scholarly journals Challenges of Managing Advanced Cancer Patients through Phone Triaging at an Outpatient Supportive Care Clinic: A Case Series of Palliative Care Patients

2012 ◽  
Vol 6 ◽  
pp. PCRT.S10733
Author(s):  
Lindsey E. Pimentel ◽  
Sriram Yennurajalingam ◽  
Elizabeth D. Brown ◽  
Debra K. Castro
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Advanced Cancer ◽  
Case Reports ◽  
Care Center ◽  
Case Series ◽  
Cancer Center ◽  
Advanced Cancer Patients ◽  
Care Clinic ◽  
Outpatient Supportive Care

Palliative care strives to improve the quality of life for patients and their families by impeccable assessment and management using an interdisciplinary approach. However, patients with cancer-related pain and other symptoms tend to be undertreated because of limited follow-up visits due to late referrals and logistics. Thus, patients who present to the outpatient Supportive Care Center at The University of Texas MD Anderson Cancer Center often experience severe physical and psychological symptoms. The two case reports presented highlight the challenges of managing distressed patients with advanced cancer in the outpatient setting. These descriptions focus on addressing patient needs over the phone to enhance the care patients receive at the Supportive Care Center. Future prospective studies are needed to measure the effectiveness of using phone triaging in conjunction with standard outpatient palliative care.

Frequency, predictors, and outcomes of urine drug test among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 94-94
Author(s):  
Joseph Anthony Arthur ◽  
Tonya Edwards ◽  
David Hui ◽  
Jessica Marie Waletich-Flemming ◽  
Suresh K. Reddy ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Opioid Therapy ◽  
Cancer Stage ◽  
Chronic Opioid Therapy ◽  
Advanced Cancer Patients ◽  
Care Clinic ◽  
Urine Drug ◽  
Outpatient Supportive Care

94 Background: Data on the utilization and outcomes of urine drug tests (UDT) among advanced cancer patients is limited. The main objective of this study was to determine the factors associated with UDT ordering and results in advanced cancer outpatients. Methods: A retrospective chart review of 1058 patients seen from March 2014 to November 2015 at an outpatient supportive care clinic was conducted. Sixty-one patients on chronic opioid therapy who underwent UDT were identified. A control group of 120 patients who did not undergo UDT was selected for comparison of information on demographic and clinical characteristics. Results: 61/1058 patients (6%) underwent UDT. 33/61 patients (54%) had abnormal results. Multivariate analysis found that the odds ratio for UDT ordering was 3.9 in CAGE positive patients (p = 0.002), 4.41 in patients less than 45years (p < 0.001), 5.58 in patients with moderate to severe pain (ESAS pain score ≥ 4) (p < 0.001), 0.27 in patients with advanced cancer stage, (p = 0.008), and 0.25 in patients with moderate to severe fatigue (p = 0.001). Among 52 abnormal UDT results in 33 patients, the most common opioid findings were: prescribed opioids absent in urine (14/52, 27%) and un-prescribed opioids in urine (13/52, 25%). Conclusions: UDT was used infrequently among advanced cancer patients receiving outpatient chronic opioid therapy. Younger age, CAGE positivity, early cancer stage or NED status, higher pain intensity, and lower fatigue were significant predictors of UDT ordering. More than 50% of UDTs were abnormal. More research is necessary to better characterize aberrant opioid use in advanced cancer patients.

Impact of a dedicated supportive care center telephone triaging program (SCCTP) for patients with advanced cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 54-54
Author(s):  
Lindsey E Pimentel ◽  
Sriram Yennurajalingam ◽  
Gary B. Chisholm ◽  
Tonya Edwards ◽  
Maria Guerra-Sanchez ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Symptom Management ◽  
Care Center ◽  
Assessment Scale ◽  
Cancer Type ◽  
Advanced Cancer Patients ◽  
At Home

54 Background: Due to high symptom burden in advanced cancer patients, ongoing symptom management for outpatient palliative care patients is vital. More patients are receiving outpatient care; Yet, most palliative care patients receive less than 2 follow ups. Nurse telephone care can improve quality of life in these patients. Our aim was to determine frequency and care provided by Supportive Care Center Telephone Program (SCCTP) in advanced cancer patients. Methods: 400 consecutive patients who utilized palliative care service, 200 from outpatient Supportive Care Center (SCC) and 200 from inpatient Palliative Care (IPC), were followed for 6 months starting 3/2012 to examine call frequency and reason and outcomes including pain and other symptoms [Edmonton Symptom Assessment Scale (ESAS) and Memorial Delirium Assessment Scale (MDAS)] associated with utilization of SCCTP. We also examined the effect of SCCTP interventions on pain, ESAS and counseling needs. Results: 375 patients were evaluable. Median age 59 years, 53% female, 70% white. Most frequent cancer type were gastrointestinal (20%, p < 0.0001) for IPC and thoracic (23%, p <0.0001) for SCC. SCC patients had higher prevalence of CAGE positivity (28% SCC vs 11% IPC, p <0.0001), ESAS SDS(p=0.0134), depression(p=0.0009), anxiety(p=0.0097) and sleep(p=0.0015); MDAS scores were significantly higher in IPC (p<0.0001).115/400 patients (29%) utilized SCCTP. 96/115 outpatients (83%) used the SCCTP vs 19/115 IPC (17%). Common reasons for calls were pain (24%), pain medication refills (24%) and counseling (12%). Of 115 phone calls, 340 recommendations were made; 43% (145/340) were regarding care at home; 56% of these recommendations were regarding opioids. Patients who utilized SCCTP had worse pain(p=0.0059), fatigue(p=0.0448), depression(p=0.0410), FWB(p=0.0149) and better MDAS scores(p=0.0138) compared to non-utilizers. Conclusions: There was more frequent SCCTP use by outpatients than inpatients. Most common reason for utilization was pain control. Frequently, recommendations were made to continue symptom management at home. Patients who utilized SCCTP had worse pain, fatigue, depression, well-being scores and better delirium scores.

Frequency and factors associated with falls in patients with advanced cancer presenting to an outpatient supportive care clinic

2014 ◽  
Vol 13 (2) ◽  
pp. 223-227 ◽  
Author(s):  
Meiko Kuriya ◽  
Sriram Yennurajalingam ◽  
Maxine Grace de la Cruz ◽  
Wei Wei ◽  
Shana Palla ◽  
...  
Keyword(s):  
Supportive Care ◽  
Advanced Cancer ◽  
Performance Status ◽  
Assistive Devices ◽  
Assessment Scale ◽  
Cancer Center ◽  
Care Clinic ◽  
Factors Associated ◽  
Edmonton Symptom Assessment Scale ◽  
Outpatient Supportive Care

AbstractObjective:The aim of this study was to determine the frequency and factors associated with fall episodes in advanced cancer patients.Method:We analyzed data that included demographic characteristics, utilization of assistive devices, cancer diagnosis, metastatic site, performance status, medications including hypnotics and opioids, Edmonton Symptom Assessment Scale (ESAS) score, and Memorial Delirium Assessment Scale (MDAS) score in 384 consecutive patients who were newly referred to the Supportive Care Clinic at the MD Anderson Cancer Center from January 1 to December 31, 2009. All patients completed standardized forms to report falls within the last month. Multivariate backward regression analyses were employed to identify factors predictive of falls in advanced cancer.Results:The mean age of patients was 58 years, and 192 (50%) were male. Mean (SD)/median score for pain was 5 (2.8), 5; fatigue 5.6 (2.6), 6; sleep disturbance 5(2.7), 5; drowsiness 3.7(3), 3; and anorexia 5(3), 5. Some 31 patients (8%) reported fall episodes within the past month, 17 (55%) of whom reported the use of assistive devices. Using assist devices (OR = 5.5, 95% CI: 2.6–11.9, p < 0.0001) and taking zolpidem (OR = 3.39, 95% CI: 1.39–7.7, p = 0.008) were associated with an enhanced chance of falling. Higher MDAS score (4.00 vs. 1.42, p = 0.001) and MDAS positive screening for delirium (21 vs. 3.6%, p < 0.001) were also associated with falls. However, severity on the ESAS at the initial consult was not associated with falls.Significance of Results:We conclude that 31 of 384 patients (8%) with advanced cancer receiving outpatient supportive care reported falls in the previous month. Patients with assistive devices, taking zolpidem, and with a higher MDAS score, and a positive delirium screening reported more frequent falls. Further studies are warranted.

The frequency of falls in patients with advanced cancer followed in an outpatient palliative care center.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 225-225
Author(s):  
Maxine De la Cruz ◽  
Neha Didwaniya ◽  
Kimberson Tanco ◽  
SeongHoon Shin ◽  
Akhila Sunkepally Reddy ◽  
...  
Keyword(s):  
Palliative Care ◽  
Brain Metastasis ◽  
Supportive Care ◽  
Functional Status ◽  
Advanced Cancer ◽  
Care Center ◽  
Assistive Device ◽  
Severity Scores ◽  
Patient Reported ◽  
Outpatient Supportive Care

225 Background: Falls are a concern in patients who are frail, have advance age or severe underlying medical condition as a significant cause of morbidity and reduced quality of life. It has been reported to occur in up to 50% of palliative care patients in different settings. Our aim was to determine the frequency of falls and identify its predictors and correlates in patients with advanced cancer. Methods: We reviewed 1,984 consecutive patients with advanced cancer seen in the outpatient supportive care center and determined the frequency of patient reported falls within the last month prior to the visit. Baseline patient characteristics, symptom severity scores in the Edmonton Symptom Assessment Scale (ESAS), medication use, functional status, and use of assistive devices were used to identify factors that are predictive of falls using backwards stepwise logistic regression. Results: 1,041 (52%) were female, 1,377 (69%) were non-Hispanic-white, 343 (17%) had peripheral neuropathy, 237 (12%) were on psychotropic medications, and 1,140 (58%) were on opioids. There were 211 (11%) patient reported falls. Presence of brain metastasis, use of assistive device, ECOG, ESAS depression, and weight prior to visit were significantly associated with patient reported falls in the multivariate model. Conclusions: One tenth of patients seen in the outpatient supportive care clinic reported falls. Our findings showing that falls to be associated with brain metastasis, assistive device, functional status, ESAS depression and weight are useful in stratifying high risk patients. They also show that certain medications deemed as risk factors in other populations were not associated with falls. [Table: see text]

Advanced cancer patients' self-reported perception of timeliness of their referral to outpatient supportive/palliative care and their survival data.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10121-10121 ◽  
Author(s):  
Angelique Wong ◽  
David Hui ◽  
Margeaux Epner ◽  
Vishidha Reddy Balankari ◽  
Vera J De la Cruz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Just In Time ◽  
Advanced Cancer Patients ◽  
Care Clinic ◽  
Disease Trajectory ◽  
Number Of Patients ◽  
Significant Difference

10121 Background: Palliative Care referral is often thought to be delayed as judged by health professionals and caregivers. However, no studies have ever examined patients’ perception of timeliness of referral. The primary objective of this study was to determine patients’ perception of the timeliness of their own referral to an outpatient palliative care clinic. We also examined the association between perceived timeliness and actual timing of referral. Methods: In this prospective survey, patients with advanced cancer were asked to rate their perceived timeliness of referral using a 5-point Likert scale ranging from much too early to much too late within 7-35 days after their first consultation visit at Supportive Care Center. They were also asked when they felt referral to Supportive Care should occur along 4 points in their disease trajectory. Actual timing of referral was assessed based on survival from the timing of completion of the survey. Results: 200 advanced cancer patients were surveyed. Median age was 64, 111 (55%) were female, and 35 (18%), 32 (16%) and 26 (13%) had gastrointestinal, lung and breast cancer, respectively. The median overall survival was 8.5 months. 144 (72%) patients perceived their referral was “just in time,” 42 (21%) felt it was “late/much too late,” and 14 (7%) felt it was much “too early/early.” 76/193 (39%) felt the referral should occur at the time of diagnosis of cancer, 32 (17%) when they start first-line chemotherapy, 46 (24%) at diagnosis of recurrent disease, 14 (7%) when there are no further treatment options, and 4 (2%) reported never. We found no significant difference in survival among patients who reported their referral was early, just in time, and late (median 9.8 vs. 8.3 vs. 9.0 months, P=0.43). Conclusions: Patients with advanced cancer were referred to our outpatient Supportive Care clinic a median of 8.5 months before death. A vast majority of patients perceived the timing of referral was appropriate, and many agreed that referral should occur early in the disease trajectory. The lack of association between perceived timeliness of referral and survival may be related to the ceiling effect and the small number of patients who felt their referral was late.

Consistency of symptom clusters among advanced cancer patients seen at an outpatient supportive care clinic in a tertiary cancer center

2013 ◽  
Vol 11 (6) ◽  
pp. 473-480 ◽  
Author(s):  
Sriram Yennurajalingam ◽  
Jung Hye Kwon ◽  
Diana L. Urbauer ◽  
David Hui ◽  
Cielito C Reyes-Gibby ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Symptom Clusters ◽  
Advanced Cancer Patients ◽  
Palliative Care Teams ◽  
Loss Of Appetite ◽  
Outpatient Supportive Care

AbstractObjective:Advanced cancer patients often develop severe physical and psychological symptom clusters (SCs), but limited data exist on their consistency or severity after an outpatient interdisciplinary team consultation led by palliative care specialists. The primary aim of the study was to determine the consistency and severity of SCs in advanced cancer patients in this setting.Method:A total of 1373 patients with advanced cancer who were referred to The University of Texas MD Anderson Cancer Center's Outpatient Supportive Care Center between January 2003 and October 2008 with a complete Edmonton Symptom Assessment Scale (ESAS; 0–10 scale) occurred at initial and first follow-up visit were reviewed (median 14 days, range 1–4 weeks). We used a Wilcoxon signed-rank test to determine whether symptoms changed over time, and a principal components factor analysis with varimax rotation to determine SCs at baseline and at first follow-up. The number of factors calculated was determined based upon the number of eigenvalues.Results:The patients' ratings of the following symptoms (mean, SD) at the initial and follow-up visits, respectively, were: fatigue 6.2 (2.3) and 5.7 (2.5, p < 0.0001), pain 5.4 (2.9) and 4.6 (3, p < 0.0001), nausea 2.2 (2.8) and 2.0 (2.6, p < 0.0001), depression 3.0 (2.9) and 2.5 (2.7, p < 0.0001), anxiety 3.4 (3.0) and 2.8 (2.8, p < 0.0001), drowsiness 4.8 (3.1) and 4.4 (3.1, p < 0.0001), dyspnea 3.0 (2.9) and 2.7 (2.8), p < 0.0001), loss of appetite 4.2 (2.7) and 3.9 (2.7, p < 0.0001), sleep disturbances 4.2 (2.6) and 3.8 (2.6, P < 0.0001), and well-being 4.3 (2.5) and 3.9 (2.3, p < 0.0001). Cluster composition differentiated into physical (fatigue, pain, nausea, drowsiness, dyspnea, and loss of appetite) and psychological (anxiety and depression) components at the initial visit, and these two SCs were consistent upon follow-up.Significance of results:We conclude that SCs remain constant between baseline and near-term follow-up but that the severity of those symptoms lessened during that interval. This knowledge may allow palliative care teams to provide more targeted and higher-quality care, but further studies are needed.

Symptom Assessment and Early Access to Supportive and Palliative Care for Patients With Advanced Solid Tumors in Mexico

2019 ◽  
Vol 35 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Mirza Jacqueline Alcalde-Castro ◽  
Enrique Soto-Perez-de-Celis ◽  
Alfredo Covarrubias-Gómez ◽  
Sofía Sánchez-Román ◽  
Paulina Quiróz-Friedman ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Solid Tumors ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
First Year ◽  
Advanced Solid Tumors ◽  
Care Clinic ◽  
Care Services ◽  
Oncology Care

Background: Early specialized palliative care improves quality of life of patients with advanced cancer, and guidelines encourage its integration into standard oncology care. However, many patients fail to obtain timely palliative/supportive care evaluations, particularly in limited-resource settings. We aimed to determine the proportion of patients with advanced cancer who received an assessment of symptoms and were referred to supportive and palliative care services during the first year after diagnosis in a Mexican hospital. Methods: Individuals with newly diagnosed advanced solid tumors and 1 year of follow-up at the oncology clinics in the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City from October 2015 to April 2016 were included in this retrospective study. Results: Seventy-seven patients were included. Forty-two (54.5%) were referred to the various supportive care services during the first year after diagnosis, and 23 (29.8%) were referred to the palliative care clinic. The most commonly assessed symptoms by oncologists were pain (77.9%), anorexia (74.0%), fatigue (68.8%), and nausea (55.8%), while depression/anxiety were evaluated in 10 (12.9%) patients. The oncologist offered to clarify treatment goals in 39 (50.6%) cases and evaluated the understanding of diagnosis/illness and prognosis in 22 (28.5%). Conclusion: Palliative and supportive care services were widely underutilized, which may be related to a lack of standardized symptom assessments and poor end-of-life communication. Novel strategies are needed to improve the implementation of tools for systematic symptom assessment and to optimize the integration of supportive care interventions into oncology care in developing countries.

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