scholarly journals Palliative Care in Gynaecological Oncology

2021 ◽  
Author(s):  
Nalezinska Monika ◽  
Chovanec Josef
Keyword(s):  
Palliative Care ◽  
Treatment Options ◽  
Locally Advanced ◽  
Curative Intent ◽  
Aggressive Cancer ◽  
Life Prognosis ◽  
Patient’S Autonomy ◽  
Postmenopausal Status ◽  
Oncological Diseases

Palliative care in gynaecologic oncology focuses on specific and severe symptoms resulting from affected abdominal and pelvic organs and feminine genitals. These symptoms are mainly connected to advanced gynaecologic malignancies. Patients with locally advanced or recurrent gynaecologic cancers may present with various symptoms. Among those we discuss vaginal bleeding, vaginal discharge and fistulas. Vice versa non-malignant diseases and non-pelvic site diseases such as inflammations, overdose of anticoagulants, wounds or pressure ulcers may have similar clinical manifestation. Some symptoms may result from aggressive cancer treatment (oncological surgery, radiotherapy) with curative intent. Some symptoms get worse on account of the postmenopausal status (natural or artificial following any type of ovarian failure). For advanced gynae-oncological diseases it has been in practise, that the best palliative care is offered and practised simultaneously with curative treatment. The problematics of gynaecologic symptoms in palliative care represents delicate and intimate sphere and it may disturb patient’s autonomy and dignity. The mission of physicians, nurses and caregivers is to consider treatment options thoroughly in context of patient’s quality of life, prognosis and life conditions to fulfil the ideals of the best symptomatic and supportive care.

Multidisciplinary cancer conferences as a forum for early identification of patients who can benefit from palliative care.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 148-148
Author(s):  
Frances Catriona Wright ◽  
Hardeep Johal ◽  
Marnie MacKinnon ◽  
Erin Arthurs
Keyword(s):  
Palliative Care ◽  
Treatment Options ◽  
Baseline Survey ◽  
Comfort Levels ◽  
Standardized Reporting ◽  
Advance Care ◽  
Aggressive Care ◽  
The Uk ◽  
Surprise Question

148 Background: Introducing palliative care early in the cancer journey results in a better quality of life, less aggressive care and longer survival compared to patients receiving standard care. The INTEGRATE Project goal is to identify and manage patients who can benefit from palliative care using the UK Gold Standards Framework Surprise Question (would you be surprised if this person died within the next year?). Multidisciplinary cancer conferences (MCCs) are scheduled meetings for oncology teams to prospectively discuss patient diagnostic tests and treatment options, which were leveraged for the INTEGRATE Project. Methods: A pilot study to test the efficacy of the Surprise Question at MCCs and implementation of a palliative model of care has been implemented in 3 academic and 1 non-academic cancer centres. A survey was completed to identify provider comfort levels in providing palliative care. All sites completed Pallium Canada’s LEAP Onco module, which equips providers with skills to provide primary level palliative care. Patients identified at MCCs received advance care planning, symptom management, referrals and standardized reporting to primary care. Results: Four disease sites (Lung, GI, CNS and Head & Neck) are participating. A baseline survey showed over 50% of providers had no training in palliative care. 161 providers participated in LEAP Onco. Implementation of the Surprise Question at MCCs began in February 2015. Two months of implementation identified 39 patients at the CNS, Lung and GI disease sites out of 108 of patients reviewed. At the CNS MCC, 100% glioblastoma patients were identified. The Lung and GI disease sites had lower identification rates (27% and 10%, respectively). Identified patients will have their healthcare utilization (referrals to community providers, billing patterns, ER visits) analyzed to determine impact of this project. Implementation continues until 2016. Conclusions: MCCs appear to be an excellent forum for identifying patients who can benefit from a palliative approach to care within the CNS, Lung and GI site groups. Further data is being collected to inform provincial recommendations for broader implementation of palliative care in Ontario.

Comparative quality of life in patients randomized contemporaneously to docetaxel or abiraterone in the STAMPEDE trial.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 14-14 ◽  
Author(s):  
Hannah L. Rush ◽  
Adrian David Cook ◽  
Christopher D. Brawley ◽  
Laura Murphy ◽  
Archie Macnair ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Repeated Measures ◽  
Treatment Options ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Clinical Parameter ◽  
Cross Sectional ◽  
Multi Stage ◽  
Eortc Qlq

14 Background: Docetaxel (DOC) and abiraterone (ABI) both improve overall survival (OS) in men with locally advanced or metastatic hormone-sensitive prostate cancer (HSPC) but no head to head trials compare the 2 agents. STAMPEDE, a multi-arm multi-stage platform trial, recruited patients (pts) to treatments including DOC or ABI between Nov-11 and Mar-13. There was no evidence OS differed between DOC or ABI, thus quality of life (QOL) may increasingly inform treatment options. Methods: QOL scores were analysed in pts contemporaneously randomised to receive DOC or ABI, in addition to standard of care treatment. Self-assessment QOL questionnaires EORTC QLQ C30 and PR25 were completed during treatment and follow-up. These analyses focus on average global QOL over the first 2 years after randomisation, using repeated measures analysis, plus cross-sectional analyses at 3, 6, 12 and 24 months. A score difference of ≥4 points was pre-defined as clinically meaningful. Results: 173 men randomised to DOC and 342 men randomised to ABI participated in the QOL sub-study and contributed to this analysis. Baseline characteristics and proportion of missing data were similar between groups. Baseline global QOL scores were similar (mean (sd): DOC 77.8 (20) and ABI 78.0 (19.3)). Average global QOL over 2 years was higher in pts randomised to ABI than DOC, although the difference was statistically significant it did not meet the pre-defined clinical parameter (+3.9, 95%CI 0.6 to 7.1, p=0.021). Cross-sectional analyses showed clinically meaningful superior QOL in the ABI group at 3 and 6 months (+6.6, 95%CI 2.6 to 10.7, p=0.001; +8.0, 95%CI 3.6 to 12.3, p<0.001), but not at 1 or 2 years (+1.3, 95%CI -3.0 to 5.6, p=0.545; +4.5, 95%CI -0.25 to 9.2, p=0.063). An exploratory analysis indicated average QOL for pts with metastatic disease (n=207) was better in the ABI group (+4.44, 95%CI 0.2 to 8.6, p=0.036). Conclusion: Global QOL was significantly higher in the first 2 years of treatment for the ABI group compared to the DOC group, though did not meet the pre-defined clinically meaningful threshold. The majority of difference was seen in the first year of treatment. This should be considered when discussing treatment options with pts. Clinical trial information: NCT00268476.

RELEVANT study: Patient (Pt) and physician (PI) perspectives on meaningful outcomes in advanced pancreatic ductal adenocarcinoma (PDAC).

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 150-150
Author(s):  
Rille Pihlak ◽  
Melissa Frizziero ◽  
Soo Yit Gustin Mak ◽  
Christina Nuttall ◽  
Angela Lamarca ◽  
...  
Keyword(s):  
Treatment Options ◽  
Symptom Control ◽  
Symptom Burden ◽  
Ductal Adenocarcinoma ◽  
Study Patient ◽  
Final Decision ◽  
High Expectations ◽  
Aggressive Cancer ◽  
Clinically Significant

150 Background: PDAC is an aggressive cancer with median overall survival (OS) ~6 months (m). Methods: Pts with advanced PDAC due to start first-line chemo (Chx) completed 1 study survey and 2 quality of life (QoL) questionnaires (QLQ-C30 and PAN26) on 3 time-points: baseline (T1), before (T2) and after (T3) their 1st on-treatment CT scan, PIs filled in paired surveys T1/2/3. Results: 71 Pts and 12 PIs were recruited. 4% Pts died/deteriorated between consent and T1, 28% between T1 - T2 (~2.3m later), 13% between T2 - T3 (~1.3m), only 55% reached T3. 49% Pts preferred to share decision making with their PI, 31% Pts preferred to make the final decision about treatment after considering PI opinion. 86% Pts had personal goals to reach (12% PIs knew of these). 70% Pts were aware that Chx was unlikely to cure cancer however, they had much higher expectations than PIs (%, Table). Choosing between treatment options Pts prioritised: 54% OS, 26% balance between side-effects (SEs) and OS, 15% could not choose and 5% symptom control. These did not match with PIs (p<0.001). Pts who prioritised OS had higher symptom burden (p=0.03). OS was different in these Pts: who prioritised symptom control- OS 2.8m from T1, OS priority- 6.4m, could not choose- 8.7m and balance priority- 9.2m (p=0.01). At T1 Pts had low QoL (57/100, higher better). ‘Future worries’ and ‘planning of activities’ were scored the worst (58 and 56/100, lower better). Clinically significant (+/- 10p) worsening between T1/2/3 were: PF (10p), nausea/vomiting (NV, 12p), body image (18p p=0.01), taste (25p p=0.002). Financially 29% Pts were “a little/ lot” out of pocket at T1, 41% at T2 (p=0.036), 42% at T3 (p=0.034). Acceptability of SEs showed that least acceptable SEs (ranked 1-10, 10-least) were the ones Pts were already struggling with: NV (ranked 9/10, 46p/100 on QLQ), diarrhoea (8/10, 45/100); fatigue (less acceptable T3 (p=0.05), 46/100); appetite loss (7-8/10, 47/100). In contrast, most Pts (97%) were willing to take few/medium and around 50% large amount of SEs as a trade-off for extra time, whilst 9% PIs thought that Pts would accept excess SEs (p<0.001). Conclusions: Pts worry about future, have high symptom burden and high expectations of Chx. Pts want to be involved in decisions, but the contrasting views between Pts and PI show differing aims. [Table: see text]

Genitourinary Issues in Palliative Care

2021 ◽  
pp. 198-213
Author(s):  
Min Ji Kim ◽  
Kimberson Tanco
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Symptom Management ◽  
Urinary Tract Obstruction ◽  
Performance Status ◽  
Treatment Options ◽  
Symptom Control ◽  
Kidney Injury ◽  
Management Options

Genitourinary problems in palliative care can be very distressing to patients and require prompt management and alleviation of symptoms. Examples include urinary tract obstruction, which can lead to pain and kidney injury, as well as infection, hematuria, renal colic, and bladder spasm-related pain. This chapter addresses relevant aspects of palliative care in patients with genitourinary issues, including consideration for context of symptoms and subsequent practical management. Options for symptom management may range from medications to procedural interventions. In deciding between treatment options, factors such as the patient’s preexisting comorbidities, performance status, goals of care, and anticipated benefit in symptom control and in quality of life versus potential burden of treatment must be considered.

scholarly journals Locally Advanced Oral Cavity Cancers: What Is The Optimal Care?

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482092072 ◽  
Author(s):  
Rajab Alzahrani ◽  
Arwa Obaid ◽  
Hadi Al-Hakami ◽  
Ahmed Alshehri ◽  
Hossam Al-Assaf ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Oral Cavity ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Optimal Care ◽  
Curative Intent ◽  
Disease Induction ◽  
Oral Cavity Cancers ◽  
Care Surgery

Patients with oral cavity cancers often present late to seek medical care. Surgery is usually the preferred upfront treatment. However, surgical resection cannot be achieved in many cases with advanced disease without major impact on patient’s quality of life. On the other hand, radiotherapy (RT) and chemotherapy (CT) have not been employed routinely to replace surgery as curative treatment or to facilitate surgery as neoadjuvant therapy. The optimal care of these patients is challenging when surgical treatment is not feasible. In this review, we aimed to summarize the best available evidence-based treatment approaches for patients with locally advanced oral cavity cancer. Surgery followed by RT with or without CT is the standard of care for locally advanced oral cavity squamous cell carcinoma. In the case of unresectable disease, induction CT prior to surgery or chemoradiotherapy (CRT) can be attempted with curative intent. For inoperable patients or when surgery is expected to result in poor functional outcome, patients may be candidates for possibly curative CRT or palliative RT with a focus on quality of life.

scholarly journals Individual Meaning-Centered Psychotherapy for palliative cancer patients in Lithuania. A case report

2017 ◽  
Vol 24 (1) ◽  
pp. 67-73 ◽  
Author(s):  
Meda Sutkevičiūtė ◽  
Monika Stančiukaitė ◽  
Giedrė Bulotienė
Keyword(s):  
Palliative Care ◽  
Driving Force ◽  
Human Life ◽  
Group Model ◽  
Search For Meaning ◽  
Oncological Diseases ◽  
Psychological Difficulties ◽  
The Individual ◽  
Palliative Patients

Patients with oncological diseases, especially palliative care patients, suffer from physical and psychological difficulties. The quality of life of such patients is bad, they do not have purpose to live and they feel anxiety and distress. In 1959 Victor Frankl wrote the book Man’s Search for Meaning in which he stated that the driving force of human life lay in the ability to discern the  meaning of faith and spirituality. Inspired by Frankl’s ideas, the American psychiatrist William Breitbart with colleagues have developed both an individual and group model of Meaning-Centered Psychotherapy. Studies show that this therapy helps patients to cope with distress, to discover the  meaning of life in palliative care patients, and to find the  strength to look at life positively; also, it relieves the  symptoms of illness. The  Meaning-Centered Psychotherapy is integrated in various countries and has recently been initiated for palliative patients in Lithuania. The individual Meaning-Centered Psychotherapy was used in the case reviewed in this paper.

scholarly journals ASSESSMENT OF QUALITY OF RENDERING PALLIATIVE CARE TO THE ONCOLOGY PATIENTS

2017 ◽  
Vol 20 (7) ◽  
pp. 177-187
Author(s):  
E.P. Gladunova
Keyword(s):  
Palliative Care ◽  
Malignant Neoplasms ◽  
Medical Assistance ◽  
Oncology Patients ◽  
Patients With Cancer ◽  
The World ◽  
Oncological Diseases ◽  
Prevalence Of Cancer ◽  
Palliative Patients

The analysis of prevalence of cancer in the world, in Russia and on the territory of the Samara Region. The results of analysis of neglect of oncological diseases in the Samara region; the results of regression analysis of growth of oncological diseases are presented. The organization of rendering palliative care in the Samara Region is studied and assessment of provision of palliative patients with berths is carried out. The estimate of provision of patients with malignant neoplasms with drugs for pain management. Factors that reduce the quality of rendering of medical assistance to the oncology patients are revealed. Directions of improving the quality of pharmaceutical care of patients with cancer are suggested.

scholarly journals Palliative Care Comics: Designing a Person-Centered Patient Education Tool

2019 ◽  
Vol 43 (2) ◽  
Author(s):  
Mona Li ◽  
Shelley Wall ◽  
Camilla Zimmermann
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Treatment Options ◽  
Patient Journey ◽  
Narrative Design ◽  
Disease Trajectory ◽  
Life Threatening ◽  
Education Tool ◽  
Timely Referral

Palliative care can improve quality of life in patients facing life-threatening illnesses by addressing their physical, emotional, spiritual, and practical needs. Research has shown that palliative care initiated early in the disease trajectory improves patients’ mood, quality of life, and even survival. Nevertheless, timely referral and willingness to initiate palliative care are hindered by stigma and the misconception that palliative care is for patients who have exhausted treatment options. Well-designed comics may be useful for addressing complex, stigmatized topics, because they are unintimidating, easy to consume, and relatable to readers. Unsurprisingly, educational comics can teach more effectively than text or verbal instruction. Since palliative care is valued by patients for being a person-centered and patient-led experience, comics may be uniquely suited to educate about this topic by embedding information in the context of an individual patient journey. The comic, currently a work-in-progress, will include a didactic narrative about palliative care and a situational narrative describing the patient experience. Feedback from palliative care patients during the development process will inform visual and narrative design of the comic.

Quality of life of elderly patients undergoing concomitant chemoradiation therapy for head and neck cancers, including assessment of geriatric parameters.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6100-6100 ◽  
Author(s):  
Martine Extermann ◽  
William J Fulp ◽  
Ji-Hyun Lee ◽  
Julie Ann Kish ◽  
Marina Sehovic ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck ◽  
Locally Advanced ◽  
Stage Iv ◽  
Chemoradiation Therapy ◽  
Curative Intent ◽  
Significant Information ◽  
Concomitant Chemoradiation ◽  
Ecog Ps

6100 Background: Data on the quality of life of older patients undergoing concomitant chemoradiation therapy (CCRT) for head and neck (H&N) cancer are very scarce and no study has focused specifically on them. Furthermore, no study has assessed the contribution of geriatric symptoms to their quality of life. Methods: We prospectively assessed patients aged 65 and older undergoing curative intent CCRT for H&N cancers, either alone or adjuvantly after surgery. We used the Quality of life-Radiation Therapy Instrument (QOL-RTI), with its H&N module (Trotti et al., 1998). In addition we created a 12-items senior adult questionnaire (SAQ). Patients were assessed at baseline, at 4 weeks, at the end of treatment (EOT), and 2 months after EOT (recovery). Results: Fifty patients were enrolled. Median age was 69 years (range 65-87). Eighty-two percent of patients had locally advanced stage IV disease. Twenty-eight percent had prior surgery. All patients were treated with IMRT, 92% at 70 Gy. The most frequent chemotherapy regimen was cisplatin q3wks (58%), followed by weekly carboplatin (24%). Patients had on average 4 comorbidities (CIRS-G), 54% of them a grade 3 or 4 disease. Forty-four percent were independent in IADL, and 98% were ECOG PS 0 or 1. The baseline scores were QOL-RTI: 7.72 (SD 1.36), H&N module 7.7 (SD 2.16), SAQ 8.21 (SD 1.54). At EOT, the scores were 6.22 (1.26), 4.59 (1.82), 7.38 (1.38) respectively, and at recovery 7.17 (1.25), 6.06 (1.66), 7.96 (1.16). The scores paralleled functional evolution, as 24% of patients had an ECOG PS 2 and 76% were IADL dependent at EOT; 16% ECOG 2-3 and 55% IADL dependent at recovery. Cronbach alphas for the 3 QOL measures were 0.88, 0.89, and 0.81, suggesting adequate internal consistency reliability. The SAQ was low-to-moderately correlated with the other two QOL measures (r=0.22 to 0.59) at different points of assessment. Conclusions: Older H&N cancer patients experience significant impact of CCRT on their function, and on their quality of life on all three measures. Most recover after two months, although some may take longer. A geriatric module adds significant information to the general QOL-RTI and H&N questionnaires.

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