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Rondanina G, Siri G, Marra D, DeCensi A. Effect of sex on psychological distress and fatigue over time in a prospective cohort of cancer survivors. J Cancer Surviv 2024; 18:586-595. [PMID: 36344904 DOI: 10.1007/s11764-022-01291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Studies indicate a higher level of distress in women than men with cancer, but whether this difference is retained over time is unknown. We studied the frequency and level of distress and fatigue during time according to gender in a cohort of cancer survivors. PATIENTS AND METHODS In this prospective study, cancer survivors were invited to undergo a psychological session immediately before the medical visit. Distress was assessed by the distress thermometer, and fatigue was assessed by the ESAS-r scale. Patients underwent follow-up visits to assess changes over time. RESULTS A total of 305 patients and 568 visits were performed with a median follow-up of 15.8 months. At baseline, females, young age, and breast cancer patients had significantly higher distress. However, there was an increase in distress of 0.29 points every 6 months in males (95% CI, 0.09-0.50) versus no change in females (0.03 points, 95% CI, - 0.09-0.15; p-interaction = 0.01). The different behavior of cancer distress during time according to gender was more evident in subjects aged 68 or older due to increasing physical problems in men (p-interaction = 0.005). There was no change in fatigue with time according to sex. CONCLUSIONS Women, younger age, and breast cancer patients had increased cancer distress at the initial visit. However, women tend to stabilize during follow-up, whereas men tend to worsen their distress, especially because of physical and emotional problems, suggesting different coping capabilities. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov NCT05122052. IMPLICATIONS FOR CANCER SURVIVORS Interventions aimed at improving recognition of emotions related to disease experience in male cancer survivors appear necessary.
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Affiliation(s)
- Gabriella Rondanina
- E.O. Ospedali Galliera, 16128, Genoa, Italy.
- Villa Serena Hospital, GVM, 16145, Genoa, Italy.
| | | | | | - Andrea DeCensi
- E.O. Ospedali Galliera, 16128, Genoa, Italy
- Villa Serena Hospital, GVM, 16145, Genoa, Italy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
- European Institute of Oncology, IRCCS, 20141, Milan, Italy
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Zeneli A, Leombruni P, Miniotti M, Scarpi E, Maltoni M, Cavalieri S, Legni V, Nanni C, Tarca M, Rustignoli M, Montalti S. Psychometric Properties of the Italian Version of the Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF34-It): A Multicenter Validation Study. NURSING REPORTS 2024; 14:303-316. [PMID: 38391068 PMCID: PMC10885028 DOI: 10.3390/nursrep14010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
This study aimed to evaluate psychometric properties of the Italian version of the Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF34) in a cancer population. A multicenter prospective observational study was carried out in outpatient and inpatient settings. The evaluated psychometric properties were as follows: the five-domain structure, the internal consistency, the convergent validity with the Edmond Symptom Assessment System (ESAS) questionnaire, the discriminant validity and test-retest reliability. A total of 714 patients with different types, stages and treatment settings of cancer were recruited. A total of 56% of participants were women, the median age 59 years (range 18-88). The prevalence of patients reporting at least one unmet need was 78.7%. The factor analysis explained 71.3% of the total variance, confirming the five-domain structure of the original model. Internal consistency was good, with Cronbach's alpha values ranging from 0.87 ("psychosocial need", "patient support and health system", "information") to 0.90 ("sexuality"). The convergent validity of the SCNS-SF34-It with the ESAS scale was low, suggesting that these questionnaires cover different concepts. The SCNS-SF34-It was able to discriminate differences between groups, and the test-retest reliability was good (ICC 0.72-0.84). The SCNS-SF34-It proved to be a reliable instrument for use in clinical practice for evaluating unmet needs in the Italian population of cancer patients. This study was not registered.
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Affiliation(s)
- Anita Zeneli
- Nursing and Technical Directorate, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), Via Maroncelli 40, 47014 Meldola, Italy
| | - Paolo Leombruni
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Marco Miniotti
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Emanuela Scarpi
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), Via Maroncelli 40, 47014 Meldola, Italy
| | - Marco Maltoni
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Sara Cavalieri
- Nursing and Technical Directorate, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), Via Maroncelli 40, 47014 Meldola, Italy
| | - Valentina Legni
- Nursing and Technical Directorate, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), Via Maroncelli 40, 47014 Meldola, Italy
| | - Cristina Nanni
- Nursing and Technical Directorate, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), Via Maroncelli 40, 47014 Meldola, Italy
| | - Mihaiela Tarca
- Nursing and Technical Directorate, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), Via Maroncelli 40, 47014 Meldola, Italy
| | - Michela Rustignoli
- Nursing and Technical Directorate, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), Via Maroncelli 40, 47014 Meldola, Italy
| | - Sandra Montalti
- Nursing and Technical Directorate, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), Via Maroncelli 40, 47014 Meldola, Italy
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Goodrose-Flores C, Bonn SE, Klasson C, Frankling MH, Lagerros YT, Björkhem-Bergman L. Appetite and its association with mortality in patients with advanced cancer - a Post-hoc Analysis from the Palliative D-study. BMC Palliat Care 2023; 22:159. [PMID: 37880704 PMCID: PMC10601273 DOI: 10.1186/s12904-023-01287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Loss of appetite is a common nutrition symptom in patients with cancer. Understanding the trajectory of appetite could be of clinical use for prognostication in palliative cancer care. Our primary aim was to explore the association between self-assessed appetite and mortality in patients suffering from advanced cancer. Secondary aims included the relation between fatigue, albumin levels and CRP/albumin ratio and mortality. We also aimed to study potential sex-differences in the associations. METHODS Post-hoc analyses were performed using data from the Palliative D-study comprising 530 patients with cancer admitted to palliative care. Appetite and fatigue were assessed with the Edmonton Symptom Assessment System (ESAS). Cox proportional hazards models were used to calculate Hazard ratios (HR) with 95% confidence intervals (CI) for exposures of appetite, fatigue, albumin and CRP/albumin ratio, and time from study inclusion to death or censoring. Analyses were also performed stratified by sex. RESULTS The follow-up time ranged between 7 to 1420 days. Moderate and poor appetite were significantly associated with a higher mortality rate compared to reporting a good appetite; HR 1.44 (95%CI: 1.16-1.79) and HR 1.78 (95%CI: 1.39-2.29), respectively. A higher mortality rate was also seen among participants reporting severe fatigue compared to those reporting no fatigue; HR 1.84 (95%CI:1.43-2.36). Participants with low albumin levels (< 25 g/L) and those in the highest tertile of CRP/albumin ratio, had higher mortality rates, HR 5.35 (95%CI:3.75-7.63) and HR 2.66 (95%CI:212-3.35), compared to participants with high albumin levels (> 36 g/L) and those in lowest tertile of CRP/albumin ratio. These associations were more pronounced in men than in women. CONCLUSION Poor appetite, severe fatigue, low albumin level and a high CRP/albumin ratio were associated with increased mortality rates among patients with advanced cancer. All these variables might be clinically useful for prognostication in palliative cancer care. TRIAL REGISTRATION Clinicaltrial.gov. Identifier: NCT03038516;31, January 2017.
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Affiliation(s)
- Charlotte Goodrose-Flores
- Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden.
| | - Stephanie E Bonn
- Department of Medicine, Division of Clinical Epidemiology (KEP), Solna, Karolinska Institutet, Stockholm, Sweden
| | - Caritha Klasson
- Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Maria Helde Frankling
- Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Thoracic Oncology Center, Theme Cancer, Solna, Stockholm, SE-171 64, Sweden
| | - Ylva Trolle Lagerros
- Department of Medicine, Division of Clinical Epidemiology (KEP), Solna, Karolinska Institutet, Stockholm, Sweden
- Center of Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Linda Björkhem-Bergman
- Division of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Stockholms Sjukhem, Palliative Medicine, Mariebergsgatan 22, SE-122 19, Stockholm, Sweden
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Miccinesi G, Ripamonti C, Leoni S, Gandelli M, Di Pede P, Visani V, Ambrosini P, De Feo G, Bellandi L, Toffolatti L, Chelazzi C, Trinci C, Chiesi F. Assessing suffering of patients on cancer treatment and of those no longer treated using ESAS-Total Care (TC). Support Care Cancer 2023; 31:579. [PMID: 37715838 PMCID: PMC10505109 DOI: 10.1007/s00520-023-08035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/02/2023] [Indexed: 09/18/2023]
Abstract
AIM The aim of the study was to assess the suffering of patients on oncologic treatment and of those no longer on treatment. Preliminarily, we aimed to confirm the psychometric properties of Edmonton Symptom Assessment System-Total Care (ESAS-TC) in different stages of the disease. The ESAS-TC screens physical and psychological symptoms, but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation. METHODS A sample of consecutive advanced cancer patients on oncologic therapies treated at the Internistic and Geriatric Supportive Care Unit (IGSCU) of Istituto Nazionale dei Tumori, Milano, and of terminal patients no longer on treatment and cared for by the Fondazione ANT palliative home care team were asked to fill the ESAS-TC. In order to strengthen the previous validation study of the ESAS-TC, 3-ULS (to assess social isolation), JSWBS (to assess spiritual well-being), COST-IT (to assess financial distress), and KPS (to assess functional status) were administered too. RESULTS The questionnaires were self-reported by 108 patients on treatment (52% >60 years old, female 53%, and 61% with KPS 90-100) and by 94 home care patients (71% >60 years old, female 51%, and 68% with KPS 10-50). The sound psychometric characteristics of ESAS-TC were confirmed. Patients on treatment showed lower total ESAS-TC score (19.3 vs 52.7, p<.001) after controlling for age and functional status, and lower financial distress (p.<001). Financial distress, spiritual suffering, and social isolation, after controlling for age, showed a significantly higher score in home care patients. CONCLUSIONS Only through an adequate routine assessment with validated tools is it possible to detect total suffering, the "Total pain" of patients, and treat it through a multidisciplinary approach. The study confirms the reliability and validity of the Italian version of ESAS-TC and the importance of supportive and early palliative care fully integrated with oncological treatment.
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Affiliation(s)
- Guido Miccinesi
- Clinical Epidemiology Unit, Oncological Network Prevention and Research Institute (ISPRO), Florence, Italy
| | - Carla Ripamonti
- Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Universita' degli Studi di Brescia, Brescia, Italy.
| | | | - Monica Gandelli
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Patricia Di Pede
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Paolo Ambrosini
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia De Feo
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Luisa Toffolatti
- Internistic and Geriatric Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Cosimo Chelazzi
- Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Universita' degli Studi di Brescia, Brescia, Italy
| | | | - Francesca Chiesi
- Department of Neuroscience, Psychology, Drug, and Child's Health (NEUROFARBA), Section of Psychology, University of Florence, Florence, Italy
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Porcu L, Recchia A, Bosetti C, Chiaruttini MV, Uggeri S, Lonati G, Ubezio P, Rizzi B, Corli O. Development and external validation of a predictive multivariable model for last-weeks survival of advanced cancer patients in the palliative home care setting (PACS). Support Care Cancer 2023; 31:536. [PMID: 37624424 DOI: 10.1007/s00520-023-07990-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Various prognostic indexes have been proposed to improve physicians' ability to predict survival time in advanced cancer patients, admitted to palliative care (PC) with a survival probably to a few weeks of life, but no optimal score has been identified. The study aims therefore to develop and externally validate a new multivariable predictive model in this setting. METHODS We developed a model to predict short-term overall survival in cancer patients on the basis of clinical factors collected at PC admission. The model was developed on 1020 cancer patients prospectively enrolled to home palliative care at VIDAS Milan, Italy, between May 2018 and February 2020 and followed-up to June 2020, and validated in two separate samples of 544 home care and 247 hospice patients. RESULTS Among 68 clinical factors considered, five predictors were included in the predictive model, i.e., rattle, heart rate, anorexia, liver failure, and the Karnofsky performance status. Patient's survival probability at 5, 15, 30 and 45 days was estimated. The predictive model showed a good calibration and moderate discrimination (area under the receiver operating characteristic curve between 0.72 and 0.79) in the home care validation set, but model calibration was suboptimal in hospice patients. CONCLUSIONS The new multivariable predictive model for palliative cancer patients' survival (PACS model) includes clinical parameters routinely at patient's admission to PC and can be easily used to facilitate immediate and appropriate short-term clinical decisions for PC cancer patients in the home setting.
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Affiliation(s)
- Luca Porcu
- Methodological Research Unit, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Angela Recchia
- Fondazione VIDAS, Via U. Ojetti, 66, 20151, Milan, Italy.
| | - Cristina Bosetti
- Unit of Cancer Epidemiology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maria Vittoria Chiaruttini
- Unit of Cancer Epidemiology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Sara Uggeri
- Unit of Pain and Palliative Care Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Paolo Ubezio
- Unit of Biophysics, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Barbara Rizzi
- Fondazione VIDAS, Via U. Ojetti, 66, 20151, Milan, Italy
| | - Oscar Corli
- Unit of Pain and Palliative Care Research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Bosetti C, Casirati A, Da Prat V, Masi S, Crotti S, Ferrari A, Perrone L, Serra F, Santucci C, Cereda E, Iannelli E, De Lorenzo F, Pedrazzoli P, Caccialanza R. Multicentric, observational, longitudinal study for the evaluation of nutritional management implications in newly diagnosed Italian cancer patients: the Italian Registry of Malnutrition in Oncology (IRMO). BMJ Open 2023; 13:e071858. [PMID: 37604631 PMCID: PMC10445343 DOI: 10.1136/bmjopen-2023-071858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/17/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Malnutrition is a frequent problem in oncology and is associated with reduced response to cancer treatments, increased drug-related toxicity, higher rates of clinical complications, reduced quality of life (QoL) and worse prognosis. Guidelines on clinical nutrition in oncology emphasise the usefulness of early assessment of nutritional status for a prompt identification of malnutrition and the implementation of effective interventions, but no real-world clinical data are available on the adequate management of nutritional support in patients with cancer in Italy. METHODS AND ANALYSIS This is an observational, longitudinal, multicentre registry of patients with a new diagnosis of cancer or metastatic disease, candidates for active treatment. They will be identified in at least 15 Italian oncological centres, members of the Alliance Against Cancer Working Group 'Survivorship Care and Nutritional Support'. At least 1500 patients with cancer are expected to be enrolled each year. Detailed clinical and nutritional data will be collected by oncologists and clinical nutritionists during the visits foreseen in the clinical practice, through an ad hoc developed digital platform (e-Nutracare). The effects of malnutrition and nutritional support-at diagnosis and during follow-up-on overall survival and progression-free survival, as well as on patients' symptoms and QoL, will be investigated. ETHICS AND DISSEMINATION The study protocol was approved by the Ethics Committee of the Fondazione IRCCS Policlinico San Matteo, Pavia, Italy and from the Ethics Committees of all other participating centres. An informed consent will be obtained from each patient enrolled in the study. Study findings will be disseminated through peer-reviewed journals, conferences and patients with cancer or professional associations. The registry will allow a better monitoring of the nutritional status of patients with cancer, promoting adequate and sustainable nutritional support, with the ultimate goal of improving the care and prognosis of these patients.
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Affiliation(s)
- Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Amanda Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Da Prat
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Masi
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Crotti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Ferrari
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Perrone
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Serra
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudia Santucci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Zerbinati L, Guerzoni F, Napoli N, Preti A, Esposito P, Caruso R, Bulighin F, Storari A, Grassi L, Battaglia Y. Psychosocial determinants of healthcare use costs in kidney transplant recipients. Front Public Health 2023; 11:1158387. [PMID: 37333548 PMCID: PMC10272730 DOI: 10.3389/fpubh.2023.1158387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Psychosocial factors frequently occur in kidney transplant recipients (KTRs), leading to behavioral alterations and reduced therapeutic adherence. However, the burden of psychosocial disorders on costs for KTRs is unknown. The aim of the study is to identify predictors of healthcare costs due to hospital admissions and emergency department access in KTRs. Methods This is a longitudinal observational study conducted on KTRs aged >18 years, excluding patients with an insufficient level of autonomy and cognitive disorder. KTRs underwent psychosocial assessment via two interviews, namely the Mini-International Neuropsychiatric Interview 6.0 (MINI 6.0) and the Diagnostic Criteria for Psychosomatic Research Interview (DCPR) and via the Edmonton Symptom Assessment System Revised (ESAS-R) scale, a self-administrated questionnaire. Sociodemographic data and healthcare costs for hospital admissions and emergency department access were collected in the 2016-2021 period. Psychosocial determinants were as follows: (1) ESAS-R psychological and physical score; (2) symptomatic clusters determined by DCPR (illness behavior cluster, somatization cluster, and personological cluster); and (3) ICD diagnosis of adjustment disorder, anxiety disorder, and mood disorder. A multivariate regression model was used to test the association between psychosocial determinants and total healthcare costs. Results A total of 134 KTRs were enrolled, of whom 90 (67%) were men with a mean age of 56 years. A preliminary analysis of healthcare costs highlighted that higher healthcare costs are correlated with worse outcomes and death (p < 0.001). Somatization clusters (p = 0.020) and mood disorder (p < 0.001) were positively associated with costs due to total healthcare costs. Conclusions This study showed somatization and mood disorders could predict costs for hospital admissions and emergency department access and be possible risk factors for poor outcomes, including death, in KTRs.
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Affiliation(s)
- Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Franco Guerzoni
- Programming and Management Control Service, Unit of Controls, St. Anna University-Hospital, Ferrara, Italy
| | - Nicola Napoli
- Programming and Management Control Service, Statistics Service, St. Anna University-Hospital, Ferrara, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Pasquale Esposito
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | | | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University-Hospital, Ferrara, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Yuri Battaglia
- Department of Medicine, University of Verona, Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, Verona, Italy
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Naik B, Nagaraju SP, Guddattu V, Salins N, Prabhu R, Damani A, Naik P, Rao KS, Rao IR, Singhai P. Kannada Translation and Validation of the ESAS-r Renal for Symptom Burden Survey in Patients with End-Stage Kidney Disease. Indian J Palliat Care 2023; 29:195-199. [PMID: 37325264 PMCID: PMC10261939 DOI: 10.25259/ijpc_216_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/23/2023] [Indexed: 06/17/2023] Open
Abstract
Objectives End-stage kidney disease (ESKD) is a life-limiting illness that leads to significant health-related suffering for the patients and their caregivers. Moreover, disease-directed options such as dialysis and renal transplant might not be universally accessible. Inadequate assessment and management of symptoms often lead to diminished quality of life. For evaluating symptoms and their associated distress, various tools have been identified. However, these are not available for the native Kannada-speaking population for assessing ESKD symptom burden. In this study, we determined the reliability and validity of the Edmonton Symptom Assessment System Revised Renal (ESAS-r: Renal) in Kannada-speaking ESKD patients. Materials and Methods ESAS-r: Renal English version was translated into Kannada using the forward and backward method. The translated version was endorsed by Nephrology, Palliative care, Dialysis technology and Nursing experts. As a pilot study, 12 ESKD patients evaluated the content of the questionnaires for appropriateness and relevance. The ESAS-r: Renal Kannada version was validated by administering this tool to 45 patients twice a fortnight. Result The translated ESAS-r: Renal Kannada version questionnaire had an acceptable face and content validity. Experts' opinion was assessed by content validity ratio (CVR), and the value of CVR of ESAS-r: Renal Kannada version was-'1'-. Internal consistency of the tool was assessed among Kannada-speaking ESKD patients; its Cronbach's α was 0.785, and test-retest validity was 0.896. Conclusion The validated Kannada version of ESAS-r: Renal was reliable and valid for assessing symptom burden in ESKD patients.
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Affiliation(s)
- Bharathi Naik
- Department of Renal Replacement Therapy and Dialysis Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vasudeva Guddattu
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravindra Prabhu
- Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anuja Damani
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prathvi Naik
- Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Krithika S. Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pankaj Singhai
- Department of Palliative Medicine, Sri Aurobindo Medical College and PG Institute, Sri Aurobindo University, Indore, Madhya Pradesh, India
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Lombi L, Alfieri S, Brunelli C. 'Why should I fill out this questionnaire?' A qualitative study of cancer patients' perspectives on the integration of e-PROMs in routine clinical care. Eur J Oncol Nurs 2023; 63:102283. [PMID: 36893578 DOI: 10.1016/j.ejon.2023.102283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE There is increasing interest in integrating electronic patient-reported outcomes (e-PROs) into clinical routines in cancer settings. However, little is known about patients' experiences with and perceptions of e-PRO measures (e-PROMs). This study examines patients' experiences with e-PROMS, particularly their perspectives about its usefulness and its implications for the clinical encounter with their doctors. METHOD A total of 19 individual in-person interviews with cancer patients at a Comprehensive Cancer Center in northern Italy conducted in 2021 inform this study. RESULTS The findings suggested that, overall, patients had positive attitudes towards data collection using e-PROMs. On the one hand, most patients found the integration of e-PROMs into routine clinical practice as beneficial in treating patients with cancer. The main benefits of e-PROMs according to this group of patients were that: they promoted patient-centred care; could be used to tailor and improve the quality of care through a holistic approach; supported early detection of problematic symptoms; increased patient self-awareness; and contributed to clinical research. On the other hand, many patients did not fully understand the purpose of e-PROMs and some patients were also sceptical about their usefulness in routine clinical practice. CONCLUSIONS These findings have several practical implications for ensuring the successful implementation of e-PROMs in routine clinical practice. These include the following preconditions: patients are informed about the purposes of data collection; physicians provide feedback to patients about the e-PROMs' results; and that hospital administrators allocate sufficient time for clinical interactions to integrate e-PROMs into routine clinical practice.
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Affiliation(s)
- Linda Lombi
- Department of Sociology, Università Cattolica del Sacro Cuore, Italy.
| | - Sara Alfieri
- Clinical psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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10
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Palagini L, Zerbinati L, Balestrieri M, Belvederi Murri M, Caruso R, D'Agostino A, Ferrara M, Ferrari S, Minervino A, Massa L, Milia P, Miniati M, Maria Giulia N, Petrucci A, Pini S, Politi P, Porcellana M, Rocchetti M, Taddei I, Toffanin T, Grassi L. Poor sleep quality may contribute to dysfunctional illness perception, physical and emotional distress in hospitalised patients: results of a national survey of the Italian Society of Consultation-Liaison Psychiatry. J Sleep Res 2023; 32:e13617. [PMID: 35460144 DOI: 10.1111/jsr.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/03/2023]
Abstract
Distress associated with physical illness is a well-known risk factor for adverse illness course in general hospitals. Understanding the factors contributing to it should be a priority and among them dysfunctional illness perception and poor sleep quality may contribute to it. As poor sleep quality is recognised as a major risk factor for health problems, we aimed to study its association with illness perception and levels of distress during hospitalisation. This cross-sectional study included a consecutive series of 409 individuals who were hospitalised in medical and surgical units of different hospitals located throughout the Italian national territory and required an assessment for psychopathological conditions. Sleep quality was assessed with the Pittsburgh (Sleep Quality Index), emotional and physical distress with the Edmonton Symptom Assessment System (ESAS), and illness perception with the Brief Illness Perception Questionnaire (BIPQ). Differences between groups, correlations and mediations analyses were computed. Patients with poor sleep quality were more frequently females, with psychiatric comorbidity, with higher scores in the ESAS and BIPQ. Poor sleep quality was related to dysfunctional illness perception, and to both emotional and physical distress. In particular, by affecting cognitive components of illness perception, poor sleep quality may, directly and indirectly, predict high levels of distress during hospitalisation. Poor sleep quality may affect >70% of hospitalised patients and may favour dysfunctional illness perception and emotional/physical distress.Assessing and treating sleep problems in hospitalised patients should be included in the routine of hospitalised patients.
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Affiliation(s)
- Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy.,Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Matteo Balestrieri
- Psychiatric Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Armando D'Agostino
- Department of Health Sciences, University of Milan, Italy; Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Silvia Ferrari
- Department of Diagnostic-Clinical Medicine and Public Health, Section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Lucia Massa
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Paolo Milia
- Psychiatric Clinic and Medical Clinic, University of Sassari, Sassari, Italy
| | - Mario Miniati
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Nanni Maria Giulia
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Alessandra Petrucci
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Matteo Porcellana
- Department of Health Sciences, University of Milan, Italy; Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Matteo Rocchetti
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Ines Taddei
- Department of Psychiatric Sciences and Psychological Medicine, University La Sapienza, 3rd Psychiatric Clinic, Rome, Italy
| | - Tommaso Toffanin
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
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11
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Shamieh O, Alarjeh G, Qadire MA, Amin Z, AlHawamdeh A, Al-Omari M, Mohtadi O, Illeyyan A, Ayaad O, Al-Ajarmeh S, Al-Tabba A, Ammar K, Al-Rimawi D, Abu-Nasser M, Abu Farsakh F, Hui D. Validation of the Arabic Version of the Edmonton Symptom Assessment System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2571. [PMID: 36767943 PMCID: PMC9915286 DOI: 10.3390/ijerph20032571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Quality cancer care is a team effort. In addition, patients' symptoms change over the course of treatment. As such, the Edmonton Symptom Assessment System (ESAS) is a simple tool designed to quickly monitor symptom change. Here, we present the results from a two-phase study aimed at validating the Arabic version of the ESAS (ESAS-A). Phase one involved the creation of two versions of the ESAS with both reverse and forward translations by bilingual, native Arabic speakers as well as evaluation by an expert panel. The reconciled version was then administered to 20 patients as a pilot from which to create the final version, which was then used with 244 patients. Phase two for the ESAS-involved an ESAS-based validation of 244 adults aged 18 years and older who were diagnosed with advanced cancer; then, further validation was completed in conjunction with two other symptom survey tools, the EORTC-Pal 15 and the HADS. The ESAS-A items possessed good internal consistency with an average Cronbach's alpha of 0.84, ranging from 0.82 to 0.85. Moreover, the results of ESAS-A showed good agreement with those of EORTC QLQ- 15 PAL (r = 0.36 to 0.69) and HADS (r = 0.60 and 0.57) regarding anxiety and depression. We found the ESAS-A to be responsive to symptom change and a median time to completion of 3.73 min. The results of our study demonstrate that the ESAS-A is a reliable, valid, and feasible tool for the purposes of monitoring symptom change over the course of cancer treatment.
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Affiliation(s)
- Omar Shamieh
- Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
- Center for Palliative & Cancer Care in Conflict, King Hussein Cancer Center, Amman 11941, Jordan
- Faculty of Medicine, the University of Jordan, Amman 11942, Jordan
| | - Ghadeer Alarjeh
- Center for Palliative & Cancer Care in Conflict, King Hussein Cancer Center, Amman 11941, Jordan
| | - Mohammad Al Qadire
- Adult Health Department, Faculty of Nursing, Al Al-Bayt University, Mafraq 25113, Jordan
- College of Nursing, Sultan Qaboos University, Muscat 123, Oman
| | - Zaid Amin
- Department of Medicine, King Hussein Cancer Center, Amman 11941, Jordan
| | | | - Mohammad Al-Omari
- Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
| | - Omar Mohtadi
- Department of Medicine, King Hussein Cancer Center, Amman 11941, Jordan
| | - Abdullah Illeyyan
- Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
| | - Omar Ayaad
- Sultan Qaboos Comprehensive Cancer Center Care and Research Center, Muscat P.O. Box 566 PC 123, Oman
| | - Sawsan Al-Ajarmeh
- Center for Palliative & Cancer Care in Conflict, King Hussein Cancer Center, Amman 11941, Jordan
| | - Amal Al-Tabba
- Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
| | - Khawlah Ammar
- Center of Research Shared Resources, King Hussein Cancer Center, Amman 11941, Jordan
| | - Dalia Al-Rimawi
- Center of Research Shared Resources, King Hussein Cancer Center, Amman 11941, Jordan
| | - Mahmoud Abu-Nasser
- Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
- Department of Medicine, King Hussein Cancer Center, Amman 11941, Jordan
| | - Fadi Abu Farsakh
- Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
| | - David Hui
- MD Anderson Cancer Center, Houston, TX 77030, USA
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12
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Celio L, Cortinovis D, Cogoni AA, Cavanna L, Martelli O, Carnio S, Collovà E, Bertolini F, Petrelli F, Cassano A, Chiari R, Zanelli F, Pisconti S, Vittimberga I, Letizia A, Misino A, Gernone A, Bonizzoni E, Pilotto S, De Placido S, Bria E. Exploratory analysis of the effect of a dexamethasone-sparing regimen for prophylaxis of cisplatin-induced emesis on food intake (LUNG-NEPA study). Sci Rep 2023; 13:1257. [PMID: 36690734 PMCID: PMC9870907 DOI: 10.1038/s41598-023-28464-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
We demonstrated the non-inferiority of a dexamethasone (DEX)-sparing (single-dose) regimen with NEPA, a netupitant/palonosetron fixed combination, for preventing chemotherapy-induced nausea and vomiting (CINV) caused by cisplatin. This pre-planned exploratory analysis assessed the effect of the DEX-sparing regimen on a patient's food intake. Chemotherapy-naïve patients undergoing cisplatin (≥ 70 mg/m2) were given NEPA and DEX (12 mg) on day 1 and randomized to receive either no further DEX (DEX1), or oral DEX (4 mg BID) on days 2-4 (DEX4). Patient-reported endpoint maintenance of usual daily food intake was assessed during the 5-days post-chemotherapy. The relationship between usual daily food intake and CINV control, pre-chemotherapy self-rated food intake and BMI-adjusted weight loss (WL) were evaluated. One-hundred fifty-two patients (76/group) were assessable. The proportion of patients reporting maintenance of usual daily food intake was similar in both groups: 69.7% (95% CI, 58.6-78.9) for DEX1 vs. 72.4% (95% CI, 61.4-81.2) for DEX4. Only CINV control was significantly associated with maintenance of usual daily food intake (P ≤ 0.001) during the overall phase. The DEX-sparing regimen does not adversely affect patient-reported daily food intake post-chemotherapy. The current analysis adds further insights into antiemetic efficacy of DEX sparing beyond day 1 in the challenging setting of cisplatin.Trial registration: The parent study was registered on ClinicalTrials.gov (NCT04201769).
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Affiliation(s)
- Luigi Celio
- Medical Oncology Unit, ASST del Garda, Località Montecroce 1, 25015, Desenzano del Garda, BS, Italy.
| | - Diego Cortinovis
- Medical Oncology Department, ASST Monza San Gerardo Hospital, Monza, Italy
| | - Alessio Aligi Cogoni
- Medical Oncology Department, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Luigi Cavanna
- Oncology Department, Azienda Ospedaliera di Piacenza, Piacenza, Italy
| | | | - Simona Carnio
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Elena Collovà
- Cancer Centre Department - Oncology Unit, ASST Ovest Milanese - Legnano Hospital, Legnano, Milan, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, AOU Policlinico di Modena, Modena, Italy
| | - Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Alessandra Cassano
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rita Chiari
- Oncology Unit, AULSS6 Euganea, Padova, Italy
| | - Francesca Zanelli
- Medical Oncology Unit, IRCCS Santa Maria Nuova, Reggio Emilia, Italy
| | - Salvatore Pisconti
- Medical Oncology Department, San Giuseppe Moscati Hospital, Statte, Taranto, Italy
| | | | - Antonietta Letizia
- Department of Pneumology and Oncology, AORN dei Colli-Ospedale Monaldi, Naples, Italy
| | - Andrea Misino
- Medical Oncology, Clinical Cancer Center, "Giovanni Paolo II" - IRCCS, Bari, Italy
| | - Angela Gernone
- Medical Oncology Unit, University of Bari, Policlinico di Bari, Bari, Italy
| | - Erminio Bonizzoni
- Department of Clinical Science and Community, Section of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Sabino De Placido
- Clinical Medicine and Surgery Department, University of Naples "Federico II", Naples, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Sanna V, Fedele P, Deiana G, Alicicco MG, Ninniri C, Santoro AN, Pazzola A, Fancellu A. Edmonton Symptom Assessment Scale may reduce medical visits in patients undergoing chemotherapy for breast cancer. World J Clin Oncol 2022; 13:577-586. [PMID: 36157162 PMCID: PMC9346425 DOI: 10.5306/wjco.v13.i7.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/05/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adjuvant chemotherapy is recommended in high-risk breast cancer. However, no universally accepted guidelines exist on pre-chemotherapy assessment. In particular, the number and frequency of medical visits vary according to each institution’s policy. We hypothesised that the Edmonton Symptom Assessment Scale (ESAS) may have a favourable impact on the pre-treatment assessment in candidates for adjuvant chemotherapy.
AIM To investigate whether the ESAS can be used to safely reduce the number of medical visits in women with breast cancer undergoing adjuvant chemotherapy.
METHODS In a retrospectively prospective matched-pair analysis, 100 patients who completed the ESAS questionnaire before administration of adjuvant chemotherapy (ESAS Group) were compared with 100 patients who underwent chemotherapy according to the traditional modality, without ESAS (no-ESAS Group). Patients of the ESAS Group received additional visits before treatment if their ESAS score was > 3. The primary endpoint was the total number of medical visits during the entire duration of the chemotherapy period. The secondary endpoints were the occurrence of severe complications (grade 3-4) and the number of unplanned visits during the chemotherapy period.
RESULTS The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group (age P = 0.880; breast cancer stage P = 0.56; cancer histology P = 0.415; tumour size P = 0.258; lymph node status P = 0.883; immunohistochemical classification P = 0.754; type of surgery P = 0.157), except for premenopausal status (P = 0.015). The study variables did not statistically differ between patients of the ESAS Group and no-ESAS Group regarding age, cancer stage, histology, tumour size, lymph node status, immunohistochemical classification, and type of surgery. Unplanned visits during the entire duration of chemotherapy were 8 in the ESAS Group and 18 in the no-ESAS Group visits (P = 0.035). Grade 3-4 toxicity did not differ between the study groups (P = 0.652). Forty-eight patients of the ESAS Group received additional visits due to an ESAS score > 3. The mean number of medical visits was 4.38 ± 0.51 in the ESAS Group and 16.18 ± 1.82 in the no-ESAS group (P < 0.001). With multivariate analysis, women of the ESAS group were more likely to undergo additional visits for an ESAS score > 3 if they were aged 60 or older, received a mastectomy, or had tumour stage II/III.
CONCLUSION The ESAS score may safely reduce the number of medical visits in candidates for adjuvant chemotherapy for early breast cancer. Our results suggest that the ESAS score may be used for selecting a group of breast cancer patients for whom it is safe to reduce the number of medical visits in the setting of adjuvant chemotherapy. This may translate into several advantages, such as a more rational utilization of human resources and a possible reduction of coronavirus pandemic infection risk in oncologic patients.
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Affiliation(s)
- Valeria Sanna
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Palma Fedele
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Giulia Deiana
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | | | - Chiara Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Anna N Santoro
- Unit of Medical Oncology, Hospital “D. Camberlingio”, Francavilla Fontana 72100, Brindisi, Italy
| | - Antonio Pazzola
- Unit of Medical Oncology, A.O.U. Sassari, Sassari 07100, Italy
| | - Alessandro Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
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14
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Moscato S, Orlandi S, Giannelli A, Ostan R, Chiari L. Automatic pain assessment on cancer patients using physiological signals recorded in real-world contexts. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1931-1934. [PMID: 36086417 DOI: 10.1109/embc48229.2022.9871990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pain assessment represents the first fundamental stage for proper pain management, but currently, methods applied in clinical practice often lack in providing a satisfying characterization of the pain experience. Automatic methods based on the analysis of physiological signals (e.g., photoplethysmography, electrodermal activity) promise to overcome these limitations, also providing the possibility to record these signals through wearable devices, thus capturing the physiological response in everyday life. After applying preprocessing, feature extraction and feature selection methods, we tested several machine learning algorithms to develop an automatic classifier fed with physiological signals recorded in real-world contexts and pain ratings from 21 cancer patients. The best algorithm achieved up to 72% accuracy. Although performance can be improved by enlarging the dataset, preliminary results proved the feasibility of assessing pain by using physiological signals recorded in real-world contexts.
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15
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Ghoshal A, Damani A, Deodhar J, Quadros L, Ganpathy KV, Muckaden MA. A novel nurse-coordinated home care model for palliative care in advanced cancer: A pilot interventional study from suburban Mumbai. PROGRESS IN PALLIATIVE CARE 2022. [DOI: 10.1080/09699260.2022.2081440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A. Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - A. Damani
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - J. Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - L. Quadros
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - K. V. Ganpathy
- JEET ASSOCIATION FOR SUPPORT TO CANCER PATIENTS (JASCAP), Mumbai
| | - M. A. Muckaden
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
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16
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Goodrose-Flores C, Bonn S, Klasson C, Helde Frankling M, Trolle Lagerros Y, Björkhem-Bergman L. Appetite in Palliative Cancer Patients and Its Association with Albumin, CRP and Quality of Life in Men and Women—Cross-Sectional Data from the Palliative D-Study. Life (Basel) 2022; 12:life12050671. [PMID: 35629338 PMCID: PMC9144128 DOI: 10.3390/life12050671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022] Open
Abstract
Albumin is an important biochemical marker in palliative cancer care, used for assessment of nutritional status, disease severity and prognosis. Our primary aim was to investigate sex differences in the association between appetite and albumin levels in palliative cancer patients. We also aimed to study associations between appetite and C-reactive protein (CRP), Quality of Life (QoL), pain and fatigue. In the Palliative D-cohort, consisting of 266 men and 264 women, we found a correlation between appetite and albumin; low appetite, measured with the Edmonton Symptom Assessment System, correlated significantly with low albumin in men: (r = −0.33, p < 0.001), but not in women (r = −0.03, p = 0.65). In a regression analysis adjusted for confounding factors, results were similar. Lower appetite was correlated with higher CRP in men (r = 0.27, p < 0.001), but not in women (r = 0.12, p = 0.05). Appetite was correlated with QoL, fatigue and pain in both men and women; those with a low appetite had a low QoL and high fatigue- and pain-scores (p < 0.001). In conclusion, our results indicated possible sex differences in the associations between appetite and albumin, and between appetite and CRP, in palliative care patients. Understanding these associations could provide additional value for clinical practice.
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Affiliation(s)
- Charlotte Goodrose-Flores
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, 171 77 Solna, Sweden; (S.B.); (Y.T.L.)
- Correspondence:
| | - Stephanie Bonn
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, 171 77 Solna, Sweden; (S.B.); (Y.T.L.)
| | - Caritha Klasson
- Division of Geriatrics, Department of Neurobiology, Care Sciences and Society (Huddinge), Karolinska Institutet, 171 77 Solna, Sweden; (C.K.); (M.H.F.); (L.B.-B.)
| | - Maria Helde Frankling
- Division of Geriatrics, Department of Neurobiology, Care Sciences and Society (Huddinge), Karolinska Institutet, 171 77 Solna, Sweden; (C.K.); (M.H.F.); (L.B.-B.)
- Theme Cancer, Karolinska University Hospital, 112 19 Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, 171 77 Solna, Sweden; (S.B.); (Y.T.L.)
- Center of Obesity, Academic Specialist Center, Stockholm Health Services, 112 19 Stockholm, Sweden
| | - Linda Björkhem-Bergman
- Division of Geriatrics, Department of Neurobiology, Care Sciences and Society (Huddinge), Karolinska Institutet, 171 77 Solna, Sweden; (C.K.); (M.H.F.); (L.B.-B.)
- Theme Cancer, Karolinska University Hospital, 112 19 Stockholm, Sweden
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17
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Artico M, Piredda M, D'Angelo D, Di Nitto M, Giannarelli D, Marchetti A, Facchinetti G, De Chirico C, De Marinis MG. Palliative care organization and staffing models in residential hospices: Which makes the difference? Int J Nurs Stud 2021; 126:104135. [PMID: 34923319 DOI: 10.1016/j.ijnurstu.2021.104135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The number of patients using palliative care services, particularly residential hospices, is increasing. Policymakers are urging these services to reflect on the most effective organizational strategies for meeting patients' complex care needs. AIM To analyze the predictive power of staffing, structure and process indicators towards optimal control of patients' clinically significant symptoms over time. DESIGN Secondary analysis of data from a multicentre prospective longitudinal observational study (PRELUdiHO) collected between November 2017 and September 2018. SETTING/PARTICIPANTS Adult patients (n = 992) enrolled in 13 Italian residential hospices. METHODS Two generalized estimating equations logistic models were built, both with number of hospice beds and length of stay as independent variables as well as, in one case, patient-to-healthcare worker ratios, and, in the other, health professionals' qualification levels. Dependent variables were six not clinically significant (score<4) symptoms: pain, nausea, shortness of breath, feeling sad, feeling nervous, and 'how you feel overall', according to the Edmonton Symptom Assessment System revised (ESAS-r) scale. RESULTS The generalized estimating equations indicators on staff revealed the following 'optimal' model: Patient-to-Physician ratio (5.5:1-6.5:1); Patient-to-Nurse ratio (1.5:1-2.7:1); Patient-to-Nurse-Assistant ratio (4.1:1-6.3:1); with the most balanced staff composition including 19% physicians, 23% nurse assistants, and 58% registered nurses; hospice beds (12-25); length of stay (median = 12 days). This model predicted an up to four times greater likelihood of controlling all six ESAS-r symptoms over time. The generalized estimating equations model on the educational level of physicians and registered nurses showed that it was significantly associated with optimal patients' symptom control during the entire hospice stay. CONCLUSIONS This study showed the exact skill-mix composition and proportions of palliative care team able to ensure optimal control of patients' symptoms. The added value of physicians and nurses with a qualification in palliative care in terms of better patient outcomes reaffirmed the importance of education in guaranteeing quality care. Hospices with 12-25 beds, and recruitment methods guaranteeing at least 12-day stay ensured the most propitious organizational environment for optimal management of clinically significant symptoms. The transferability of these results mainly depends on whether the skills of health professionals in our `ideal' model are present in other contexts. Our results provide policymakers and hospice managers with specific, evidence-based information to support decision-making processes regarding hospice staffing and organization. Further prospective studies are needed to confirm the positive impact of this 'optimal' organizational framework on patient outcomes.
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Affiliation(s)
- Marco Artico
- Palliative Care Unit, Azienda ULSS4 Veneto Orientale, Piazza De Gasperi, 5, San Donà di Piave, Venezia 30027, Italy
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
| | - Daniela D'Angelo
- Center for Clinical Excellence and Quality of Care (CNEC), Istituto Superiore di Sanità (ISS), Via Regina Elena, 299, Rome 00161, Italy.
| | - Marco Di Nitto
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier, 1, Rome 00133, Italy.
| | - Diana Giannarelli
- Biostatistical Unit, National Cancer Institute "Regina Elena" - IRCCS, Via Chianesi, 53, Rome 00144, Italy.
| | - Anna Marchetti
- Palliative Care Center "Insieme per la cura", Via Alvaro del Portillo, 15, Rome 00128, Italy.
| | - Gabriella Facchinetti
- Palliative Care Center "Insieme per la cura", Via Alvaro del Portillo, 15, Rome 00128, Italy
| | - Cosimo De Chirico
- Palliative Care Unit, Azienda ULSS4 Veneto Orientale, Piazza De Gasperi, 5, San Donà di Piave, Venezia 30027, Italy.
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
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Battaglia Y, Zerbinati L, Belvederi Murri M, Provenzano M, Esposito P, Andreucci M, Storari A, Grassi L. Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis. J Clin Med 2021; 10:jcm10204747. [PMID: 34682870 PMCID: PMC8540707 DOI: 10.3390/jcm10204747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Although kidney transplant can lead to psychiatric disorders, psychosocial syndromes and demoralization, a positive post-traumatic growth (PTG) can occur in kidney transplant recipients (KTRs). However, the PTG-Inventory (PTGI), a reliable tool to measure PTG is scarcely used to explore the effect of this stressful event in KTRs. Thus, the purpose of our study was to assess the level of PTG and its correlation with demoralization, physical and emotional symptoms or problems via network analysis in KTRs. Additionally, we aimed at exploring the association of PTG with psychiatric diagnoses, Diagnostic Criteria for Psychosomatic Research (DCPR) conditions, and medical variables. A total of 134 KTRs were tested using MINI International Neuropsychiatric Interview 6.0 (MINI 6.0), DCPR interview, PTGI, Edmonton Symptom Assessment System (ESAS), Canadian Problem Checklist (CPC) and Demoralization scale (DS-IT). PTGI was used to investigate the positive psychological experience of patients after KT. It consists of 21 items divided in five factors. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. A symptom network analysis was conducted among PTGI, ESAS and DS-IT. Mean score of PTGI total of sample was 52.81 ± 19.81 with higher scores in women (58.53 ± 21.57) than in men (50.04 ± 18.39) (p < 0.05). PTGI-Relating to Others (16.50 ± 7.99) sub-score was markedly higher than other PTGI factor sub-scores. KTRs with DCPR-alexithymia or International Classification of Diseases, tenth revision (ICD-10) anxiety disorders diagnosis had lower PTGI total score and higher PTGI-Personal Strength sub-score, respectively (p < 0.05). The network analysis identified two communities: PTGI and ESAS with DS-IT. DS-IT Disheartenment, DS-IT Hopelessness and PTGI Relating to Others were the most central items in the network. After 1000 bootstrap procedures, the Exploratory graph analysis revealed the presence of a median of two communities in the network in 97.5% of the bootstrap iterations. A more extensive use of PTGI should be encouraged to identify and enhance the positive psychological changes after KT.
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Affiliation(s)
- Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
- Correspondence:
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (M.B.M.); (L.G.)
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (M.B.M.); (L.G.)
| | - Michele Provenzano
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Pasquale Esposito
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (M.B.M.); (L.G.)
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Ripamonti C, Leporati R, De Feo G, Di Pede P, Toffolatti L, Guglielmo M, La Carpia D, Miccinesi G, Chiesi F. Italian version of the Edmonton Symptom Assessment System (ESAS)-Total Care (TC): development and psychometric validation in patients undergoing cancer treatment or follow-up. Support Care Cancer 2021; 30:1923-1933. [PMID: 34623487 DOI: 10.1007/s00520-021-06594-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The routine use of patient-reported outcomes (PROs) in clinical practice improves quality of care, it helps in reducing the access to emergency services and unscheduled visits, and it can improve cancer patients' time survival. The Edmonton Symptom Assessment System (ESAS) is a PRO largely used in different care settings to monitor physical and psychological symptoms. Nonetheless, along with these symptoms, literature also highlighted the presence and effect of spiritual pain, financial distress, and social isolation on quality of care, treatment effectiveness, and survival. AIM The aims of the current study were (a) to complete the Italian version of the ESAS validation process by adding the missing symptom "insomnia" and (b) to develop and validate the ESAS-Total Care (ESAS-TC) that is intended to evaluate and screen not only physical and psychological symptoms but also spiritual pain, discomfort deriving from financial problems associated with illness, and suffering related to social isolation. METHODS A sample of Italian native outpatients, who referred to the dedicated Supportive Care Unit of the Fondazione IRCCS, Istituto Nazionale deiTumori (INT), Milano, were asked to fill the ESAS-TC to assess item properties, factorial structure, internal consistency, test-retest reliability (patients were asked to retake the scale after 2-6 weeks), and external validity. Concerning the latter, other self-administered scales were employed to assess perceived stress (Perceived Stress Scale), unmet needs (using theNeed Evaluation Questionnaire that describes informative, assistance/care, relational, needs for psycho-emotional support, material needs), and perceived social support (administering the Multidimensional Scale of Perceived Social Support that evaluates perceived support of family, friends, and significant others in the wider social field). RESULTS The scales were administered to 243 patients with solid (90%) and hematologic (10%) cancers, mean age 62.6, female 76.5%. Analysis suggested that a single factor better represents the structure of the ESAS scales, their internal consistency and test-retest reliability were good, and evidence of construct and criterion validity were provided. Additionally, incremental validity of the ESAS-TC was proved showing that the added items offer a unique contribution in predicting the patient's stress. Finally, known groups validity was confirmed testing the differences in the ESAS scores due to the Karnofsky Performance Status. CONCLUSIONS The current study allowed to complete the validation of the Italian version of the ESAS and to develop a psychometrically sound scale, the ESAS-Total Care, that potentially helps in moving cancer research toward personalized total cancer care.
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Affiliation(s)
- Carla Ripamonti
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy.
| | - Rita Leporati
- Medical Oncology Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Giulia De Feo
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Patricia Di Pede
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Luisa Toffolatti
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Mauro Guglielmo
- Department of Medical Oncology and Haematology, Oncology-Supportive Care Unit, Fondazione IRCCS, Istituto Nazionale Tumori Di Milano, 20133, Milan, Italy
| | - Domenico La Carpia
- Azienda USL Toscana Centro, UDS Cure Palliative Prato Pistoia, Firenze, Italy
| | - Guido Miccinesi
- Epidemiologia Clinica e Di Supporto Al Governo Clinico, Istituto Per lo Studio, la Prevenzione e la Rete Oncologica-ISPRO, Firenze, Italy
| | - Francesca Chiesi
- Department of Neuroscience and Child's Health (NEUROFARBA), University of Florence, Florence, Italy
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Moscato S, Sichi V, Giannelli A, Palumbo P, Ostan R, Varani S, Pannuti R, Chiari L. Virtual Reality in Home Palliative Care: Brief Report on the Effect on Cancer-Related Symptomatology. Front Psychol 2021; 12:709154. [PMID: 34630217 PMCID: PMC8497744 DOI: 10.3389/fpsyg.2021.709154] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022] Open
Abstract
Virtual reality (VR) has been used as a complementary therapy for managing psychological and physical symptoms in cancer patients. In palliative care, the evidence about the use of VR is still inadequate. This study aims to assess the effect of an immersive VR-based intervention conducted at home on anxiety, depression, and pain over 4days and to evaluate the short-term effect of VR sessions on cancer-related symptomatology. Participants were advanced cancer patients assisted at home who were provided with a VR headset for 4days. On days one and four, anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS) and pain by the Brief Pain Inventory (BPI). Before and after each VR session, symptoms were collected by the Edmonton Symptom Assessment Scale (ESAS). Participants wore a smart wristband measuring physiological signals associated with pain, anxiety, and depression. Fourteen patients (mean age 47.2±14.2years) were recruited. Anxiety, depression (HADS), and pain (BPI) did not change significantly between days one and four. However, the ESAS items related to pain, depression, anxiety, well-being, and shortness of breath collected immediately after the VR sessions showed a significant improvement (p<0.01). A progressive reduction in electrodermal activity has been observed comparing the recordings before, during, and after the VR sessions, although these changes were not statistically significant. This brief research report supports the idea that VR could represent a suitable complementary tool for psychological treatment in advanced cancer patients assisted at home.
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Affiliation(s)
- Serena Moscato
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Bologna, Italy
| | - Vittoria Sichi
- National Tumor Assistance (ANT) Foundation, Bologna, Italy
| | | | - Pierpaolo Palumbo
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Bologna, Italy
| | - Rita Ostan
- National Tumor Assistance (ANT) Foundation, Bologna, Italy
| | - Silvia Varani
- National Tumor Assistance (ANT) Foundation, Bologna, Italy
| | | | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Bologna, Italy
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
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21
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Corli O, Santucci C, Uggeri S, Bosetti C, Cattaneo M, Ermolli D, Varrassi G, Myrcik D, Paladini A, Rekatsina M, Gerosa C, Ornaghi M, Roccasalva A, Santambrogio P, Beretta M. Factors for Timely Identification of Possible Occurrence of Delirium in Palliative Care: A Prospective Observational Study. Adv Ther 2021; 38:4289-4303. [PMID: 34228345 PMCID: PMC8342371 DOI: 10.1007/s12325-021-01814-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/01/2021] [Indexed: 12/19/2022]
Abstract
Delirium occurs in 50–80% of end-of-life patients but is often misdiagnosed. Identification of clinical factors potentially associated with delirium onset can lead to a correct early diagnosis. To this aim, we conducted a prospective cohort study on patients from an Italian palliative care unit (PCU) admitted in 2018–2019. We evaluated the presence of several clinical factors at patient admission and compared their presence in patients who developed delirium and in those who did not develop it during follow-up. Among 503 enrolled patients, after a median follow-up time of 16 days (interquartile range 6–40 days), 95 (18.9%) developed delirium. Hazard ratios (HR) and corresponding 95% confidence intervals were computed using Cox proportional hazard models. In univariate analyses, factors significantly more frequent in patients with delirium were care in hospice, compromised performance status, kidney disease, fever, renal failure, hypoxia, dehydration, drowsiness, poor well-being, breathlessness, and “around the clock” therapy with psychoactive drugs, particularly haloperidol. In multivariate analyses, setting of care (HR 2.28 for hospice versus home care, 95% CI 1.45–3.60; p < 0.001), presence of breathlessness (HR 1.71, 95% CI 1.03–2.83, p = 0.037), and administration of psychoactive drugs, particularly haloperidol (HR 2.17 for haloperidol, 95% CI 1.11–4.22 and 1.53 for other drugs, 95% CI 0.94–2.48; p = 0.048) were significantly associated with the risk of developing delirium. The study indicates that some clinical factors are associated with the probability of delirium onset. Their evaluation in PC patients could help healthcare professionals to identify the development of delirium in those patients in a timely manner.
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Bovero A, Cotardo F, Pierotti V, Gottardo F, Botto R, Opezzo M, Geminiani GC. Personality Traits and Sense of Dignity in End-of-Life Cancer Patients: A Cross-Sectional Study. Am J Hosp Palliat Care 2021; 38:39-46. [PMID: 33256475 DOI: 10.1177/1049909120920232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
CONTEXT Patients' personality traits can play an important role in the end-of-life care process. OBJECTIVES The present study aimed to investigate the relationship between personality traits and dignity in cancer patients nearing death. In addition, the associations between personality traits and physical, psychological symptoms, and coping strategies during the end-of-life stage were explored. METHODS The study is cross-sectional. The sample consisted of 210 participants with a Karnofsky Performance Status (KPS) lower than 50 and a life expectancy of a few weeks. For each patient, personal and clinical data were collected and a set of validated rating scales, assessing personality, dignity, physical, psychological symptoms and coping strategies was administered during the first psychological consultation. RESULTS The results highlighted significant associations between personality traits and dignity. In particular, Conscientiousness was negatively correlated with Social Support and Extroversion was negatively associated with Loss of Purpose and Meaning. Neuroticism was related to all the dimensions of dignity and Extroversion was significantly associated with the physical and psychological symptoms. Regarding coping styles, active coping strategies were predictors of Extroversion and Agreeableness. Conversely, anxiety symptoms predicted the Neuroticism trait. CONCLUSIONS Personality traits seem to be actively involved into the loss of dignity. These findings highlighted the importance of including personality traits and dignity into the patient's care process. Exploring individual differences and coping mechanisms at the end-of-life could improve palliative care and lead to better patient-tailored psychological interventions.
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Affiliation(s)
- Andrea Bovero
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, 9314University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Francesca Cotardo
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, 9314University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Vanni Pierotti
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, 9314University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Francesco Gottardo
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, 9314University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Rossana Botto
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, 9314University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Marta Opezzo
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, 9314University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Giuliano Carlo Geminiani
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, 9314University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
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Borelli E, Bigi S, Potenza L, Artioli F, Eliardo S, Mucciarini C, Cagossi K, Razzini G, Pasqualini A, Lui F, Ferlazzo F, Cruciani M, Bruera E, Efficace F, Luppi M, Cacciari C, Porro CA, Bandieri E. Different semantic and affective meaning of the words associated to physical and social pain in cancer patients on early palliative/supportive care and in healthy, pain-free individuals. PLoS One 2021; 16:e0248755. [PMID: 33788893 PMCID: PMC8011738 DOI: 10.1371/journal.pone.0248755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/04/2021] [Indexed: 12/25/2022] Open
Abstract
Early palliative/supportive care (ePSC) is a medical intervention focused on patient's needs, that integrates standard oncological treatment, shortly after a diagnosis of advanced/metastatic cancer. ePSC improves the appropriate management of cancer pain. Understanding the semantic and emotional impact of the words used by patients to describe their pain may further improve its assessment in the ePSC setting. Psycholinguistics assumes that the semantic and affective properties of words affect the ease by which they are processed and comprehended. Therefore, in this cross-sectional survey study we collected normative data about the semantic and affective properties of words associated to physical and social pain, in order to investigate how patients with cancer pain on ePSC process them compared to healthy, pain-free individuals. One hundred ninety patients and 124 matched controls rated the Familiarity, Valence, Arousal, Pain-relatedness, Intensity, and Unpleasantness of 94 words expressing physical and social pain. Descriptive and inferential statistics were performed on ratings in order to unveil patients' semantic and affective representation of pain and compare it with those from controls. Possible effects of variables associated to the illness experience were also tested. Both groups perceived the words conveying social pain as more negative and pain-related than those expressing physical pain, confirming previous evidence of social pain described as worse than physical pain. Patients rated pain words as less negative, less pain-related, and conveying a lower intense and unpleasant pain than controls, suggesting either an adaptation to the pain experience or the role played by ePSC in improving patients' ability to cope with it. This exploratory study suggests that a chronic pain experience as the one experienced by cancer patients on ePSC affects the semantic and affective representation of pain words.
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Affiliation(s)
- Eleonora Borelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Sarah Bigi
- Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Milan, Italy
| | - Leonardo Potenza
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Artioli
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Sonia Eliardo
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Claudia Mucciarini
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Katia Cagossi
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Giorgia Razzini
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | | | - Fausta Lui
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Ferlazzo
- Department of Psychology, Sapienza University, Rome, Italy
| | | | - Eduardo Bruera
- Palliative Care & Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Mario Luppi
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Cacciari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Adolfo Porro
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
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Autelitano C, Bertocchi E, Artioli G, Alquati S, Tanzi S. The Specialist Palliative Care Nurses' in an Italian Hospital: role, competences, and activities. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021006. [PMID: 33855987 PMCID: PMC8138805 DOI: 10.23750/abm.v92is2.11360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/04/2021] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: Many authors tried to clarify the palliative care nurses’ role, overall in the home care setting, but little is known in different settings of care. We aim to present a Specialist profile of palliative care (PC) nurses in an Italian hospital-based Palliative Care Unit. Methods: With an organizational case study approach, we conducted a literature review on PC nurse’s role, and we presented the Specialist PC nurses’ profile, describing competences and key related activities. Results: Our specialist profile highlights that clinical activities are similar to the experiences described in the literature (symptom assessment and management, communication, interprofessional work), while training and research activities are new fields of interest that it’s important to explore and promote, most of all in our country. Conclusions: Sustaining the flexibility of the role, being recognized by colleagues and keeping the three dimensions connected are the major challenges: drawing up a specialist palliative care nurses’ profile can help the team to better define the role framework in an interdisciplinary context.
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Wong A, Tayjasanant S, Rodriguez-Nunez A, Park M, Liu D, Zapata KP, Allo J, Frisbee-Hume S, Williams J, Bruera E. Edmonton Symptom Assessment Scale Time Duration of Self-Completion Versus Assisted Completion in Patients with Advanced Cancer: A Randomized Comparison. Oncologist 2020; 26:165-171. [PMID: 33252169 DOI: 10.1002/onco.13619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/10/2020] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION To compare the time duration of self-completion (SC) of the Edmonton Symptom Assessment Scale (ESAS) by patients with advanced cancer (ACPs) versus assisted completion (AC) with a health care professional. MATERIALS AND METHODS In this randomized comparison of ACPs seen in initial consultation at the outpatient Supportive Care Center at MD Anderson, ACPs who have never completed the ESAS at MD Anderson were allocated (1:1) to either SC of the ESAS form versus AC by a nurse. Time of completion was measured by the nurse using a stopwatch. Patients completed the Rapid Estimate of Adult Literacy in Medicine (REALM) test prior to administration of the ESAS. In the SC group, the nurse reviewed the responses to verify that the reported ESAS scores were correct. RESULTS A total of 126 ACPs were enrolled (69 patients to AC and 57 to SC). Seventy-one patients were female, median age was 60 years, and median REALM score was 65. Median (interquartile range) time (in seconds) of SC was significantly less than AC (73 [42.9-89.1] vs. 109 [79.5-136.7], p < .0001). With nurse review time included, median time of SC increased to 117 seconds, which was not significantly different from AC (p = .28). Lower literacy (REALM) score and shortness of breath were significantly associated with increased completion time (p = .007). CONCLUSION Regular use of ESAS will have minimal impact on clinical time, as it can be completed in about 1 minute and provides a concise yet comprehensive and multidimensional perspective of symptoms that affect quality of life of patients with cancer. IMPLICATIONS FOR PRACTICE Because the Edmonton Symptom Assessment Scale can be completed in less than 2 minutes, hopefully the routine use of this simple yet comprehensive and multidimensional symptom assessment tool will be used at all medical visits in all patients with cancer so that the timely management of symptoms affecting patients' lives and treatment courses can occur, further enhancing personalized cancer care.
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Affiliation(s)
- Angelique Wong
- Departments of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Supakarn Tayjasanant
- Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Alfredo Rodriguez-Nunez
- Palliative Care and Continuing Care Program, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Minjeong Park
- Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane Liu
- Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kresnier Perez Zapata
- Departments of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julio Allo
- Departments of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan Frisbee-Hume
- Departments of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet Williams
- Departments of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Departments of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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The PERSONS score: A new tool for cancer patients' symptom assessment in simultaneous care and home care settings. Palliat Support Care 2020; 18:33-38. [PMID: 31434598 DOI: 10.1017/s1478951519000543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Scientific societies recommend early interaction between oncologic and supportive care, but there is still a lack of systematic evaluations regarding symptoms from the perspective of oncologists. PATIENTS AND METHODS The aim of this prospective study was to evaluate the PERSONS score, in both "simultaneous care" and "supportive care" settings using the Edmonton Symptom Assessment Scale (ESAS) as a comparator. RESULTS From November 2017 to April 2018, 67 and 110 consecutive patients were enrolled in outpatient and home care cohorts, respectively. The final study population comprised 163 patients. There were no significant changes over time in the total PERSONS scores and total ESAS scale. The intra-interviewer reliability (ICC2,1) and inter-interviewer reliability (ICC2,k) showed good reproducibility (test-retest) in each group of patients: 0.60 (0.49-0.70) and 0.82 (0.75-0.87), respectively, for the home care patients and 0.73 (0.62-0.81) and 0.89 (0.83-0.93), respectively, for the outpatient cohort. There were high correlations between PERSONS and ESAS, both at the baseline and final assessments. The mean PERSONS and ESAS scores between the home care patients and outpatients were not different at the baseline and final assessments. Receiver operating characteristics (ROC) curve for the PERSONS total score revealed good diagnostic ability. Area under the curve (AUC) was 0.825 and 0.805 for improvement and deterioration, respectively. CONCLUSIONS The PERSONS score is an easy to apply tool for symptom assessment. Importantly, the PERSONS score showed high concordance with the established ESAS scale and, therefore, provides an alternative for everyday use in supportive care assessment.
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Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data. TRANSPLANTOLOGY 2020. [DOI: 10.3390/transplantology1020012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Although the donation rate for deceased and living kidneys has been increasing, the donor organ availability meets only the 30% of kidney needs in Italy. Consequently, hemodialysis patients stay for a long time, an average of 3.2 years, on a waiting list for a kidney transplant with consequent relevant psychological distress or even full-fledged psychiatric disorders, as diagnosed with traditional psychiatric nosological systems. Recent studies report, however, a higher prevalence of other psychosocial syndromes, as diagnosed by using the Diagnostic Criteria for Psychosomatic Research (DCPR) in medically ill and kidney transplant patients. Nevertheless, no data regarding DCPR prevalence are available in patients waitlisted for a renal transplant (WKTs). Thus, the primary aim of this study was to identify sub-threshold or undetected syndromes by using the DCPR and, secondly, to analyze its relationship with physical and psychological symptoms and daily-life problems in WKTs. A total of 30 consecutive WKTs were assessed using the DCPR Interview and the MINI International Neuropsychiatric Interview 6.0. The Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist were used to assess physical and psychological distress symptoms and daily-life problems. A total of 60% of patients met the criteria for at least one DCPR diagnosis; of them, 20% received one DCPR diagnosis (DCPR = 1), and 40% more than one (DCPR > 1), especially the irritability cluster (46.7%), Abnormal Illness Behavior (AIB) cluster (23.3%) and somatization cluster (23.3%). Fifteen patients met the criteria for an ICD diagnosis. Among patients without an ICD-10 diagnosis, 77.8% had at least one DCPR syndrome (p < 0.05). Higher scores on ESAS symptoms (i.e., tiredness, nausea, depression, anxiety, feeling of a lack of well-being and distress), ESAS-Physical, ESAS-Psychological, and ESAS-Total were found among DCPR cases than DCPR non-cases. In conclusion, a high prevalence of DCPR diagnoses was found in WKTs, including those who resulted to be ICD-10 non-cases. The joint use of DCPR and other screening tools (e.g., ESAS) should be evaluated in future research as part of a correct psychosocial assessment of WKTs.
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The Sense of Dignity at the End of Life: Reflections on Lifetime Values through the Family Photo Album. Behav Sci (Basel) 2020; 10:bs10110177. [PMID: 33238420 PMCID: PMC7700553 DOI: 10.3390/bs10110177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 01/29/2023] Open
Abstract
This study focuses on the dimensions of dignity, linking Chochinov's Dignity Therapy to Schwartz's Theory of Values. The use of family photo albums has enriched the application of dignity therapy. Seven terminal patients in home-based palliative care participated in the therapeutic intervention. To measure the effects of the intervention, we administered the Edmonton Symptom Assessment Scale and the Patient Dignity Inventory, then, at the end of the meetings, collected the opinions of participants, available nurses, and relatives who attended the sessions. The resulting generativity documents were then analyzed through thematic analysis, which revealed three main themes linked to both fundamental values and the dimensions of dignity: The relationship between continuity of self and myriad values in the context of family relationships; personal dignity as characterized by the values of personal success, hope, and wisdom; and hope and generativity. The fourth theme reflected the participants' final judgements on the intervention, which were highly positive and greatly encouraged further use of photographs in similar therapeutic interventions. The assessment protocol highlighted a significant decrease in tiredness amongst the participants and a trend towards a significant decrease in drowsiness after the intervention.
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Corli O, Pellegrini G, Bosetti C, Riva L, Crippa M, Amodio E, Scaccabarozzi G. Impact of Palliative Care in Evaluating and Relieving Symptoms in Patients with Advanced Cancer. Results from the DEMETRA Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228429. [PMID: 33202542 PMCID: PMC7698052 DOI: 10.3390/ijerph17228429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/29/2022]
Abstract
Background: Cancer patients experience multiple symptoms throughout the course of the disease. We aimed to provide a comprehensive analysis of the symptom burden in patients with advanced cancer at admission to specialist palliative care (PC) services and seven days later to estimate the immediate impact of PC intervention. Patient and methods: The analysis was based on an observational, prospective, multicenter study (named DEMETRA) conducted in Italy on new patients accessing network specialist PC centers during the period May 2017–November 2017. The prevalence and intensity of symptoms were assessed at baseline and after seven days using three tools including the Edmonton Symptom Assessment System (ESAS). Results: Five PC centers recruited 865 cancer patients. Thirty-three different symptoms were observed at the baseline, the most frequent being asthenia (84.9%) and poor well-being (71%). The intensity of the most frequent symptoms according to ESAS ranged from 5.5 for asthenia to 3.9 for nausea. The presence and intensity of physical symptoms increased with increasing levels of anxiety and depression. After seven days, prevalence of nausea and breathlessness as well as intensity of almost all symptoms significantly decreased. Conclusions: The study confirmed the considerable symptom burden of patients with advanced cancer. PC intervention has significantly reduced the severity of symptoms, despite the patients’ advanced disease and short survival.
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Affiliation(s)
- Oscar Corli
- Department of Oncology, Unit of Pain and Palliative Care Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Giacomo Pellegrini
- Fondazione Floriani, Via Privata Nino Bonnet, 2-20154 Milan, Italy;
- Correspondence: ; Tel.: +39-02-6261-1132
| | - Cristina Bosetti
- Department of Oncology, Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156, Milan, Italy;
| | - Luca Riva
- Dipartimento Fragilità/Rete Locale Cure palliative, ASST Lecco, 23900 Lecco, Italy; (L.R.); (G.S.)
| | - Matteo Crippa
- Fondazione Floriani, Via Privata Nino Bonnet, 2-20154 Milan, Italy;
| | - Emanuele Amodio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
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Watson L, Qi S, DeIure A, Photitai E, Chmielewski L, Smith L. Validating a Patient-Reported Outcomes-Derived Algorithm for Classifying Symptom Complexity Levels Among Patients With Cancer. J Natl Compr Canc Netw 2020; 18:1518-1525. [PMID: 33152696 DOI: 10.6004/jnccn.2020.7586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 05/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The patient-reported outcomes (PROs) symptom complexity algorithm, derived from self-reported symptom scores using the Edmonton Symptom Assessment System and concerns indicated on the Canadian Problem Checklist, has not been validated extensively. METHODS This is a retrospective chart review study using data from the Alberta Cancer Registry and electronic medical records from Alberta Health Services. The sample includes patients with cancer who visited a cancer facility in Alberta, Canada, from February 2016 through November 2017 (n=1,466). RESULTS The effect size (d=1.2) indicates that the magnitude of difference in health status between the severe- and low-complexity groups is large. The symptom complexity algorithm effectively classified subgroups of patients with cancer with distinct health status. Using Karnofsky performance status, the algorithm shows a sensitivity of 70.3%, specificity of 84.1%, positive predictive value of 79.1%, negative predictive value of 76.7%, and accuracy of 77.7%. An area under the receiver operating characteristic of 0.824 was found for the complexity algorithm, which is generally regarded as good, This same finding was also regarded as superior to the alternative algorithm generated by 2-step cluster analysis (area under the curve, 0.721). CONCLUSIONS The validity of the PRO-derived symptom complexity algorithm is established in this study. The algorithm demonstrated satisfactory accuracy against a clinician-driven complexity assessment and a strong correlation with the known group analysis. Furthermore, the algorithm showed a higher screening capacity compared with the algorithm generated from 2-step cluster analysis, reinforcing the importance of contextualization when classifying patients' symptoms, rather than purely relying on statistical outcomes. The algorithm carries importance in clinical settings, acting as a symptom complexity flag, helping healthcare teams identify which patients may need more timely, targeted, and individualized patient symptom management.
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Affiliation(s)
- Linda Watson
- 1Alberta Health Services, and.,2University of Calgary, Calgary, Alberta, Canada
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Merchant SJ, Kong W, Brundage M, Booth CM. Symptom Evolution in Patients with Esophageal and Gastric Cancer Receiving Palliative Chemotherapy: A Population-Based Study. Ann Surg Oncol 2020; 28:79-87. [PMID: 33140252 DOI: 10.1245/s10434-020-09289-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/22/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Palliative chemotherapy (PC) is associated with a modest survival benefit in patients with incurable esophageal and gastric cancer; however, changes in symptom profile during treatment are not well described. Understanding the trajectory of symptoms during treatment may lead to improved care and facilitate shared decision making. In this study, we address this knowledge gap among all patients receiving PC in the Canadian province of Ontario. METHODS Patients diagnosed with incurable esophageal and gastric cancer who received PC from 2012 to 2017 were identified from the Ontario Cancer Registry. Patients with one or more recorded Edmonton Symptom Assessment System (ESAS) scores in the 12 months following cancer diagnosis were included. The ESAS includes scores from 0 to 10 in nine domains (anxiety, depression, drowsiness, lack of appetite, nausea, pain, shortness of breath, tiredness, and lack of well-being). Symptom severity is categorized as none-mild (≤ 3), moderate (4-6), or severe (7-10). We focused on potentially modifiable symptoms, i.e. nausea, pain, and anxiety/depression. Logistic regression was used to identify factors associated with moderate-severe ESAS scores in these domains. Among those patients with serial ESAS scores (at 8 ± 2 and 12 ± 2 weeks) receiving chemotherapy, we describe changes during treatment (decrease by ≥ 1 = improved; - 1 > 0 > 1 = unchanged; increase by ≥ 1 = deteriorated). RESULTS The cohort included 1900 patients who received PC, of whom 79% (1497/1900) had one or more recorded ESAS scores. In multivariate analysis, younger patients were more likely to have moderate-severe scores in nausea (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.23-2.90 [p < 0.01] in patients aged 41-50 years compared with patients aged ≥ 71 years) and pain (OR 1.88, 95% CI 1.36-2.60 [p < 0.01] in patients aged 51-60 years compared with patients aged ≥ 71 years). Compared with males, females were more likely to report moderate-severe scores in anxiety/depression (OR 1.58, 95% CI 1.21-2.08 [p < 0.01]). At 8 ± 2 weeks from PC initiation, symptom scores were unchanged in 19-42% of patients, improved in 30-51% of patients, and deteriorated in 17-35% of patients. The greatest change in symptom burden was observed for appetite (51% improvement) and anxiety/depression (35% deterioration). Similar trends were observed at 12 ± 2 weeks. CONCLUSIONS In this large, population-based study, we observed that younger patients were more likely to report moderate-severe symptoms in pain and nausea, and females were more likely to report moderate-severe symptoms in anxiety/depression. Anxiety/depression symptoms become increasingly problematic for a substantial proportion of patients receiving PC. Supportive care efforts to mitigate these symptoms in routine practice are needed.
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Affiliation(s)
- Shaila J Merchant
- Department of Surgery, Queen's University, Kingston, ON, Canada. .,Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada. .,Division of General Surgery and Surgical Oncology, Kingston Health Sciences Centre, Kingston, ON, Canada.
| | - Weidong Kong
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Michael Brundage
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
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Artico M, Piredda M, D'Angelo D, Lusignani M, Giannarelli D, Marchetti A, De Chirico C, Mastroianni C, De Marinis MG. Prevalence, incidence and associated factors of pressure injuries in hospices: A multicentre prospective longitudinal study. Int J Nurs Stud 2020; 111:103760. [PMID: 32919359 DOI: 10.1016/j.ijnurstu.2020.103760] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients in palliative care are the population cohort that most frequently develop pressure injuries, severely impacting their quality of life. Data from prospective studies on the prevalence and incidence of pressure injuries in hospices are lacking. AIM To describe the point prevalence and cumulative incidence of pressure injuries in patients admitted to residential hospices, and to analyze their predictive factors over time. DESIGN Multicentre prospective longitudinal observational study. SETTING/PARTICIPANTS Adult patients (n = 992) enrolled in 13 Italian residential hospices, with a minimum sample of 280 for each macro-region (North, center, South/Islands). METHODS Assessments including the Karnofsky Performance Status, Braden, Edmonton Symptom Assessment System Revised scales and pressure injury staging according to National Pressure Ulcer Advisory Panel were conducted at least every four days, from admission to patients' death/discharge. RESULTS The 7,967 observations recorded provided prevalence and incidence rates of 34.1% and 26.5%, respectively. The logistic regression model showed non-cancer disease (OR = 2.39, 95%CI = 1.65-3.47), age >80 (OR = 2.01, 95%CI = 1.49-2.71), Braden score 'at risk' (OR = 1.92, 95%CI = 1.17-3.14), urinary catheter (OR = 1.96, 95%CI = 1.40-2.75), drowsiness (OR = 1.41, 95%CI = 1.02-1.95) and artificial nutrition (OR = 1.47, 95%CI = 1.01-2.14) as the variables associated with pressure injury at admission. The generalized estimating equations models, built on the timeframes for observation groups, revealed male gender (OR = 1.68, 95%CI = 1.01-2.79) and Braden score 'at risk' (OR = 4.45, 95%CI = 1.74-11.34) as predictive factors of a new pressure injury developed up to three weeks before a patient's death, while in the last ten days of life these predictors were replaced by diagnosis of cancer (OR = 1.80, 95%CI = 1.11-2.91), worsening pain (OR = 1.65, 95%CI = 1.10-2.49), drowsiness (OR = 1.79, 95%CI = 1.25-2.57) and dyspnea (OR = 1.48, 95%CI = 1.01-2.18). CONCLUSIONS The high incidence and prevalence of pressure injuries confirm the importance of palliative care nurses continuously focusing on prevention and management strategies. In the last three weeks of a patient's life, the predictive power of the Braden scale for a new pressure injury is not confirmed, throwing doubt on the effectiveness of aimed interventions at modifying risk factors. Along the different disease trajectories, pressure injuries developed during the instability/worsening phases of illness, occurring before hospice admission for non-cancer patients and in the end-of-life phase for cancer patients. Despite continuous provision of appropriate interventions, most of the new pressure injuries were detected during the last ten days of a patient's' life and assessed as 'unavoidable'. These results are crucial to guiding palliative care nursing plans during the different phases of illness, and to predicting care needs, possible management strategies ('wound management' vs. 'wound palliation'), and resource utilization.
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Affiliation(s)
- Marco Artico
- Palliative Care Unit, Azienda ULSS4 Veneto Orientale, Piazza De Gasperi, 5, San Donà di Piave, Venezia 30027, Italy.
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
| | - Daniela D'Angelo
- Center for Clinical Excellence and Quality of Care (CNEC), Istituto Superiore di Sanità (ISS), Via Regina Elena, 299, Rome 00161, Italy.
| | - Maura Lusignani
- Associate Professor, Department of Biomedical Sciences for Health, University of Milan, Via Pascal, 35, Milan 20133, Italy.
| | - Diana Giannarelli
- Biostatistical Unit, National Cancer Institute "Regina Elena" - IRCCS, Via Chianesi, 53, Rome 00144, Italy.
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
| | - Cosimo De Chirico
- Palliative Care Unit, Azienda ULSS4 Veneto Orientale, Piazza De Gasperi, 5, San Donà di Piave, Venezia 30027, Italy.
| | - Chiara Mastroianni
- Centro ANTEA, Piazza Santa Maria della Pietà, 5 Pad. XXII, Rome 00135, Italy.
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
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White R, Weekes CE, Grant R, Baldwin C, Ahmed H. Determining the prevalence and severity of cancer cachexia in advanced non-small cell lung cancer and its relationship with chemotherapy outcomes. Support Care Cancer 2020; 28:4373-4380. [PMID: 31916005 PMCID: PMC7378112 DOI: 10.1007/s00520-019-05259-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/20/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE Cancer cachexia (CC) is a syndrome characterised by an ongoing loss of skeletal muscle mass associated with reduced tolerance to treatment. This study explored the prevalence and severity of CC in advanced non-small cell lung cancer (NSCLC) patients and determined its relationship with chemotherapy outcomes. METHODS CC was classified into a four-stage model: no cachexia, pre-cachexia (PC), cachexia and refractory cachexia (RC) with categorisation determined from biochemical and body composition and performance assessment. Associations between the stage of cachexia and chemotherapy outcomes including radiological response, the number of chemotherapy cycles completed and the number of cycles delayed or dose reduced were explored. RESULTS Twenty-four patients were included with 4 (18%) classified as having no cachexia, 4 (18%) PC, 3 (14%) cachexia (13.6%), and 11 (50%) RC. No association was observed between the stage of cachexia and the radiological response to chemotherapy number of cycles delayed or the number of cycle's dose reduced; however, there was an association with the number of cycles completed (p = 0.030). An association between C-reactive protein (CRP) and the number of chemotherapy cycles completed (p = 0.044) and the number of dose reductions (p = 0.044) was also identified. CONCLUSIONS Limited conclusions can be drawn given the small sample size. However, the majority of patients presented with some degree of cachexia at diagnosis. A relationship was identified between the increasing severity of cachexia and a lower number of chemotherapy cycles completed, as well as between CRP and the number of chemotherapy cycles completed and the number of dose reductions required, and therefore warrants further exploration in larger studies.
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Affiliation(s)
- Rhys White
- Nutrition and Dietetics Department, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
- Faculty of Health, Social Care and Education, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - C Elizabeth Weekes
- Nutrition and Dietetics Department, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Robert Grant
- Faculty of Health, Social Care and Education, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Christine Baldwin
- Nutrition and Dietetics, Kings College London, Franklin-Wilkins Building, Waterloo, London, SE1 9NH, UK
| | - Hafez Ahmed
- Faculty of Health, Social Care and Education, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
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Nanda R, Boulware D, Baz R, Portman D, Yu HM, Jim H, Johnstone PAS. Patient-reported outcomes regarding radiation therapy in patients with multiple myeloma. Acta Oncol 2020; 59:983-987. [PMID: 32496846 DOI: 10.1080/0284186x.2020.1772499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Radiation therapy (RT) has been widely used for palliation in multiple myeloma. However, no data exist on symptom assessment and patient-reported outcomes regarding the efficacy of RT in this disease process. This study aims to demonstrate the impact of palliative RT on patient-reported symptoms in patients with multiple myeloma.Materials and Methods: Our Radiation Oncology and Supportive Care Medicine clinics established the use of a modified Edmonton Symptom Assessment Scale (ESAS) in 2015 assessing 12 symptom domains. All had ESAS data available from each encounter. Demographic and clinical data were retrospectively collected from an institutional data warehouse. We examined total and component survey scores for correlated data of patients during radiation treatment and patients not treated with radiation.Results: Clinic records of 30 patients with multiple myeloma seen in the Radiation Oncology and Supportive Care clinics from 2015 to 2018 were retrieved. A total of 91 discrete surveys were collected (1183 data points). Twenty of these were collected from weekly visits from 12 patients receiving RT; the remainder were from new patient or follow up encounters. Odds ratios were lower with radiation therapy for total scores (OR 4.86, p = .007), as well as several component scores.Conclusions: The use of palliative RT was associated with 5 times lower total symptom scores compared with nonuse. Similar beneficial results were found for several component scores. These patient-reported outcomes strongly suggest that providers should consider palliative radiation for symptomatic multiple myeloma patients. These data should be prospectively validated in a larger cohort of myeloma patients.
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Affiliation(s)
- Ronica Nanda
- Radiation Oncology Department, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Health Outcomes & Behavior Department, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - David Boulware
- Bioinformatics & Biostatistics Department, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Rachid Baz
- Malignant Hematology Department, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Diane Portman
- Supportive Care Department, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - H. Michael Yu
- Radiation Oncology Department, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Heather Jim
- Health Outcomes & Behavior Department, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Peter A. S. Johnstone
- Radiation Oncology Department, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Health Outcomes & Behavior Department, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Brunelli C, Borreani C, Caraceni A, Roli A, Bellazzi M, Lombi L, Zito E, Pellegrini C, Spada P, Kaasa S, Foschi AM, Apolone G. PATIENT VOICES, a project for the integration of the systematic assessment of patient reported outcomes and experiences within a comprehensive cancer center: a protocol for a mixed method feasibility study. Health Qual Life Outcomes 2020; 18:252. [PMID: 32723341 PMCID: PMC7388528 DOI: 10.1186/s12955-020-01501-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Listening to "patient voices" in terms of symptoms, emotional status and experiences with care, is crucial for patient empowerment in clinical practice. Despite convincing evidence that routine patient reported outcomes and experience measurements (PRMs) with rapid feed-back to oncologists can improve symptom control, patient well-being and cost effectiveness, PRMs are not commonly used in cancer care, due to barriers at various level. Part of these barriers may be overcome through electronic PRMs collection (ePRMs) integrated with the electronic medical record (EMR). The PATIENT VOICES initiative is aimed at achieving a stepwise integration of ePRMs assessment into routine cancer care. The feasibility project presented here is aimed at assessing the knowledge, use and attitudes toward PRMs in a comprehensive cancer centre; developing and assessing feasibility of a flexible system for ePRM assessment; identifying barriers to and developing strategies for implementation and integration of ePRMs clinical practice. METHODS The project has been organized into four phases: a) pre-development; b) software development and piloting; c) feasibility assessment; d) post-development. A convergent mixed method design, based on concurrent quantitative and qualitative data collection will be applied. A web-survey on health care providers (HCPs), qualitative studies on patients and HCPs (semi-structured interviews and focus groups) as well as longitudinal and cross-sectional quantitative studies will be carried out. The quantitative studies will enroll 600 patients: 200 attending out-patient clinics (physical symptom assessement), 200 attending inpatient wards (psychological distress assessment) and 200 patients followed by multidisciplinary teams (patient experience with care assessment). The Edmonton symptom assessment scale, the Distress Thermometer, and a tool adapted from existing patient reported experience with cancer care questionnaires, will be used in quantitative studies. A multi-disciplinary stakeholder team including researchers, clinicians, health informatics professionals, health system administrators and patients will be involved in the development of potentially effective implementation strategies in the post development phase. DISCUSSION The documentation of potential advantages and implementation barriers achieved within this feasibility project, will serve as a starting point for future and more focused interventions aimed at achieving effective ePRMs routine assessment in cancer care. TRIAL REGISTRATION ClinicalTrials.gov ( NCT03968718 ) May 30th, 2019.
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Affiliation(s)
- Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Claudia Borreani
- Clinical psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Anna Roli
- Quality, education and data protection Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Bellazzi
- Information and communication technology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Linda Lombi
- Department of Sociology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Emanuela Zito
- Information and communication technology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Chiara Pellegrini
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Pierangelo Spada
- Nursing, technical and rehabilitation services Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anna Maria Foschi
- Patient representative, Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Weru J, Gatehi M, Musibi A. Randomized control trial of advanced cancer patients at a private hospital in Kenya and the impact of dignity therapy on quality of life. BMC Palliat Care 2020; 19:114. [PMID: 32703307 PMCID: PMC7379366 DOI: 10.1186/s12904-020-00614-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 07/05/2020] [Indexed: 01/29/2023] Open
Abstract
Background Palliative care is a modality of treatment that addresses physical, psychological and spiritual symptoms. Dignity therapy, a form of psychotherapy, was developed by Professor Harvey Chochinov, MD in 2005.The aim of the study was to assess the effect of one session of dignity therapy on quality of life in advanced cancer patients. Methods This was a randomized control trial of 144 patients (72 in each arm) randomized into group 1 (intervention arm) and group 2 (control arm). Baseline ESAS scores were determined in both arms following which group 1 received Dignity therapy while Group 2 received usual care only. Data collected was presented as printed (Legacy) documents to group 1 participants. These documents were a summary of previous discussions held. Post intervention ESAS scores were obtained in both groups after 6 weeks. Analysis was based on the intention to treat principle and descriptive statistics computed. The main outcome was symptom distress scores on the ESAS (summated out of 100 and symptom specific scores out of 10). The student T-test was used to test for difference in ESAS scores at follow up and graphs were computed for common cancers and comorbidities. Results Of the 144 (72 patients in each arm) patients randomized, 70%were female while 30% were male with a mean age of 50 years. At 6 weeks, 11 patients were lost to follow up, seven died and 126 completed the study. The commonly encountered cancers were gastrointestinal cancers (43%, p = 0.29), breast cancer (27.27% p = 0.71) and gynaecologic cancers (23% p = 0.35). Majority of the patients i.e. 64.3% had no comorbidities. The primary analysis results showed higher scores for the DT group (change in mean = 1.57) compared to the UC group (change in mean = − 0.74) yielding a non-statistically significant difference in change scores of 1.44 (p = 0.670; 95% CI − 5.20 to 8.06). After adjusting for baseline scores, the mean (summated) symptom distress score was not significant (GLM p = 0.78). Dignity therapy group showed a trend towards statistical improvement in anxiety (p = 0.059). The largest effects seen were in improvement of appetite, lower anxiety and improved wellbeing (Cohen effect size 0.3, 0.5 and 0.31 respectively). Conclusion Dignity therapy showed no statistical improvement in overall quality of life. Symptom improvement was seen in anxiety and this was a trend towards statistical significance (p = 0.059). Trial registration Trial registration number PACTR201604001447244 retrospectively registered with Pan African Clinical trials on 28th January 2016.
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Affiliation(s)
- John Weru
- Palliative care, AKUHN, Nairobi, Kenya.
| | | | - Alice Musibi
- Oncology, Kenyatta National Hospital, Nairobi, Kenya
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Batra A, Yang L, Boyne DJ, Harper A, Cheung WY, Cuthbert CA. Associations between baseline symptom burden as assessed by patient-reported outcomes and overall survival of patients with metastatic cancer. Support Care Cancer 2020; 29:1423-1431. [PMID: 32676854 DOI: 10.1007/s00520-020-05623-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/07/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Serial symptom assessments using patient-reported outcomes may be challenging to implement in routine clinical practices. We aimed to determine if a single measurement of symptom burden at the time of metastatic diagnosis is associated with survival. METHODS We examined baseline patient-reported outcomes (within 90 days of diagnosis) of patients newly diagnosed with metastatic breast, lung, colorectal, or prostate cancer using the revised Edmonton Symptom Assessment System (ESASr) questionnaire. The ESASr was categorized into physical, psychological, and total symptom domains whereby scores were classified as none to mild (0-3) or moderate to severe (4-10). Multivariable Cox proportional hazards models were constructed to evaluate the effect of baseline symptom scores on overall survival. RESULTS We identified 1316 patients eligible for analysis. There were 181, 601, 240, and 294 patients with breast, lung, colorectal, and prostate cancer, respectively. Approximately one-quarter of all patients reported moderate to severe physical, psychological, and total symptom subscores. On multivariable Cox regression analysis, older age (P < 0.001), male sex (P = 0.002), primary lung cancer (P < 0.001), and smoking in the previous month (P = 0.007) were predictive of inferior overall survival as were baseline moderate to severe physical (hazard ratio, 1.49; 95% confidence interval, 1.16-1.90; P = 0.002) and total symptom subscores (hazard ratio, 1.38; 95% confidence interval, 1.06-1.81; P = 0.017). CONCLUSIONS A single assessment of baseline symptom burden using the ESASr in patients with metastatic cancer has significant prognostic value. This may represent a feasible first step towards routine collection of patient-reported outcomes in real-world settings where serial symptom measurements can be challenging to implement.
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Affiliation(s)
- Atul Batra
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, University of Calgary, Calgary, Alberta, Canada
| | - Devon J Boyne
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Harper
- Department of Cancer Epidemiology and Prevention Research, University of Calgary, Calgary, Alberta, Canada
| | - Winson Y Cheung
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colleen A Cuthbert
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
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van der Baan FH, Koldenhof JJ, de Nijs EJ, Echteld MA, Zweers D, Hesselmann GM, Vervoort SC, Vos JB, de Graaf E, Witteveen PO, Suijkerbuijk KP, de Graeff A, Teunissen SC. Validation of the Dutch version of the Edmonton Symptom Assessment System. Cancer Med 2020; 9:6111-6121. [PMID: 32643871 PMCID: PMC7476846 DOI: 10.1002/cam4.3253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The Utrecht Symptom Diary (USD) is a Dutch and adapted version of the Edmonton Symptom Assessment System, a patient-reported outcome measurement (PROM) tool to asses and monitor symptoms in cancer patients. This study analyses the validity and responsiveness of the USD and the cutoff points to determine the clinical significance of a symptom score. METHODS Observational longitudinal cohort study including adult in- and outpatients treated in an academic hospital in the Netherlands who completed at least one USD as part of routine care (2012-2019). The distress thermometer and problem checklist (DT&PC) was used as a reference PROM. Content, construct and criterion validity, responsiveness, and cutoff points are shown with prevalences, area under receiver operating characteristic (ROC) curve, Chi-squared test, Wilcoxon signed-rank test, and positive and negative predictive values, respectively. RESULTS A total of 3913 patients completed 22 400 USDs. Content validity was confirmed for all added USD items with prevalences of ≥22%. All USD items also present on the DT&PC demonstrated a good criterion validity (ROC >0.8). Construct validity was confirmed for the USD as a whole and for the items dry mouth, dysphagia and well-being (P < .0001). USD scores differed significantly for patients when improving or deteriorating on the DT&PC which confirmed responsiveness. Optimal cutoff points (3 or 4) differed per symptom. CONCLUSION The USD is a valid 12-item PROM for the most prevalent symptoms in cancer patients, which has content, criterion, and construct validity, and detects clinically important changes over time, in both curative and palliative phase.
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Affiliation(s)
- Frederieke H van der Baan
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Josephine J Koldenhof
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Ellen J de Nijs
- Center of Expertise Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael A Echteld
- Avans University of Applied Sciences, Breda/Tilburg, The Netherlands
| | - Danielle Zweers
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Ginette M Hesselmann
- Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Sigrid C Vervoort
- Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Jan B Vos
- Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Everlien de Graaf
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Karijn P Suijkerbuijk
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Saskia C Teunissen
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
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Singh N, Batra A, Yang L, Boyne DJ, Harper A, Ghatage P, Cuthbert CA, Cheung WY. Patient-Reported Symptom Burden Near the End of Life in Patients With Gynaecologic Cancers. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:26-33. [PMID: 32967796 DOI: 10.1016/j.jogc.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There are limited data on patient-reported outcomes near the end of life in patients with gynaecologic cancers. This study aimed to assess the symptom burden in the last 6 months of life in a real-world cohort. METHODS Patients diagnosed with metastatic gynaecologic malignancies from 2016 to 2019 who completed the revised Edmonton Symptom Assessment System (ESASr) questionnaire within 6 months of death in a large Canadian province were identified. Patient-reported symptom scores were categorized as none to mild (0-3) and moderate to severe (4-10). Individual symptoms were subsequently grouped into physical, psychological, and total subscores. The severity of symptoms was further analyzed for any associations with age, time to death, and primary tumour site (ovarian vs. uterocervical and vulvovaginal). RESULTS We identified 107 patients with gynaecologic malignancies including 59 ovarian, 29 uterocervical, and 19 vulvovaginal cancers. The median ages at diagnosis and questionnaire completion were 64 and 65 years, respectively. The median time from completing the ESASr questionnaire to death was 65 days. Overall, physical and psychological symptoms were moderate to severe in 57.9% and 40.2% of patients, respectively. Among the individual symptoms, tiredness was the most commonly reported moderate to severe symptom (74.9%), while shortness of breath was least commonly reported (31.6%). While physical (P < 0.001) and total symptom (P = 0.009) subscores were more likely to be moderate to severe in intensity as death approached, the psychological subscore (P = 0.744) had no relationship with time to death. Longer time to death was predictive of lower physical (P = 0.002) and total symptom (P = 0.002) subscores, while a primary uterocervical cancer site was associated with a lower psychological symptom subscore (P = 0.042). CONCLUSIONS In the real-world setting, unique symptom trajectories can emerge for patients with gynaecologic cancer near the end of life. Knowledge of these specific symptom patterns can help inform the development and delivery of targeted palliative interventions to improve quality of life for these patients.
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Affiliation(s)
| | | | - Lin Yang
- Tom Baker Cancer Centre, Calgary, AB
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Battaglia Y, Zerbinati L, Piazza G, Martino E, Massarenti S, Provenzano M, Esposito P, Andreucci M, Storari A, Grassi L. The Use of Demoralization Scale in Italian Kidney Transplant Recipients. J Clin Med 2020; 9:jcm9072119. [PMID: 32635625 PMCID: PMC7408932 DOI: 10.3390/jcm9072119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023] Open
Abstract
Demoralization is a commonly observed syndrome in medically ill patients. The risk of demoralization may increase in patients after a kidney transplant (KTRs) because of the stressful nature of renal transplantation, psychosocial challenges, and adjustment needs. No study is available on demoralization amongst KTRs. The purpose of our study was to evaluate the validity of the Italian version of the Demoralization Scale (DS-IT) and the prevalence of demoralization in KTRs. Also, we aimed at exploring the association of the DS-IT with International Classification of Diseases (ICD) psychiatric diagnoses, post-traumatic growth (PTG), psychological and physical symptoms, and daily-life problems. A total of 134 KTRs were administered the MINI International Neuropsychiatric Interview 6.0. and the Diagnostic Criteria for Psychosomatic Research-Demoralization (DCPR/D) Interview. The DS-IT, the Edmonton Symptom Assessment System (ESAS), the Canadian Problem Checklist (CPC), were used to measure demoralization, physical and psychological symptoms, and daily-life problems; also, positive psychological experience of kidney transplantation was assessed with the PTG Inventory. Routine biochemistry and sociodemographic data were collected. Exploratory factor analysis demonstrated a four-dimensional factor structure of the DS-IT, explaining 55% of the variance (loss of meaning and purpose, disheartenment, dysphoria, and sense of failure). DS-IT Cronbach alpha coefficients indicated good or acceptable level of internal consistency. The area under the Receiving Operating Characteristics (ROC) curve for DS-IT (against the DCPR/D interview as a gold standard) was 0.92. The DS-IT optimal cut-off points were ≥20 (sensitivity 0.87, specificity 0.82). By examining the level of demoralization, 14.2%, 46.3%, 24.6%, and 14.6% of our sample were classified as having no, low, moderate, and high demoralization, respectively, with differences according to the ICD psychiatric diagnoses (p < 0.001). DS-IT Total and subscales scores were positively correlated with scores of ESAS symptoms and CPC score. A correlation between DS-IT loss of meaning and purpose subscale and PTGI appreciation of life subscale (p < 0.05) was found. This study shows, for the first time, a satisfactory level of reliability of the DS-IT and a high prevalence of severe demoralization in KTRs.
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Affiliation(s)
- Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
- Correspondence:
| | - Luigi Zerbinati
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Giulia Piazza
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Elena Martino
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Sara Massarenti
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Michele Provenzano
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Pasquale Esposito
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
| | - Luigi Grassi
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
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Tanzi S, Luminari S, Cavuto S, Turola E, Ghirotto L, Costantini M. Early palliative care versus standard care in haematologic cancer patients at their last active treatment: study protocol of a feasibility trial. BMC Palliat Care 2020; 19:53. [PMID: 32321483 PMCID: PMC7178743 DOI: 10.1186/s12904-020-00561-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 04/13/2020] [Indexed: 01/03/2023] Open
Abstract
Background Patients with advanced haematological malignancies suffer from a very high symptom burden and psychological, spiritual, social and physical symptoms comparable with patients with metastatic non-haematological malignancy. Referral to palliative care services for these patients remains limited or often confined to the last days of life. We developed a palliative care intervention (PCI) integrated with standard haematological care. The aim of the study was focussed on exploring the feasibility of the intervention by patients, professionals and caregivers and on assessing its preliminary efficacy. Methods/design. This is a mixed-methods phase 2 trial. The Specialist Palliative Care Team (SPCT) will follow each patient on a monthly basis in the outpatient clinic or will provide consultations during any hospital admission. SPCT and haematologists will discuss active patient issues to assure a team approach to the patient’s care. This quantitative study is a monocentric parallel-group superiority trial with balanced randomisation comparing the experimental PCI plus haematological standard care versus haematological standard care alone. The primary endpoint will calculate on adherence to the planned PCI, measured as the percentage of patients randomised to the experimental arm who attend all the planned palliative care visits in the 24 weeks after randomisation. The qualitative study follows the methodological indications of concurrent nested design and was aimed at exploring the acceptability of the PCI from the point of view of patients, caregivers and physicians. Discussion In this trial, we will test the feasibility of an integrated palliative care approach starting when the haematologist decides to propose the last active treatment to the patient, according to his/her clinical judgement. We decided to test this criterion because it is able to intercept a wide range of patients’needs. The feasibility of this approach requires that we enrol at least 60 patients and that more than 50% of them be followed by the palliative care team for at least 24 weeks. The trial will include integrated qualitative data analysis; to give essential information on feasibility and acceptability. Trial registration ClinicalTrials.gov: NCT03743480 (November 16, 2018).
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Affiliation(s)
- Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy. .,Clinical and Experimental Medicine PhD program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Stefano Luminari
- Haematology Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Clinical Trials an Statistics Unit, Infrastructure Research and Statistic, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Turola
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Costantini
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Cuomo A, Cascella M, Forte CA, Bimonte S, Esposito G, De Santis S, Cavanna L, Fusco F, Dauri M, Natoli S, Maltoni M, Morabito A, Mediati RD, Lorusso V, Barni S, Porzio G, Mercadante S, Crispo A. Careful Breakthrough Cancer Pain Treatment through Rapid-Onset Transmucosal Fentanyl Improves the Quality of Life in Cancer Patients: Results from the BEST Multicenter Study. J Clin Med 2020; 9:jcm9041003. [PMID: 32252426 PMCID: PMC7230287 DOI: 10.3390/jcm9041003] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To explore the effect of breakthrough cancer pain (BTcP) treatment on quality of sleep and other aspects of the health-related quality of life (HRQoL) in patients with cancer pain. METHODS In an observational, multicenter, cohort study, cancer patients from palliative care units, oncology departments, and pain clinics and affected by BTcP were included. Enrolled patients were assessed at the four visits: T0 (baseline), T7, T14, and T28. Stable chronic background pain (numeric rating scale, NRS ≤ 4) during the whole study period was mandatory. BTcP was treated through transmucosal fentanyl. Three questionnaires were used to measure the HRQoL: EORTC QLQ-C15-PAL, Pittsburgh Sleep Quality Index (PSQI), and the Edmonton Symptom Assessment System (ESAS). RESULTS In 154 patients, the HRQoL showed a significant improvement for all physical and emotional characteristics in the EORTC QLQ-C15-PAL, except for nausea and vomiting (linear p-value = 0.1) and dyspnea (Linear p-value = 0.05). The ESAS and PSQI questionnaires confirmed these positive results (p < 0.0001 and p = 0.002, respectively). CONCLUSIONS This prospective investigation by an Italian expert group, has confirmed that careful management of BTcP induces a paramount improvement on the HRQoL. Because in cancer patients there is a high prevalence of BTcP and this severe acute pain has deleterious consequences, this information can have an important clinical significance.
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Affiliation(s)
- Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
- Correspondence: ; Tel./Fax: +39-081-5903-778
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
| | - Gennaro Esposito
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
| | - Stefano De Santis
- Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, 00149 Rome, Italy;
| | - Luigi Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, 29121 Piacenza, Italy;
| | - Flavio Fusco
- Palliative Home Care Unit, ASL 3, 16153 Genova, Italy;
| | - Mario Dauri
- Department of Anesthesiology and Resuscitation, II University of Rome, Tor Vergata, 00133 Roma, Italy; (M.D.); (S.N.)
| | - Silvia Natoli
- Department of Anesthesiology and Resuscitation, II University of Rome, Tor Vergata, 00133 Roma, Italy; (M.D.); (S.N.)
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Alessandro Morabito
- Medical Oncology Unit, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy;
| | - Rocco Domenico Mediati
- Palliative Care and Pain Therapy Unit, University Hospital Careggi, 50134 Firenze, Italy;
| | - Vito Lorusso
- UO Oncologia Medica, Istituto Tumori “G Paolo II”, 70124 Bari, Italy;
| | - Sandro Barni
- Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio, Italy;
| | - Giampiero Porzio
- Medical Oncology Unit, San Salvatore Hospital, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Sebastiano Mercadante
- Main regional center for Pain Relief & Supportive Care, La Maddalena Cancer Center, 90146 Palermo, Italy;
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy;
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Battaglia Y, Zerbinati L, Piazza G, Martino E, Provenzano M, Esposito P, Massarenti S, Andreucci M, Storari A, Grassi L. Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients. J Clin Med 2020; 9:jcm9040995. [PMID: 32252326 PMCID: PMC7230823 DOI: 10.3390/jcm9040995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023] Open
Abstract
An average prevalence of 35% for psychiatric comorbidity has been reported in kidney transplant recipients (KTRs) and an even higher prevalence of other psychosocial syndromes, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), has also been found in this population. Consequently, an easy, simple, rapid psychiatric tool is needed to measure physical and psychological symptoms of distress in KTRs. Recently, the Edmonton Symptom Assessment System (ESAS), a pragmatic patient-centred symptom assessment tool, was validated in a single cohort of KTRs. The aims of this study were: to test the screening performances of ESAS for the International Classification of Diseases-10th Revision (ICD-10) psychiatric diagnoses in KTRs; to investigate the optimal cut-off points for ESAS physical, psychological and global subscales in detecting ICD-10 psychiatric diagnoses; and to compare ESAS scores among KTR with ICD-10 diagnosis and DCPR diagnosis. 134 KTRs were evaluated and administered the MINI International Neuropsychiatric Interview 6.0 and the DCPR Interview. The ESAS and Canadian Problem Checklist (CPC) were given as self-report instruments to be filled in and were used to examine the severity of physical and psychological symptoms and daily-life problems. The physical distress sub-score (ESAS-PHYS), psychological distress sub-score (ESAS-PSY) and global distress score (ESAS-TOT) were obtained by summing up scores of six physical symptoms, four psychological symptoms and all single ESAS symptoms, respectively. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. Receiving Operating Characteristic (ROC) analysis was used to examine the ability of the ESAS emotional distress (DT) item, ESAS-TOT, ESAS-PSY and ESAS-PHYS, to detect psychiatric cases defined by using MINI6.0. The area under the ROC curve for ESAS-TOT, ESAS-PHYS, ESAS-PSY and DT item were 0.85, 0.73, 0.89, and 0.77, respectively. The DT item, ESAS-TOT and ESAS-PSY optimal cut-off points were ≥4 (sensitivity 0.74, specificity 0.73), ≥20 (sensitivity 0.85, specificity 0.74) and ≥12 (sensitivity 0.85, specificity 0.80), respectively. No valid ESAS-PHYS cut-off was found (sensitivity <0.7, specificity <0.7). Thirty-nine (84.8%) KTRs with ICD-10 diagnosis did exceed both ESAS-TOT and ESAS-PSY cut-offs. Higher scores on the ESAS symptoms (except shortness of breath and lack of appetite) and on the CPC problems were found for ICD-10 cases and DCRP cases than for ICD-10 no-cases and DCPR no-cases. This study shows that ESAS had an optimal screening performance (84.8%) to identify ICD-10 psychiatric diagnosis, evaluated with MINI; furthermore, ESAS-TOT and ESAS-PSY cut-off points could provide a guide for clinical symptom management in KTRs.
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Affiliation(s)
- Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
- Correspondence:
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Giulia Piazza
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Elena Martino
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Michele Provenzano
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Pasquale Esposito
- Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Sara Massarenti
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Alda Storari
- Nephrology and Dialysis Unit, St. Anna University Hospital, 44124 Ferrara, Italy;
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44124 Ferrara, Italy; (L.Z.); (G.P.); (E.M.); (S.M.); (L.G.)
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Dano S, Pokarowski M, Liao B, Tang E, Ekundayo O, Li V, Edwards N, Ford H, Novak M, Mucsi I. Evaluating symptom burden in kidney transplant recipients: validation of the revised Edmonton Symptom Assessment System for kidney transplant recipients - a single-center, cross-sectional study. Transpl Int 2020; 33:423-436. [PMID: 31919903 DOI: 10.1111/tri.13572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/20/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022]
Abstract
We assessed the validity of the Edmonton Symptom Assessment System (ESAS-r) in kidney transplant recipients (KTR). A cross-sectional sample of 252 KTR was recruited. Individual ESAS-r symptom scores and symptom domain scores were evaluated. Internal consistency, convergent validity, and construct validity were assessed with Cronbach's α, Spearman's rank correlations, and a priori-defined risk group comparisons. Mean (SD) age was 51 (16), 58% were male, and 58% Caucasian. ESAS-r Physical, Emotional, and Global Symptom Scores demonstrated good internal consistency (α > 0.8 for all). ESAS-r Physical and Global Symptom Scores strongly correlated with PHQ-9 scores (0.72, 95% CI: 0.64-0.78 and 0.74, 95% CI: 0.67-0.80). For a priori-defined risk groups, individual ESAS-r symptom score differed between groups with lower versus higher eGFR [pain: 1 (0-3) vs. 0 (0-2), delta = 0.18; tiredness: 3 (1-5) vs. 1.5 (0-4), delta = 0.21] and lower versus higher hemoglobin [tiredness: 3 (1-6) vs. 2 (0-4), delta = 0.27]. ESAS-r Global and Physical Symptom Scores differed between groups with lower versus higher hemoglobin [13 (6-29) vs. 6.5 (0-18.5), delta = 0.3, and 9 (2-19) vs. 4 (0-13), delta = 0.24] and lower versus higher eGFR [11 (4-20) vs. 6.5 (2-13), delta = 0.21, and 7 (2-16) vs. 3 (0-9), delta = 0.26]. These data support reliability and construct validity of ESAS-r in KTR. Future studies should explore its clinical utility for symptom assessment among KTR.
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Affiliation(s)
- Sumaya Dano
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Martha Pokarowski
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Betty Liao
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Evan Tang
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Oladapo Ekundayo
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vernon Li
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nathaniel Edwards
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Heather Ford
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Multi-Organ Transplant Program, Division of Nephrology University Health Network, University of Toronto, Toronto, ON, Canada
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Ripamonti CI, Chiesi F, Di Pede P, Guglielmo M, Toffolatti L, Gangeri L, Allocca E. The validation of the Italian version of the COmprehensive Score for financial Toxicity (COST). Support Care Cancer 2020; 28:4477-4485. [DOI: 10.1007/s00520-019-05286-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/26/2019] [Indexed: 01/29/2023]
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Tricou C, Ruer M, Nekolaichuk C, Sigurdardottir K, Perceau-Chambard E, Bruera E, Filbet M. Transcultural Validation of the French Version of the Modified Edmonton Symptom Assessment Scale: The ESAS12-F. J Palliat Med 2019; 22:1553-1560. [PMID: 31287375 DOI: 10.1089/jpm.2018.0578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Cancer-related physical symptoms can decrease patients' overall quality of life and are often underdiagnosed. The Edmonton Symptom Assessment Scale (ESAS) is widely used in palliative care for cancer patients to easily assess cancer patients' symptoms. It has been often modified, adding symptoms and explanations, and translated into many languages. The European Association of Palliative Care research team developed a database, which included the modified 12-item ESAS-r as the symptom assessment tool. Objectives: The purpose of this study was to achieve the translation and cross-cultural validation in French of the 12-item ESAS-r, the ESAS12-F. Design: A French version of the ESAS-r was developed using a standardized forward and backward translation method. Patients completed the ESAS12-F and provided feedback on the translation. Setting/Subjects: Forty-five patients with advanced cancer, followed by the palliative care team from the Lyon Sud University Hospital in France, were recruited. Results: Eighty-nine percent of patients considered the ESAS easy to understand. They highlighted some concerns more about the tool itself than the translation: the time line "now," the difficulty to quantify a symptom in a numerical evaluation. Some items (sleep and appetite) needed to be reread and for some others (digestive and psychological symptoms, and well-being) to be reordered in the questionnaire. Conclusion: The ESAS12-F is well accepted and easy to use for the cancer patients. The next step is to carry out a psychometric validation of the definitive version of the ESAS12-F.
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Affiliation(s)
- Colombe Tricou
- Palliative Care Unit, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Murielle Ruer
- Palliative Care Unit, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.,Tertiary Palliative Care Unit, Grey Nuns Community Hospital, Edmonton, Alberta, Canada.,Palliative Institute, Covenant Health, Edmonton, Alberta, Canada
| | - Katrin Sigurdardottir
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian, University of Science and Technology (NTNU), Trondheim, Norway.,Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Elise Perceau-Chambard
- Palliative Care Unit, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | | | - Marilene Filbet
- Palliative Care Unit, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
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Exploring demoralization in end-of-life cancer patients: Prevalence, latent dimensions, and associations with other psychosocial variables. Palliat Support Care 2019; 17:596-603. [DOI: 10.1017/s1478951519000191] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AbstractObjectiveDemoralization is an existential distress syndrome that consists of an incapacity of coping, helplessness, hopelessness, loss of meaning and purpose, and impaired self-esteem. It can affect cancer patients, and the Demoralization Scale is a valid instrument to assess it. The present study aimed to investigate the prevalence of demoralization in end-of-life cancer patients and its associations with the medical and psychosocial variables. In addition, the latent dimensions of demoralization emerging in this distinctive population were explored.MethodThe study is cross-sectional. The sample consisted of 235 end-of-life cancer patients with a Karnofsky performance status (KPS) lower than 50 and a life expectancy of a few weeks. For each patient, personal and medical data was gathered by a palliative physician and a set of validated rating scales, assessing demoralization, anxiety, depression, physical symptoms, pain, spiritual well-being, and dignity, was administered by a psychologist during the first consultation.ResultSixty-four participants (27.2%) had low demoralization, 50.2% (n = 118) had medium demoralization, and 22.6% (n = 53) had high demoralization. Factor analysis evidenced a five-factor solution that identified the following demoralization factors: Emotional Distress and Inability to Cope, Loss of Purpose and Meaning, Worthlessness, Sense of Failure, and Dysphoria. All the considered variables were associated with demoralization, except for pain, nausea, breathing problems, and sociodemographic and clinical variables.Significance of resultsEnd-of-life cancer patients showed higher levels of demoralization than has been reported in other studies with advanced cancer. These data could suggest that demoralization could increase in proximity to death and with impaired clinical condition. In particular, the five demoralization dimensions that emerged could represent the typical concerns around which the syndrome evolves in end-of-life cancer patients. Finally, spiritual well-being could play a protective role with respect to demoralization.
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Bandieri E, Banchelli F, Artioli F, Mucciarini C, Razzini G, Cruciani M, Potenza L, D'Amico R, Efficace F, Bruera E, Luppi M. Early versus delayed palliative/supportive care in advanced cancer: an observational study. BMJ Support Palliat Care 2019; 10:e32. [PMID: 31201152 DOI: 10.1136/bmjspcare-2019-001794] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/09/2019] [Accepted: 05/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The positive impact of early palliative care interventions in advanced cancer patients has so far been largely evaluated in randomised controlled trials. This study aimed at providing information on the value of early palliative/supportive care, integrated with standard oncologic care, in a real-life setting. METHODS This was a retrospective observational study of 292 advanced cancer patients consecutively admitted at Carpi Hospital in Modena, Italy, between 2014 and 2017. For the purpose of this analysis, patients were classified into two groups (early and delayed palliative/supportive care patients), and analysed for different clinical indicators. Early and delayed palliative/supportive care were classified according to the time elapsed from advanced cancer diagnosis until palliative/supportive care start. RESULTS A total of 200 patients (68%), with at least three visits, were included in the analyses. The frequency of chemotherapy use in the last 60 days of life was 3.4% and 24.6% in the early and delayed groups, respectively (adjusted OR=0.1; 95% CI 0.0 to 0.4; p=0.002). The estimated survival probability at 1 year was 74.5% (95% CI 65.0% to 85.4%) and 45.5% (95% CI 37.6% to 55.0%), in the early and delayed groups, respectively. Performance status, pain and all the Edmonton Symptom Assessment Scale items, assessed at baseline and at 1 to 12 weeks after the intervention, showed significant improvement over time. However, no between-group differences were found with regard to symptom outcomes. CONCLUSIONS An earlier palliative/supportive care intervention was associated with reduced aggressiveness of therapy, in patients receiving community oncology care. Symptom burden was improved by early palliative/supportive care, independently of the timing of patient referral.
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Affiliation(s)
- Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Federico Banchelli
- Statistic Unit, Department of Medical and Surgical Sciences, UNIMORE, Modena, Italy
| | - Fabrizio Artioli
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Claudia Mucciarini
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | - Giorgia Razzini
- Oncology and Palliative Care Units, Civil Hospital Carpi, USL, Carpi, Italy
| | | | - Leonardo Potenza
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D'Amico
- Statistic Unit, Department of Medical and Surgical Sciences, UNIMORE, Modena, Italy
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Eduardo Bruera
- Palliative Care & Rehabilitation Medicine, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Mario Luppi
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Cortellini A, Porzio G, Cofini V, Necozione S, Giusti R, Marchetti P, Aloe Spiriti MA, Costanzi A, Peris F, Ravoni G, Spinelli G, Ficorella C, Verna L. What cancer patients actually know regarding medical cannabis? A cross-sectional survey with a critical analysis of the current attitudes. J Oncol Pharm Pract 2019; 25:1439-1444. [PMID: 31042135 DOI: 10.1177/1078155219843161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND In Italy medical cannabis is a prescription drug since 1998. Even though it could not be considered a therapy as such, it is indicated as a symptomatic treatment also in cancer patients, to cure iatrogenic nausea/vomiting and chronic pain. PATIENTS AND METHODS We conducted a knowledge survey about medical cannabis among cancer patients referred to two outpatient cancer care centers and a home care service. RESULTS From February to April 2018, 232 patient were enrolled; 210 patients were on active disease-oriented treatment (90.5%), while 22 (9.5%) not. Eighty-one percent of the patients have heard about medical cannabis, but only 2% from healthcare professionals. Thirty-four percent of responders thought about using cannabis to treat one or more of their own health problems, especially pain (55%). Despite that, 18% of the participants believe that medical cannabis could have negative effects on their own symptoms. Patients with high educational level better knew cannabis (odds ratio = 3.52; 95% confidence interval: 1.07-11.53), and medical cannabis (odds ratio = 3.21; 95% confidence interval: 1.48-6.98), when compared to patient with low educational level. Patients who were on active disease-oriented treatment better knew medical cannabis (odds ratio = 3.91; 95% confidence interval: 1.26-12.11) compared to "out of treatment" patients. Metastatic patients were less informed about medical cannabis compared to patients on adjuvant treatment. CONCLUSIONS Our survey shows that most of Italian cancer patients know medical cannabis and a third of them have considered using cannabis to treat one (or more) of their own health problems. In the same time, they are poorly informed and do not tend to ask for information about medical cannabis to healthcare professionals.
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Affiliation(s)
- Alessio Cortellini
- 1 Medical Oncology, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,2 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giampiero Porzio
- 1 Medical Oncology, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,2 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Vincenza Cofini
- 3 Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stefano Necozione
- 3 Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Giusti
- 4 Medical Oncology, St Andrea University Hospital, Rome, Italy
| | - Paolo Marchetti
- 4 Medical Oncology, St Andrea University Hospital, Rome, Italy.,5 Medical Oncology (B), Umberto I University Hospital, Rome, Italy
| | | | - Andrea Costanzi
- 6 Simultaneous Care Unit, St Andrea University Hospital, Rome, Italy
| | - Flaminia Peris
- 7 Tuscany Tumors Association, Home Care Service, Florence, Italy
| | - Giulio Ravoni
- 7 Tuscany Tumors Association, Home Care Service, Florence, Italy
| | | | - Corrado Ficorella
- 1 Medical Oncology, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,2 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lucilla Verna
- 2 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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50
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Giusti R, Mazzotta M, Verna L, Sperduti I, Di Pietro FR, Marchetti P, Porzio G. The Incidence of Alcoholism in Patients with Advanced Cancer Receiving Active Treatment in Two Tertiary Care Centers in Italy. Alcohol Alcohol 2019; 54:47-50. [PMID: 30260381 DOI: 10.1093/alcalc/agy070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/07/2018] [Indexed: 12/27/2022] Open
Abstract
Introduction Substance abuse is frequently under-diagnosed among cancer patients. Alcoholism is a problem afflicting about 18% of the general population. This percentage is higher in hospitalized patients. Previous studies conducted on advanced cancer patients admitted in palliative care units have highlighted this problem only for a small percentage of cases. The objective of the study was to evaluate the incidence of alcoholism in patients with advanced cancer admitted to two Italian Oncology Units for active cancer treatment, using a recognized and validated assessment tool. Short summary To evaluate the incidence of alcoholism in cancer patients and its impact on symptoms, the CAGE questionnaire was completed by 117 patients in active anticancer treatment. The percentage of CAGE-positive patients was higher than previously detected in palliative settings and was associated to male sex and lower ESAS score. Methods All eligible patients were enrolled consecutively during a 12-month recruitment period. Clinical and demographic data were collected. Each enrolled patient completed the Cut down, Annoyed, Guilty, Eye-opener (CAGE) questionnaire. Results Hundred and seventeen consecutive patients were surveyed in the 12-month period. The mean age was 63.3 (SD 12.0) years and 66 were males. The mean Karnofsky level was 68.3 (SD 16.0). Twelve patients were CAGE positive (10.3%). Males (P = 0.05) and patients with low Edmonton Symptom Assessment System score (P = 0.03) proved to be CAGE positive. Conclusions Alcoholism is widespread and under-diagnosed among patients undergoing active cancer treatment. Compared with other experience in palliative settings among European population, percentage of CAGE-positive patients was double. CAGE-positive patients were more likely to be male, with lower ESAS score. It is possible to hypothesize an effect of alcohol consumption on patients' perception of symptoms. This data has never been reported in the literature and will certainly need confirmation studies.
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Affiliation(s)
- Raffaele Giusti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Marco Mazzotta
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Lucilla Verna
- Medical Oncology Unit, University of L'Aquila, L'Aquila, Italy
| | - Isabella Sperduti
- Biostatistics Unit and Clinical Trial Center, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Paolo Marchetti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
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