Supportive and Palliative Oncology—A New Paradigm for Comprehensive Cancer Care

2013 ◽  
Vol 09 (01) ◽  
pp. 68 ◽  
Author(s):  
David Hui ◽  
Eduardo Bruera ◽  
◽  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Life Quality ◽  
Symptom Burden ◽  
Tumor Burden ◽  
Cost Of Care ◽  
New Paradigm ◽  
Interprofessional Teamwork

Patients with advanced cancer often experience symptoms related to increasing tumor burden, cancer treatments, and psychosocial stressors. They also have significant social, informational, and decision-making needs. Palliative care practitioners have developed expertise to address many of these supportive care concerns through interprofessional teamwork, validated assessments, multidimensional interventions, and frequent communication. In this article, we aim to provide an evidence-based update on several important palliative care topics, including management of pain, fatigue, anorexia–cachexia, depression, and anxiety, as well as patient–clinician communication and decision-making. Multiple randomized controlled trials have demonstrated that palliative care can improve symptom burden, quality of life, quality of care, satisfaction, and possibly survival and cost of care. To enhance the level of care for patients with advanced cancer, oncologists need to have a good working knowledge of the major palliative care principles, and to refer patients to palliative care programs often and early in the disease trajectory.

Supportive and palliative care

2016 ◽  
pp. 293-301
Author(s):  
David Hui ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Life Quality ◽  
Symptom Burden ◽  
Cost Of Care ◽  
Care Needs ◽  
Palliative Care Teams ◽  
Information And Communication ◽  
Cancer Experience

Patients with advanced cancer experience significant symptom burden as a result of disease progression, anti-neoplastic therapies and various psychosocial factors. Furthermore, they are often faced with complex decisions regarding information and communication. Palliative care is a professional specialty that specifically addresses patients’ and their families’ supportive care needs through validated assessments, evidence-based interventions, impeccable communication, and collaborative teamwork. Palliative care involvement is associated with improved symptom burden, quality of life, quality of care, satisfaction, and possibly survival and cost of care. In this chapter, we describe the structure, processes, and outcomes of palliative care, and discuss contemporary models of integration between oncology and palliative care. We will also discuss the latest insights into management of cancer pain, fatigue, and depression. Oncologists equipped with basic palliative care skills can deliver effective front-line supportive care. Patients in distress may also benefit from early referral to specialist palliative care teams.

Early Palliative Care for Patients with Advanced Cancer (DRAFT)

2018 ◽  
Author(s):  
David Hui
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Controlled Trial ◽  
Symptom Burden ◽  
Early Palliative Care ◽  
Key Points ◽  
Oncology Care ◽  
Cluster Randomized ◽  
Study Intervention

This chapter discusses the Zimmermann trial, a large partially blinded, cluster randomized controlled trial of routine oncology care with or without early routine referral to palliative care. This landmark study found that early palliative care involvement was associated with improved quality of life, symptom burden and satisfaction among patients with advanced cancer. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case to illustrate some key points around palliative care referral.

Palliative care utilization in oncology patients with 30-day hospital readmission.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 110-110
Author(s):  
Chintan Pandya ◽  
Gradon Nielsen ◽  
John Hu ◽  
Jodi Ram ◽  
Cheryl Rozario ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Hospital Readmissions ◽  
Cost Of Care ◽  
Care Utilization ◽  
Advanced Cancer Patients ◽  
Discharge Disposition

110 Background: Reducing the rate of hospital readmissions is an important aspect of improving quality of life and cost of care for patients with advanced cancer. Early Palliative Care (PC) has been shown to improve quality of life and downstream healthcare utilization in patients with advanced cancer. The aim of this study was to examine palliative care (PC) utilization and factors associated with 30-day readmission in cancer patients. Methods: All patients with 30 day readmissions to the inpatient oncology service at the Wilmot Cancer Institute from July 2015-June 2016 were identified. Chart reviews were conducted to determine primary cancer stage and type; reason for, length of stay and discharge disposition (e.g. discharged on hospice, deceased) for index and readmission; potential preventability of readmission; and if and when the patient had met with PC. Results: A total of thirty-nine patients experienced a 30-day readmission, with 95% of patients having stage IV disease and 77% having a primary lung or GI malignancy. Most patients (74%) had not met with PC at the time of the index admission and 49% of patients had not met with PC by the time of readmission. Forty one percent (N = 17) of patients either died during readmission or were discharged on hospice. Forty one percent (N = 7) of those that died during readmission or were discharged on hospice did not meet with palliative care. Forty four percent of readmissions were classified as potentially preventable. Conclusions: Nearly half of all advanced cancer patients had not met with PC by the time of their readmission. Upon readmission, many patients were either discharged to hospice or died, suggesting that patients with advanced cancer could benefit from earlier PC. Increased and improved patient-oncologist PC communication, including referrals to PC specialists, may reduce readmission rates for patients with advanced cancer.

scholarly journals Advance care planning in patients with advanced cancer: A 6-country, cluster-randomised clinical trial

PLoS Medicine ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. e1003422
Author(s):  
Ida J. Korfage ◽  
Giulia Carreras ◽  
Caroline M. Arnfeldt Christensen ◽  
Pascalle Billekens ◽  
Louise Bramley ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Care Planning ◽  
Shared Decision ◽  
Specialist Palliative Care ◽  
Cluster Randomised ◽  
Advance Care

Background Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. Methods and findings To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015–2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0–3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients’ age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients’ quality of life did not differ between intervention and control groups (T-score −1.8 versus −0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. Conclusions Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed. Trial registration ISRCTN registry ISRCTN63110516.

scholarly journals Advanced cancer and COVID-19 comorbidity: medical oncology-palliative medicine ethics meetings in a comprehensive cancer centre

2021 ◽  
pp. bmjspcare-2021-002946
Author(s):  
Laura Thery ◽  
Pauline Vaflard ◽  
Perrine Vuagnat ◽  
Ophélie Soulie ◽  
Sylvie Dolbeault ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Intensive Care ◽  
Advanced Cancer ◽  
Ethics Committee ◽  
Decision Making Process ◽  
Ethical Guidelines ◽  
Institutional Ethics ◽  
Palliative Care Teams

ObjectivesIn managing patients with cancer in the COVID-19 era, clinical oncologists and palliative care practitioners had to face new, disrupting and complex medical situations, challenging the quality of the shared decision-making process. During the first lockdown in France, we developed an onco-palliative ethics meeting to enhance the quality of the decision-making process for patients with advanced cancer treated for COVID-19.MethodsA least one of the institutional ethics committee members was present along with oncologists, palliative care teams, psycho-oncologists, radiologists and intensive care specialists. Specific medical parameters were systematically collected to form a standardised framework for the discussions.ResultsThe main raised issues were the definition of new criteria for the implementation of invasive resuscitation techniques, optimal ways to adapt or delay anticancer treatment and best procedures to address terminal respiratory failure and end-of-life care. The main clinical and ethical guidelines that emerged during these debates are presented. The palliative care team played a major role in assessing and reporting patients’ awareness of cancer-related prognosis and their wishes concerning invasive therapies or transfer to intensive care units, enabling an individualised benefit–risk balance assessment. The ethics committee members ensured continuous monitoring during the discussions. Their function was to recall the main ethical principles including dignity, which is conferred on people when there are treated as having equal status.ConclusionsThe onco-palliative ethics meeting provided a powerful avenue for improvement of collegiality and reinforcement of teamwork, which could be a major protection against burnout for healthcare professionals facing an epidemic onslaught.

scholarly journals Integrated outpatient palliative care for patients with advanced cancer: A systematic review and meta-analysis

2018 ◽  
Vol 33 (2) ◽  
pp. 123-134 ◽  
Author(s):  
Jessica J Fulton ◽  
Thomas W LeBlanc ◽  
Toni M Cutson ◽  
Kathryn N Porter Starr ◽  
Arif Kamal ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Healthcare Utilization ◽  
Advanced Cancer ◽  
Meta Analysis ◽  
Symptom Burden ◽  
Short Term ◽  
Randomized Controlled ◽  
Oncology Care

Background: Despite increasing emphasis on integration of palliative care with disease-directed care for advanced cancer, the nature of this integration and its effects on patient and caregiver outcomes are not well-understood. Aim: We evaluated the effects of integrated outpatient palliative and oncology care for advanced cancer on patient and caregiver outcomes. Design: Following a standard protocol (PROSPERO: CRD42017057541), investigators independently screened reports to identify randomized controlled trials or quasi-experimental studies that evaluated the effect of integrated outpatient palliative and oncology care interventions on quality of life, survival, and healthcare utilization among adults with advanced cancer. Data were synthesized using random-effects meta-analyses, supplemented with qualitative methods when necessary. Data sources: English-language peer-reviewed publications in PubMed, CINAHL, and Cochrane Central through November 2016. We subsequently updated our PubMed search through July 2018. Results: Eight randomized-controlled and two cluster-randomized trials were included. Most patients had multiple advanced cancers, with median time from diagnosis or recurrence to enrollment ranging from 8 to 12 weeks. All interventions included a multidisciplinary team, were classified as “moderately integrated,” and addressed physical and psychological symptoms. In a meta-analysis, short-term quality of life improved, symptom burden improved, and all-cause mortality decreased. Qualitative analyses revealed no association between integration elements, palliative care intervention elements, and intervention impact. Utilization and caregiver outcomes were often not reported. Conclusions: Moderately integrated palliative and oncology outpatient interventions had positive effects on short-term quality of life, symptom burden, and survival. Evidence for effects on healthcare utilization and caregiver outcomes remains sparse.

Factors associated with quality of life in a cohort of patients with palliative advanced cancer from a developing country: Relevance of perception of cancer curability.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 93-93
Author(s):  
Pedro Emilio Perez-Cruz ◽  
Paola Langer ◽  
Cecilia Carrasco Escarate ◽  
Pilar Bonati ◽  
Bogomila Batic ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Developing Countries ◽  
Developing Country ◽  
Advanced Cancer ◽  
Public Hospital ◽  
Symptom Burden ◽  
Factors Associated ◽  
Symptom Intensity

93 Background: Improving quality of life (QOL) is a key goal in palliative care for patients with advanced cancer. Most studies about QOL in palliative care patients have been performed in the developed world. However, little is known about the factors that influence patients QOL in developing countries. The aim of this study is to describe factors associated with QOL in a cohort of patients with advanced cancer who were enrolled in the outpatient clinic public hospital in Santiago, Chile. Methods: Patients with advanced cancer admitted to the National Program of Palliative Care at a public Hospital in Santiago, Chile were prospectively enrolled in a study to assess QOL longitudinally. QOL was assessed with the EORTC-QLQ-PAL 15 questionnaire. Demographics, symptom intensity, depression and anxiety were assessed. Descriptive statistics and regression analysis were performed. Information about cancer curability and perception of personal health were also included. Results: In this preliminary report, the first 37 patients were included. Baseline characteristics were: mean patient age was 64, 21 (57%) females, 14 (38%) had GI cancer, 7 (19%) lung cancer, 4 (11%) breast cancer and 12 (22%) other. Mean (SD) QOL was 63 (34) in a 0 to 100 scale. QOL was not associated with age, gender, functionality, depression, anxiety, spiritual pain or financial distress. QOL was negatively associated with total symptom burden (coef -.53, p = .48), and positively associated with believing that cancer was curable (coef 33.3, p = .003). In a multivariate analysis, QOL was independently associated with both lower overall symptom burden (coef -.55, p = .38) and believing that cancer was curable (coef 28.6, p = .009). Conclusions: In palliative care patients with advanced cancer from a developing country, QOL was associated with lower overall symptom burden and with believing that cancer was curable. Further studies are needed to explore whether clarifying prognostic information about cancer curability in developing countries may impact patients’ QOL.

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.

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