Moving palliative care upstream for patients diagnosed with head and neck cancers.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 227-227
Author(s):  
Tamara M Day
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Head And Neck ◽  
Symptom Burden ◽  
Psychosocial Distress ◽  
Head And Neck Cancers ◽  
Improve Quality ◽  
Convenience Sample

227 Background: Adults with cancer face complex treatment choices and symptom burden that impact their quality of life. Goals of palliative care (PC) are to reduce symptom burden and improve quality of life. Strong evidence exists that PC helps reduce symptom burden, decreases hospital utilization, and improve quality of life. Yet, PC remains underutilized, especially in the context of cancer care. Methods: This descriptive longitudinal study evaluated whether use of a psychosocial distress screening tool would help identify patients eligible for PC. A convenience sample of adults with diagnosis of head and neck cancers presenting to an otolaryngology clinic, located in the cancer center of a Midwestern academic health system, were screened for eligibility for PC referral. If eligible, the provider was notified and introduced PC to the patient. Upon acceptance, a PC referral was ordered. The project consisted of baseline (n = 61) and follow-up chart reviews (n = 60) of patients seen in clinic during over a 3-month period. Results: We found an increase in PC referrals from 14.6% at baseline to 30.8% in follow-up, a 227% increase. Psychosocial distress screenings increased from 5% at baseline to 45% in follow-up, an increase of 200%. Of patients who received a PC referral, 85.6% accepted. There were statistically significant differences found between the pre- and post-intervention groups for marital status, χ2 (3) = 9.67, ( p = .02); and cancer stage χ2 (4) = 21.35, ( p = .00) with increased referrals for married patients at higher cancer stages in the prospective group. Conclusions: This study has shown physicians maybe more likely to offer PC referrals based on cancer stages, and not based on psychosocial distress symptoms. Potential barriers to early referral to PC were identified and could serve as useful information for future studies.

A PROSPECTIVE OBSERVATIONAL STUDY TO DETERMINE RESPONSE AND QUALITY OF LIFE IN ADVANCED HEAD&NECK CANCERS FOLLOWING HYPOFRACTIONATED PALLIATIVE EXTERNAL BEAM RADIOTHERAPY.

2021 ◽  
pp. 77-79
Author(s):  
Roopesh Reddy Yotham ◽  
Tamohan Chaudhuri ◽  
Gautam Bhattacharjee
Keyword(s):  
Quality Of Life ◽  
Head And Neck ◽  
Cell Cancer ◽  
The United States ◽  
Head And Neck Cancers ◽  
External Beam ◽  
Radio Therapy ◽  
Fractionation Schedule

Introduction: Squamous cell cancer of the head and neck (HNSCC) represents the sixth most common malignancy, with 6,50,000 new cases and 3,00,000 HNSCC related deaths reported annually worldwide. HNSCC constitutes approximately 90 percent of all head and neck cancers, and accounted for approximately 3 percent (about 50,000) of all new cancer cases and 2 percent (approximately 12,000) of all cancer deaths in 2010 in the United States. Overall, 57.5% of global head and neck cancers occur in Asia. Aims And Objectives: To Determine Local Control And Quality Of Life in stage III & IV Advanced HNSCC Following Hypo Fractionated Palliative Radiotherapy. To study the response with hypo fractionated external beam radio therapy treatment using RECISTcriteria (version 1.1). Materials And Methods: At the completion of treatment both the primary and the node Response was assessed as per the RECIST 1.1 Response Criteria and Quality of life with QLQ H&N 35 module. Results And Conclusion: At the completion of RT, 32.1% had CR, 50% had PR,14.3% had SD and 3.6% had PD. At 4 weeks of follow-up, 28.6% had CR, 53.6% had PR,14.3% had SD and 3.6% had PD. At 3 months of follow up 17.9% had CR, 60.7% had PR,10.7% had SD and 10.7% had PD. There is a statistically signicant improvement in distressing symptoms like pain, swallowing difculty, opening mouth difculty. This fractionation schedule allowed treatment to be completed in a short overall period with good tolerance and clinically acceptable toxicities

scholarly journals Analysis of the Eligibility of Patients with Sickle Cell Disease for Palliative Care

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4681-4681
Author(s):  
Pedro de Oliveira Toro da Silva ◽  
Cristina Bueno Terzi ◽  
Antonio Luis Eiras Falcão ◽  
Sara T Olalla Saad ◽  
Fernando Ferreira Costa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Sickle Cell ◽  
Household Income ◽  
Older Patients ◽  
Symptom Burden ◽  
Medical Specialties ◽  
Monthly Household Income

Background: Palliative care (PC) is an approach that improves the quality of life of patients facing problems associated with any disease that leads to multiple or hard to manage symptoms, through the prevention and relief of suffering by early identification and impeccable assessment of physical, psychosocial and spiritual problems. Sickle cell diseases (SCD) consist of a group of congenital diseases characterized by the presence of the sickle hemoglobin (HbS), which can polymerize and predispose to hemolytic and ischemic events. In addition to the acute pain events, sometimes recurrent and hard to control, lesions in target organs commonly occur, leading to multiple comorbidities and serious decrease in quality of life. Aims: To evaluate clinical and demographic factors that could influence physical, psychosocial and spiritual symptom burden and confer eligibility criteria to PC in a group of SCD patients. Methods: Clinical and demographic data of SCD patients were collected by interviews using a standardized questionnaire: diagnosis, time from diagnosis, number of comorbidities and of medical specialties on regular follow up, infectious episodes, need for seeking the emergency and for hospitalization during the last 12 months, delirium events, wounds, dysphagia, recurrent falls, adverse events to medication, quality of communication with the medical team, fears regarding the disease and its complications, religious support, age, gender, monthly household income (MI), level of schooling (SCH) and profession. Specific PC scores were also applied: Edmonton Symptom Assessment Scale (ESAS) and Palliative Performance Scale (PPS). Statistical univariate and multivariate analysis were performed. P value <0.05 was considered statistically significant. This research was approved by the Institutional and National Review Board; written informed consent was obtained from all subjects. Results: Fifty-one patients were evaluated (SS, n=34; SC, n=11; SB+, n=3; SB0, n=3), with a median of age of 40 years (18-69). SB0 patients were considered in the SS subgroup for statistical analysis. According to ESAS, pain scores were worse for patients with a higher age (p=0.0039), higher number of children (p=0.0228), for individuals that had completed only primary school versus patients who received more education (p=0.0293), and for the subjects on follow up with three or more medical specialties (p=0.0411). ESAS evaluation for tiredness revealed worse scores for the patients that had no formal occupation versus those who actively work (p=0.0275). ESAS assessment for depression was worse in patients that had a lower MI (p=0.0080), lower SCH (p=0.0585) and for those who had been to emergency services three or more times during the last year (p=0.0290). ESAS for appetite scored worse for older patients (p=0.0165), for those with a lower MI (p=0.0105) and for the individuals with a higher number of comorbidities (p=0.0018). Regarding shortness of breath, ESAS was poorer for older patients (p=0.0330), for those with a lower MI (p=0.0009), for the subjects in follow up with three or more medical specialties (p=0.0064) and for the patients with lower SCH (p=0.0413). ESAS for best wellbeing was worse for the patients with a lower MI (p=0.0425) and for those with lower SCH (p=0.0314). Due to the low incidence of the following symptoms, no differences were observed between groups for ESAS evaluation of nausea, anxiety and drowsiness. PPS score was significantly better for married individuals (p=0.0490) and for those with higher MI (p=0.0121). Finally, patients with no formal occupation showed a significant higher risk of going to the emergency within twelve months (OR=14.286, CI 95% 1.475-142.857, p=0.0217). Conclusions: This study strongly indicated that SCD patients live with chronic limiting symptoms that significantly impair their quality of life, which make them a group eligible for PC. The results showed that age and a higher number of comorbidities significantly impact symptom burden. Importantly, social and economic factors, in particular a lower monthly household income and a worse level of schooling have a major adverse impact on palliative scores. These data reinforce the negative impact of social inequality in this underprivileged group of patients and the need of facing this problem when seeking global patient care. Disclosures No relevant conflicts of interest to declare.

Comparitive study of quality of life in locally advanced head and neck cancers with concurrent chemoradiotherpy with three weekly cisplatin versus weekly cisplatin regimen.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17028-e17028
Author(s):  
Kesava Ramgopal Adavikolanu ◽  
Monica Malik ◽  
Pavankumar Lachi ◽  
Syedakram Kothwal ◽  
Deepajoseph M ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Concurrent Chemotherapy ◽  
Head And Neck Cancers ◽  
Advanced Head ◽  
Weekly Cisplatin

e17028 Background: Concurrent chemoradiotherapy with three weekly cisplatin is the standard of care for organ preservation in locally advanced head and neck cancers. Quality of life (QoL) is vital in this strategy and this study aims to compare QoL in patients of locally advanced head and neck cancers treated with concurrent chemoradiation with either three weekly or weekly cisplatin regimen. Methods: Between January 2011 and May 2012, 30 patients of locally advanced head and neck cancer were divided into two arms each consisting of 15 patients. All patients received conformal radiotherapy (RT) on linear accelerator to a total dose of 70 Gy, 2 Gy per fraction over 35 fractions. Patients in Arm A received concurrent chemotherapy with Cisplatin 100mg/m2 given on day1,22,43. Patients in Arm B received concurrent chemotherapy with Cisplatin 40 mg/m2given weekly for seven weeks. QoL was assessed using EORTC QLQ-C30 and QLQ-H&N35 questionnaires at baseline, completion of RT and at one and two months following completion of treatment. The collected data was analyzed using standard statistical software package (SPSS version 20.0). Results: Median age in Arm A and Arm B were 45 years (range 23-67years) and 48 years (range 36-71) respectively. All patients completed the planned RT, 73% of patients in Arm A and 93% of patients in Arm B received the planned dose of chemotherapy. Compliance with completion of QoL questionnaires was high in both arms. QoL scores decreased during chemoradiotherapy in both arms, and the scores were better in Arm B without statistical significance. The QoL scores reached baseline earlier in the Arm B compared to Arm A for most of the function scales and symptom scales at second month follow up. There was no statistical difference between the two arms for most of the parameters, except for symptom scales of pain (p=0.029) at 1st month follow-up and swallowing (p=0.023) at 2ndmonth follow-up favouring Arm B. Conclusions: Chemoradiotherapy with weekly cisplatin 40mg/m2 with its better compliance and favourable quality of life can serve as an alternative for the conventional three weekly cisplatin regimen.

The effectiveness of hope-fostering interventions in palliative care: A systematic review and meta-analysis

2021 ◽  
pp. 026921632199472
Author(s):  
Natalia Salamanca-Balen ◽  
Thomas V Merluzzi ◽  
Man Chen
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Palliative Care ◽  
Meta Analysis ◽  
Symptom Burden ◽  
Well Being ◽  
Medium Effect ◽  
Spiritual Well Being ◽  
Quasi Experimental

Background: The concept of hope is an important theme in chronic illness and palliative care and has been associated with increased psycho-spiritual well-being and quality of life. Psycho-spiritual interventions have been described in this population, but no systematic review of hope-enhancing interventions or hopelessness-reducing interventions has been conducted for persons with palliative care diseases. Aim: To describe and assess the effectiveness of interventions in palliative care that measure hope and/or hopelessness as an outcome. Design: This systematic review and meta-analysis was pre-registered (Prospero ID: CRD42019119956). Data sources: Electronic databases, journals, and references were searched. We used the Cochrane criteria to assess the risk of bias within studies. Results: Thirty-five studies (24 randomized controlled trials, 5 quasi-experimental, 6 pre-post studies) involving a total of 3296 palliative care patients were included. Compared with usual/standard cancer care alone, interventions significantly increased hope levels at a medium effect size ( g = 0.61, 95% confidence interval (CI) = 0.28–0.93) but did not significantly reduce hopelessness ( g = −0.08, 95% CI = −0.18 to 0.02). It was found that interventions significantly increase spirituality ( g = 0.70, 95% CI = 0.02–1.37) and decrease depression ( g = −0.29, 95% CI = −0.51 to −0.07), but had no significant effect over anxiety, quality of life, and symptom burden. Overall, quality of evidence across the included studies was rated as low. Conclusions: Evidence suggests that interventions can be effective in increasing hope in palliative care patients.

scholarly journals Filipino head and neck cancer patients and their quality of life

2020 ◽  
Vol 6 (3) ◽  
pp. 439
Author(s):  
Frederic Ivan L. Ting ◽  
Aylmer Rex B. Hernandez ◽  
Reno Eufemon P. Cereno ◽  
Irisyl B. Orolfo-Real ◽  
Corazon A. Ngelangel
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
The Philippines ◽  
Head And Neck Cancers ◽  
The Social ◽  
The University

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>In the management of head and neck cancer (HNC), assessment of quality of life (QoL) is imperative because of the potentially debilitating effect of treatment toxicities. Currently, there are no published data assessing the QoL in Filipino HNC patients, thus this study.</p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>This cross-sectional study utilized the University of the Philippines - Department of Health Quality of Life scale. Patients with head and neck cancers at the University of the Philippines - Philippine General Hospital from February to September 2019 were invited to participate.  </p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>A total of 418 patients were included in the study with a mean age of 42 years old (range 18 to 73 years old). In general, Filipino head and neck cancer patients had moderate QoL (mean score of 4.59±0.79). All of the QoL domains (physical, emotional, cognitive, and related functions) had a score of 3-5 (moderate), except for the social status domain which had a mean score of 5.51±0.83 (high). Among socio-demographic factors, patients who are employed and with additional funding sources on top of their income have better global QoL (p&lt;0.01). Clinically, patients with higher stages of disease, fungating tumors, post-laryngectomy, have a feeding tube, with a tracheostomy, and had chemotherapy have lower global QoL (p&lt;0.01).</p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>Filipino patients with head and neck cancers have an overall moderate quality of life, with high scores in the social domain. Patients with higher tumor burdens and have been exposed to chemotherapy have lower QoL scores, while patients with financial stability and aid have better QoL scores.</p><p class="abstract"><span lang="EN-US"> </span></p>

Telemedically Augmented Palliative Care

2014 ◽  
pp. 185-201
Author(s):  
Romina Nemecek ◽  
Patrick Huber ◽  
Sophie Schur ◽  
Eva Masel ◽  
Stefanie Porkert ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Family Caregivers ◽  
Hospital Admissions ◽  
Intervention Group ◽  
Symptom Burden ◽  
Well Being ◽  
Control Group ◽  
User Friendly

Patients with advanced cancer have a substantial symptom burden, which deteriorates their quality of life. Palliative care improves well-being of patients and their family caregivers. Within the scope of a controlled pilot study, a user-friendly telepresence system is developed, which enables patients and family caregivers to send a direct request to a palliative care team. Additionally, a specially tailored database is developed, which contains up to date patient information. Twenty patients with advanced non-small cell lung cancer are consecutively assigned in a control and an intervention group. The intervention group receives the telemedically augmented care, whereas the control group receives standard care. The primary goal of this chapter is to determine the usability and feasibility; the secondary goal is the assessment of the intervention's impact on quality of life and the number of unscheduled hospital admissions. To sum up, telemedically supported ambulatory palliative care may synergistically help to improve safety and quality of life.

scholarly journals Impact of Disease-Specific Fears on Pulmonary Rehabilitation Trajectories in Patients with COPD

2019 ◽  
Vol 8 (9) ◽  
pp. 1460 ◽  
Author(s):  
Thomas Janssens ◽  
Zora Van de Moortel ◽  
Wolfgang Geidl ◽  
Johannes Carl ◽  
Klaus Pfeifer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Rehabilitation ◽  
Smoking Status ◽  
Symptom Burden ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Target Disease ◽  
Disease Specific

Disease-specific fears predict health status in chronic obstructive pulmonary disease (COPD), but their role in pulmonary rehabilitation (PR) remains poorly understood and especially longer-term evaluations are lacking. We therefore investigated changes in disease-specific fears over the course of PR and six months after PR, and investigated associations with PR outcomes (COPD assessment test (CAT) and St. Georges respiratory questionnaire (SGRQ)) in a subset of patients with COPD (n = 146) undergoing a 3-week inpatient PR program as part of the STAR study (Clinicaltrials.gov, ID: NCT02966561). Disease-specific fears as measured with the COPD anxiety questionnaire improved after PR. For fear of dyspnea, fear of physical activity and fear of disease progression, improvements remained significant at six-month follow-up. Patients with higher disease-specific fears at baseline showed elevated symptom burden (CAT and SGRQ Symptom scores), which persisted after PR and at follow-up. Elevated disease-specific fears also resulted in reduced improvements in Quality of Life (SGRQ activity and impact scales) after PR and at follow-up. Finally, improvement in disease-specific fears was associated with improvement in symptom burden and quality of life. Adjustment for potential confounding variables (sex, smoking status, age, lung function, and depressive symptoms) resulted in comparable effects. These findings show the role of disease-specific fears in patients with COPD during PR and highlight the need to target disease-specific fears to further improve the effects of PR.

scholarly journals Proton therapy for non-squamous cell carcinoma of the head and neck: planning comparison and toxicity

2019 ◽  
Vol 60 (5) ◽  
pp. 612-621 ◽  
Author(s):  
Hiromitsu Iwata ◽  
Toshiyuki Toshito ◽  
Kensuke Hayashi ◽  
Maho Yamada ◽  
Chihiro Omachi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Proton Therapy ◽  
Patient Specific ◽  
Dose Distributions

Abstract To investigate optimal treatment planning using proton beams for non-squamous cell carcinoma of the head and neck (NSCHN), the dose distributions of plans involving pencil beam scanning (PBS) with or without a patient-specific aperture system (PSAS), passive-scattering proton therapy (PSPT) and X-ray intensity-modulated radiotherapy (IMRT) were compared. As clinical results, toxicities of PBS with PSAS, including changes in quality of life, were reported. Between April 2014 and August 2016, a total of 30 patients were treated using PBS with PSAS. In 20 patients selected at random, the dose distributions of PBS with or without the PSAS, PSPT and IMRT plans were compared. Neutron exposure by proton therapy was calculated using a Monte Carlo simulation. Toxicities were scored according to CTCAE ver. 4.0. Patients completed EORTC quality of life survey forms (QLQ-C30 and QLQ-HN35) before and 0–12 months after proton therapy. The 95% conformity number of PBS with the PSAS plan was the best, and significant differences were detected among the four plans (P < 0.05, Bonferroni tests). Neutron generation by PSAS was ~1.1-fold higher, but was within an acceptable level. No grade 3 or higher acute dermatitis was observed. Pain, appetite loss and increased weight loss were more likely at the end of treatment, but recovered by the 3 month follow-up and returned to the pretreatment level at the 12 month follow-up. PBS with PSAS reduced the penumbra and improved dose conformity in the planning target volume. PBS with PSAS was tolerated well for NSCHN.

Aspiration Prevention Surgery under Local Anesthesia for Palliative Care in Patients with Head and Neck Cancer: A Report of Two Cases

ORL ◽  
2020 ◽  
pp. 1-7
Author(s):  
Misaki Sekiguchi Koyama ◽  
Rumi Ueha ◽  
Takao Goto ◽  
Taku Sato ◽  
Akane Tachibana ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Local Anesthesia ◽  
Neck Cancer ◽  
Respiratory Impairment ◽  
Severe Dysphagia ◽  
Type Of Surgery

Aspiration prevention (AP) surgery may improve the quality of life (QOL) of patients with severe dysphagia. However, not all patients can endure this type of surgery under general anesthesia because of their poor status. Herein, we describe the cases of 2 patients with head and neck cancer (HNC) who underwent AP surgery for palliative care. Although both patients had tracheostomy due to severe dysphagia and respiratory impairment and frequently needed suction, they were successfully managed with AP surgery under local anesthesia. A tracheostoma was reshaped to be sufficiently large for an airway to be secured without a cannula. Their respiratory failure gradually improved, and suction frequency markedly decreased after surgery; thus, they could receive medical treatment at home. When patients with HNC under palliative care have a tracheal cannula and cannot vocalize, AP surgery under local anesthesia is an option to improve their QOL.

Sign in / Sign up

Export Citation Format

Share Document