (median age: 78 years; female: 55.2%), of whom 8.3% used CBPC and 19.6% used HBPC. PC users were more likely to use opioids (CBPC: 72.2% vs. HBPC: 63.4% vs. NPC: 56.3%, P<.001). The most commonly prescribed opioid type in NPC, HBPC and CBPC users was fentanyl (54.1%), hydromorphone (27.7%) and morphine (26.1%). Compared to other study patients, CBPC users had shorter median dispensed days per prescription (CBPC: 3 days vs. HBPC: 4 days vs. NPC: 4 days, P<.001) but higher median MEDs per prescription (CBPC: 25 mg vs. HBPC: 25 mg vs. NPC: 0.13 mg, P<.001). Adjusting for demographic and clinical factors, no significantly different uptake rates of opioids were determined in PC users compared to NPC users (CBPC: RR, 1.02, P=.057; HBPC: RR, 1.002, P=.783). HBPC users had higher adjusted daily MEDs than CBPC and NPC users 3 months after diagnosis (135.1 mg/d vs. 126.5 mg/d vs. 65.7 mg/d, P<.001). CBPC users had higher adjusted daily MEDs than HBPC and NPC users 3 months before death (164.3mg/d vs. 155.6 mg/d vs. 92.1 mg/d, P=.0002). CBPC users had lower but HBPC users had higher adjusted hazard ratios of delirium (CBPC: HR, 0.95, HBPC: HR, 1.26, P<.001) and drowsiness (CBPC: HR, 0.94, HBPC: HR, 1.53, P<.001) than NPC users. Conclusions: Older pancreatic cancer patients using PC tended to use opioids and consumed higher opioid doses. CBPC users had lower risks of opioid-related delirium and drowsiness. The factors of the opioid use variations need to be assessed.

Community-based palliative care and end-of-life care in elderly patients with pancreatic cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 70-70
Author(s):  
Zhanni Lu ◽  
Cecilia M Ganduglia Cazaban ◽  
Luis G LeonNovelo ◽  
Sriram J. Yennu ◽  
Sadie H Conway ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Linear Regression ◽  
End Of Life ◽  
Cancer Patients ◽  
Linear Regression Models ◽  
Exact Matching ◽  
Community Based ◽  
Eol Care ◽  
The Impact

70 Background: No population-based studies have evaluated the impact of community-based palliative care (CBPC) on aggressive end-of-life (EOL) care use and Medicare charges for elderly pancreatic cancer patients. We analyzed the impact of CBPC on aggressive EOL care use in the last 30 days of life and on emergency department (ED) and intensive care unit (ICU) Medicare charges using the SEER-Medicare data. Methods: 12399 elderly pancreatic cancer patients survived for at least 1 month after diagnosis from 2007 to 2013 were identified. CBPC and hospital-based palliative care (HBPC) users were identified by diagnosis codes and place of services and matched by the coarsened exact matching [786:786; age, sex, residence urbanization level, comorbidities, illness duration, palliative care (PC) exposure]. Zero-inflated Poisson and multivariable logistic/linear regression models examined the variations of aggressive EOL care use in the matched patients. Generalized linear regression with a gamma distribution determined how CBPC impacted ED and ICU Medicare charges. Results: 22.1% eligible patients (median age: 76 years) used PC in the 6 years, including 7.7% who used CBPC and 14.5% who used HBPC. The median duration from cancer diagnosis to death of CBPC, HBPC and Non-PC users was 11 months, 6 months and 8 months (P < .001). Matched CBPC users were less likely than HBPC users to be admitted to ICU (risk ratio [RR], 0.64; 95% CI, 0.50-0.81), ED (RR, 0.63; 95% CI, 0.53-0.73), and hospital (RR, 0.50; 95% CI, 0.35-0.72). Compared to matched HBPC users, CBPC users utilized less life-extending care (OR, 0.59; 95% CI, 0.43-0.80) and had shorter hospital (Coef., −0.42; 95% CI, −0.65- −0.18) and ICU stays (Coef., −0.35; 95% CI, −0.59 - −0.10). They tended to die at home (OR, 1.46; 95% CI, 1.19-1.78) and not in ED/ICU/hospital settings (OR, 0.62; 95% CI, 0.45-0.83). CBPC users’ adjusted mean ED and ICU Medicare charges were 0.2% (P = .80) and 1.1% (P < .001) lower than those of Non-PC users and 4.5% (P = .43) and 21.0% (P = .08) lower than those of matched HBPC users. Conclusions: CBPC users utilized less aggressive EOL care than HBPC users, implying CBPC's potential to reduce aggressive EOL care use. Their ICU Medicare charge was lower than that of Non-PC users.

scholarly journals Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States

2021 ◽  
Vol 18 (11) ◽  
pp. 6040
Author(s):  
Jessica Y. Islam ◽  
Veeral Saraiya ◽  
Rebecca A. Previs ◽  
Tomi Akinyemiju
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Gynecological Cancer ◽  
The United States ◽  
Care Utilization ◽  
Treatment Facility ◽  
Facility Type ◽  
Race Ethnicity ◽  
Distance To Care ◽  
The U.S

Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. We used 2004–2016 data from the U.S. National Cancer Database and included patients with metastatic (stage III–IV at-diagnosis) ovarian, cervical, and uterine cancer (n = 176,899). Palliative care was defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management, or any combination. HCA measures included insurance type, area-level socioeconomic measures, distance-to-care, and cancer treatment facility type. We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable logistic regression. Our population was mostly non-Hispanic White (72%), had ovarian cancer (72%), and 24% survived <6 months. Five percent of metastatic gynecological cancer patients utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR: 1.80,95% CI: 1.53–2.12), and cervical (aOR: 1.45,95% CI: 1.26–1.67) cancer were more likely to use palliative care. Patients with ovarian (aOR: 0.58,95% CI: 0.48–0.70) or cervical cancer (aOR: 0.74,95% CI: 0.60–0.88) who reside >45 miles from their provider were less likely to utilize palliative care than those within <2 miles. Ovarian cancer patients treated at academic/research programs were less likely to utilize palliative care compared to those treated at community cancer programs (aOR: 0.70, 95%CI: 0.58–0.84). Associations between HCA measures and palliative care utilization were largely consistent across U.S. racial-ethnic groups. Insurance type, cancer treatment facility type, and distance-to-care may influence palliative care use among metastatic gynecological cancer patients in the U.S.

scholarly journals Factors Influencing the Willingness of Palliative Care Utilization among the Older Population with Active Cancers: A Case Study in Mandalay, Myanmar

2021 ◽  
Vol 18 (15) ◽  
pp. 7887
Author(s):  
Aye Tinzar Myint ◽  
Sariyamon Tiraphat ◽  
Isareethika Jayasvasti ◽  
Seo Ah Hong ◽  
Vijj Kasemsup
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Rural Areas ◽  
Psychosocial Support ◽  
Care Utilization ◽  
Severe Illness ◽  
Cross Sectional Survey ◽  
Care Services ◽  
Palliative Care Services ◽  
Older Cancer Patients

Palliative care is an effective, multidisciplinary healthcare service to alleviate severe illness patients from physical, psychological, and spiritual pain. However, global palliative care has been underutilized, especially in developing countries. This cross-sectional survey aimed to examine the factors associated with older cancer patients’ willingness to utilize palliative care services in Myanmar. The final sample was composed of 141 older adults, 50-years of age and above who suffered from cancers at any stage. Simple random sampling was applied to choose the participants by purposively selecting three oncology clinics with daycare chemotherapy centers in Mandalay. We collected data using structured questionnaires composed of five sections. The sections include the participant’s socio-economic information, disease status, knowledge of palliative care, psychosocial and spiritual need, practical need, and willingness to utilize palliative care services. The study found that approximately 85% of older cancer patients are willing to receive palliative care services. The significant predictors of willingness to utilize palliative care services include place of living, better palliative care knowledge, more need for spiritual and psychosocial support, and practical support. This study can guide health policymakers in increasing the rate of palliative care utilization. The suggested policies include developing community-level palliative care services in Myanmar, especially in rural areas, promoting palliative care knowledge, applying appropriate religious and spiritual traditions at palliative treatment, and developing suitable medicines for the critically ill.

Embedded model palliative care (PC) at a community oncology practice in central Nebraska.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 64-64
Author(s):  
Cindy Kathman ◽  
Mehmet Sitki Copur ◽  
Penny Price ◽  
Carrie Edwards ◽  
Pornchai Jonglertham ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Symptom Management ◽  
Hospice Care ◽  
Prognostic Index ◽  
Cancer Center ◽  
Care Utilization ◽  
Community Oncology ◽  
Oncology Practice ◽  
Active Cancer

64 Background: PC combined with cancer care has been shown to improve patient outcomes and caregiver satisfaction while lessening unnecessary health care utilization. 85% of cancer patients receive their oncology care in the communities they live. Establishing a viable and sustainable outpatient PC service in the community oncology setting is challenging and rare nationwide. We present our 18-month PC services since its implementation at Morrison Cancer Center, a community oncology practice. Methods: Cancer patients were referred to PC by oncologists for symptom management, psychosocial support, and Advanced Care Planning (APC). PC visits were provided at the oncology clinic, home, nursing home, or hospital by our PC team (APRN, Social Workers, Chaplain and RN's). Palliative Care Prognostic Index (PPI), time to PC consultation, proportion of patients --on chemotherapy, switching to hospice care, receiving chemotherapy within the last 30 days of life, visiting ER and/or being admitted to hospital within the last 30 days of life-- were studied. Results: Over an 18-month period 72 patients were referred for a total of 470 visits. Lung, pancreas, gastroesophageal, and head and neck cancers were topmost sites. PC referrals per quarter increased from an initial 4 to an 18 at 18 months. Mean time from diagnosis to PC referral was 5.6 months (range: 1-36). Referral reasons included symptom management/support (58%), goals of care (50%), and/or predetermined triggers (15%). Mean PPI score was 50% (range 30-70). All patients had ACP. While 83% of patients were able to continue on active cancer treatment, only 5% received chemotherapy within the last 30 days of life, and 4 % had two or more ER visits with or without a hospital admission. Eventually, 17% of PC patients transitioned to hospice care. Conclusions: A PC program fostering expert symptom management, seamless communication, and trusting relationships between oncologists, palliative care team, and patients, without prematurely stopping active cancer treatments, is feasible and can be incorporated into a community oncology practice as demonstrated by the growth and success of our program. Our model may set an example for similar practices in the community oncology setting.

scholarly journals m-Palliative Care Link: Developing a Mobile Application to Improve Symptom Control and Information Exchange Among Specialists and Local Health Workers Treating Tanzanian Cancer Patients (Preprint)

2020 ◽  
Author(s):  
Robert S Morse ◽  
Kaley Lambden ◽  
Erin Quinn ◽  
Twalib Ngoma ◽  
Beatrice Mushi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Care Coordination ◽  
Mobile Application ◽  
Health Workers ◽  
Symptom Control ◽  
Symptom Assessment ◽  
Local Health ◽  
Community Based ◽  
Functional Prototype

BACKGROUND Improving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania in need of innovative community-based solutions. Mobile health technology holds promise; however, existing resources are limited and access to palliative care specialists (hereafter, specialists) is poor. A mobile platform that extends specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and symptom management can address this gap in care, particularly in low-resource settings. OBJECTIVE The aim of this study was to design and develop mobile-Palliative Care Link (mPCL), a mobile/web application to support symptom assessment and care coordination and control, with a focus on pain. METHODS A human-centered iterative design framework was used to develop the mPCL prototype for use by specialists (palliative care physicians and nurses), poor-prognosis cancer patients and their lay caregivers (patients/caregivers), and LHWs. Central to mPCL is the validated patient-focused African Palliative care Outcome Scale (POS), adapted for automated, twice-weekly collection of patient/caregiver responses, and timely review, reaction and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person in a controlled setting with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative feedback on ease-of-use and recommendations for improvement. Results were used to build a usable, functional prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the application among ten patients/caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering feedback from the specialists, LHWs and nurses who used mPCL to manage care. This feedback was employed to further optimize the application for a broader randomized field study to examine the application’s effectiveness in symptom control among cancer patients. RESULTS mPCL functionalities include the ability to create and update a synoptic clinical record; regular real-time symptom assessment; patient/caregiver and care team communication and care coordination; symptom-focused educational resources; and easy access to emergency contact information. Results from usability and pilot testing demonstrated that all users were able to successfully navigate the application and feedback suggests that mPCL has clinical utility. User-informed recommendations included: further improvement in navigation of the application, simplification of patient/caregiver components and language, and delineation of user roles. CONCLUSIONS We designed, built, and tested a usable, functional prototype of a mobile application supporting palliative care for cancer patients in Tanzania. mPCL is expressly designed to support coordinated care via customized interfaces supporting core users—patients/caregivers, LHWs and members of the palliative care team—and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas.

Sign in / Sign up

Export Citation Format

Share Document