scholarly journals 13 / FREQUENCY, OUTCOMES AND PREDICTIVE FACTORS ASSOCIATED WITH OPIOID-INDUCED NEUROTOXICITY FOR PATIENTS WITH ADVANCED CANCER RECEIVING PALLIATIVE CARE

2018 ◽  
Author(s):  
Kyu Hyoung Lim
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Predictive Factors ◽  
Factors Associated

scholarly journals Palliative Care and COVID-19 Pandemic: Retrospective Study of Factors Associated With Infection and Death at an Oncological Palliative Care Reference Center

2021 ◽  
pp. 104990912098696
Author(s):  
Livia Costa de Oliveira ◽  
Karla Santos da Costa Rosa ◽  
Ana Luísa Durante ◽  
Luciana de Oliveira Ramadas Rodrigues ◽  
Daianny Arrais de Oliveira da Cunha ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Tumor Type ◽  
Advanced Cancer Patients ◽  
Factors Associated ◽  
Reactive Protein

Background: Advanced cancer patients are part of a group likely to be more susceptible to COVID-19. Aims: To describe the profile of advanced cancer inpatients to an exclusive Palliative Care Unit (PCU) with the diagnosis of COVID-19, and to evaluate the factors associated with death in these cases. Design: Retrospective cohort study with data from advanced cancer inpatients to an exclusive PCU, from March to July 2020, with severe acute respiratory syndrome. Diagnostic of COVID-19 and death were the dependent variables. Logistic regression analyses were performed, with the odds ratio (OR) and 95% confidence interval (CI). Results: One hundred fifty-five patients were selected. The mean age was 60.9 (±13.4) years old and the most prevalent tumor type was breast (30.3%). Eighty-three (53.5%) patients had a diagnostic confirmation of COVID-19. Having diabetes mellitus (OR: 2.2; 95% CI: 1.1-6.6) and having received chemotherapy in less than 30 days before admission (OR: 3.8; 95% CI: 1.2-12.2) were associated factors to diagnosis of COVID-19. Among those infected, 81.9% died and, patients with Karnofsky Performance Status (KPS) < 30% (OR: 14.8; 95% CI 2.7-21.6) and C-reactive protein (CRP) >21.6mg/L (OR: 9.3; 95% CI 1.1-27.8), had a greater chance of achieving this outcome. Conclusion: Advanced cancer patients who underwent chemotherapy in less than 30 days before admission and who had diabetes mellitus were more likely to develop Coronavirus 2019 disease. Among the confirmed cases, those hospitalized with worse KPS and bigger CRP were more likely to die.

Personalized symptom goals in symptom assessment: A prospective multicenter study.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 190-190
Author(s):  
David Hui ◽  
Omar M. Shamieh ◽  
Carlos Eduardo Paiva ◽  
Pedro Emilio Perez-Cruz ◽  
Mary Ann Muckaden ◽  
...  
Keyword(s):  
Palliative Care ◽  
Logistic Regression ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
Well Being ◽  
Physical Symptoms ◽  
Multivariate Logistic Regression ◽  
Factors Associated ◽  
Symptom Intensity ◽  
Symptom Response

190 Background: PSG is a novel measure to assess treatment response in symptom management. In this multicenter prospective longitudinal observational study, we examined the PSG for 10 common symptoms in patients with advanced cancer, and identified the factors associated with PSG intensity and PSG response. Methods: We enrolled patients with advanced cancer seen at 5 outpatient palliative care clinics (USA, Jordan, Brazil, Chile and India). We assessed the intensity of 10 symptoms using the Edmonton Symptom Assessment Scale at first consultation visit and then a second visit 14-34 days later. We also assessed the PSG by asking patients “At what level would you feel comfortable with this symptom?” using the same 0-10 numeric rating scale for each symptom. Response was defined as symptom intensity ≤ PSG. We used multivariate logistic regression to determine factors associated with PSG intensity and PSG response. Results: 728 patients were enrolled from 5 palliative care clinics. The average age was 57 (range 19-85), 361 (50%) were female, and 29 (31%) were White. The medianPSG was 1/10 for nausea, 2/10 for depression, anxiety, drowsiness, well-being, dyspnea and sleep, and 3/10 for pain, fatigue, and appetite. In multivariate logistic regression, Asian ethnicity (odds ratio [OR] 2.4-8.2, P < 0.001), CAGE positivity (OR 1.7-2.3, P < 0.05) and higher baseline symptom intensity (ORs 1.08-1.15 per point, P < 0.03) were associated with PSG ≥ 2 for essentially all symptoms. At visit 2, 34%-73% of patients had a PSG response, which represents a significant improvement compared to the first visit (P < 0.05 except for depression, drowsiness and well-being). PSG response was associated with baseline PSG intensity (ORs 1.3-1.5 per point, P < 0.001) and ethnicity (P < 0.02) for physical symptoms, and male sex (ORs 1.45-1.65, P < 0.02) for psychological symptoms. Conclusions: PSG was 3 or lower for a majority of patients, and varied according to ethnicity, alcoholism and symptom intensity. PSG response allows clinicians and researchers to tailor treatment goals, while adjusting for individual differences in scale interpretation and factors associated with symptom response.

scholarly journals Predictors of the final place of care of patients with advanced cancer receiving integrated home-based palliative care: a retrospective cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ri Yin Tay ◽  
Rozenne W. K. Choo ◽  
Wah Ying Ong ◽  
Allyn Y. M. Hum
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Family Caregivers ◽  
Advanced Cancer ◽  
Terminal Care ◽  
Retrospective Cohort ◽  
Home Death ◽  
Factors Associated ◽  
Home Based ◽  
To Receive

Abstract Background Meeting patients’ preferences for place of care at the end-of-life is an indicator of quality palliative care. Understanding the key elements required for terminal care within an integrated model may inform policy and practice, and consequently increase the likelihood of meeting patients’ preferences. Hence, this study aimed to identify factors associated with the final place of care in patients with advanced cancer receiving integrated, home-based palliative care. Methods This retrospective cohort study included deceased adult patients with advanced cancer who were enrolled in the home-based palliative care service between January 2016 and December 2018. Patients with < 2 weeks’ enrollment in the home-based service, or ≤ 1-week duration at the final place of care, were excluded. The following information were retrieved from patients’ electronic medical records: patients’ and their families’ characteristics, care preferences, healthcare utilization, functional status (measured by the Palliative Performance Scale (PPSv2)), and symptom severity (measured by the Edmonton Symptom Assessment System). Multivariate logistic regression was employed to identify independent predictors of the final place of care. Kappa value was calculated to estimate the concordance between actual and preferred place of death. Results A total of 359 patients were included in the study. Home was the most common (58.2%) final place of care, followed by inpatient hospice (23.7%), and hospital (16.7%). Patients who were single or divorced (OR: 5.5; 95% CI: 1.1–27.8), or had older family caregivers (OR: 3.1; 95% CI: 1.1–8.8), PPSv2 score ≥ 40% (OR: 9.1; 95% CI: 3.3–24.8), pain score ≥ 2 (OR: 3.6; 95% CI: 1.3–9.8), and non-home death preference (OR: 23.8; 95% CI: 5.4–105.1), were more likely to receive terminal care in the inpatient hospice. Patients who were male (OR: 3.2; 95% CI: 1.0–9.9), or had PPSv2 score ≥ 40% (OR: 8.6; 95% CI: 2.9–26.0), pain score ≥ 2 (OR: 3.5; 95% CI: 1.2–10.3), and non-home death preference (OR: 9.8; 95% CI: 2.1–46.3), were more likely to be hospitalized. Goal-concordance was fair (72.6%, kappa = 0.39). Conclusions Higher functional status, greater pain intensity, and non-home death preference predicted institutionalization as the final place of care. Additionally, single or divorced patients with older family caregivers were more likely to receive terminal care in the inpatient hospice, while males were more likely to be hospitalized. Despite being part of an integrated care model, goal-concordance was sub-optimal. More comprehensive community networks and resources, enhanced pain control, and personalized care planning discussions, are recommended to better meet patients’ preferences for their final place of care. Future research could similarly examine factors associated with the final place of care in patients with advanced non-cancer conditions.

Predictors of palliative care (PC) referral for advanced cancer patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19613-e19613
Author(s):  
Kimberson Tanco ◽  
David Hui ◽  
Sun Hyun Kim ◽  
Jung Hye Kwon ◽  
Tao Zhang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Neck Cancer ◽  
Hematologic Malignancy ◽  
Gynecologic Cancer ◽  
Cancer Center ◽  
Factors Associated

e19613 Background: We previously examined factors associated with delayed PC referral. Little is known about the actual proportion of patients referred to PC. We determined the proportion of patients who had a PC consultation at our cancer center and the predictors of referral. Methods: All adult patients in the Houston area who died of advanced cancer between 9/1/2009 and 2/28/2010 while under the care of our institution were included. We collected baseline demographics and data on PC referral. Multivariate logistic regression was used to examine factors associated with PC referral. Results: 386/912 (42%) decedents had a PC referral, and 179 (46%) were seen initially as outpatients. In multivariate analysis, PC referral was associated with younger age (odds ratio (OR) 0.98 per year; 95% confidence interval (CI) 0.97-0.99; P<0.001), married status (OR 1.5; 1.1-2.0; P=0.005), and gynecologic cancer (OR 1.9, 1.1-3.5, P=0.02 relative to lung). Among patients with a PC referral, outpatient consultation was more likely among patients with head and neck cancer (OR=5.5, 1.7-17.6, P=0.004 relative to lung). In contrast, hematologic malignancy was associated with decreased PC referral (OR=0.59, 0.36-0.97, P=0.04), fewer outpatient PC consultations (OR=0.3, 0.1-0.7, P=0.01) and less time from referral to death (Table). Conclusions: Younger, married patients and those with gynecologic cancer were more like to be referred to palliative care. Head and neck cancer patients were more often seen as PC outpatients. Patients with hematologic malignancies had fewer PC referrals and often late in the disease trajectory compared to patients with solid tumors. [Table: see text]

Association between feeling of well-being and overall survival in advanced lung or non-colonic gastrointestinal patients receiving palliative care.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 199-199
Author(s):  
Sriram Yennu ◽  
Yu Jung Kim ◽  
Yi Zhang ◽  
Ji Chan Park ◽  
David Hui ◽  
...  
Keyword(s):  
Palliative Care ◽  
Overall Survival ◽  
Advanced Cancer ◽  
Independent Predictor ◽  
Well Being ◽  
Assessment System ◽  
Advanced Lung Cancer ◽  
Factors Associated ◽  
Patient Reported ◽  
Family Distress

199 Background: The aim of this study was to determine the association between feeling of well-being (FWB, 0= best, 10= worst) and overall survival in advanced lung or non-colonic gastrointestinal patients who were referred to an outpatient palliative care clinic (OPC). We also determined the predictors of severity of moderate or severe - feeling of well-being in advanced lung or non-colonic gastrointestinal patients presenting to palliative care. Methods: We reviewed the records of consecutive patients with incurable advanced lung cancer and non-colonic gastrointestinal cancer presenting to OPC. Edmonton Symptom Assessment System (ESAS) scores were obtained at the initial visit between from Jan. 1, 2008-Dec. 31, 2013. Descriptive statistics were used to summarize patient characteristics. Clinically significant FWB was defined as ≥4/10. Overall Survival (OS) was calculated from the time of diagnosis of advanced cancer to death or last contact. Univariate analyses were performed and only significant variables were included in multivariate regression analysis to determine factors associated with severity OF FWB. Results: A total of 826 evaluable patients were analyzed (median age, 62 years; 57% male). Median ESAS FWB scores was 5 IQR (3-7). Worse FWB was significantly associated with OS (months) 6.33 (5.03, 8) vs 4.2 (3.37, 4.67) P=0.0003, from the time of diagnosis of advanced cancer. The final model of the Backwards Stepwise regression of factors associated with OS found that FWB (HR 1.09, p=0.3) was not an independent predictor of OS. ESAS FWB was significantly associated with ESAS fatigue (OR 2.31, p<0.001); anxiety (OR 1.98, p<0.001); anorexia (OR 2.31, p<0.001); CAGE positivity [alcoholism] (HR 1.80, p=0.008); and family distress (HR 1.93, p=0.002). Conclusions: Worse ESAS FWB showed univariate association with OS but it does not appear to be an independent predictor of OS when controlling for other known predictors. ESAS FWB was significantly associated with fatigue, anxiety, anorexia, CAGE positivity, and family distress, suggests that ESAS FWB may be a multidimensional screening measure for patient reported health related quality of life.

Symptom Prevalence and Place of Death Preference in Advanced Cancer Patients: Factors Associated With the Achievement of Home Death

2021 ◽  
pp. 104990912110487
Author(s):  
Julia Fee Voon Ho ◽  
Nur Syafiqah Marzuki ◽  
Nur Syuhadah Monica Meseng ◽  
Viknaswary Kaneisan ◽  
Yin Khek Lum ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Place Of Death ◽  
Hospital Death ◽  
Advanced Cancer Patients ◽  
Home Death ◽  
Factors Associated ◽  
Symptom Prevalence

Objectives: Achievement of patients’ preferred place of death is recognized as a component of a good death. This study aimed to investigate the symptom burden in advanced cancer patients, achievement of their place of death preferences and factors associated with home death. Methods: In this retrospective review of 287 patient deaths, we examined patients’ symptom prevalence, preferred and actual place of death and achievement of their place of death preferences using descriptive statistics. Associations between patient factors, home death preference and actual home death were further analyzed using multivariate logistic regression. Results: The most prevalent symptoms were weakness, pain and poor appetite, with a mean of 5.77(SD: 2.37) symptoms per patient. The median interval from palliative care referral to death was 21 (IQR: 74) days. Of the 253 patients with documented place of death preference, 132 (52.1%) preferred home death, 111(43.9%) preferred hospital death, 1 (0.4%) preferred to die at a temple and 9(3.6%) expressed no preference. Overall, 221 of 241(91.7%) patients with known actual place of death achieved their preference. Older patients were more likely to prefer home death (OR 1.021; 95% CI 1.004-1.039, p = 0.018) and die at home (OR 1.023; 95% CI 1.005-1.041, p = 0.014). Gender, marital status, cancer diagnosis and symptoms were not associated with preference for or actual home death. Conclusion: Despite a high symptom burden, most patients preferred and achieved a home death. Late palliative care referral and difficult symptom management contributed to failure to fulfill home death preference. Preference for home death should be considered when managing terminally ill geriatric patients.

Factors Associated with Early Referral to Palliative Care in Outpatients with Advanced Cancer

2018 ◽  
Vol 21 (9) ◽  
pp. 1322-1328 ◽  
Author(s):  
Deepa Wadhwa ◽  
Gordana Popovic ◽  
Ashley Pope ◽  
Nadia Swami ◽  
Lisa W. Le ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Early Referral ◽  
Factors Associated

scholarly journals The desire to hasten death in advanced cancer patients at a Mexican palliative care service

Salud Mental ◽  
2019 ◽  
Vol 42 (3) ◽  
pp. 103-109 ◽  
Author(s):  
Oscar Rodríguez-Mayoral ◽  
Leticia Ascencio-Huertas ◽  
Emma Verástegui ◽  
Marvin O. Delgado-Guay ◽  
Silvia Allende-Pérez
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Assisted Suicide ◽  
Palliative Care Service ◽  
Physical Symptoms ◽  
Advanced Cancer Patients ◽  
Care Clinic ◽  
Factors Associated ◽  
Cancer Multiple

Introduction. The desire to hasten death (DHD) might be present in patients with advanced cancer. Multiple distressing physical and psychosocial symptoms may be related to it. There is limited literature about the characteristics of these patients in México. Objective. To describe the prevalence and factors associated with DHD in advanced cancer patients evaluated by a palliative care psychiatrist. Method. We conducted a cross-sectional study, including all patients referred to psychiatric assessment at the Servicio de Cuidados Paliativos of the Instituto Nacional de Cancerología in Mexico City, from January to December 2016. DHD was defined as the presence of death ideas, suicidal ideation, and/or request for euthanasia or medically assisted suicide. Patients with delirium, dementia, psychosis, or uncontrolled physical symptoms were excluded. Results. Sixty-four patients were included in the study. Most of them were women (59%); the mean age was 49 years old (SD = 16). Of them, 64% met criteria for a major depressive disorder, 64% for generalized anxiety disorder and/or panic disorder, and 11% for substance use disorders. 44% expressed DHD. In a multivariate regression analysis predicting DHD, only one factor emerged: clinical depression (OR = 13.5, p = .002, 95% CI [02.562, 71.726]). Discussion and conclusion. The desire to hasten death is a frequent issue for the patients evaluated at the psychiatric palliative care clinic. Depression and other distressing psychiatric pathologies were associated with DHD. Interdisciplinary interventions are needed to treat DHD. More research is warranted in order to understand the factors associated with the expression of DHD.

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