The Core Information Tools for Palliative Care Symptom Management in Patients with Cancer

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Richard R Love ◽  
Kazi Shafiul Alam ◽  
Kazi Zawad Arefin ◽  
Sheikh I Ahamed
Keyword(s):  
Palliative Care ◽  
Symptom Management ◽  
Patients With Cancer ◽  
The Core ◽  
Information Tools

Pain and Symptom Management in Palliative Care

1996 ◽  
Vol 3 (3) ◽  
pp. 204-213 ◽  
Author(s):  
Carla Ripamonti ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
Cancer Pain ◽  
Control Strategy ◽  
Symptom Management ◽  
Pain Control ◽  
Advanced Disease ◽  
Patients With Cancer ◽  
Pharmacologic Management

Background Pain, dyspnea, and anorexia are common symptoms experienced by patients with cancer and often are poorly managed. Methods The incidence and causes of these symptoms are described, as well as factors that exacerbate or ameliorate their impact. Results Pharmacologic management of cancer pain is based on the use of a sequential “ladder” that incorporates nonopioid, opioid, and adjuvant drugs, depending on the severity of the pain. This approach usually is effective. Other symptoms of advanced disease may be more difficult to control. Conclusions Adherence to an adequate pain-control strategy will significantly enhance palliation of pain in patients with cancer.

scholarly journals Palliative Care and Symptom Management in Older Patients with Cancer

2016 ◽  
Vol 32 (1) ◽  
pp. 45-62 ◽  
Author(s):  
Koshy Alexander ◽  
Jessica Goldberg ◽  
Beatriz Korc-Grodzicki
Keyword(s):  
Palliative Care ◽  
Symptom Management ◽  
Older Patients ◽  
Patients With Cancer

scholarly journals RELIEF: A Digital Health Tool for the Remote Self-Reporting of Symptoms in Patients with Cancer to Address Palliative Care Needs and Minimize Emergency Department Visits

2021 ◽  
Vol 28 (6) ◽  
pp. 4273-4280
Author(s):  
Ravi Bhargava ◽  
Bonnie Keating ◽  
Sarina R. Isenberg ◽  
Saranjah Subramaniam ◽  
Pete Wegier ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Symptom Management ◽  
Digital Health ◽  
Clinical Intervention ◽  
Emergency Department Visits ◽  
Self Report ◽  
Care Needs ◽  
Patients With Cancer ◽  
Palliative Care Needs

The lack of timely symptom reporting remains a barrier to effective symptom management and comfort for patients with cancer-related palliative care needs. Poor symptom management at home can lead to unwanted outcomes, such as emergency department visits and death in hospital. We developed and evaluated RELIEF, a remote symptom self-reporting app for community patients with palliative care needs. A pilot feasibility study was conducted at a large, community hospital in Ontario, Canada. Patients self-reported their symptoms each morning using validated clinical symptom measures and RELIEF would alert for worsening or severe symptoms. RELIEF alerts were monitored by palliative care nurses who would then contact patients to determine if appropriate clinical intervention could be initiated to avoid unnecessary emergency department visits. A total of 20 patients were recruited to use RELIEF for two months. Patients completed 80% of daily self-report assessments; 133 alerts were trigged, half of which required clinical intervention. No patient visited the emergency department for symptom management during the study. Clinical staff estimated five emergency department visits were avoided because of RELIEF—saving an estimated cost of over CAD 60,000. RELIEF is a feasible and acceptable method for the remote monitoring of patients with palliative care needs through regular symptom self-reporting.

scholarly journals Models of Palliative Care Delivery for Patients With Cancer

2020 ◽  
Vol 38 (9) ◽  
pp. 852-865 ◽  
Author(s):  
David Hui ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
Symptom Management ◽  
Hospice Care ◽  
Care Delivery ◽  
Outpatient Clinics ◽  
Specialist Palliative Care ◽  
Community Based ◽  
Patients With Cancer ◽  
Palliative Care Units

Palliative care has evolved over the past five decades as an interprofessional specialty to improve quality of life and quality of care for patients with cancer and their families. Existing evidence supports that timely involvement of specialist palliative care teams can enhance the care delivered by oncology teams. This review provides a state-of-the-science synopsis of the literature that supports each of the five clinical models of specialist palliative care delivery, including outpatient clinics, inpatient consultation teams, acute palliative care units, community-based palliative care, and hospice care. The roles of embedded clinics, nurse-led models, telehealth interventions, and primary palliative care also will be discussed. Outpatient clinics represent the key point of entry for timely access to palliative care. In this setting, patient care can be enhanced longitudinally through impeccable symptom management, monitoring, education, and advance care planning. Inpatient consultation teams provide expert symptom management and facilitate discharge planning for acutely symptomatic hospitalized patients. Patients with the highest level of distress and complexity may benefit from an admission to acute palliative care units. In contrast, community-based palliative care and hospice care are more appropriate for patients with a poor performance status and low to moderate symptom burden. Each of these five models of specialist palliative care serve a different patient population along the disease continuum and complement one another to provide comprehensive supportive care. Additional research is needed to define the standards for palliative care interventions and to refine the models to further improve access to quality palliative care.

scholarly journals Palliative Care Education During COVID-19: The MERI Center for Education in Palliative Care at UCSF/Mt. Zion

2021 ◽  
pp. 104990912110002
Author(s):  
Michael W. Rabow ◽  
Judith Redwing Keyssar ◽  
Judith Long ◽  
Maki Aoki ◽  
Gayle Kojimoto
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Symptom Management ◽  
Care Planning ◽  
Systemic Racism ◽  
Care Education ◽  
The Core ◽  
Palliative Care Education ◽  
Global Pandemic ◽  
Advance Care

In the setting of the COVID-19 pandemic as well as the recognition of systemic racism in our institutions, the symptom management, emotional/psychological support and advance care planning at the core of palliative care—once considered “an extra layer of support” —have been revealed as instrumental to individuals, families, communities, and countries facing the threat of the global pandemic. In this article, we outline the primary palliative care education efforts of one palliative care education center (The MERI Center at UCSF/Mt Zion campus) and detail the critical adjustments necessary and opportunities found in the COVID crisis.

scholarly journals Symptom clusters and their influence on prognosis using EORTC QLQ-C15-PAL scores in terminally ill patients with cancer

2021 ◽  
Author(s):  
Nanako Koyama ◽  
Chikako Matsumura ◽  
Yuuna Tahara ◽  
Morito Sako ◽  
Hideo Kurosawa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Terminally Ill ◽  
Symptom Clusters ◽  
Rank Test ◽  
Appetite Loss ◽  
Patients With Cancer ◽  
Terminally Ill Patients ◽  
Log Rank Test ◽  
Eortc Qlq ◽  
Cluster 2

Abstract Purpose The aims of the present study were to investigate the symptom clusters in terminally ill patients with cancer using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL), and to examine whether these symptom clusters influenced prognosis. Methods We analyzed data from 130 cancer patients hospitalized in the palliative care unit from June 2018 to December 2019 in an observational study. Principal component analysis was used to detect symptom clusters using the scored date of 14 items in the QLQ-C15-PAL, except for overall QOL, at the time of hospitalization. The influence of the existence of these symptom clusters and Palliative Performance Scale (PPS) on survival was analyzed by Cox proportional hazards regression analysis, and survival curves were compared between the groups with or without existing corresponding symptom clusters using the log-rank test. Results The following symptom clusters were identified: cluster 1 (pain, insomnia, emotional functioning), cluster 2 (dyspnea, appetite loss, fatigue, and nausea), and cluster 3 (physical functioning). Cronbach’s alpha values for the symptom clusters ranged from 0.72 to 0.82. An increased risk of death was significantly associated with the existence of cluster 2 and poor PPS (log-rank test, p = 0.016 and p < 0.001, respectively). Conclusion In terminally ill patients with cancer, three symptom clusters were detected based on QLQ-C15-PAL scores. Poor PPS and the presence of symptom cluster that includes dyspnea, appetite loss, fatigue, and nausea indicated poor prognosis.

scholarly journals Acupuncture for palliative cancer pain management: systematic review

2021 ◽  
pp. bmjspcare-2020-002638
Author(s):  
Juan Yang ◽  
Dietlind L Wahner-Roedler ◽  
Xuan Zhou ◽  
Lesley A Johnson ◽  
Alex Do ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Included Study ◽  
Favourable Effect ◽  
Levels Of Evidence ◽  
Patients With Cancer ◽  
Level 3 ◽  
Randomised Controlled

BackgroundPain is one of the most common and problematic symptoms encountered by patients with cancer. Due to the multifactorial aetiology, pain management of these patients frequently requires multidisciplinary interventions including conventional support and specialty palliative care. Acupuncture has been identified as a possible adjunctive therapy for symptom management in cancer pain, and there is currently no systematic review focused solely on the evidence of acupuncture on cancer pain in palliative care.ObjectiveTo critically analyse currently available publications regarding the use of acupuncture for pain management among patients with cancer in palliative care settings.MethodsMultiple academic databases were searched from inception to 29 October 2020. Randomised controlled trials involving acupuncture in palliative care for treatment of cancer-related pain were synthesised. Data were extracted by two independent reviewers, and methodological quality of each included study was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence.ResultsFive studies (n=189) were included in this systematic review. Results indicated a favourable effect of acupuncture on pain relief in palliative care for patients with cancer. According to OCEBM 2011 Levels of Evidence, they were level 2 in one case (20%), level 3 in two cases (40%) and level 4 in the remaining (40%). Low-level evidence adversely affects the reliability of findings.ConclusionsAcupuncture may be an effective and safe treatment associated with pain reduction in the palliative care of patients with cancer. Further high-quality, adequately powered studies are needed in the future.

scholarly journals Concerns of Patients With Cancer on Accessing Cannabis Products in a State With Restrictive Medical Marijuana Laws: A Survey Study

2019 ◽  
Vol 15 (10) ◽  
pp. 531-538 ◽  
Author(s):  
Vinita Singh ◽  
Ali J. Zarrabi ◽  
Kimberly A. Curseen ◽  
Roman Sniecinski ◽  
Justine W. Welsh ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Providers ◽  
Medical Marijuana ◽  
Survey Study ◽  
Care Practice ◽  
Care Providers ◽  
Patients With Cancer ◽  
Medical Marijuana Laws ◽  
Source Of Information

PURPOSE: Several states, particularly in the Southeast, have restrictive medical marijuana laws that permit qualified patients to use specific cannabis products. The majority of these states, however, do not provide avenues for accessing cannabis products such as in-state dispensaries. METHODS: We conducted a survey of patients registered for medical marijuana (low tetrahydrocannabinol [THC] oil cards) in an ambulatory palliative care practice in Georgia (one of the states with restrictive medical marijuana laws). RESULTS: We had a total of 101 responses. Among our sample of patients who use cannabis as part of a state-approved low THC oil program, 56% were male and 64% were older than age 50 years. Advanced cancer was the most common reason (76%) for granting the patients access to a low THC oil card. Although patients reported cannabis products as being extremely helpful for reducing pain, they expressed considerable concerns about the legality issues (64%) and ability to obtain THC (68%). Several respondents were using unapproved formulations of cannabis products. For 48% of the patients, their physician was the source of information regarding marijuana-related products. Furthermore, they believed that their health care providers and family members were supportive of their use of cannabis (62% and 79%, respectively). CONCLUSION: Patients on Georgia’s medical marijuana program are most concerned about the legality of the product and their ability to obtain marijuana-related products. Therefore, we recommend that states with medical marijuana laws should provide safe and reliable access to cannabis products for qualifying patients.

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