scholarly journals 09 - EFFICACY OF STEROID THERAPY FOR END-OF-LIFE TREATMENT IN PATIENTS WITH ADVANCED LUNG CANCER TRANSFERRED TO PALLIATIVE CARE UNIT

2019 ◽  
Author(s):  
Hironobu Kanazawa ◽  
Hitomi Sakamoto
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
End Of Life ◽  
Steroid Therapy ◽  
Palliative Care Unit ◽  
Advanced Lung Cancer ◽  
End Of Life Treatment

Impact of a mature palliative service for patients with lung cancer admitted to the ICU.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 102-102
Author(s):  
Brian James Smith ◽  
Suzanne Jermstad ◽  
Susan Yun ◽  
Judie R. Goodman
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
End Of Life ◽  
Terminally Ill ◽  
Stage Iv ◽  
Stage Iii ◽  
Advanced Lung Cancer ◽  
Code Status ◽  
Palliative Care Consultation ◽  
Care Consultation

102 Background: In 2012 ASCO made the clinical recommendation for patients with stage IV solid organ cancer to receive palliative care consultation (PCC) at the time of detection. This was intended to increase utilization and effectiveness of palliative care. In this study, we estimate the proportion and impact of late "brink of death" PCC for patients with stage III-IV lung cancer admitted to the ICU of a hospital with a Joint Commission approved palliative care program. Methods: Retrospective review of patients with advanced lung cancer (stage III-IV) admitted to ICU in 2015-17. IRB approval was obtained. There were no exclusion criteria within this population. Areas assessed were age, stage, reason for admission, interventions, disposition, length of stay, days in the intensive care unit, palliative care consultation, code status, and documented end of life discussion. Results: A total of 13 patient met inclusion criteria. They were 38% male 62% female with a mean age of 67 years (SD: 14.9). All had prior diagnosis of advanced lung cancer and 92% were stage IV. The most common indication for admission was sepsis (38%). Less than half (46%) had a PCC, and fewer (31%) had a documented end of life care discussion. Even in the minority of patients with PCC, 33% received the PCC on day of death. Full code status was maintained in 77%. 53% expired during admission with only 57% of those that died having palliative care discussion. Conclusions: Even in a mature TJC certified PCC program, less than half of these terminally ill patients received a PCC. There is a chasm between ASCO's goal of early PCC and the reality of palliative care utilization in ICU admitted patients with advanced lung cancer. A possible solution is to initiate triggered palliative consultation for this high mortality population upon admission, with possible expansion to other terminally ill groups. In a world of electronic medical records, it should be possible to arrange a system to flag these patients for direct review by the palliative team to determine appropriateness and then notify the primary team in order to coordinate care.[Table: see text]

Quality of Life in Patients With Advanced Lung Cancer Treated at Home and at a Palliative Care Unit

2011 ◽  
Vol 29 (5) ◽  
pp. 379-387 ◽  
Author(s):  
Wojciech Leppert ◽  
Anna Turska ◽  
Mikolaj Majkowicz ◽  
Sylwia Dziegielewska ◽  
Piotr Pankiewicz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Palliative Care ◽  
Palliative Care Unit ◽  
Advanced Lung Cancer ◽  
Lung Cancer Patients ◽  
Assess Quality ◽  
Eortc Qlq ◽  
At Home

Background: To assess quality of life (QOL) in patients with advanced lung cancer. Patients and Methods: A prospective study of 78 patients cared at home and at a palliative care unit (PCU) with 2 QOL assessments was conducted. Results: Fifty patients completed the study. In the EORTC QLQ-C30 role, cognitive, social functioning, global QOL, fatigue, pain, dyspnea, and appetite deteriorated; nausea/vomiting improved; dyspnea was more intense in the case of in-home patients. In the EORTC QLQ-LC13 hemoptysis improved; pain in other parts was more intense in the PCU patients. Pain (Visual Analogue scale) was more intense in the PCU patients; the level of activity (Karnofsky) decreased in the case of patients treated at home. Conclusions: QOL deteriorated with few differences between home and the PCU patients.

scholarly journals Association of Palliative Care Use and Setting With Health-care Utilization and Quality of Care at the End of Life Among Patients With Advanced Lung Cancer

CHEST Journal ◽  
2020 ◽  
Vol 158 (6) ◽  
pp. 2667-2674 ◽  
Author(s):  
Kelly C. Vranas ◽  
Jodi A. Lapidus ◽  
Linda Ganzini ◽  
Christopher G. Slatore ◽  
Donald R. Sullivan
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Palliative Care ◽  
Quality Of Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Advanced Lung Cancer ◽  
Care Utilization

Preparation for the end of life and life completion during late-stage lung cancer: An exploratory analysis

2017 ◽  
Vol 15 (5) ◽  
pp. 554-564 ◽  
Author(s):  
Gail Adorno ◽  
Cara Wallace
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Older Adults ◽  
Palliative Care ◽  
Depressive Symptoms ◽  
End Of Life ◽  
Late Stage ◽  
Advanced Lung Cancer ◽  
Stage Lung Cancer

ABSTRACTObjective:Our aim was to explore preparation for the end of life (EoL) and life closure among persons with advanced metastatic lung cancer. Understanding quality of life through the lens of preparation and completion is important since the trajectory of lung cancer can be relatively short, often leading to application of cancer-directed therapies near death without the opportunity for advance planning or palliative care. Clinical research is needed to understand the kinds of distress specific to older adults with advanced lung cancer that are amendable to palliative care interventions.Method:We employed an exploratory cross-sectional design to examine psychosocial and existential concerns among a purposive sample (N = 30) of advanced lung cancer patients using the “end-of-life preparation” and “life completion” subscales of the Quality of Life at the End of Life (QUAL–E) questionnaire. Nonparametric methods were employed to analyze preparation, completion, global quality of life (QoL), and the associations among depressive symptoms, preparation, completion, and global QoL.Results:Higher scores on life completion were associated with better global QoL, and with items related to transcendence, communicative acts, and interpersonal relationships demonstrating important contributions. The perception of being a future burden on family members was the greatest concern within the preparation domain. Depressive symptoms were not associated with preparation, completion, or global QoL.Significance of Results:Psychosocial and existential issues contribute to QoL at the EoL among older adults with late-stage lung cancer during cancer-directed therapy, concurrent care, and hospice. The role of preparation, especially self-perceived burden, merits further research early on in the oncological setting. The preparation and life completion subscales of the QUAL–E are feasible clinical tools for facilitating dyadic communication about sensitive topics in the palliative care setting.

Systemic inflammatory markers may predict survival in advanced cancer patients admitted to an acute palliative care unit.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 134-134
Author(s):  
Si Won Lee ◽  
Yu Jung Kim
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Inflammatory Markers ◽  
Poor Prognosis ◽  
Albumin Level ◽  
Palliative Care Unit ◽  
Advanced Lung Cancer ◽  
Advanced Cancer Patients

134 Background: The Acute Palliative Care Unit (APCU) is an inpatient palliative care program that provides intensive symptom management and facilitates the transition from hospital discharge to hospice. Often patients are admitted to the APCU very late at the end of their disease trajectory. The purpose of this study was to investigate whether systemic inflammatory markers can predict remaining survival in these patients. Methods: Advanced cancer patients admitted to the APCU at a tertiary cancer center in Korea between April 2015 and March 2016 were included in this retrospective study. Of the 405 consecutive APCU admissions during this time period, there were 312 individual patients. Within this cohort, 267 patients were eligible for this study. Systemic inflammatory markers including albumin level, neutrophil to lymphocyte ratio (NLR), and Advanced Lung cancer Inflammation index (ALI = BMI x Albumin / NLR) were analyzed. Results: Of the 267 patients analyzed, the median age of patients was 66 (range, 23-97), and 45% were female. Primary cancer types were lung cancer (21%), gastric cancer (17%), colorectal cancer (15%), and pancreatobiliary cancer (14%). Overall survival after admission to the APCU was 21 days. Patients with low albumin level ( < 3.3g/dL) showed shorter survival compared with those with normal albumin level (16 days vs 32 days, hazard ratio [HR] 1.79, 95% CI 1.37-2.33, P < 0.001). Median NLR was 8.7, and patients with high NLR (≥8.7) exhibited poorer survival (HR 1.32, 95% CI 1.03-1.68, P = 0.028). Patients with low ALI ( < 18) had poor prognosis compared with those with high ALI (≥18) (HR 1.54, 95% CI 1.15-2.08, P = 0.004). Conclusions: Low albumin level ( < 3.3), high NLR (≥8.7), and low ALI ( < 18) may indicate poor prognosis in advanced cancer patients admitted to the APCU. A prospective cohort studies are necessary to validate these results.

OP456 Encouraging Shared Decision-Making Of Goals Of Care Discussions In Lung Cancer Patients Using A Smartphone Application

2021 ◽  
Vol 37 (S1) ◽  
pp. 17-17
Author(s):  
Amanda Lovato ◽  
Nisha Almeida
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Focus Groups ◽  
End Of Life ◽  
Cancer Patients ◽  
Smartphone Application ◽  
Quality Improvement Initiative ◽  
Care Hospital ◽  
Goals Of Care ◽  
Lung Cancer Patients

IntroductionAn important reason for receiving non-beneficial treatment at end-of life is the lack of timely discussions on goals of care and end-of-life preferences. A recent randomized clinical trial demonstrated that patients primed with a questionnaire on their end-of-life preferences were more likely to initiate such conversations with their doctors. Our objective is to integrate the questionnaire into a smartphone application to facilitate early goals of care discussions. To achieve this goal, we first plan to undertake a feasibility study to understand stakeholder preferences.MethodsAs part of a quality improvement initiative at our Canadian quaternary-care hospital, we conducted focus groups with oncology and palliative care physicians and patients to understand barriers to early conversations on end-of-life preferences, and to assess feasibility of using smartphone technology in facilitating these conversations. The app would integrate a questionnaire to patients and send prompts to physicians on patient readiness and timing of conversations.ResultsWe conducted separate focus groups with lung cancer patients (n = 6) and clinicians in oncology (n = 6) and palliative care (n = 6). Clinical teams expressed enthusiasm about early conversations but raised several barriers including system (lack of electronic documentation and access to data; multiple physicians), clinician (lack of time) and patient (stigma associated with end-of-life) barriers. Clinicians agreed that an app could overcome some of these barriers such as access to patient and electronic data by making patients the repository of all their data and empowering them to initiate discussions. However, they raised concerns about universal accessibility of such technology, especially among the elderly. Patient focus groups will take place in March 2021 and inform us on feasibility in this population.ConclusionsThere is a consensus among physicians at our hospital that early end-of-life conversations have the potential to mitigate adverse events and that use of a smart phone app could facilitate such conversations.

Patient-Centered Palliative Care for Patients With Advanced Lung Cancer

2022 ◽  
Author(s):  
Jennifer S. Temel ◽  
Laura A. Petrillo ◽  
Joseph A. Greer
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Checkpoint Inhibitors ◽  
Care Delivery ◽  
Cancer Therapeutics ◽  
Evidence Base ◽  
Advanced Lung Cancer ◽  
Care Needs ◽  
Patient Centered ◽  
Patient Reported

The evidence base demonstrating the benefits of an early focus on palliative care for patients with serious cancers, including advanced lung cancer, is substantial. Early involvement of specialty-trained palliative care clinicians in the care of patients with advanced lung cancer improves patient-reported outcomes, such as quality of life, and health care delivery, including hospice utilization. Since the time that many of these palliative care trials were conducted, the paradigm of cancer care for many cancers, including lung cancer, has changed dramatically. The majority of patients with advanced lung cancer are now treated with immune checkpoint inhibitors or targeted therapies, both of which have had a significant impact on patient's experience and outcomes. With this changing landscape of lung cancer therapeutics, patients are facing new and different challenges, including dealing with novel side effect profiles and coping with greater uncertainty regarding their prognosis. Patients who are living longer with their advanced cancer also struggle with how to address survivorship issues, such as sexual health and exercise, and decision making about end-of-life care. Although palliative care clinicians remain well-suited to address these care needs, they may need to learn new skills to support patients treated with novel therapies. Additionally, as the experience of patients with advanced lung cancer is becoming more varied and individualized, palliative care research interventions and clinical programs should also be delivered in a patient-centered manner to best meet patient's needs and improve their outcomes. Tailored and technology-based palliative care interventions are promising strategies for delivering patient-centered palliative care.

Sign in / Sign up

Export Citation Format

Share Document