scholarly journals Palliative Care Consultations in Patients With Cancer: A Mayo Clinic 5-Year Review

2011 ◽  
Vol 7 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Arif H. Kamal ◽  
Keith M. Swetz ◽  
Elise C. Carey ◽  
Andrea L. Cheville ◽  
Heshan Liu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Mayo Clinic ◽  
Multidisciplinary Care ◽  
Complex Needs ◽  
Patients With Cancer ◽  
Short Intervention

Patients with cancer often have complex needs that must be met within a short intervention window. The authors highlight opportunities for improved multidisciplinary care for patients with advanced cancer and their families.

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.

Palliative care referral and associated outcomes among patients with cancer in the last 2 weeks of life

2015 ◽  
Vol 9 (1) ◽  
pp. e16-e16 ◽  
Author(s):  
Mathilde Ledoux ◽  
Wadih Rhondali ◽  
Véronique Lafumas ◽  
Julien Berthiller ◽  
Marion Teissere ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Academic Medical Centre ◽  
Haematological Cancer ◽  
Patients With Cancer ◽  
Respiratory Cancer ◽  
Academic Medical ◽  
Cancer Types ◽  
The Impact

BackgroundPalliative care (PC) improves the quality of life of patients with advanced cancer. Our aim was to describe PC referral among patients with advanced cancer, and associated outcomes in an academic medical centre.MethodsWe reviewed the medical records of 536 inpatients with cancer who had died in 2010. Our retrospective study compared patients who accessed PC services with those who did not. Statistical analysis was conducted using non-parametric tests due to non-normal distribution. We also conducted a multivariate analysis using a logistic regression model including age, gender, type of cancer and metastatic status.ResultsOut of 536 patients, 239 (45%) had PC referral. The most common cancer types were respiratory (22%) and gastrointestinal (19%). Patients with breast cancer (OR 23.76; CI 6.12 to 92.18) and gynaecological cancer (OR 7.64; CI 2.61 to 22.35) had greater PC access than patients with respiratory or haematological cancer. Patients referred to PC had significantly less chemotherapy in the last 2 weeks of life than non-referred patients, with 22 patients (9%) vs 59 (19%; p<0.001). PC-referred patients had significantly fewer admissions to intensive care units in the last month of life than non-referred patients, with 14 (6%) vs 58 (20%; p<0.001).ConclusionsThere was a large variation in access to PC according to the type of cancer. There is a need to improve collaboration between the PC service and the respiratory, cancer and haematology specialists. Further research will be required to determine the modality and the impact of this collaboration.

Using palliative care to maximize the value of care for patients with advanced cancer.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 59-59
Author(s):  
Risha Gidwani ◽  
Randall Gale ◽  
Diane E. Meier ◽  
Steven M Asch
Keyword(s):  
Palliative Care ◽  
Patient Outcomes ◽  
Advanced Cancer ◽  
Cancer Care ◽  
Financial Burden ◽  
Medical Costs ◽  
The United States ◽  
Care Patient ◽  
Care Needs ◽  
Patients With Cancer

59 Background: Cancer is one of the highest cost conditions in the United States, with growth in cancer costs outpacing general medical costs. This is troubling from a patient perspective. Patients with cancer experience significantly greater financial burdens compared with patients with other medical conditions. Many patients forgo or discontinue cancer treatment partly because they do not want to burden their families with significant debt. The growth of cancer and other medical costs is also threatening the health of the U.S. economy, prompting calls for the need for high-value practices. In healthcare, value indicates an achievement of patient outcomes proportional to the resources spent to achieve them. Increasing the provision of palliative care may be one way to achieve higher value care in cancer. Methods: We summarize the literature regarding palliative care, patient outcomes, and costs to assess the value of palliative care in advanced cancer. We also review the literature to identify reasons for low patient receipt of palliative care. Results: Palliative care represents a strong opportunity to improve the value of cancer care. Palliative care is associated with better informed and more satisfied patients and families, a reduction in use of undesired medical services, and does not pose a risk of increased mortality. Reasons for low rates of palliative care include a mismatch between how patients perceive palliative care and how physicians believe patients perceive palliative care, a lack of familiarity with locally-available palliative services, and a perceived incompatibility with cancer therapy. Conclusions: Palliative care for patients with cancer can improve the patient and family experience while maximizing value for the healthcare system and averting unnecessary patient financial burden. Systems redesign is needed in order to support oncologists in supporting the palliative care needs of their patients and realizing this high-value cancer care.

Patterns of palliative care utilization and end of life care in adult patients with cancer who died as inpatients at Mayo Clinic.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e21681-e21681
Author(s):  
Collin Thomas Zimmerman ◽  
Shivani S. Shinde ◽  
Pashtoon Murtaza Kasi ◽  
Mark Robert Litzow ◽  
Jeanne M. Huddleston
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Mayo Clinic ◽  
End Of Life Care ◽  
Adult Patients ◽  
Care Utilization ◽  
Life Care ◽  
Patients With Cancer

scholarly journals Palliative Care Needs of Patients With Cancer Living in the Community

2011 ◽  
Vol 7 (6) ◽  
pp. 382-388 ◽  
Author(s):  
Arif H. Kamal ◽  
Janet Bull ◽  
Dio Kavalieratos ◽  
Donald H. Taylor ◽  
William Downey ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Community Dwelling ◽  
Care Needs ◽  
Patients With Cancer ◽  
Palliative Care Needs

The authors describe the current palliative care needs of a population of community-dwelling patients with advanced cancer who are not yet ready for transition to hospice.

scholarly journals Desafios da enfermagem nos cuidados paliativos: revisão integrativa

2012 ◽  
Vol 3 (3) ◽  
pp. 127-130 ◽  
Author(s):  
Esleane Vilela Vasconcelos ◽  
Mary Elizabeth De Santana ◽  
Sílvio Éder Dias Da Silva
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Nursing Care ◽  
Integrative Review ◽  
Patients With Cancer ◽  
Care Issue ◽  
De Se ◽  
Cáncer Avanzado

Trata-se de uma revisão integrativa cujo objetivo é analisar as tendências do tema enfermagem nos cuidados paliativos no período de 2000 a 2011. O levantamento foi realizado nos bancos de dados da Biblioteca Virtual de Saúde: Lilacs e Medline. Na análise emergiram as seguintes categorias: o cuidado de enfermagem ao paciente com câncer avançado com 30 artigos e os cuidadores do paciente com câncer em seu domicilio com 15 artigos. Constatou-se que os estudos propiciaram apreender os aspectos do contexto psicossocial, tão importantes e necessários no sentido de se olhar mais atentamente a prática assistencial.Descritores: Enfermagem, Cuidados Paliativos, Cuidadores.Challenges in nursing hospice: Integrative reviewIt is an integrative review that aimed to analyze trends in nursing in palliative care issue in the period 2000 to 2011. The survey was conducted in the databases of the Virtual Health Library: Lilacs and Medline. The analysis yielded the following categories: Nursing care of patients with advanced cancer with 30 articles and caregivers of patients with cancer in his home with 15 articles. It was found that the studies led to grasp aspects of the psychosocial context, as important and necessary in order to look more closely at the practice.Descriptors: Nursing, Palliative Care, Caregivers.Desafíos en hospicio de enfermería: Revisión integradoraSe trata de una revisión integradora tiene como objetivo analizar las tendencias en enfermería en la cuestión de los cuidados paliativos en el período de 2000 a 2011. La encuesta se realizó en las bases de datos de la Biblioteca Virtual en Salud: LILACS y MEDLINE. El análisis arrojó las siguientes categorías: Cuidado de enfermería de los pacientes con cáncer avanzado, con 30 artículos y cuidadores de pacientes con cáncer en su casa con 15 artículos. Se encontró que los estudios lo llevaron a comprender los aspectos del contexto psicosocial, tan importante y necesario con el fin de observar más de cerca la práctica.Descriptores: Enfermería, Cuidados Paliativos, Los Cuidadores.

scholarly journals Quality Measures for Palliative Care in Patients With Cancer: A Systematic Review

2014 ◽  
Vol 10 (4) ◽  
pp. 281-287 ◽  
Author(s):  
Arif H. Kamal ◽  
Margaret Gradison ◽  
Jennifer M. Maguire ◽  
Donald Taylor ◽  
Amy P. Abernethy
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Adverse Effects ◽  
Advanced Cancer ◽  
Quality Measures ◽  
Social Distress ◽  
Patients With Cancer

Within quality measures for palliative care, there is often a focus on symptoms and adverse effects of therapy; little attention is given to other aspects of suffering observed in patients with advanced cancer, such as psychological and social distress.

Reducing the percent of ICU deaths of patients with advanced cancer at Stanford.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 234-234
Author(s):  
Pelin Cinar ◽  
Zarrina Bobokalonova ◽  
Eric Hadhazy ◽  
Sandy Chan ◽  
Holley Stallings
Keyword(s):  
Palliative Care ◽  
Solid Tumors ◽  
Advanced Cancer ◽  
Short Interval ◽  
Similar Rate ◽  
Advanced Stage ◽  
Early Palliative Care ◽  
Patients With Cancer ◽  
Pdsa Cycle ◽  
Stage Disease

234 Background: Intensive care at the end of life, for patients with advanced cancer can compromise quality of life and result in excessive costs for patients and their families. In 2014, 40% of patients with solid tumors admitted to the Stanford Health Care ICU died with advanced stage disease. Sixty-five percent of the patients with advanced stage saw palliative care (PC) < 7 days of life. The aim was to decrease the percent of advanced solid tumor ICU deaths by 25%, through early palliative care intervention. Methods: The current process was analyzed through mapping and a cause and effect diagram. The outcome measure was defined as percentage of patients with advanced solid tumors dying in ICU. A key intervention was the development of criteria designed to trigger an earlier PC referral for patients with stage III-IV lung/pancreatic cancer. PC referral triggers included: 2+ lines of prior chemotherapy with life expectancy < 6 months or refractory disease, hospitalization within prior 30 days, > 7days of hospitalization, uncontrolled symptoms. ICU trainees were to contact the primary oncologists and discuss the role of PC consultation for patients who met the criteria. A balance measure was developed to assess if primary oncologists were contacted. Charts of patients admitted to the ICU 2 weeks pre- and post-implementation were reviewed. Results: During the pre-PDSA cycle, 13 patients with cancer were admitted to the ICU while 10 were admitted post-PDSA cycle. Primary oncologists of the patients with advanced cancer who met our criteria were contacted in similar rate pre- and post-PDSA (39% vs 40%). PC consultation was also similar for pre- and post-PDSA cycles (31% vs 30%). The percent of ICU deaths of patients in the pre-PDSA was 22% and 22% in the post-PDSA cycles. Conclusions: The percentage of deaths in the ICU for patients with advanced cancer met our target goal of 25% reduction from the baseline. However, the improvement was independent of our intervention, given the timing and short interval. The percent of PC consults for patients meeting the criteria did not change. Data from subsequent PDSA cycles and a SPC chart will be reported in the conference.

Home parenteral nutrition versus artificial hydration in malnourished patients with cancer in palliative care: a prospective, cohort survival study

2020 ◽  
pp. bmjspcare-2020-002343
Author(s):  
Paolo Cotogni ◽  
Marta Ossola ◽  
Roberto Passera ◽  
Taira Monge ◽  
Maurizio Fadda ◽  
...  
Keyword(s):  
Palliative Care ◽  
Parenteral Nutrition ◽  
Advanced Cancer ◽  
Prospective Cohort ◽  
Home Parenteral Nutrition ◽  
University Hospital ◽  
Guideline Recommendation ◽  
Outcome Analysis ◽  
Patients With Cancer ◽  
Significant Difference

ObjectiveThe evidence base for home parenteral nutrition (HPN) in patients with advanced cancer is lacking. To compare the survival of malnourished patients with cancer undergoing palliative care who received HPN with a homogeneous group of patients, equally eligible for HPN, who did not receive HPN.DesignProspective, cohort study; tertiary university hospital, home care, hospice.MethodsPatients were assessed for HPN eligibility according to the guidelines. In the eligible population, who received both HPN and chemotherapy was excluded, while who received only HPN was included in the HPN+ group and who received neither HPN nor chemotherapy but artificial hydration (AH) was included in the HPN− group.Results301 patients were assessed for HPN eligibility and 86 patients (28.6%) were excluded for having severe organ dysfunction or Karnofsky performance status <50. In outcome analysis, 90 patients (29.9%) were excluded for receiving both HPN and chemotherapy, while 125 (41.5%) were included, 89 in HPN+ group (29.5%) and 36 in HPN− group (12%). The survival of the two groups showed a significant difference favouring patients receiving HPN (median overall survival: 4.3 vs 1.5 months, p<0.001). The multivariate analysis of the risk factors for mortality showed that not receiving HPN accounted for the strongest one (HR 25.72, 95% CI 13·65 to 48.44).ConclusionsComparative survival associated with the use of HPN versus AH showed significantly longer survival in malnourished patients with advanced cancer receiving HPN. These data support the guideline recommendation that HPN should be considered when malnutrition represents the overriding threat for the survival of these patients.

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.

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