Assesment of symptom burden and related factors of patients with lung cancer in a palliative care unit

Background: Palliative care has been widely implemented in clinical practice for patients with cancer but is not routinely provided to people with chronic obstructive pulmonary disease. Aim: The study aims were to compare palliative care services, medications, life-sustaining interventions, place of death, symptom burden and health-related quality of life among chronic obstructive pulmonary disease and lung cancer populations. Design: Systematic review with meta-analysis (PROSPERO: CRD42019139425). Data sources: MEDLINE, EMBASE, PubMed, CINAHL and PsycINFO were searched for studies comparing palliative care, symptom burden or health-related quality of life among chronic obstructive pulmonary disease, lung cancer or populations with both conditions. Quality scores were assigned using the QualSyst tool. Results: Nineteen studies were included. There was significant heterogeneity in study design and sample size. A random effects meta-analysis ( n = 3–7) determined that people with lung cancer had higher odds of receiving hospital (odds ratio: 9.95, 95% confidence interval: 6.37–15.55, p < 0.001) or home-based palliative care (8.79, 6.76–11.43, p < 0.001), opioids (4.76, 1.87–12.11, p = 0.001), sedatives (2.03, 1.78–2.32, p < 0.001) and dying at home (1.47, 1.14–1.89, p = 0.003) compared to people with chronic obstructive pulmonary disease. People with lung cancer had lower odds of receiving invasive ventilation (0.26, 0.22–0.32, p < 0.001), non-invasive ventilation (0.63, 0.44–0.89, p = 0.009), cardiopulmonary resuscitation (0.29, 0.18–0.47, p < 0.001) or dying at a nursing home/long-term care facility (0.32, 0.16–0.64, p < 0.001) than people with chronic obstructive pulmonary disease. Symptom burden and health-related quality of life were relatively similar between the two populations. Conclusion: People with chronic obstructive pulmonary disease receive less palliative measures at the end of life compared to people with lung cancer, despite a relatively similar symptom profile.

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Real-world evidence highlights sizeable gap in adopting early palliative care referral in patients with advanced cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e24147 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e24147-e24147

Author(s):

Suzanne Cole ◽

Sarah Storie ◽

Sonya Owens ◽

LaShanta Gipson ◽

Michael Hardy ◽

...

Keyword(s):

Palliative Care ◽

Real World ◽

Qualitative Methodology ◽

Treatment Options ◽

Community Setting ◽

Symptom Burden ◽

Community Practice ◽

Related Factors ◽

Early Integration ◽

Early Palliative Care

e24147 Background: Early referral to palliative care (PC) for patients w/ adv cancer is supported by compelling evidence from large RCTs demonstrating a lower symptom burden, higher QOL, and increased OS. However, these studies reflect pts who have self-selected to accept a PC referral and attend a PC visit. WHO/NCCN/ASCO guidelines support early integration of PC. We sought to characterize the referral patterns in our heme/onc practice to identify and mitigate the barriers to early PC adoption in the community setting. We began a concerted effort to discuss early PC referral w/ pts recently diagnosed w/ adv cancer at the time systemic therapy was initiated. Methods: To ensure real-world applicability of this study, we identified a large satellite clinic of a major academic center w/ access to PC on the main campus (located 20 miles from the satellite clinic). We retrospectively reviewed new pts age 18y+ w/ adv cancer, characterized PC referrals and outcomes. Using qualitative methodology, we identified pt-reported barriers to accepting PC care. Results: 407 new pts were seen; 168 w/ benign heme, 145 w/ early cancers, 94 w/ adv cancers. Of the 94 pts w/ adv cancers, 25 pts had one-time 2ndopinion visits, and 16 pts were not candidates for, or did not desire cancer treatment and directly enrolled on hospice. Our analysis cohort consisted of 53 pts w/ adv cancer pursuing life prolonging therapy. At initiation of treatment, 57 % (n=30) were not offered a PC referral, 22% (n=12) received a PC referral and attended the appt, however 21% (n=11) received a PC referral but did not attend the appt. A qualitative analysis of the 11 patients referred to early PC who did not attend the appt revealed; 5 patients scheduled an appt but did not attend (3-unknown reason, 2-hospitalized during appt, 1-lack of transportation), 2 pts were unreachable, and 4 pts were contacted but declined to schedule stating: “I feel pressured” “I want to hear what other treatment options I have” “I want to be treated first and then see if I need it” "I am overwhelmed with too many new doctors and visits". Conclusions: Despite the benefit of early PC referral in pts w/ adv cancer, we identified a considerable gap in its adoption in our community practice despite access to proximate PC clinic. Further studies are under design to address institutional and pt-related factors to improve real-world adoption of this critical service.

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Quality of Life and Symptom Burden in Cancer Patients Admitted to An Acute Palliative Care Unit

Journal of Palliative Care ◽

10.1177/082585971002600205 ◽

2010 ◽

Vol 26 (2) ◽

pp. 94-102 ◽

Cited By ~ 24

Author(s):

Jennifer M. Jones ◽

S. Robin Cohen ◽

Camilla Zimmermann ◽

Gary Rodin

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Cancer Patients ◽

Symptom Burden ◽

Palliative Care Unit

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

10.26226/morressier.5cdbe0a5618793e647b11ba0 ◽

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

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Admission of a Terminally Ill Lung Cancer Patient With the Accidental Diagnosis of SARS-CoV-2 to a Palliative Care Unit Resulting in a SARS-CoV-2 Outbreak

Workplace Health & Safety ◽

10.1177/21650799211042518 ◽

2021 ◽

Vol 69 (12) ◽

pp. 580-584

Author(s):

Carmen Roch ◽

Ulrich Vogel ◽

Katharina Smol ◽

Steffen Pörner ◽

Birgitt van Oorschot

Keyword(s):

Lung Cancer ◽

Palliative Care ◽

Terminally Ill ◽

Palliative Care Unit ◽

Positive Test Result ◽

Staff Members ◽

Testing Strategies ◽

Admission Screening ◽

Positive Results ◽

Test Result

The COVID-19 pandemic poses challenges for palliative care. Terminal patients cannot wear masks and may demonstrate unspecific symptoms reminiscent of those caused by COVID-19. This report is about a terminally ill patient with lung cancer who displayed fever, cough, and fatigue. During hospital admission screening, the patient tested negative for SARS-CoV-2. When admitting his wife to stay with him, she also had to test for SARS-CoV-2 and displayed a positive test result. Until the positive results were reported, six staff members were infected with SARS-CoV-2, even though they were routinely wearing respirators. This resulted in the palliative care unit having to be closed. Hospitals need strict and adequate testing and re-testing strategies even for intra-hospital transfers. Workers must strictly adhere to recommended respirator practices. Ventilation of patient rooms is essential due to the possible enrichment of particle aerosols containing viruses, as negative pressure rooms are not recommended in all countries.

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Indicatives of palliative care in patients with lung cancer treated in the Brazilian public health system.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e24007 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e24007-e24007

Author(s):

Thiago Henrique Mascarenhas Nébias ◽

Munir Murad Junior ◽

Marcos Antonio da Cunha Santos ◽

Mariangela Cherchiglia

Keyword(s):

Public Health ◽

Lung Cancer ◽

Palliative Care ◽

Health System ◽

Cancer Treatment ◽

Public Health System ◽

Symptom Burden ◽

Stage Iv ◽

Access Methods ◽

One Year

e24007 Background: In the last decade, a growing body of evidence has demonstrated that palliative care improves outcomes such as QOL, symptom burden, survival and decreases resource utilization. However, many patients eligible for PC are not referred to it or receive these services only in the last phase of their illness. Significant barriers explain the lack of access to PC, including identifying patients who would benefit from this approach. The aim of this study is to identify indicatives of palliative care in patients with lung cancer in Brazil in order to improve access. Methods: Prospective non-concurrent cohort carried out from a database developed through probabilistic and deterministic linkage of data from information systems of the Brazilian Public Health System. Study population was composed of all patients who started cancer treatment between 2009 and 2014 and who was hospitalized at least one time after starting treatment. To address the indication for palliative care, patients whose death occurred within one year after the first hospitalization were selected. Logistic regression models were used to assess the association between death in one year and sociodemographic, clinical and treatment-related variables. Results: A total of 27,634 patients diagnosed with lung cancer started cancer treatment in that period and 17,805 (64%) died one year after the first hospitalization. Among the deceased patients, the median age was 63 years, 59,8% of them were in stage IV, 32.4% in stage III and the majority received chemotherapy as their first treatment (72,3%). In this sub-group, 44,3% lived in the southeastern region of the country and 63,3% were male. Furthermore, 91% of the patients required emergency hospitalization and 20,1% were admitted in ICU units. The multivariate analysis revealed that being male (OR=1.2; CI, 1.13-1.28), live in the north region (OR=1.38, CI, 1.13-1.69) and having an older age (40-59 years, OR= 1.32; CI, 1.07-1.63; 60-79 years, OR=1.48; CI, 1.2-1.83; 80 or more years, OR=1.62; CI, 1.26-2.08) were associate with the outcome. Patients that were diagnosed with stage IV lung cancer (OR=1.99; CI, 1.7-2.33) and those who received radiotherapy (OR=7.83; CI, 6.86-8.94) as first treatment presented higher odds of dying in one year after the first hospitalization. In addition, patients who were hospitalized on an emergency basis (OR=10.94; CI, 10.19-11.74) and those who were admitted in ICU units (OR= 1.17; CI; 1.07-1.26) had higher association with the outcome. Interestingly, patients that took more than 60 days to initiate cancer treatment (OR=0.69; CI, 0.64-0.74) presented lower association with dying in one year. Conclusions: Our study demonstrates variables that can be used to identify patients who may benefit most from PC. Moreover, this indicatives can be easily assessed in the moment of hospitalization.

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Interdisciplinary palliative care in metastatic non-small-cell lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9068 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9068-9068

Author(s):

Marianna Koczywas ◽

Mihaela C. Cristea ◽

Karen L. Reckamp ◽

Jay Thomas ◽

Virginia Sun ◽

...

Keyword(s):

Lung Cancer ◽

Palliative Care ◽

Psychological Distress ◽

Symptom Burden ◽

Well Being ◽

Small Cell ◽

Small Cell Lung ◽

Metastatic Nsclc ◽

Care Intervention ◽

Over Time

9068 Background: Palliative cancer care is the integration into cancer care of therapies that address multiple issues that cause suffering for patients and their families and impact their life quality. Challenges and barriers continue to hinder the integration of palliative care into comprehensive, ambulatory oncology care. This paper aims to describe how symptoms, distress, and quality of life (QOL) data from the usual care phase of a NCI-supported Program Project (P01) informed the development of an interdisciplinary palliative care intervention for patients with metastatic non-small-cell lung cancer (NSCLC). Methods: Patients receiving usual care for metastatic NSCLC were recruited into this prospective longitudinal study. A total of 130 patients with stage IV NSCLC were accrued, and 114 patients had evaluable data. Upon informed consent, patients completed outcome measures that assessed physical function/cognitive status, social activities and support, symptom characteristics, psychological distress, and overall QOL. Patient-reported outcomes were completed at baseline, 6, 12, and 24 weeks post-accrual. Results: Subjects were primarily female (64%), ranged in age from 40-84 years, and 39% were ethnic minorities. The majority were former smokers (66%). KPS, IADL, and Cognitive scores deteriorated significantly over time (p=.001, .009, and .042, respectively). Patients reported higher severity scores with symptoms such as dyspnea, fatigue, insomnia, lack of appetite, peripheral neuropathy, pain, dry skin, nail changes, and problems with sexual interest in all four time periods. Global Symptom Distress Index and Total Symptom score both significantly worsened at 24 weeks (p=.003 and .017, respectively). Physical Well-Being worsened significantly (p=.036), while overall QOL, spiritual well-being, and psychological distress scores remained statistically stable over time. Conclusions: Patients with metastatic NSCLC continue to experience high symptom burden and diminished physical well-being over time while receiving treatments. An interdisciplinary palliative care intervention is currently being tested to improve symptom burden and overall QOL.

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Discharge from a Palliative Care Unit: Prevalence and Related Factors from a Retrospective Study in Japan

Journal of Palliative Medicine ◽

10.1089/jpm.2008.0216 ◽

2009 ◽

Vol 12 (2) ◽

pp. 142-149 ◽

Cited By ~ 13

Author(s):

Mitsunori Miyashita ◽

Kazuko Arai ◽

Yosuke Yamada ◽

Machiko Owada ◽

Tomoyo Sasahara ◽

...

Keyword(s):

Palliative Care ◽

Retrospective Study ◽

Palliative Care Unit ◽

Related Factors

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The role of palliative care in the management of patients with lung cancer

Lung Cancer Management ◽

10.2217/lmt-2020-0016 ◽

2020 ◽

Vol 9 (4) ◽

pp. LMT39

Author(s):

Irena Tan ◽

Kavitha Ramchandran

Keyword(s):

Lung Cancer ◽

Palliative Care ◽

Clinical Judgment ◽

Patient Reported Outcomes ◽

Symptom Burden ◽

Advanced Lung Cancer ◽

Patient Reported ◽

Patient Prognosis

Palliative care (PC) is the care of patients and their families with serious illness and is rapidly becoming an important part of the care of cancer patients. Patients with advanced lung cancer are a highly symptomatic population of patients and clearly experience benefits in quality of life and potentially benefits in overall survival when PC is incorporated early on after diagnosis. However, referrals to PC are still reliant on clinical judgment of patient prognosis and symptom burden. Moving forward, improving the integration of PC and lung cancer care will require more efficient real-time screening of patient symptoms, which may be accomplished through the use of patient-reported outcomes.

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