What Keeps Oncologists From Addressing Palliative Care Early on With Incurable Cancer Patients? An Active Stance Seems Key

Objective: The primary aim of the present article was to identify palliative care patient populations who are willing to participate in and able to complete a group exercise/physical training program designed specifically for the individual patient.Method: We conducted a prospective phase II intervention study examining the willingness and ability of palliative care cancer patients to participate in a group exercise physical training program. Patients who were diagnosed with incurable cancer and had a life expectancy of less than 1 year at two outpatient clinics were invited to participate in an exercise program in the hospitals. The groups met twice a week over a 6-week period.Results: One hundred one consecutive patients were asked for inclusion. Sixty-three patients agreed to participate. Sixteen (25%) of the 63 patients dropped out after consent was given, but before the program started due to medical problems, social reasons, or death. Thus, 47 patients started the exercise program. Thirteen patients withdrew during the program due to sudden death, medical problems, or social reasons. The most frequent reasons for withdrawal were increased pain or other symptoms. Thirty-four patients completed the exercise program.Significance of results: A high proportion of incurable cancer patients were willing to participate (63%) in a structured exercise program. The attrition rate was high, but despite being severely ill, 54% of the patients completed the exercise period. This shows that a physical exercise program tailored to the individual patient is feasible in this population.

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ARRANGEMENT OF WORK AT PALLIATIVE CARE DEPARTMENT IN ALMETYEVSK BRANCH OF THE REPUBLICAN CLINICAL ONCOLOGICAL DISPENSARY OF THE MINISTRY OF HEALTH OF TATARSTAN REPUBLIC

Siberian Journal of Oncology ◽

10.21294/1814-4861-2018-17-5-72-76 ◽

2018 ◽

Vol 17 (5) ◽

pp. 72-76

Author(s):

F. Sh. Akhmetzyanov ◽

I. I. Khayrullin ◽

R. А. Gazizov ◽

S. A. Karamalikov ◽

I. V. Shaimardanov

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Pain Syndrome ◽

Incurable Cancer ◽

Quality Cancer Care ◽

Relief Of Suffering ◽

The Russian Federation ◽

The Republic ◽

Oncology Center

In the Russian Federation, the incidence of cancer diagnosed at an advanced stage still remains high. A majority of patients (75 %) present with an advanced disease. The goal of palliative care is achievement of the best quality of life and relief of suffering of cancer patients. However, today there is no single model of palliative care.The aim of the studywas to analyze the activities of the Department of Palliative Care of Almetyevsky Branch of the Republican Clinical Oncology Center of the Republic of Tatarstan.Material and methods.The Palliative Service of the Republic of Tatarstan is unites several institutions, including the Almetyevsky branch of the Republican Clinical Oncological Dispensary, which was organized in 2015. Based on the population of Almetyevsky region, there are two medical outreach teams.Results.Between 2016 and 2017, 1 025 patients received palliative care at home, and 6 625 visits were made. Pain syndrome was the most common reason for admission (more than 80 %) followed by depression (more than 80 %), disability disorders (more than 40 %), insomnia (25 %), dyspnea (22 %), and impaired consciousness (5 %). As a result of the creation of this service, a decrease in the number of ambulance visits to patients was recorded: from 92 to 12 % for the reason of severe intolerable pain, from 75 to 6.6 % due to moderate pain and from 6.7 to 0, 3 % due to mild pain. The incidence of unjustified hospital stay decreased by 28 %.Conclusion.Organization of the team of professionals invoplved in providing high-quality cancer care in Almetyevsk helped to improve the quality of palliative care for incurable cancer patients.

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The Relationship Between Symptom Severity and Caregiver Burden in Cancer Patients Under Palliative Care: A Cross-Sectional Study

Journal of Palliative Care ◽

10.1177/08258597211045780 ◽

2021 ◽

pp. 082585972110457

Author(s):

Emir Celik ◽

Muhammed Samil Aslan ◽

Nilay Sengul Samanci ◽

Mehmet Karadag ◽

Tarik Saglam ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Caregiver Burden ◽

Symptom Severity ◽

Well Being ◽

Cross Sectional Study ◽

Sectional Study ◽

Incurable Cancer ◽

Cross Sectional ◽

Mean Values

Introduction Hospitalization is a stressful experience both for primary caregivers (PCs) and cancer patients alike. Although there is significant evidence that PCs of cancer patients can experience significant caregiver burden (CB), less is known about the relationships between PCs and patient symptom severity that influence CB. Methods: In this cross-sectional study, measures of the symptom severity were obtained from cancer patients. The PCs were assessed for CB. Associations between patients' symptoms and demographic characteristics and CB were investigated using multivariate analyses. Results: A total of 98 participants (patient-caregiver dyads) filled the questionnaires. According to the Zarit Burden Interview results, 65.3% of PCs had a high CB. Pain, tiredness, nausea, depression, drowsiness, well-being, and dyspnea had significantly higher mean values in those with high CB (p < .05). Financial difficulties, first-degree relationships with the patient, higher anxiety levels, and more pronounced tiredness appear to be the variables most predictive with high CB. Conclusion: In conclusion, the present study showed CB of PCs among a group of hospitalized incurable cancer patients. PCs of more symptomatic cancer patients had a higher CB, according to our findings. This emphasized the significance of palliative care. Appropriate guidance should be provided for the psychostress caused by the CB.

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Appropriate Referral Timing To Specialized Palliative Care Service: Survey of Bereaved Families of Cancer Patients Who Died in Palliative Care Units

10.21203/rs.3.rs-585422/v1 ◽

2021 ◽

Author(s):

Keita Tagami ◽

Kento Masukawa ◽

Akira Inoue ◽

Tatsuya Morita ◽

Yusuke Hiratsuka ◽

...

Keyword(s):

Palliative Care ◽

Cancer Treatment ◽

Cancer Patients ◽

Care Service ◽

Palliative Care Service ◽

Death Process ◽

Incurable Cancer ◽

Anti Cancer ◽

Specialized Palliative Care ◽

Palliative Care Units

Abstract Few studies have investigated appropriate referral timing of specialized palliative care (SPC) from the perspective of cancer patients’ and families’ experiences. We aimed to clarify appropriate SPC referral timing for patients with advanced cancer and their families. We used data from a nationwide bereaved family survey in Japan. We sent a questionnaire to 999 bereaved families of cancer patients who died in 164 palliative care units (PCUs) and analyzed the first SPC referral timing and how patients evaluated it. We defined SPC as outpatient or inpatient palliative care service comprising certified palliative care physicians, advanced-practice nurses, and multidisciplinary practitioners. Finally, 51.6% (n = 515) of all responses were analyzed. The SPC referral timing was evaluated as appropriate (26.1%), late or too late (20.2%), early or too early (1.2%), and none of these (52.5%). Of these, 32.3% reported that they were referred to an SPC when diagnosed with advanced or incurable cancer or during anti-cancer treatment, and 62.6% reported they were referred after anti-cancer treatment. Patient-perceived appropriateness of SPC referral timing was associated with their good death process. After excluding “none of these” responses, a significantly higher proportion of respondents who reported being referred to SPC at diagnosis and during anti-cancer treatment evaluated the response timing as appropriate, compared to those who reported being referred after anti-cancer treatment. Appropriate timing for SPC referrals relates to quality of death; findings suggest that appropriate timing is at the time of diagnosis or during anti-cancer treatment.

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The psychological distress and psychic phenomena in cancer patients during palliative care

Psychosomatic Medicine and General Practice ◽

10.26766/pmgp.v1i1.13 ◽

2016 ◽

Vol 1 (1) ◽

pp. 010113

Author(s):

Inna Mukharovska

Keyword(s):

Palliative Care ◽

Psychological Distress ◽

Cancer Patients ◽

Mental Distress ◽

Palliative Therapy ◽

Well Being ◽

Psychological Needs ◽

Second Phase ◽

Incurable Cancer ◽

Psychological Phenomena

Background The diagnostic cancer in incurable stages, the transition to palliative care because of disease progression are significant psychological challenge for the patient. Psychological help for cancer patients during palliative treatment are no less important than medical therapy. Methods The study conducted at the Kyiv City Clinical Cancer Center during the 2012 - 2013 years in two phases. In first phase provided psychological investigation psychological condition of incurable cancer patients and its dynamics during palliative therapy with followed qualitative analysis of the data – participated 436 patients. Second phase included determining factors of psychological maladjustment and evaluation intensity of mental distress – participated 63 palliative cancer patients. The SCL-90r used for assessment of psychic distress. Results The prominent psychopathological symptoms in incurable cancer patients were somatization, depression and nonspecific symptoms. Less pronounced signs of mental distress in descending order of severity were anxiety, hostility, paranoid ideation, interpersonal sensitivity, obsessive-compulsive, psychoticism and phobic anxiety. Factors of psychological distress in cancer patients during palliative care include high physical distress; the impossibility of total control on physical and psychological symptoms; chronic pain; progressive deterioration of physical well-being; need to use opioids for relief pain; need for help; existential nature of stress; individual psychological characteristics. In patients identified psychological phenomena related to the palliative phase of treatment: psychological induction "pendulum", externalizing of mental stress, decentralization. Conclusion Cancer patients in the palliative stage of treatment experiencing intensive psychological distress and clinically constitute a special group with specific psychological needs, which need to be consider in providing psychological care.

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Access to Palliative Care for Critically Ill Cancer Patients in Mexico

Journal of Palliative Care ◽

10.1177/08258597211014365 ◽

2021 ◽

pp. 082585972110143

Author(s):

Silvio A. Ñamendys-Silva ◽

Adán R. López-Zamora ◽

Bertha M. Córdova-Sánchez ◽

Luis A. Sánchez-Hurtado ◽

Francisco J. García-Guillén ◽

...

Keyword(s):

Palliative Care ◽

Risk Factor ◽

Intensive Care ◽

Cancer Patients ◽

Critically Ill ◽

Palliative Care Team ◽

Care Team ◽

Incurable Cancer ◽

Qsofa Score

Objective: To determine the outcomes of hospitalized cancer patients requiring intensive care unit (ICU) intervention and receiving palliative care. Materials and Methods: An observational retrospective study was completed at a single academic critical care unit in Mexico City. All hospitalized cancer patients who were evaluated by the intensive care team to assess need for ICU were included between January and December 2018. Results: During the study period, the ICU group made 408 assessments of critically ill cancer patients in noncritical hospitalized areas. In total, 24.2% (99/408) of the patients in this population were consulted by the palliative care team. Of the patients evaluated, 46.5% (190/408) had advanced stage, but only 28.4% were receiving care by the palliative care team. The only risk factor for hospital mortality in the multivariate analysis was the quick Sequential Organ Failure Assessment (qSOFA) score at the time of the consultation by the ICU group (HR = 2.10, 95% CI = 1.34-3.29, p = 0.001). The median time between palliative care consultation and death was 3 days (IQR = 2-22). A total of 63% (37/58) of patients who were discharged from the hospital died during follow-up. The median follow-up time was 55 days (95% CI = 26.9-83.0). The overall mortality rate for the entire group during hospitalization and after hospital discharge was 80.8% (80/99). Conclusion: Fewer than 3 out of 10 hospitalized cancer patients requiring admission to the ICU were evaluated by the palliative care team despite having incurable cancer. The qSOFA score of patients at the time of the ICU consultation was the only risk factor for mortality during hospitalization. Future research efforts in Mexico should focus on earlier integration of palliation care with usual oncology care in incurable cancer patients.

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