Total relaxation: A Buddhist mindfulness-based intervention pilot studies in laypersons and cancer patients.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 187-187
Author(s):  
Suthida Suwanvecho ◽  
Buntharika Suwanvecho ◽  
Krit Pongpirul
Keyword(s):  
Cancer Patients ◽  
Symptom Assessment ◽  
Group Session ◽  
Cancer Center ◽  
Pilot Studies ◽  
Edmonton Symptom Assessment Scale ◽  
Before And After ◽  
The Mean ◽  
Symptom Assessment Scale ◽  
Mean Differences

187 Background: Total relaxation (TR), a mindfulness-based intervention based on the Buddha’s teaching of Sutra on Full Awareness of Breathing (Anapanasati Sutta) and Sutra on the Four Establishments of Mindfulness (Satipatthana Sutta). This study was aimed (1) to explore benefits of TR perceived by laypersons and (2) to share experience in piloting the intervention in cancer patients. Methods: Laypersons who attended the 5 - day retreat program with daily TR sessions at Khao Yai, Nakhon Ratchasima, Thailand during October 22-26, 2014 responded to the Edmonton Symptom Assessment Scale (ESAS) before and after the TR session on the first day (TR1 Before, TR1 After) and after the fourth TR session (TR4 After). ESAS was responded by cancer patients who visited Horizon Cancer Center, Bumrungrad International Hospital before and after their participation in a 45 minute TR group session. Paired t-test was used to evaluate the before-after difference in score of each matched variables. Results: Of 162 laypersons, 90.74% responded. They reported a significant improvement of all ESAS items (p < 0.001). Ten cancer patients (6 breast, 2 colon, and 1 stomach cancers and 1 lymphoma) who participated in the TR group session also saw the improvement of all ESAS items, with the mean differences ranging from 0.36 (feeling depressed) to 3.09 points (fatigue/tiredness). No adverse events were observed. Conclusions: Total relaxation is a Buddhist mindfulness-based technique that can improve undesirable symptoms of layperson and cancer patients.

The influence of a cachexia clinic on palliative care integration in oncology.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 124-124
Author(s):  
Diane Portman ◽  
Sarah Thirlwell ◽  
Kristine A. Donovan
Keyword(s):  
Palliative Care ◽  
Weight Loss ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Cancer Center ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
The Impact

124 Background: Appetite and weight loss are common in patients with advanced cancer and specialized cachexia clinics have been established to address these symptoms. Given the association between anorexia/cachexia and other adverse symptoms, these patients may also benefit from specialty level palliative care (PC). However, referral to outpatient specialty level PC is often delayed or does not occur. We sought to examine the prevalence of other factors associated with appetite and weight loss in patients with advanced cancer and the impact of a specialized cachexia clinic on identification and treatment of other PC needs. Methods: The records of patients referred by their Oncologist to the cachexia clinic of a cancer center from August 2016 to June 2017 were reviewed retrospectively. Subjects who had been referred to PC by their Oncologist were excluded. Patients had been assessed for symptom burden using the Edmonton Symptom Assessment Scale (ESAS-r). Patients identified with PC needs had been referred to the PC clinic for follow-up within 30 days after cachexia clinic consultation. Results: Thirty subjects were evaluated in the cachexia clinic (average age 68 years; 63% female). The predominant diagnosis was lung cancer (70%). An average of 6 symptoms per patient were in the moderate to severe range on ESAS, excluding appetite. Depression, fatigue and pain were most common. The average cachexia clinic total ESAS score was 51.61. Only 17% of patients had completed advance directives. Ninety-three % of patients were referred to PC and 68% were seen. The average number of PC visits was 2.79. Within the PC clinic, advance directive completion increased to 37%, goals of care discussion occurred with 50% and 17% received hospice referrals. At the most recent follow-up in the PC clinic, the average total ESAS score had decreased by 11.44 (22%) and all ESAS item scores were improved on average. Conclusions: The cachexia clinic proved a useful means to identify other PC needs and achieve effective PC referrals. We suggest this is proof of concept that specialty clinics can be a meaningful way to achieve an earlier entry point to comprehensive PC in patients who were not previously referred by their Oncologists.

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 conversion ratio for opioid rotation from hydrocodone to other strong opioids in cancer patients.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 164-164
Author(s):  
Akhila Sunkepally Reddy ◽  
Sriram Yennu ◽  
Jimin Wu ◽  
Diane Liu ◽  
Suresh K. Reddy ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Care Center ◽  
Linear Regression Analysis ◽  
Symptom Assessment ◽  
Conversion Ratio ◽  
Opioid Rotation ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
Strong Opioids

164 Background: Cancer pain is initially treated with intermediate strength analgesics such as hydrocodone and subsequently escalated to stronger opioids. There are no studies on the process of opioid rotation (OR) from hydrocodone to strong opioids in cancer patients. Our aim was to determine the conversion ratio (CR) for OR from hydrocodone to morphine equivalent daily dose (MEDD) in cancer outpatients. Methods: We reviewed records of 3,144 consecutive patient visits at our Supportive Care Center in 2011-12 for OR from hydrocodone to stronger opioids. Data regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and MEDD were collected in patients who returned for follow up within 6 weeks. Linear regression analysis was used to estimate the CR between hydrocodone and MEDD. Successful OR was defined as 2-point or 30% reduction in the pain score and continuation of the new opioid at follow up. Results: 170/3,144 patients underwent OR from hydrocodone to stronger opioid. 72% were white, 56% male, and 81% had advanced cancer. The median time between OR and follow up was 21 days. 53% had a successful OR with significant improvement in the ESAS pain and symptom distress scores. In 100 patients with complete OR and no worsening of pain at follow up, the median CR (Q1-Q3) from hydrocodone to MEDD was 1.5 (0.9-2) and hydrocodone dose to MEDD correlation was.52 (P<0.0001). The correlation of CR with hydrocodone dose was -0.52 (P<0.0001). The median CR of hydrocodone to MEDD was 2 in patients receiving < 40mg of hydrocodone/day and 1 in patients receiving ≥ 40mg of hydrocodone/day (P<0.0001). The median conversion ratio of hydrocodone to morphine was 1.5 (n=44) and hydrocodone to oxycodone was 0.9 (n=24). Conclusions: Hydrocodone is 1.5-fold stronger than Morphine. The median conversion ratio from hydrocodone to MEDD varied according to hydrocodone dose/day. [Table: see text]

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.

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

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 181-181
Author(s):  
Akhila Sunkepally Reddy ◽  
Ali Haider ◽  
Supakarn Tayjasanant ◽  
Jimin Wu ◽  
Diane D Liu ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Care Center ◽  
Linear Regression Analysis ◽  
Symptom Assessment ◽  
Transdermal Fentanyl ◽  
Opioid Rotation ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
Frequent Reason

181 Background: Cancer patients frequently undergo opioid rotation (OR) for uncontrolled pain or opioid induced neurotoxicity. TDF is one of the most common opioids prescribed to cancer patients. However, the accurate ORR from other opioids to TDF is unknown and various currently used methods result in a wide variation of ORRs. Our aim was to determine the ORR of morphine equivalent daily dose (MEDD) to TDF when correcting for MEDD of breakthrough opioids (net MEDD) in cancer outpatients. Methods: We reviewed records of 22,532 consecutive patient visits at our Supportive Care Center in 2010-13 for OR from to TDF by a palliative medicine specialist. Data regarding Edmonton Symptom Assessment Scale (ESAS) and MEDD were collected in patients who returned for follow up within 5 weeks. Linear regression analysis was used to estimate the ORR between TDF dose and net MEDD (MEDD prior to OR minus MEDD of breakthrough opioid used along with TDF after OR). Successful OR was defined as 2-point or 30% reduction in pain score and continuation of the new opioid at follow up. Results: 129 patients underwent OR to TDF from other opioids. The mean age was 56 years, 59% male, and 88% had advanced cancer. The median time between OR and follow up was 14 days. Uncontrolled pain (80%) was the most frequent reason for OR and 59% had a successful OR with significant improvement in ESAS pain, constipation, and symptom distress scores. In 101 patients with OR and no worsening of pain at follow up, the median ORR (range) from net MEDD to TDF mg/day was .01 (-0.02-0.04) and correlation of TDF dose to net MEDD was .77 (P < .0001). The ORR was not significantly impacted by variables such as mucositis, serum albumin, and body mass index (BMI). The ORR of .01 suggests that MEDD of 100mg is equivalent to 1mg TDF/day or 40mcg/hour TDF patch (1000mcg/24hours). Conclusions: The median ORR from MEDD to TDF mg/day is .01 and the ORR from MEDD to TDF mcg/hour patch is 0.4. Further validation studies are needed. [Table: see text]

scholarly journals Comfort level of caregivers of cancer patients receiving palliative care

2018 ◽  
Vol 26 (0) ◽  
Author(s):  
Maisa Vitória Gayoso ◽  
Marla Andréia Garcia de Avila ◽  
Thays Antunes da Silva ◽  
Rúbia Aguiar Alencar
Keyword(s):  
Palliative Care ◽  
Functional Status ◽  
Cancer Patients ◽  
Symptom Assessment ◽  
Cross Sectional Study ◽  
Demographic Variables ◽  
Comfort Level ◽  
Cross Sectional ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

ABSTRACT Objective: To verify the association between the level of comfort of the caregiver and socio-demographic variables related to caregiving, and the patient’s functional status and symptoms. Method: Cross-sectional study with non-probabilistic intentional sample. The instruments Palliative Performance Scale (score 0 to 100%), Edmonton Symptom Assessment Scale (symptom scores from zero to ten) and Holistic Comfort Questionnaire (total score ranging from 49 to 294 and mean score from 1 to 6) were used. The relationship between comfort scores and independent variables was calculated by multiple linear regression. Results: Fifty informal caregivers participated in the study - 80% were female, 32% were 60 years old or older, 36% were children of the patient, 58% had paid work and 60% did not have help in the care. The mean overall comfort was 4.52 points. A better functional status of the patients was associated with higher levels of comfort of the caregivers. Older caregivers who received helped in the care activities presented higher comfort scores. Conclusion: The level of comfort of caregivers of cancer patients receiving palliative care was associated with socio-demographic variables and patients’ functional status and symptoms.

scholarly journals CN41 The use of the Edmonton Symptom Assessment scale in advanced lung cancer patients

2020 ◽  
Vol 31 ◽  
pp. S1139
Author(s):  
M. Lavdaniti ◽  
K. Patrikou ◽  
I. Tsatsou ◽  
M. Tsiligiri ◽  
P.M. Prapa ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Symptom Assessment ◽  
Assessment Scale ◽  
Advanced Lung Cancer ◽  
Lung Cancer Patients ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

scholarly journals Inpatient Acupuncture at a Major Cancer Center

2017 ◽  
Vol 17 (1) ◽  
pp. 148-152 ◽  
Author(s):  
M. Kay Garcia ◽  
Lorenzo Cohen ◽  
Michael Spano ◽  
Amy Spelman ◽  
Yousra Hashmi ◽  
...  
Keyword(s):  
Sleep Disturbance ◽  
Symptom Assessment ◽  
Post Treatment ◽  
Hospital Environment ◽  
Cancer Center ◽  
Edmonton Symptom Assessment Scale ◽  
Before And After ◽  
Integrative Therapies ◽  
The Impact

Background: Use of complementary and integrative therapies is increasing among cancer patients, but data regarding the impact treatments such as acupuncture have in an inpatient oncology setting are limited. Methods: Patients who received acupuncture in an inpatient hospital environment between December 2014 and December 2015 were asked to complete a modified Edmonton Symptom Assessment Scale (ESAS; 0-10 scale) before and after each visit. Pre- and post-treatment scores were examined for each symptom using paired t tests. Results: A total of 172 inpatients were treated with acupuncture in their hospital beds (257 visits). Thirty percent (n = 51) received at least one additional follow-up treatment (mean visits/patient = 1.5). Completion rate of the modified ESAS after acupuncture was 42%. The most common reasons for not completing the post-treatment ESAS were “patient too drowsy” or “patient fell asleep” (72%). For patients who reported a baseline symptom score ≥1, the greatest improvements (mean change ± SD) after acupuncture on the initial visit were found for pain (−1.8 ± 2.2; n = 69; P < .0001), nausea (−1.2 ± 1.9; n = 30; P < .001), anxiety (−0.8 ± 1.8; n = 36; P = .01), drowsiness (−0.6 ± 1.8; n = 57; P = .02), and fatigue (−0.4 ± 1.1; n = 67; P = .008). For patients who received at least one follow-up visit, significant improvement from baseline was found for sleep disturbance (−2.5 ± 4.4; n = 17; P = .03), anxiety (−2.4 ± 1.7; n = 9; P = .002), pain (−2.3 ± 2.7; n = 20; P = .001), and drowsiness (−2.0 ± 2.6; n = 16; P = .008). Conclusions: Patients who received inpatient acupuncture at a major cancer center experienced significant improvement after treatment for pain, sleep disturbance, anxiety, drowsiness, nausea, and fatigue.

Minimal clinically important differences in the Edmonton Symptom Assessment Scale in cancer patients: A prospective study.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. 9601-9601
Author(s):  
David Hui ◽  
Omar M. Shamieh ◽  
Carlos Eduardo Paiva ◽  
Pedro Emilio Perez-Cruz ◽  
Jung Hye Kwon ◽  
...  
Keyword(s):  
Prospective Study ◽  
Cancer Patients ◽  
Symptom Assessment ◽  
Assessment Scale ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
A Prospective Study
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