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Hahn W, Schütte K, Schultz K, Wolkenhauer O, Sedlmayr M, Schuler U, Eichler M, Bej S, Wolfien M. Contribution of Synthetic Data Generation towards an Improved Patient Stratification in Palliative Care. J Pers Med 2022; 12:1278. [PMID: 36013227 PMCID: PMC9409663 DOI: 10.3390/jpm12081278] [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: 07/04/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
AI model development for synthetic data generation to improve Machine Learning (ML) methodologies is an integral part of research in Computer Science and is currently being transferred to related medical fields, such as Systems Medicine and Medical Informatics. In general, the idea of personalized decision-making support based on patient data has driven the motivation of researchers in the medical domain for more than a decade, but the overall sparsity and scarcity of data are still major limitations. This is in contrast to currently applied technology that allows us to generate and analyze patient data in diverse forms, such as tabular data on health records, medical images, genomics data, or even audio and video. One solution arising to overcome these data limitations in relation to medical records is the synthetic generation of tabular data based on real world data. Consequently, ML-assisted decision-support can be interpreted more conveniently, using more relevant patient data at hand. At a methodological level, several state-of-the-art ML algorithms generate and derive decisions from such data. However, there remain key issues that hinder a broad practical implementation in real-life clinical settings. In this review, we will give for the first time insights towards current perspectives and potential impacts of using synthetic data generation in palliative care screening because it is a challenging prime example of highly individualized, sparsely available patient information. Taken together, the reader will obtain initial starting points and suitable solutions relevant for generating and using synthetic data for ML-based screenings in palliative care and beyond.
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Affiliation(s)
- Waldemar Hahn
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Katharina Schütte
- University Palliative Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Kristian Schultz
- Department of Systems Biology and Bioinformatics, University of Rostock, Universitätsplatz 1, 18051 Rostock, Germany
| | - Olaf Wolkenhauer
- Department of Systems Biology and Bioinformatics, University of Rostock, Universitätsplatz 1, 18051 Rostock, Germany
- Leibniz-Institute for Food Systems Biology, Technical University Munich, 85354 Freising, Germany
- Stellenbosch Institute of Advanced Study, Wallenberg Research Centre, Stellenbosch University, Stellenbosch 7602, South Africa
| | - Martin Sedlmayr
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ulrich Schuler
- University Palliative Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Martin Eichler
- National Center for Tumor Diseases Dresden (NCT/UCC), Fetscherstraße 74, 01307 Dresden, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Bautzner Landstraße 400, 01328 Dresden, Germany
| | - Saptarshi Bej
- Department of Systems Biology and Bioinformatics, University of Rostock, Universitätsplatz 1, 18051 Rostock, Germany
- Leibniz-Institute for Food Systems Biology, Technical University Munich, 85354 Freising, Germany
| | - Markus Wolfien
- Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
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Whitelaw S, Bell A, Clark D. The expression of 'policy' in palliative care: A critical review. Health Policy 2022; 126:889-898. [PMID: 35840439 DOI: 10.1016/j.healthpol.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
The importance of 'policy' within palliative care has steadily increased over the past 25 years. Whilst this has been welcomed within the palliative care field and seen as a route to greater recognition, we focus here on a more critical perspective that challenge the effectiveness of a 'policy turn' in palliative care. Applying Bacchi's "What's the Problem Represented to Be?" (WPR) framework to data from a systematic search, we address the research question, "in what ways has 'policy' been articulated in palliative care literature?". The paper describes the construction of 'the problem' context and reflects critically on the robustness and pragmatic utility of such representations. In particular, we identify five elements as prominent and problematic: (1) a lack of empirical evidence that connects policy to practice; (2) the dominance of 'Global North' approaches; (3) the use of a policy narrative based on 'catastrophe' in justifying the need for palliative care; (4) the use of idealistic and aspirational 'calls to action'; and (5) a disengaged and antagonistic orientation to existing health systems. We conclude by suggesting that the efficacy of palliative care policy could be enhanced via greater emphases on 'Global South' perspectives, 'assets-based' approaches and attention to pragmatic implementation.
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Affiliation(s)
- Sandy Whitelaw
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom.
| | - Anthony Bell
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
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Auclair J, Sanchez S, Chrusciel J, Hannetel L, Frasca M, Economos G, Habert-Dantigny R, Bruera E, Burucoa B, Ecarnot F, Colombet I, Barbaret C. Duration of palliative care involvement and immunotherapy treatment near the end of life among patients with cancer who died in-hospital. Support Care Cancer 2022; 30:4997-5006. [PMID: 35192058 DOI: 10.1007/s00520-022-06901-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionised cancer treatment, but their use near the end of life in patients with advanced cancer is poorly documented. This study investigated the association between administration of ICI therapy in the last month of life and the duration of involvement of the palliative care (PC) team, among patients with advanced cancer who died in-hospital. METHODS In a retrospective, multicentre study, we included all patients who died in 2018 of melanoma, head and neck carcinoma, non-small cell lung cancer or urothelial or renal cancer, in 2 teaching hospitals and one community hospital in France. The primary outcome was the association between ICI therapy in the last month of life and duration of involvement of the PC team in patient management. RESULTS Among 350 patients included, 133 (38%) received anti-cancer treatment in the last month of life, including 71/133 (53%) who received ICIs. A total of 207 patients (59%) received palliative care, only 127 (36%) 30 days before death. There was a significant association between ongoing ICI therapy in the last month of life and shorter duration of PC management (p = 0.04). Receiving ICI therapy in the last month of life was associated with an increased risk of late PC initiation by multivariate regression analysis (hazard ratio 1.668; 95% CI 1.022-2.722). CONCLUSION ICI therapy is frequently used close to the end of life in patients with advanced cancer. Innovative new anti-cancer treatments should not delay PC referral. Improved collaboration between PC and oncological teams is needed to address this issue.
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Affiliation(s)
- Juline Auclair
- Department of Palliative Care, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Stéphane Sanchez
- Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France
| | - Jan Chrusciel
- Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France
| | - Louise Hannetel
- Department of Palliative Care, Hôpitaux Champagne Sud, Troyes, France
| | - Matthieu Frasca
- Department of Palliative Care, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Guillaume Economos
- Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Lyon-Sud, Lyon, France
| | - Raphaelle Habert-Dantigny
- Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Avenue du Maquis du Grésivaudan, La Tronche, 38700, Grenoble, France
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benoit Burucoa
- Department of Palliative Care, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, University of Franche-Comté, EA392025000, Besançon, France
| | | | - Cécile Barbaret
- Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Avenue du Maquis du Grésivaudan, La Tronche, 38700, Grenoble, France.
- Laboratoire ThEMAS (Techniques pour l'évaluation et la Modélisation des Actions de Santé (TIMC-IMAG : Technique de l'Ingénierie Médicale et de la Compléxité-Informatique, Mathématiques et Applications, Grenoble), Grenoble, France.
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Le QV, Trinh HL, Mai KNT, Pham MD, Glare PA. Screening Patients With Cancer Admitted to Hanoi Medical University Hospital for Palliative Care Needs. JCO Glob Oncol 2021; 6:1321-1327. [PMID: 32841066 PMCID: PMC7456321 DOI: 10.1200/go.20.00102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate a screening tool for identifying which patients admitted to the oncology ward of a Vietnamese hospital should be referred to specialist palliative care (PC). METHODS We performed a cross-sectional survey of consecutive patients hospitalized in the Department of Oncology and Palliative Care at Hanoi Medical University Hospital between June 2019 and September 2019. We translated a validated 11-item screening tool into Vietnamese and used a total score of ≥ 5 as a positive screen. RESULTS One hundred participants were recruited. Forty-four patients (44%) screened positive. Of these, 37 (84%) had locally advanced or metastatic disease, 31 (70%) had uncontrolled symptoms, and 43 (98%) requested a PC consultation. A score ≥ 5 was significantly more common in patients with stage IV disease versus earlier stage, performance status of Eastern Cooperative Oncology Group (ECOG) 2 versus ECOG 0, and when life-limiting complications of cancer were present. Screening identified four patients overlooked by oncologists as needing referral, and 34% of patients requesting a referral had scores < 5. CONCLUSION This screening tool provided oncologists with easy-to-use criteria for referring patients for PC. At the same time, it relieved the work load for under-resourced PC physicians by screening out requests with low-level need. This tool should be part of routine assessment on admission in all oncology units in Vietnam.
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Affiliation(s)
- Quang V Le
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Socialist Republic of Vietnam
| | - Huy L Trinh
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Socialist Republic of Vietnam
| | - Kim Ngan T Mai
- Department of Oncology and Palliative Care, Hanoi Medical University Hospital, Hanoi, Socialist Republic of Vietnam
| | - Manh D Pham
- Hanoi Medical University, Hanoi, Socialist Republic of Vietnam
| | - Paul A Glare
- Sydney Medical School, University of Sydney, New South Wales, Australia
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Schibel S, Steinert M, Matthes H, Grah C. ACCEPT®: A Complementary Anthroposophical Program for the Palliative Treatment of Lung Cancer - Rationale and a Randomized Feasibility Study. Complement Med Res 2021; 29:27-34. [PMID: 34233331 DOI: 10.1159/000516820] [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: 11/05/2020] [Accepted: 04/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lung cancer is the oncological disease with the highest mortality worldwide. Health-related quality of life is severely compromised in the majority of patients. While the efficacy of early palliative psychosocial therapy has been demonstrated in several recent studies, appropriate therapy modules could so far not be integrated into daily practice of care. Therefore, an additive multimodal treatment concept for oncological centers was drafted: the Additive anthroposophic integrative medicine Cancer Concept of Early supportive or Palliative lung cancer Treatment (ACCEPT®). PATIENTS AND METHODS The first module consisted of a 3-month health education program, the second module was a concept of psychosocial interventions, and the third module was a supervised home training program. Between 2017 and 2018, 20 lung cancer patients (UICC IIIB/IV) were included and randomly assigned to treatment (n = 10) or a waiting control group (n = 10). The treatment group started ACCEPT® for 3 months immediately after diagnosis and received also standard oncological care (SOC) while the waiting control group received SOC only for 3 months, followed by ACCEPT® after this period. Health-related quality of life, disease management, disease-specific symptoms, and feasibility of the ACCEPT® were monitored at 4 time points. RESULTS 7 out of 10 patients in the treatment group (3 dropped out) and 6 out of 10 in the waiting control group (4 died during the intervention) completed treatment. DISCUSSION/CONCLUSION Lung cancer patients with high symptom load may benefit from ACCEPT®. The feasibility of this adjunctive therapy was demonstrated. The combination of SOC and ACCEPT® is feasible and applicable to a heterogeneous patient group and should be further evaluated with respect to efficacy and dosing.
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Affiliation(s)
| | - Marie Steinert
- Research Center Havelhöhe, Berlin, Germany.,School of Psychology, Berlin, Germany
| | - Harald Matthes
- Research Center Havelhöhe, Berlin, Germany.,Hospital Havelhöhe, Berlin, Germany.,Institute of Social Medicine Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Grah
- Research Center Havelhöhe, Berlin, Germany.,Hospital Havelhöhe, Berlin, Germany.,Lung Cancer Center Havelhöhe, Berlin, Germany
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Woodrell CD, Goldstein NE, Moreno JR, Schiano TD, Schwartz ME, Garrido MM. Inpatient Specialty-Level Palliative Care Is Delivered Late in the Course of Hepatocellular Carcinoma and Associated With Lower Hazard of Hospital Readmission. J Pain Symptom Manage 2021; 61:940-947.e3. [PMID: 33035651 PMCID: PMC8021616 DOI: 10.1016/j.jpainsymman.2020.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/19/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Little is known about receipt of specialty-level palliative care by people with hepatocellular carcinoma (HCC) or its impact on health care utilization. OBJECTIVES Identify patient characteristics associated with receipt of specialty-level palliative care among hospitalized HCC patients and measure association with time to readmission. METHODS We used logistic regression to examine relationships between receipt of inpatient palliative care consultation by HCC patients at an academic center (N = 811; 2012-2016) and clinical and demographic covariates at index hospitalization. We used a survival analysis model accounting for competing risk of mortality to compare time to readmission among individuals who did or did not receive palliative care during the admission and performed a sensitivity analysis using kernel weights to account for selection bias. RESULTS Overall, 16% received inpatient palliative care consults. Those who received consults had worse laboratory values than those who did not. In a multivariable model, higher Model for End-Stage Liver Disease Sodium, receipt of sorafenib, and higher pain scores were significantly associated with increased odds of palliative care, whereas liver transplantation and admission to a surgical service were associated with lower odds. For time to readmission (2076 hospitalizations for 811 individuals with 175 palliative care visits), the subhazard ratio for readmission for patients who received consults was 0.26 (95% CI = 0.18-0.38) and 0.35 (95% CI = 0.24-0.52) with a kernel-weighted sample. CONCLUSION Inpatient palliative care consultation was received by individuals with more advanced disease and associated with lower readmission hazard. These findings support further research and the development of HCC-specific programs that increase access to specialty-level palliative care.
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Affiliation(s)
- Christopher D Woodrell
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.
| | - Nathan E Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Jaison R Moreno
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas D Schiano
- Division of Liver Diseases, Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Myron E Schwartz
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa M Garrido
- Boston Veterans Affairs Healthcare System, Boston, Massachusetts, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Mathews J, Hannon B, Zimmermann C. Models of Integration of Specialized Palliative Care with Oncology. Curr Treat Options Oncol 2021; 22:44. [PMID: 33830352 PMCID: PMC8027976 DOI: 10.1007/s11864-021-00836-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 12/20/2022]
Abstract
OPINION STATEMENT Evidence from randomized controlled trials and meta-analyses has shown that early integration of specialized palliative care improves symptoms and quality of life for patients with advanced cancer. There are various models of early integration, which may be classified based on setting of care and method of palliative care referral. Most successful randomized controlled trials of early palliative care have used a model of specialized teams providing in-person palliative care in free-standing or embedded outpatient clinics. During the COVID-19 pandemic, telehealth has become a prominent model for palliative care delivery. This model of care has been well received by patients and palliative care providers, although evidence to date is limited. Despite evidence from trials that routine early integration of palliative care into oncology care improves patient outcomes, referral to palliative care still occurs mostly according to the judgment of individual oncologists. This hinders equitable access to palliative care and to its known benefits for patients and their caregivers. Automated referral based on triggering criteria is being actively explored as an alternative. In particular, routine technology-assisted symptom screening, combined with targeted needs-based automatic referral to outpatient palliative care, may improve integration and ultimately increase quality of life.
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Affiliation(s)
- Jean Mathews
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada
- Divisions of Palliative Medicine and Medical Oncology, University of Toronto, Toronto, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada
- Divisions of Palliative Medicine and Medical Oncology, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada.
- Divisions of Palliative Medicine and Medical Oncology, University of Toronto, Toronto, Canada.
- Department of Medicine, University of Toronto, Toronto, Canada.
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Grimm D, Voiss P, Paepke D, Dietmaier J, Cramer H, Kümmel S, Beckmann MW, Woelber L, Schmalfeldt B, Freitag U, Kalder M, Wallwiener M, Theuser AK, Hack CC. Gynecologists' attitudes toward and use of complementary and integrative medicine approaches: results of a national survey in Germany. Arch Gynecol Obstet 2021; 303:967-980. [PMID: 33201377 PMCID: PMC7985114 DOI: 10.1007/s00404-020-05869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Despite patients' widespread use and acceptance of complementary and integrative medicine (IM), few data are available regarding health-care professionals' current implementation of it in clinical routine. A national survey was conducted to assess gynecologists' attitudes to and implementation of complementary and integrative treatment approaches. METHODS The Working Group on Integrative Medicine of the German Society of Gynecological Oncology conducted an online survey in collaboration with the German Society of Gynecology and Obstetrics (DGGG) in July 2019. A 29-item survey was sent to all DGGG members by email. RESULTS Questionnaires from 180 gynecologists were analyzed, of whom 61 were working office-based in private practice and 95 were employed in hospitals. Seventy percent stated that IM concepts are implemented in their routine clinical work. Most physicians reported using IM methods in gynecological oncology. The main indications for IM therapies were fatigue (n = 98), nausea and vomiting (n = 89), climacteric symptoms (n = 87), and sleep disturbances (n = 86). The most commonly recommended methods were exercise therapy (n = 86), mistletoe therapy (n = 78), and phytotherapy (n = 74). Gynecologists offering IM were more often female (P = 0.001), more often had qualifications in anthroposophic medicine (P = 0.005) or naturopathy (P = 0.019), and were more often based in large cities (P = 0.016). CONCLUSIONS There is strong interest in IM among gynecologists. The availability of evidence-based training in IM is increasing. Integrative therapy approaches are being implemented in clinical routine more and more, and integrative counseling services are present all over Germany. Efforts should focus on extending evidence-based knowledge of IM in both gynecology and gynecological oncology.
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Affiliation(s)
- Donata Grimm
- Department of Gynecology and Gynecologic Oncology, Hamburg-Eppendorf University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
- Department of Gynecology and Obstetrics, Schleswig-Holstein University Medical Center, Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Petra Voiss
- Department of Internal and Integrative Medicine, Faculty of Medicine, Evangelische Kliniken Essen-Mitte, University of Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany
| | - Daniela Paepke
- Department of Gynecology and Obstetrics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, Munich, Germany
| | - Johanna Dietmaier
- Department of Gynecology and Gynecologic Oncology, Hamburg-Eppendorf University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Faculty of Medicine, Evangelische Kliniken Essen-Mitte, University of Duisburg-Essen, Am Deimelsberg 34a, 45276 Essen, Germany
| | - Sherko Kümmel
- Breast Care Unit, Evangelische Huyssens-Stiftung, Kliniken Essen Mitte, Henricistrasse 92, 45136 MastologyEssen, Germany
| | - Matthias W. Beckmann
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21–23, 91054 Erlangen, Germany
| | - Linn Woelber
- Department of Gynecology and Gynecologic Oncology, Hamburg-Eppendorf University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology and Gynecologic Oncology, Hamburg-Eppendorf University Medical Center, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ulrich Freitag
- Dipl. Med. Ulrich Freitag, State Association Chairman of the BVF, Private Practice, Turnerweg 11a, 23970 Wismar, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, Phillips University of Marburg, Baldingerstrasse, 35033 Marburg, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Anna-Katharin Theuser
- Institute for Women’s Health (IFG) GmbH, Universitätsstrasse 21–23, 91054 Erlangen, Germany
| | - Carolin C. Hack
- Department of Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Universitätsstrasse 21–23, 91054 Erlangen, Germany
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9
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Roch C, Heckel M, van Oorschot B, Alt-Epping B, Tewes M. Screening for Palliative Care Needs: Pilot Data From German Comprehensive Cancer Centers. JCO Oncol Pract 2021; 17:e1584-e1591. [PMID: 33571007 DOI: 10.1200/op.20.00698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Guidelines recommend several screening tools to identify patients with complex palliative needs. This diversity and lack of structural recommendations offer a wide scope for implementing screening. Against this background, the current status of implementation at German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid has not yet been investigated. METHODS e-mail survey of the 17 hospital sites of the 13 CCCs. The questionnaire asked for structural characteristics of the centers as well as preconditions of the screening process. Structurally established screening procedures (one item) and standardized workflows, modes of performance, screening tools (four items), modes of training how to screen, and responsibilities (two items) were assessed. RESULTS In a 2-month period, 15 hospital sites responded; seven hospital sites conducted a palliative care needs (PCN) screening. Only one hospital site carried out PCN screening in almost all oncology departments, but only with the distress thermometer. Other hospital sites determined palliative needs by assessing physical symptoms using the Integrated Palliative Care Outcome Scale or the Minimal Documentation System, and two hospital sites combined tools to determine both physical and psychological stress. The type of screening varied from paper-pencil-based to tablet computer-based documentation. The main barriers to implementation were identified as a lack of human resources and a lack of structural conditions. CONCLUSION There is a lack of consensus among palliative care specialists and oncologists in the CCCs supported by the German Cancer Aid in PCN screening as well as of structured guidelines and the professional association. Structural requirements should be adapted to these needs, which include both technical and human resources. A combined psycho-oncologic and palliative care screening might help to formulate best practice recommendations.
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Affiliation(s)
- Carmen Roch
- Interdisciplinary Center for Palliative Medicine, CCC Mainfranken, University Hospital Wuerzburg, Julius-Maximilians-Universität Würzburg, Wuerzburg, Germany
| | - Maria Heckel
- Department of Palliative Medicine, CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Birgitt van Oorschot
- Interdisciplinary Center for Palliative Medicine, CCC Mainfranken, University Hospital Wuerzburg, Julius-Maximilians-Universität Würzburg, Wuerzburg, Germany
| | - Bernd Alt-Epping
- Heidelberg University Hospital, Department of Palliative Medicine, Heidelberg, Germany
| | - Mitra Tewes
- West German Cancer Center, Department of Medical Oncology, University Hospital Essen, Essen, Germany
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Barth C, Colombet I, Montheil V, Huillard O, Boudou-Rouquette P, Tlemsani C, Alexandre J, Goldwasser F, Vinant P. First referral to an integrated onco-palliative care program: a retrospective analysis of its timing. BMC Palliat Care 2020; 19:31. [PMID: 32164672 PMCID: PMC7069048 DOI: 10.1186/s12904-020-0539-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 03/03/2020] [Indexed: 12/16/2022] Open
Abstract
Background Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient’s profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. Methods The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011–2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). Results Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level > 35 g/l. The median [1st-3rd quartile] IP was 0.39 [0.16–0.72], ranging between 0.53 [0.20–0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07–0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units. Conclusions The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.
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Affiliation(s)
- Claire Barth
- Unité Mobile de Soins Palliatifs, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Isabelle Colombet
- Unité Mobile de Soins Palliatifs, Hôpital Cochin, AP-HP Centre, Paris, France. .,Université de Paris, Public Health, Paris, France.
| | - Vincent Montheil
- Unité Mobile de Soins Palliatifs, Hôpital Cochin, AP-HP Centre, Paris, France
| | | | | | | | - Jérôme Alexandre
- Université de Paris, Public Health, Paris, France.,Oncologie médicale, Hôpital Cochin, AP-HP Centre, Paris, France
| | - François Goldwasser
- Université de Paris, Public Health, Paris, France.,Oncologie médicale, Hôpital Cochin, AP-HP Centre, Paris, France
| | - Pascale Vinant
- Unité Mobile de Soins Palliatifs, Hôpital Cochin, AP-HP Centre, Paris, France
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11
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Ostgathe C, Wendt KN, Heckel M, Kurkowski S, Klein C, Krause SW, Fuchs FS, Bayer CM, Stiel S. Identifying the need for specialized palliative care in adult cancer patients - development and validation of a screening procedure based on proxy assessment by physicians and filter questions. BMC Cancer 2019; 19:646. [PMID: 31262285 PMCID: PMC6604384 DOI: 10.1186/s12885-019-5809-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/07/2019] [Indexed: 11/08/2022] Open
Abstract
Background One challenge in caring for cancer patients with incurable disease is the adequate identification of those in need for specialized palliative care (SPC). The study’s aim was to validate an easy to use phenomenological screening tool. Methods The German tool is based on the National Comprehensive Cancer Network (NCCN) Palliative Care guidelines and contains ten items in five domains that focus e.g. on diagnosis, functional status, complications, comorbidities, and palliative care relevant problems such as symptom management, distress, and support of family and team members. Sum score ranges from 0 to 14 (no need to great need). Assessment to identify SPC needs was done in university hospital wards between 1 and 08/2017 by health care professionals on admission of the patient if the disease was incurable and expected prognosis < 12 months. The Integrated Palliative Outcome Scale (IPOS, staff version), an outcome assessment instrument for palliative care that consists of ten items, served as external criterion; in sub samples inter-rater/test-retest were performed. Results Data from 208 patients with incurable disease and life expectancy < 12 months (54.8% female; average age 63.5 years, range 21–96) were assessed using the tool. The tool has good convergent validity; the correlation between the sum scores of IPOS and our tool showed a significant and substantial effect. The sum score was independent of the patient’s age, gender and primary diagnosis. Patients who already were in contact with SPC had significantly higher screening scores than patients without. With a cut point of ≥ 5, 80.8% of the screened patients were in need for SPC. Cronbach’s alpha was α = .600. Rater agreement (inter-rater, test-retest) varied between single items. Correlation coefficients showed significant substantial effects. Conclusions This is the first validation of a screening procedure in German language identifying SPC needs of adult patients with advanced cancer and the first using filter questions as a pre-screening. Proxy assessment of SPC needs by physicians in cancer care settings is feasible and the suggested tool presents a valid instrument to trigger a PC consultation. Trial registration The study was not registered.
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Affiliation(s)
- Christoph Ostgathe
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Kim N Wendt
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Maria Heckel
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany. .,Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.
| | - Sandra Kurkowski
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Carsten Klein
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Stefan W Krause
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Internal Medicine 5, Haematology and Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Florian S Fuchs
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Division of Respiratory Medicine, Department of Internal Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen , Erlangen, Germany
| | - Christian M Bayer
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Gynecology and Obstetrics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, University Breast Center Franconia, Erlangen, Germany
| | - Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Hannover, Germany
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12
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Scarpi E, Dall'Agata M, Zagonel V, Gamucci T, Bertè R, Sansoni E, Amaducci E, Broglia CM, Alquati S, Garetto F, Schiavon S, Quadrini S, Orlandi E, Casadei Gardini A, Ruscelli S, Ferrari D, Pino MS, Bortolussi R, Negri F, Stragliotto S, Narducci F, Valgiusti M, Farolfi A, Nanni O, Rossi R, Maltoni M. Systematic vs. on-demand early palliative care in gastric cancer patients: a randomized clinical trial assessing patient and healthcare service outcomes. Support Care Cancer 2018; 27:2425-2434. [PMID: 30357555 DOI: 10.1007/s00520-018-4517-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/16/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Early palliative care (EPC) has shown a positive impact on quality of life (QoL), quality of care, and healthcare costs. We evaluated such effects in patients with advanced gastric cancer. METHODS In this prospective, multicenter study, 186 advanced gastric cancer patients were randomized 1:1 to receive standard cancer care (SCC) plus on-demand EPC (standard arm) or SCC plus systematic EPC (interventional arm). Primary outcome was a change in QoL between randomization (T0) and T1 (12 weeks after T0) in the Trial Outcome Index (TOI) scores evaluated through the Functional Assessment of Cancer Therapy-Gastric questionnaire. Secondary outcomes were patient mood, overall survival, and family satisfaction with healthcare and care aggressiveness. RESULTS The mean change in TOI scores from T0 to T1 was - 1.30 (standard deviation (SD) 20.01) for standard arm patients and 1.65 (SD 22.38) for the interventional group, with a difference of 2.95 (95% CI - 4.43 to 10.32) (p = 0.430). The change in mean Gastric Cancer Subscale values for the standard arm was 0.91 (SD 14.14) and 3.19 (SD 15.25) for the interventional group, with a difference of 2.29 (95% CI - 2.80 to 7.38) (p = 0.375). Forty-three percent of patients in the standard arm received EPC. CONCLUSIONS Our results indicated a slight, albeit not significant, benefit from EPC. Findings on EPC studies may be underestimated in the event of suboptimally managed issues: type of intervention, shared decision-making process between oncologists and PC physicians, risk of standard arm contamination, study duration, timeliness of assessment of primary outcomes, timeliness of cohort inception, and recruitment of patients with a significant symptom burden. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT01996540).
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Affiliation(s)
- Emanuela Scarpi
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, FC, Italy.
| | - Monia Dall'Agata
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, FC, Italy
| | - Vittorina Zagonel
- Medical Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Teresa Gamucci
- Oncology Unit, SS Trinità Hospital, Sora, ASL Frosinone, Italy
| | - Raffaella Bertè
- Palliative Care, Oncology Department, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy
| | - Elisabetta Sansoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei, Tumori (IRST) IRCCS, Meldola, Italy
| | - Elena Amaducci
- Palliative Care and Hospice Unit, AUSL Romagna, Cesena, Italy
| | | | - Sara Alquati
- Palliative Care Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Stefania Schiavon
- Medical Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Silvia Quadrini
- Oncology Unit, SS Trinità Hospital, Sora, ASL Frosinone, Italy
| | - Elena Orlandi
- Medical Oncology Unit, Oncology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Andrea Casadei Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Silvia Ruscelli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Maria Simona Pino
- Medical Oncology Unit, Oncology Department, Azienda USL Toscana Centro, S. Maria Annunziata Hospital, Florence, Italy
| | - Roberto Bortolussi
- Palliative care and Pain Therapy Unit, Aviano National Cancer Institute, Aviano, Italy
| | - Federica Negri
- Medical Oncology Unit, Azienda Socio Sanitaria Territoriale, Cremona, Italy
| | - Silvia Stragliotto
- Medical Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | | | - Martina Valgiusti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alberto Farolfi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, FC, Italy
| | - Romina Rossi
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei, Tumori (IRST) IRCCS, Meldola, Italy
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei, Tumori (IRST) IRCCS, Meldola, Italy
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13
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Cheng KKF, Nicholson C. Prioritizing the integration of geriatric oncology and palliative care. J Geriatr Oncol 2018; 9:690-692. [PMID: 30025820 DOI: 10.1016/j.jgo.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Karis Kin-Fong Cheng
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore.
| | - Caroline Nicholson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London/ St. Christopher's Hospice London, United Kingdom; St Christopher's Hospice, 51-59 Lawrie Park Road, London, SE26 6DZ, United Kingdom.
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14
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Palliative Care for People With Hepatocellular Carcinoma, and Specific Benefits for Older Adults. Clin Ther 2018; 40:512-525. [PMID: 29571567 DOI: 10.1016/j.clinthera.2018.02.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, has a rapidly rising prevalence in the United States and a very poor overall rate of survival. This epidemic is driven by the cohort of aging Baby Boomers with hepatitis C viral infection and the increasing prevalence of cirrhosis as a result of nonalcoholic steatohepatitis. Because curative options are limited, the disease course creates, in patients and their families, distressing uncertainty around prognosis and treatment decisions. Older adults are disproportionately affected by HCC and have more comorbidities, adding to the complexity of the disease. This population would benefit from increased access to palliative care services, which can potentially complement the treatments throughout the disease trajectory. The purpose of this review was to use existing evidence to propose a new model of palliative care integration in patients with HCC. Thus, we focus on the HCC stage and the treatment algorithm, the ways that palliative care can offer support in this population at each stage, as well as elements that can enhance patient and family support throughout the entire disease trajectory, with an emphasis on the care of older adults with HCC. METHODS This is a narrative review in which we identify evidence-based ways that palliative care can help younger and older adults with HCC and their families, at each stage of HCC and throughout the disease trajectory. FINDINGS We propose ways to integrate HCC and palliative care based on the existing evidence in both fields. Palliative care offers support in symptom management, advanced care planning, and decision making in ways that are specific to each stage of HCC. We also discuss the evidence that illustrates the palliative care needs of patients with HCC that span the entire course of illness, including coping with the stigmatization of liver disease, addressing informational needs at different stages, and discussing quality of life longitudinally. IMPLICATIONS Integrating palliative care into the treatment of patients with HCC has the potential to improve outcomes, although more research is needed to build this evidence base.
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15
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Siouta N, Van Beek K, Payne S, Radbruch L, Preston N, Hasselaar J, Centeno C, Menten J. Is the content of guidelines/pathways a barrier for the integration of palliative Care in Chronic Heart Failure (CHF) and chronic pulmonary obstructive disease (COPD)? A comparison with the case of cancer in Europe. BMC Palliat Care 2017; 16:62. [PMID: 29179703 PMCID: PMC5704525 DOI: 10.1186/s12904-017-0243-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a notable inequity in access to palliative care (PC) services between cancer and Chronic Heart Failure (CHF)/Chronic Obstructive Pulmonary Disease (COPD) patients which also translates into discrepancies in the level of integration of PC. By cross-examining the levels of PC integration in published guidelines/pathways for CHF/COPD and cancer in Europe, this study examines whether these discrepancies may be attributed to the content of the guidelines. DESIGN A quantitative evaluation was made between integrated PC in published guidelines for cancer and CHF/COPD in Europe. The content of integrated PC in guidelines/pathways was measured using an 11 point integrated PC criteria tool (IPC criteria). A statistical analysis was carried out to detect similarities and differences in the level of integrated PC between the two groups. RESULTS The levels of integration between CHF/COPD and cancer guidelines/pathways have been shown to be statistically similar. Moreover, the quality of evidence utilized and the date of development of the guidelines/pathways appear not to impact upon the PC integration in the guidelines. CONCLUSION In Europe, the empirically observed imbalance in integration of PC for patients with cancer and CHF/COPD may only partially be attributed to the content of the guidelines/pathways that are utilized for the PC implementation. Given the similarities detected between cancer and CHF/COPD, other barriers appear to play a more prominent role.
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Affiliation(s)
- Naouma Siouta
- Dept. of Radiation-Oncology and Palliative Medicine, KU Leuven, Leuven, Belgium
| | - Karen Van Beek
- Dept. of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Sheila Payne
- International Observatory on End of Life Care Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany
| | - Nancy Preston
- International Observatory on End of Life Care Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Jeroen Hasselaar
- Anesthesiology, Pain and Palliative Care, UMC St Radboud, Nijmegen, The Netherlands
| | - Carlos Centeno
- Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Johan Menten
- Dept. of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
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16
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Renovanz M, Hechtner M, Kohlmann K, Janko M, Nadji-Ohl M, Singer S, Ringel F, Coburger J, Hickmann AK. Compliance with patient-reported outcome assessment in glioma patients: predictors for drop out. Neurooncol Pract 2017; 5:129-138. [PMID: 31385978 DOI: 10.1093/nop/npx026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Patient-reported outcomes are of high importance in clinical neuro-oncology. However, assessment is still suboptimal. We aimed at exploring factors associated with the probability for a) drop out of study and b) death during follow-up. Methods Patients were assessed twice during follow-up visits scheduled within 3 to 5 months of each other by using 3 validated patient-reported outcome measures (t1: first assessment, t2: second assessment). As "death" was seen as a competing risk for drop out, univariate competing risk Cox regression models were applied to explore factors associated with dropping out (age, gender, WHO grade, living situation, recurrent surgery, Karnofsky Performance Status, time since diagnosis, and patient-reported outcomes assessed by Distress Thermometer, EORTC-QLQ-C30, EORTC-QLQ-BN20, and SCNS-SF-34G). Results Two hundred forty-six patients were eligible, 173 (70%) participated. Patients declining participation were diagnosed with glioblastomas more often than with other gliomas (56% vs 39%). At t2, 32 (18%) patients dropped out, n = 14 death-related, n = 18 for other reasons. Motor dysfunction (EORTC-QLQ-BN20) was associated with higher risk for non-death-related drop out (HR: 1.02; 95% CI, 1.00-1.03; P = .03). Death-related drop out was associated with age (HR: 1.09; 95% CI, 1.03-1.14; P = .002), Karnofsky Performance Status (HR: 0.92; 95% CI, 0.88-0.96; P < .001), lower physical functioning (EORTC-QLQ-C30; HR: 0.98; 95% CI, 0.96-1.00; P = .04) and lower motor functioning (EORTC-QLQ-BN20; HR: 1.020; 95% CI, 1.00-1.04; P = .02). Conclusion Patients with motor dysfunction and poorer clinical condition seem to be more likely to drop out of studies applying patient-reported outcome measures. This should be taken into account when planning studies assessing glioma patients and for interpretation of results of patient-reported outcome assessments in clinical routine.
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Affiliation(s)
- Mirjam Renovanz
- Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University Mainz, Mainz Germany
| | - Marlene Hechtner
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes-Gutenberg-University Mainz, Mainz Germany
| | - Karoline Kohlmann
- Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University Mainz, Mainz Germany
| | - Mareile Janko
- Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University Mainz, Mainz Germany
| | - Minou Nadji-Ohl
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart Germany
| | - Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes-Gutenberg-University Mainz, Mainz Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University Mainz, Mainz Germany
| | - Jan Coburger
- Department of Neurosurgery, University Medical Center Ulm/Günzburg, Günzburg Germany
| | - Anne-Katrin Hickmann
- Department of Neurosurgery Klinikum Stuttgart, Katharinenhospital, Stuttgart Germany.,Department of Neurosurgery Hirslanden Klinikum, Luzern Switzerland
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17
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Preisler M, Heuse S, Riemer M, Kendel F, Letsch A. Early integration of palliative cancer care: patients’ and caregivers’ challenges, treatment preferences, and knowledge of illness and treatment throughout the cancer trajectory. Support Care Cancer 2017; 26:921-931. [DOI: 10.1007/s00520-017-3911-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/25/2017] [Indexed: 12/25/2022]
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18
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Hansen L, Lyons KS, Dieckmann NF, Chang MF, Hiatt S, Solanki E, Lee CS. Background and design of the symptom burden in end-stage liver disease patient-caregiver dyad study. Res Nurs Health 2017; 40:398-413. [PMID: 28666053 PMCID: PMC5597485 DOI: 10.1002/nur.21807] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/05/2017] [Indexed: 12/25/2022]
Abstract
Over half a million Americans are affected by cirrhosis, the cause of end-stage liver disease (ESLD). Little is known about how symptom burden changes over time in adults with ESLD and their informal caregivers, which limits our ability to develop palliative care interventions that can optimize symptom management and quality of life in different patient-caregiver dyads. The purpose of this article is to describe the background and design of a prospective, longitudinal descriptive study, "Symptom Burden in End-Stage Liver Disease Patient-Caregiver Dyads," which is currently in progress. The study is designed to (i) identify trajectories of change in physical and psychological symptom burden in adults with ESLD; (ii) identify trajectories of change in physical and psychological symptom burden in caregivers of adults with ESLD; and (iii) determine predictors of types of patient-caregiver dyads that would benefit from tailored palliative care interventions. We aim for a final sample of 200 patients and 200 caregivers who will be followed over 12 months. Integrated multilevel and latent growth mixture modeling will be used to identify trajectories of change in symptom burden, linking those changes to clinical events, and quality of life outcomes and characterizing types of patient-caregiver dyads based on patient-, caregiver-, and dyad-level factors. Challenges we have encountered include unexpected attrition of study participants, participants not returning their baseline questionnaires, and hiring and training of research staff. The study will lay the foundation for future research and innovation in ESLD, end-of-life and palliative care, and caregiving.
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Affiliation(s)
- Lissi Hansen
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Karen S Lyons
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Michael F Chang
- Gastroenterology and Hepatology, VA Portland Healthcare System, Portland, Oregon
| | - Shirin Hiatt
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Emma Solanki
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Christopher S Lee
- School of Nursing, Oregon Health and Science University, Portland, Oregon
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Factors associated with supportive care needs in glioma patients in the neuro-oncological outpatient setting. J Neurooncol 2017; 133:653-662. [PMID: 28527007 DOI: 10.1007/s11060-017-2484-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/15/2017] [Indexed: 02/07/2023]
Abstract
Objective of this study aimed at assessing glioma patients' supportive care needs in a neurosurgical outpatient setting and identifying factors that are associated with needs for support. In three neuro-oncological outpatient departments, glioma patients were assessed for their psychosocial needs using the Supportive Care Needs Survey short-form (SCNS-SF34-G). Associations between clinical, sociodemographic, treatment related factors as well as distress (measured with the distress thermometer) and supportive care needs were explored using multivariable general linear models. One-hundred and seventy three of 244 eligible glioma patients participated, most of them with primary diagnoses of a high-grade glioma (81%). Highest need for support was observed in 'psychological needs' (median 17.5, range 5-45) followed by 'physical and daily living needs' (median 12.5, range 0-25) and 'health system and information needs' (median 11.3, range 0-36). Needs in the psychological area were associated with distress (R2 = 0.36) but not with age, sex, Karnofsky performance status (KPS), extend of resection, currently undergoing chemotherapy and whether guidance during assessment was offered. Regarding 'health system and information needs', we observed associations with distress, age, currently undergoing chemotherapy and guidance (R2 = 0.31). In the domain 'physical and daily living needs' we found associations with KPS, residual tumor, as well as with distress (R2 = 0.37). Glioma patients in neuro-oncological departments report unmet supportive care needs, especially in the psychological domain. Distress is the factor most consistently associated with unmet needs requiring support and could serve as indicator for clinical neuro-oncologists to initiate support.
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Dasch B, Kalies H, Feddersen B, Ruderer C, Hiddemann W, Bausewein C. Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014. PLoS One 2017; 12:e0175124. [PMID: 28384214 PMCID: PMC5383201 DOI: 10.1371/journal.pone.0175124] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/21/2017] [Indexed: 02/07/2023] Open
Abstract
Background Cancer care including aggressive treatment procedures during the last phase of life in patients with incurable cancer has increasingly come under scrutiny, while integrating specialist palliative care at an early stage is regarded as indication for high quality end-of-life patient care. Aim To describe the demographic and clinical characteristics and the medical care provided at the end of life of cancer patients who died in a German university hospital. Methods Retrospective cross-sectional study on the basis of anonymized hospital data for cancer patients who died in the Munich University Hospital in 2014. Descriptive analysis and multivariate logistic regression analyses for factors influencing the administration of aggressive treatment procedures at the end of life. Results Overall, 532 cancer patients died. Mean age was 66.8 years, 58.5% were men. 110/532 (20.7%) decedents had hematologic malignancies and 422/532 (79.3%) a solid tumor. Patients underwent the following medical interventions in the last 7/30 days: chemotherapy (7.7%/38.3%), radiotherapy (2.6%/6.4%), resuscitation (8.5%/10.5%), surgery (15.2%/31.0%), renal replacement therapy (12.0%/16.9%), blood transfusions (21.2%/39.5%), CT scan (33.8%/60.9%). In comparison to patients with solid tumors, patients with hematologic malignancies were more likely to die in intensive care (25.4% vs. 49.1%; p = 0.001), and were also more likely to receive blood transfusions (OR 2.21; 95% CI, 1.36 to 3.58; p = 0.001) and renal replacement therapy (OR 2.65; 95% CI, 1.49 to 4.70; p = 0.001) in the last 7 days of life. Contact with the hospital palliative care team had been initiated in 161/532 patients (30.3%). In 87/161 cases (54.0%), the contact was initiated within the last week of the patient’s life. Conclusions Overambitious treatments are still reality at the end of life in cancer patients in hospital but patients with solid tumors and hematologic malignancies have to be differentiated. More efforts are necessary for the timely inclusion of specialist palliative care.
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Affiliation(s)
- Burkhard Dasch
- Department of Palliative Medicine, Munich University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
- * E-mail:
| | - Helen Kalies
- Department of Palliative Medicine, Munich University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Berend Feddersen
- Department of Palliative Medicine, Munich University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Caecilie Ruderer
- Specialized Palliative Home Care, Districts of Berchtesgaden and Traunstein, Germany
| | - Wolfgang Hiddemann
- Department of Internal Medicine III, Munich University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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[Standard operating procedures (SOPs) for palliative care : Presence and relevance of palliative SOPs within the network of German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid]. Schmerz 2016; 31:47-53. [PMID: 27349234 DOI: 10.1007/s00482-016-0132-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Standard operating procedures (SOPs) can contribute to the improvement of patient care. OBJECTIVES Survey the presence and relevance of SOPs for palliative care (PC) within the network of German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid. MATERIALS AND METHODS In a descriptive survey, palliative care services within 15 CCCs funded by the German Cancer Aid were asked to rate availability and thematic relevance of (1) symptom-related, (2) clinical pathways and (3) measures- and processes-oriented SOPs using a structured questionnaire. RESULTS Pain management SOPs were the most common (n =11; 73 %). The most thematic relevance showed SOPs dedicated to pain management, care in the last days of life and delirium and other neuro-psychiatric diseases (each n =13; 87 %), followed by bowel obstruction, dyspnoea, nausea and palliative sedation (each n =12; 80 %). CONCLUSIONS There is a wide gap between availability and perceived relevance of palliative care SOPs within the network of German CCCs funded by the German Cancer Aid. It is obvious that there is a need for further development of relevant SOPs in palliative care.
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Need for palliative care for neurological diseases. Neurol Sci 2016; 37:1581-7. [DOI: 10.1007/s10072-016-2614-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/17/2016] [Indexed: 11/27/2022]
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Hui D, Meng YC, Bruera S, Geng Y, Hutchins R, Mori M, Strasser F, Bruera E. Referral Criteria for Outpatient Palliative Cancer Care: A Systematic Review. Oncologist 2016; 21:895-901. [PMID: 27185614 PMCID: PMC4943399 DOI: 10.1634/theoncologist.2016-0006] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/18/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Outpatient palliative care clinics facilitate early referral and are associated with improved outcomes in cancer patients. However, appropriate candidates for outpatient palliative care referral and optimal timing remain unclear. We conducted a systematic review of the literature to identify criteria that are considered when an outpatient palliative cancer care referral is initiated. METHODS We searched Ovid MEDLINE (1948-2013 citations) and Ovid Embase (1947-2015 citations) for articles related to outpatient palliative cancer care. Two researchers independently reviewed each citation for inclusion and extracted the referral criteria. The interrater agreement was high (κ = 0.96). RESULTS Of the 186 publications in our initial search, 21 were included in the final sample. We identified 20 unique referral criteria. Among these, 6 were recurrent themes, which included physical symptoms (n = 13 [62%]), cancer trajectory (n = 13 [62%]), prognosis (n = 7 [33%]), performance status (n = 7 [33%]), psychosocial distress (n = 6 [29%]), and end-of-life care planning (n = 5 [24%]). We found significant variations among the articles regarding the definition of advanced cancer and the assessment tools for symptom/distress screening. The Edmonton Symptom Assessment Scale (n = 7 [33%]) and the distress thermometer (n = 2 [10%]) were used most often. Furthermore, there was a lack of consensus in the cutoffs in symptom assessment tools and timing for outpatient palliative care referral. CONCLUSION This systematic review identified 20 criteria including 6 recurrent themes for outpatient cancer palliative care referral. It highlights the significant heterogeneity regarding the timing and process for referral and the need for further research to develop standardized referral criteria. IMPLICATIONS FOR PRACTICE Outpatient palliative care clinics improve patient outcomes; however, it remains unclear who is appropriate for referral and what is the optimal timing. A better understanding of the referral criteria would help (a) referring clinicians to identify appropriate patients for palliative care interventions, (b) administrators to assess their programs with set benchmarks for quality improvement, (c) researchers to standardize inclusion criteria, and (d) policymakers to develop clinical care pathways and allocate appropriate resources. This systematic review identified 20 criteria including 6 recurrent themes for outpatient palliative cancer care referral. It represents the first step toward developing standardized referral criteria.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yee-Choon Meng
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA Department of Palliative Care, Tan Tock Seng Hospital, Singapore
| | - Sebastian Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yimin Geng
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ron Hutchins
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Masanori Mori
- Department of Palliative Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Florian Strasser
- Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Van Beek K, Siouta N, Preston N, Hasselaar J, Hughes S, Payne S, Radbruch L, Centeno C, Csikos A, Garralda E, van der Eerden M, Hodiamont F, Radvanyi I, Menten J. To what degree is palliative care integrated in guidelines and pathways for adult cancer patients in Europe: a systematic literature review. BMC Palliat Care 2016; 15:26. [PMID: 26940753 PMCID: PMC4778279 DOI: 10.1186/s12904-016-0100-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/23/2016] [Indexed: 12/25/2022] Open
Abstract
Background Palliative Care (PC) aims to improve the quality of life for patients with cancer and their families and its benefits have been demonstrated by several studies. The objective of this systematic review is to assess the integration of PC in the content of guidelines/pathways of adult cancer patients in Europe. Methods We included studies of adult patients with cancer published from 01/01/1995 and 31/12/2013 in Europe in six languages. We searched nine electronic databases, hand-searched six journals and also performed citation tracking. Studies were ranked using Emanuel’s Integrated Palliative Care (IPC) criteria, a tool containing 11 domains to assess PC content in guidelines. Two reviewers screened the results and narrative synthesis has been employed. Results We identified a total of 28,277 potentially relevant articles from which 637 were eligible for full-text screening. The final review included 60 guidelines and 14 pathways. Eighty percent (80 %) of the guidelines/pathways emphasize a holistic approach and 66 % focus on PC interventions aimed at reducing suffering. Fifty seven percent (57 %) did not discuss referral criteria for PC. Of all studies, five fulfilled at least 10/11 IPC criteria. Differences existed with regard to the referral criteria for bereavement care and the continuous adjustment of goals of care. Conclusion Overall, most of the identified guidelines/pathways highlighted the importance of the holistic approach of IPC. The studies that were found to fulfil at least 10/11 Emanuel’s IPC criteria could serve as benchmarks of IPC.
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Affiliation(s)
- Karen Van Beek
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
| | - Naouma Siouta
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom.
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Sean Hughes
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom.
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom.
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
| | - Carlos Centeno
- Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain.
| | - Agnes Csikos
- Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary.
| | - Eduardo Garralda
- Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain.
| | - Marlieke van der Eerden
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
| | - Ildiko Radvanyi
- Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary.
| | - Johan Menten
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
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Kalder M, Müller T, Fischer D, Müller A, Bader W, Beckmann MW, Brucker C, Hack CC, Hanf V, Hasenburg A, Hein A, Jud S, Kiechle M, Klein E, Paepke D, Rotmann A, Schütz F, Dobos G, Voiß P, Kümmel S. A Review of Integrative Medicine in Gynaecological Oncology. Geburtshilfe Frauenheilkd 2016; 76:150-155. [PMID: 26941447 DOI: 10.1055/s-0042-100208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
In recent years complementary and alternative medicine (CAM) has increasingly been the focus of international research. Numerous subsidised trials (7903) and systematic reviews (651) have been published, and the evidence is starting to be integrated into treatment guidelines. However, due to insufficient evidence and/or insufficient good quality evidence, this has mostly not translated to practice recommendations in reviews by the Cochrane collaboration gynaecology group. There is nevertheless a not insignificant number of CAM providers and users. The percentage of oncology patients who use CAM varies between 5 and 90 %. Doctors have been identified as the main providers of CAM. Half of gynaecologists offer CAM because of personal conviction or on suggestion from colleagues. This must be viewed in a critical light, since CAM is mostly practiced without appropriate training, often without sufficient evidence for a given method - and where evidence exists, practice guidelines are lacking - and lack of safety or efficacy testing. The combination of patient demand and lucrativeness for doctors/alternative medicine practitioners, both based on supposed effectiveness CAM, often leads to its indiscriminate use with uncertain outcomes and significant cost for patients. On the other hand there is published, positive level I evidence for a number of CAM treatment forms. The aim of this article is therefore to review the available evidence for CAM in gynaecological oncology practice. The continued need for research is highlighted, as is the need to integrate practices supported by good evidence into conventional gynaecological oncology.
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Affiliation(s)
- M Kalder
- Klinik für Frauenheilkunde und Geburtshilfe, Philipps-Universität Marburg, Marburg
| | - T Müller
- AGAPLESION Markus Krankenhaus, Abteilung für Gynäkologie und Geburtshilfe, Frankfurt am Main
| | - D Fischer
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Ernst von Bergmann, Potsdam
| | - A Müller
- Frauenklinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe
| | - W Bader
- Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld
| | - M W Beckmann
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - C Brucker
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Privatuniversität, Nürnberg
| | - C C Hack
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - V Hanf
- Frauenklinik und Brustzentrum Nathanstift, Klinikum Fürth, Fürth
| | - A Hasenburg
- Klinik und Poliklinik für Geburtshilfe und Frauenkrankheiten, Universitätsmedizin Mainz, Mainz
| | - A Hein
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - S Jud
- Universitäts-Brustzentrum Franken, Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Nürnberg
| | - M Kiechle
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München
| | - E Klein
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München
| | - D Paepke
- Frauenklinik des Klinikums rechts der Isar, Technische Universität München, München
| | - A Rotmann
- Praxis für Frauenheilkunde, Geburtshilfe und Naturheilkunde, Rodgau
| | - F Schütz
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg, Heidelberg
| | - G Dobos
- Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen
| | - P Voiß
- Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen
| | - S Kümmel
- Brustzentrum und Klinik für Senologie der Kliniken Essen-Mitte, Essen
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Siouta N, van Beek K, Preston N, Hasselaar J, Hughes S, Payne S, Garralda E, Centeno C, van der Eerden M, Groot M, Hodiamont F, Radbruch L, Busa C, Csikos A, Menten J. Towards integration of palliative care in patients with chronic heart failure and chronic obstructive pulmonary disease: a systematic literature review of European guidelines and pathways. BMC Palliat Care 2016; 15:18. [PMID: 26872741 PMCID: PMC4752742 DOI: 10.1186/s12904-016-0089-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/03/2016] [Indexed: 12/02/2022] Open
Abstract
Background Despite the positive impact of Palliative Care (PC) on the quality of life for patients and their relatives, the implementation of PC in non-cancer health-care delivery in the EU seems scarcely addressed. The aim of this study is to assess guidelines/pathways for integrated PC in patients with advanced Chronic Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD) in Europe via a systematic literature review. Methods Search results were screened by two reviewers. Eligible studies of adult patients with CHF or COPD published between 01/01/1995 and 31/12/2013 in Europe in 6 languages were included. Nine electronic databases were searched, 6 journals were hand-searched and citation tracking was also performed. For the analysis, a narrative synthesis was employed. Results The search strategy revealed 26,256 studies without duplicates. From these, 19 studies were included in the review; 17 guidelines and 2 pathways. 18 out of 19 focused on suffering reduction interventions, 13/19 on a holistic approach and 15/19 on discussions of illness prognosis and limitations. The involvement of a PC team was mentioned in 13/19 studies, the assessment of the patients’ goals of care in 12/19 and the advance care planning in 11/19. Only 4/19 studies elaborated on aspects such as grief and bereavement care, 7/19 on treatment in the last hours of life and 8/19 on the continuation of goal adjustment. Conclusion The results illustrate that there is a growing awareness for the importance of integrated PC in patients with advanced CHF or COPD. At the same time, however, they signal the need for the development of standardized strategies so that existing barriers are alleviated.
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Affiliation(s)
- Naouma Siouta
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
| | - Karen van Beek
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sean Hughes
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom
| | - Eduardo Garralda
- Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain
| | - Carlos Centeno
- Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain
| | - Marlieke van der Eerden
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Marieke Groot
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Csilla Busa
- Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Agnes Csikos
- Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Johan Menten
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
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Oliver DJ, Borasio GD, Caraceni A, de Visser M, Grisold W, Lorenzl S, Veronese S, Voltz R. A consensus review on the development of palliative care for patients with chronic and progressive neurological disease. Eur J Neurol 2015; 23:30-8. [PMID: 26423203 DOI: 10.1111/ene.12889] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 07/10/2014] [Accepted: 09/02/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The European Association of Palliative Care Taskforce, in collaboration with the Scientific Panel on Palliative Care in Neurology of the European Federation of Neurological Societies (now the European Academy of Neurology), aimed to undertake a review of the literature to establish an evidence-based consensus for palliative and end of life care for patients with progressive neurological disease, and their families. METHODS A search of the literature yielded 942 articles on this area. These were reviewed by two investigators to determine the main areas and the subsections. A draft list of papers supporting the evidence for each area was circulated to the other authors in an iterative process leading to the agreed recommendations. RESULTS Overall there is limited evidence to support the recommendations but there is increasing evidence that palliative care and a multidisciplinary approach to care do lead to improved symptoms (Level B) and quality of life of patients and their families (Level C). The main areas in which consensus was found and recommendations could be made are in the early integration of palliative care (Level C), involvement of the wider multidisciplinary team (Level B), communication with patients and families including advance care planning (Level C), symptom management (Level B), end of life care (Level C), carer support and training (Level C), and education for all professionals involved in the care of these patients and families (Good Practice Point). CONCLUSIONS The care of patients with progressive neurological disease and their families continues to improve and develop. There is a pressing need for increased collaboration between neurology and palliative care.
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Affiliation(s)
- D J Oliver
- Palliative Medicine, Wisdom Hospice, Rochester, UK.,University of Kent, Kent, UK
| | - G D Borasio
- Service de soins palliatifs, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Caraceni
- Palliative Care Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy.,European Palliative Care Research Center NTNU, Trondheim, Norway
| | - M de Visser
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - W Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria
| | - S Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - S Veronese
- Fondazione Assistenza e Ricerca in Oncologia, Turin, Italy
| | - R Voltz
- Department of Palliative Medicine, University Hospital, Cologne, Germany.,EAN Subspeciality Scientific Panel on Palliative Care, Vienna, Austria
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Walbert T, Puduvalli VK, Taphoorn MJB, Taylor AR, Jalali R. International patterns of palliative care in neuro-oncology: a survey of physician members of the Asian Society for Neuro-Oncology, the European Association of Neuro-Oncology, and the Society for Neuro-Oncology. Neurooncol Pract 2015; 2:62-69. [PMID: 31386064 DOI: 10.1093/nop/npu037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/01/2014] [Indexed: 11/12/2022] Open
Abstract
Background Brain tumor patients have limited survival and suffer from high morbidity requiring specific symptom management. Specialized palliative care (PC) services have been developed to address these symptoms and provide end-of-life treatment. Global utilization patterns of PC in neuro-oncology are unknown. Methods In a collaborative effort between the Society for Neuro-Oncology (SNO), the European Association of Neuro-Oncology (EANO), and the Asian Society for Neuro-Oncology (ASNO), a 22-question survey was distributed. Wilcoxon 2-sample and Kruskal-Wallis tests were used to assess differences in responses. Results Five hundred fifty-two evaluable responses were received. The most significant differences were found between Asia-Oceania (AO) and Europe as well as AO and United States/Canada (USA-C). USA-C providers had more subspecialty training in neuro-oncology, but most providers had received no or minimal training in palliative care independent of region. Providers in all 3 regions reported referring patients at the onset of symptoms requiring palliation, but USA-C and European responders refer a larger total proportion of patients to PC (P < .001). Physicians in AO and Europe (both 46%) as well as 29% of USA-C providers did not feel comfortable dealing with end-of-life issues. Most USA-C patients (63%) are referred to hospice compared with only 8% and 19% in AO and Europe (P < .001), respectively. Conclusion This is the first report describing global differences of PC utilization in neuro-oncology. Significant differences in provider training, culture, access, and utilization were mainly found between AO and USA-C or AO and Europe. PC patterns are more similar in Europe and USA-C.
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Affiliation(s)
- Tobias Walbert
- Departments of Neurosurgery and Neurology, Henry Ford Health System, Detroit, Michigan (T.W., A.R.T.); The Ohio State University Comprehensive Cancer Center, Columbus, Ohio (V.K.P.); VU University Medical Center, Amsterdam, Netherlands (M.J.B.T.); Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Tata Memorial Centre, Mumbai, India (R.J.)
| | - Vinay K Puduvalli
- Departments of Neurosurgery and Neurology, Henry Ford Health System, Detroit, Michigan (T.W., A.R.T.); The Ohio State University Comprehensive Cancer Center, Columbus, Ohio (V.K.P.); VU University Medical Center, Amsterdam, Netherlands (M.J.B.T.); Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Tata Memorial Centre, Mumbai, India (R.J.)
| | - Martin J B Taphoorn
- Departments of Neurosurgery and Neurology, Henry Ford Health System, Detroit, Michigan (T.W., A.R.T.); The Ohio State University Comprehensive Cancer Center, Columbus, Ohio (V.K.P.); VU University Medical Center, Amsterdam, Netherlands (M.J.B.T.); Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Tata Memorial Centre, Mumbai, India (R.J.)
| | - Andrew R Taylor
- Departments of Neurosurgery and Neurology, Henry Ford Health System, Detroit, Michigan (T.W., A.R.T.); The Ohio State University Comprehensive Cancer Center, Columbus, Ohio (V.K.P.); VU University Medical Center, Amsterdam, Netherlands (M.J.B.T.); Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Tata Memorial Centre, Mumbai, India (R.J.)
| | - Rakesh Jalali
- Departments of Neurosurgery and Neurology, Henry Ford Health System, Detroit, Michigan (T.W., A.R.T.); The Ohio State University Comprehensive Cancer Center, Columbus, Ohio (V.K.P.); VU University Medical Center, Amsterdam, Netherlands (M.J.B.T.); Medical Center Haaglanden, The Hague, Netherlands (M.J.B.T.); Tata Memorial Centre, Mumbai, India (R.J.)
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Gibbs KD, Mahon MM, Truss M, Eyring K. An Assessment of Hospital-Based Palliative Care in Maryland: Infrastructure, Barriers, and Opportunities. J Pain Symptom Manage 2015; 49:1102-8. [PMID: 25640276 DOI: 10.1016/j.jpainsymman.2014.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 11/25/2014] [Accepted: 12/20/2014] [Indexed: 12/25/2022]
Abstract
CONTEXT Maryland recently passed legislation mandating that hospitals with more than 50 beds have palliative care (PC) programs. Although the state's health agency can play a key role in ensuring successful implementation of this measure, there is little actionable information from which it can guide resource allocation for enhancing PC delivery statewide. OBJECTIVES To assess the PC infrastructure at Maryland's 46 community-based nonspecialty hospitals and to describe providers' perspectives on barriers to PC and supports that could enhance PC delivery. METHODS Data on PC programs were collected using two mechanisms. First, a survey was sent to all 46 community-based hospital chief executive officers by the Maryland Cancer Collaborative. The Maryland Health Care Commission provided supplementary survey and semistructured interview data. RESULTS Twenty-eight hospitals (60.9%) provided information on their PC services. Eighty-nine percent of these hospitals reported the presence of a structured PC program. The profile of services provided by PC programs was largely conserved across hospital geography and size. The most common barriers reported to PC delivery were lack of knowledge among patients and/or families and lack of physician buy-in; most hospitals reported that networks and/or conferences to promote best practice sharing in PC would be useful supports. CONCLUSION Systematic collection of state-level PC infrastructure data can be used to guide state health agencies' understanding of extant resources and challenges, using those data to determine resource allocation to promote the timely receipt of PC for patients and families.
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Affiliation(s)
- Kenneth D Gibbs
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA; Science of Research and Technology Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA.
| | | | - Meredith Truss
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA
| | - Kira Eyring
- American Cancer Society, Atlanta, Georgia, USA
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Hui D, Kim YJ, Park JC, Zhang Y, Strasser F, Cherny N, Kaasa S, Davis MP, Bruera E. Integration of oncology and palliative care: a systematic review. Oncologist 2015; 20:77-83. [PMID: 25480826 PMCID: PMC4294615 DOI: 10.1634/theoncologist.2014-0312] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/12/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Both the American Society of Clinical Oncology and the European Society for Medical Oncology strongly endorse integrating oncology and palliative care (PC); however, a global consensus on what constitutes integration is currently lacking. To better understand what integration entails, we conducted a systematic review to identify articles addressing the clinical, educational, research, and administrative indicators of integration. MATERIALS AND METHODS We searched Ovid MEDLINE and Ovid EMBase between 1948 and 2013. Two researchers independently reviewed each citation for inclusion and extracted the indicators related to integration. The inter-rater agreement was high (κ = 0.96, p < .001). RESULTS Of the 431 publications in our initial search, 101 were included. A majority were review articles (58%) published in oncology journals (59%) and in or after 2010 (64%, p < .001). A total of 55 articles (54%), 33 articles (32%), 24 articles (24%), and 14 articles (14%) discussed the role of outpatient clinics, community-based care, PC units, and inpatient consultation teams in integration, respectively. Process indicators of integration include interdisciplinary PC teams (n = 72), simultaneous care approach (n = 71), routine symptom screening (n = 25), PC guidelines (n = 33), care pathways (n = 11), and combined tumor boards (n = 10). A total of 66 articles (65%) mentioned early involvement of PC, 18 (18%) provided a specific timing, and 28 (28%) discussed referral criteria. A total of 45 articles (45%), 20 articles (20%), and 66 articles (65%) discussed 8, 4, and 9 indicators related to the educational, research, and administrative aspects of integration, respectively. CONCLUSION Integration was a heterogeneously defined concept. Our systematic review highlighted 38 clinical, educational, research, and administrative indicators. With further refinement, these indicators may facilitate assessment of the level of integration of oncology and PC.
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Affiliation(s)
- David Hui
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea; Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland; Shaare Zedek Medical Center, Jerusalem, Israel; European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway; Cleveland Clinic, Cleveland, Ohio, USA
| | - Yu Jung Kim
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea; Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland; Shaare Zedek Medical Center, Jerusalem, Israel; European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway; Cleveland Clinic, Cleveland, Ohio, USA
| | - Ji Chan Park
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea; Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland; Shaare Zedek Medical Center, Jerusalem, Israel; European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway; Cleveland Clinic, Cleveland, Ohio, USA
| | - Yi Zhang
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea; Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland; Shaare Zedek Medical Center, Jerusalem, Israel; European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway; Cleveland Clinic, Cleveland, Ohio, USA
| | - Florian Strasser
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea; Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland; Shaare Zedek Medical Center, Jerusalem, Israel; European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway; Cleveland Clinic, Cleveland, Ohio, USA
| | - Nathan Cherny
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea; Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland; Shaare Zedek Medical Center, Jerusalem, Israel; European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway; Cleveland Clinic, Cleveland, Ohio, USA
| | - Stein Kaasa
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea; Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland; Shaare Zedek Medical Center, Jerusalem, Israel; European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway; Cleveland Clinic, Cleveland, Ohio, USA
| | - Mellar P Davis
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea; Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland; Shaare Zedek Medical Center, Jerusalem, Israel; European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway; Cleveland Clinic, Cleveland, Ohio, USA
| | - Eduardo Bruera
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea; Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China; Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland; Shaare Zedek Medical Center, Jerusalem, Israel; European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway; Cleveland Clinic, Cleveland, Ohio, USA
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Colombet I, Vinant P, Joffin I, Weiler F, Chaillot N, Moreau N, Guillard MY, Montheil V. [Use of a standard format to describe the activity of hospital-based palliative care team: a lever for improving end of life care]. Presse Med 2014; 44:e1-e11. [PMID: 25499252 DOI: 10.1016/j.lpm.2014.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 04/18/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Early integrated palliative care is recommended in patients with incurable disease. Despite their development, hospital-based palliative care teams (PCT) are introduced late in the course of standard oncology care. The objective of this study is to describe the activity of an academic hospital-based PCT, using a standard format, which integrates indicators of early introduction and quality of end of life care, thus allowing a systematic analysis of its practice. METHODS The annual activity of the PCT is described from 2007 to 2012. Data are collected for each patient prospectively by the team: reasons for referral and activities of PCT, performance status and chemotherapy at the time of first referral, visit to emergency and admission to ICU. RESULTS The number of patients referred to the PCT increased from 337 patients in 2007 to 539 in 2012, among whom 90% were cancer patients, 84% at metastatic stage. Relief of symptoms was the most frequent reason for referral. In 2012, 280 (64%) patients were receiving chemotherapy and 41% had a PS≤2 at the time of first referral. Half patients died each year (270 in 2012); 17% of these received chemotherapy in their last 14 days of life, 3% visited emergency room twice and 13% were admitted in ICU, once during their last month of life, 48% died in hospice or at home. CONCLUSION The use of a standard format to describe the activity of hospital-based PCTs, the timing of their introduction and the quality of care is feasible. The generalization of this format for monitoring to assess the curative medicine interface/palliative could be a lever for improving the integration of palliative care.
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Affiliation(s)
- Isabelle Colombet
- AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, unité fonctionnelle de médecine palliative, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France; Inserm, UMR-S 872, équipe 20, 75006 Paris, France.
| | - Pascale Vinant
- AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, unité fonctionnelle de médecine palliative, 75014 Paris, France
| | - Ingrid Joffin
- AP-HP, hôpital Avicenne, équipe mobile de soins palliatifs, 93000 Bobigny, France
| | - Fabienne Weiler
- AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, unité fonctionnelle de médecine palliative, 75014 Paris, France
| | - Nathalie Chaillot
- AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, unité fonctionnelle de médecine palliative, 75014 Paris, France
| | - Nathalie Moreau
- AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, unité fonctionnelle de médecine palliative, 75014 Paris, France
| | - Marie-Yvonne Guillard
- AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, unité fonctionnelle de médecine palliative, 75014 Paris, France
| | - Vincent Montheil
- AP-HP, groupe hospitalier Cochin Broca Hôtel-Dieu, unité fonctionnelle de médecine palliative, 75014 Paris, France
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Strupp J, Romotzky V, Galushko M, Golla H, Voltz R. Palliative care for severely affected patients with multiple sclerosis: when and why? Results of a Delphi survey of health care professionals. J Palliat Med 2014; 17:1128-36. [PMID: 25068391 DOI: 10.1089/jpm.2013.0667] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Patients severely affected by multiple sclerosis (MS) present with complex symptoms and needs requiring an interdisciplinary care approach. OBJECTIVE Analysis of when and why specialized palliative care integration would be beneficial via examining health care professionals' attitudes. DESIGN A two-round online Delphi study and expert workshop were undertaken and analyzed descriptively. SETTING/SUBJECTS Following an extensive online search, 164 professionals with expertise in treating and caring for severely affected patients with MS were contacted. Professionals included neurologists, urologists, general practitioners, MS nurses, speech therapists, physiotherapists, psychologists, and palliative care physicians. Forty-six consented to participate: 33 of 46 (71.4%) and 15 of 33 (45.5%) experts responded in the first and second round, respectively. RESULTS Consensus was reached among all respondents (100%) defining the term "severely affected": 78.8% and 86.7%, respectively, thought that specialized palliative care should begin once the disease has progressed (Expanded Disability Status Scale [EDSS]>6 and nursing care required). When the need exists for communication about disease progression (93.3%), psychological support (93.3%), relatives support (93.3%), and pain medication (86.7%) specialized palliative care should be consulted. Specialized palliative homecare was rated (93.3%) "very important." The workshop documented the paucity of home visits and specialized MS care in nursing homes. CONCLUSIONS Our results clearly identified specific areas in which palliative care will likely prove to be a valuable asset in the treatment course of MS. This information should serve clinicians, indicating when to consider palliative care services and help further reduce or eliminate uncertainty about how palliative care can be integrated in the course of MS.
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Affiliation(s)
- Julia Strupp
- 1 Department of Palliative Medicine, University Hospital of Cologne , Cologne, Germany
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Early integration of palliative care in hospitals: A systematic review on methods, barriers, and outcome. Palliat Support Care 2014; 12:495-513. [DOI: 10.1017/s1478951513001338] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:According to the World Health Organization (WHO), palliative care (PC) should be available to everyone suffering from life-threatening diseases and should be started early on in the illness trajectory. However, PC is often initiated much later and is restricted to cancer patients. There is a need for more knowledge about how early PC can be implemented in clinical practice. The purpose of our study was to document the best evidence on methods for early identification (EI) of palliative trajectories in cancer, chronic heart failure (CHF), and chronic obstructive pulmonary disease (COPD) populations, and to identify preconditions for early integration of general PC in hospitals and outcomes for patients and relatives.Method:A comprehensive systematic review of methods, preconditions, and outcomes was conducted via an electronic literature search of publications between 2002 and September 2012. A final sample of 44 papers was reviewed in detail.Results:Our study identified disease-specific and general methods for EI of patients who might benefit from PC. Prognostication of end-stage disease based on (holistic) clinical judgment, prognostic factors, and/or care needs are the most frequently recommended methods. A number of interacting disease-, staff-, user-, and organization-specific barriers need to be overcome in order to implement early integration of PC in clinical practice. Early integration of PC may lead to better symptom management, prolonged survival, and better quality of life.Significance of Results:No methods can be recommended for routine clinical practice without further validation. There is an urgent need to develop and evaluate methods based on the holistic assessment of symptoms or needs. The barriers to early integration of PC are most extensive with regard to CHF and COPD. Professional training and education are recommended to facilitate early implementation of PC. The evidence about outcome is sparse and mostly relates to cancer populations receiving specialized PC.
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Interdisciplinary palliative care intervention in metastatic non-small-cell lung cancer. Clin Lung Cancer 2013; 14:736-44. [PMID: 23871439 DOI: 10.1016/j.cllc.2013.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/15/2012] [Accepted: 06/28/2012] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Challenges and barriers continue to hinder the integration of palliative care models into comprehensive, ambulatory oncology care. This article aims to describe how symptoms, distress, and quality of life (QOL) data from the usual care phase of a National Cancer Institute-supported Program Project informed the development of an interdisciplinary, tailored palliative care intervention for patients with metastatic non-small-cell lung cancer (NSCLC). METHODS Patients receiving usual care for metastatic NSCLC were recruited into this prospective longitudinal study over a 1-year period. A total of 130 patients with stage IV NSCLC were accrued, and 114 patients had evaluable data. Research nurses assisted patients in completing the clinical section of the data forms, and patients completed surveys and self-reports at baseline and 6, 12, and 24 weeks. RESULTS Patients ranged in age from 40 to 84 years, and 61% were Caucasian non-Hispanic. Sixty-six former (N = 59) and current smokers had an average of 38 pack-year history of smoking. The Karnofsky Performance Status, Instrumental Activities of Daily Living, and Cognitive scores deteriorated significantly (P = .001, .009, and .042, respectively). Social Activity was stable, whereas Social Support increased significantly. Overall symptom distress score and Total symptom score both significantly increased at 24 weeks (P = .003 and .017, respectively). Physical Well-Being decreased significantly (P = .036), whereas the Functional Assessment of Cancer Therapy-Lung, Functional Assessment of Chronic Illness Therapy-Spirituality Subscale, and Distress scores remained statistically stable over time. CONCLUSIONS Patients with metastatic NSCLC continue to experience high symptom burden and diminished physical well-being over time while receiving cancer treatments. An interdisciplinary palliative care intervention is currently being tested to improve symptom burden and overall QOL.
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Bükki J, Scherbel J, Stiel S, Klein C, Meidenbauer N, Ostgathe C. Palliative care needs, symptoms, and treatment intensity along the disease trajectory in medical oncology outpatients: a retrospective chart review. Support Care Cancer 2013; 21:1743-50. [PMID: 23344656 DOI: 10.1007/s00520-013-1721-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 01/09/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Early integration of palliative care into cancer disease management is beneficial for patients with advanced tumors. However, little is known about the association of palliative care interventions with symptom burden and treatment aggressiveness at the end of life (EoL). METHODS To assess determinants of symptom burden and treatment intensity at the EoL, a retrospective chart review was conducted in university cancer clinic outpatients who died between July 2009 and June 2011. The objective was the correlation of place of death, palliative care utilization, prior EoL discussion, and social background (determinant variables) with symptom burden and treatment intensity (outcome variables). RESULTS Ninety-six patients (61 men and 35 women) died; the mean age at death was 62.4 years (range 24-83). Mean duration of treatment was 17.9 months (range 1-129). Data on the last 14 days (3) of life were available for 62 (44) patients. Forty-seven patients received aggressive EoL care which was strongly associated with hospital death (p = 0.000, χ2 test). The 15 patients having used palliative care services or dying in a palliative care unit (PCU) had fewer symptoms (p = 0.006, t test) and interventions (p = 0.000, t test) at the EoL. Having addressed EoL issues was correlated with fewer procedures during the last 3 days (p = 0.035, t test). CONCLUSIONS Most cancer patients receive aggressive EoL care interfering with quality of life. Despite limitations by small sample size and missing data, the results suggest that palliative care utilization is associated with reduced symptom burden and intensity of treatment at the EoL. Timely discussion of EoL issues may reduce the number of unnecessary interventions and facilitate referral to the PCU.
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Affiliation(s)
- Johannes Bükki
- Departement of Palliative Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Scheffler M, Zander T, Nogova L, Kobe C, Kahraman D, Dietlein M, Papachristou I, Heukamp L, Büttner R, Boellaard R, Lammertsma AA, Querings S, Stoelben E, Engel-Riedel W, Neumaier B, Wolf J. Prognostic impact of [18F]fluorothymidine and [18F]fluoro-D-glucose baseline uptakes in patients with lung cancer treated first-line with erlotinib. PLoS One 2013; 8:e53081. [PMID: 23308140 PMCID: PMC3537767 DOI: 10.1371/journal.pone.0053081] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 11/23/2012] [Indexed: 01/06/2023] Open
Abstract
3′-deoxy-3′-[18F]fluoro-L-thymidine (FLT) and 2′-deoxy-2′-[18F]fluoro-D-glucose (FDG) are used to visualize proliferative and metabolic activity of tumors. In this study we aimed at evaluating the prognostic value of FLT and FDG uptake measured by positron emission tomography (PET) in patients with metastatic non-small cell lung cancer (NSCLC) prior to systemic therapy with erlotinib. FLT and FDG maximum standardized uptake (SUVmax) values per patient were analyzed in 40 chemotherapy naive patients with advanced NSCLC (stage IV) before treatment with erlotinib. Prior therapy median SUVmax was 6.6 for FDG and 3.0 for FLT, respectively. In univariate analysis, patients with an FDG SUVmax <6.6 had a significantly better overall survival (16.3 months [95% confidence interval [CI] 7.1–25.4 months]) compared to patients with an FDG SUVmax ≥6.6 (3.1 months [95% CI 0.6–5.5 months]) (p<0.001, log rank). Similarly, low FLT uptake (SUVmax <3.0) was associated with significantly longer survival (10.3 months (0–23.3 months, 95% CI) compared to high FLT uptake (3.4 months (0–8.1 months, 95% CI) (p = 0.027). The independent prognostic value of baseline FDG uptake was demonstrated in multivariate analysis (p = 0.05, Cox regression). These data suggest that baseline SUVmax values for both FDG and FLT PET might be further developed as markers for prognostic stratification of patients in advanced NSCLC treated with tyrosine kinase inhibitors (TKI) directed against the epidermal growth factor receptor (EGFR).
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Affiliation(s)
- Matthias Scheffler
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - Thomas Zander
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - Lucia Nogova
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - Carsten Kobe
- Clinic for Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - Deniz Kahraman
- Clinic for Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - Markus Dietlein
- Clinic for Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - Irini Papachristou
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - Lukas Heukamp
- Center for Integrated Oncology Köln Bonn, Cologne, Germany
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Reinhard Büttner
- Center for Integrated Oncology Köln Bonn, Cologne, Germany
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Ron Boellaard
- Department of Nuclear Medicine and PET Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Adriaan A. Lammertsma
- Department of Nuclear Medicine and PET Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Silvia Querings
- Max-Planck Institute for Neurological Research, Cologne, Germany
| | - Erich Stoelben
- Lung Clinic Merheim, Hospital of Cologne, Cologne, Germany
| | | | - Bernd Neumaier
- Max-Planck Institute for Neurological Research, Cologne, Germany
| | - Jürgen Wolf
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology Köln Bonn, Cologne, Germany
- * E-mail:
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Weber M, Claus M, Zepf KI, Fischbeck S, Escobar Pinzon LC. Dying in Germany--unfulfilled needs of relatives in different care settings. J Pain Symptom Manage 2012; 44:542-51. [PMID: 22771131 DOI: 10.1016/j.jpainsymman.2011.10.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 10/05/2011] [Accepted: 10/10/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT The integration of family members in the dying process and the recognition of their special needs are important factors for the development of high-quality palliative care. OBJECTIVES This study aimed to explore important needs and personal experiences of relatives at the end of life, and to detect differences in these needs and experiences for various care settings. METHODS Our cross-sectional survey was based on a random sampling of 5000 inhabitants of Rhineland-Palatinate (Germany) who died between May 25 and August 24, 2008. Relatives of these randomly drawn deceased persons were interviewed by a written survey. RESULTS A total of 1378 questionnaires were completed (response rate 36.0%), with 1337 eligible for our analyses; 81.5% of the bereaved totally/partially agreed that the information received from physicians was comprehensive and sufficient; 7.5% neither agreed nor disagreed; and 11.0% partially/totally disagreed. Of the respondents, 54.1% totally/partially agreed to having received emotional support by physicians, 14.2% neither agreed nor disagreed, and 31.7% partially/totally disagreed. Physicians in nursing homes and standard hospital wards were rated less favorably. Whereas the professionals' lack of time was strongly associated with the unfulfilled needs for emotional support, many relatives also lacked this type of care when physicians seemed to have enough time. CONCLUSION The high rates of unfulfilled needs of relatives across all care settings and all types of diseases reinforce the necessity of a comprehensive palliative care approach. An increased awareness of the psychological vulnerability of caregivers should lead to dedicated efforts to improve deficits in the German health care system.
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Affiliation(s)
- Martin Weber
- Interdisciplinary Palliative Care Unit, III, Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, ObereZahlbacher Strasse 67, Mainz, Germany
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Abstract
PURPOSE OF REVIEW At present, clinicians and healthcare providers are increasingly urged to advance the provision of state-of-the-art palliative care for patients with incurable cancer. This review provides an overview about the recent findings and practical suggestions. RECENT FINDINGS In the last decade, the awareness about the logistic and personal resources needed to meet the somatic and psychological needs of patients with progressive and life-threatening diseases has increased and in parallel, palliative care concepts and expertise have evolved substantially. Care concepts for patients with metastatic cancer emphasized the potential of interdisciplinary care. For example, in 2010, a randomized trial reported a benefit for patients with lung cancer who received early palliative care in addition to routine care. It is discussed that this was because of increased quality of life and detailed exploration of patient preferences. SUMMARY Patients, families and physicians benefit from shared care concepts of oncology and specialized palliative care. Although this concept is already becoming increasingly implemented in tertiary (comprehensive cancer-) care settings, the potential of this approach should be explored for other clinical settings such as office-based oncology.
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Schmacke N. [Palliative care: an example of Comparative Effectiveness Research?]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2012; 106:484-491. [PMID: 22981024 DOI: 10.1016/j.zefq.2012.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/06/2012] [Accepted: 06/06/2012] [Indexed: 06/01/2023]
Abstract
Comparative Effectiveness Research (CER) seeks to establish treatment objectives and concepts striving to achieve patient relevant progress in therapy on the basis of published evidence. Using the example of palliative medicine and palliative care, respectively, it will be demonstrated that these two are under-researched areas of care. In addition, it will become clear that the success of this interdisciplinary treatment concept for the seriously ill must be weighed in the light of traditional clinical research - far beyond the cancer diagnosis. The current distinction between curative and palliative research and care urgently needs to be reconsidered.
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Affiliation(s)
- Norbert Schmacke
- Universität Bremen, Fachbereich Human- und Gesundheitswissenschaften, Institut für Public Health und Pflegeforschung.
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Are there several kinds of palliative care? Curr Opin Oncol 2012; 24:355-6. [DOI: 10.1097/cco.0b013e32835310c8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gaertner J, Frechen S, Sladek M, Ostgathe C, Voltz R. Palliative care consultation service and palliative care unit: why do we need both? Oncologist 2012; 17:428-35. [PMID: 22357732 DOI: 10.1634/theoncologist.2011-0326] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Palliative care (PC) infrastructure has developed differently around the globe. Whereas some institutions consider the palliative care unit (PCU) a valuable component, others report that the sole provision of a state-of-the art palliative care consultation service (PCCS) suffices to adequately care for the severely ill and dying. OBJECTIVE To aid institutional planning, this study aimed at gathering patient data to distinguish assignments of a concomitantly run PCU and PCCS at a large hospital and academic medical center. METHODS Demographics, Eastern Cooperative Oncology Group performance status, symptom/problem burden, discharge modality, and team satisfaction with care for all 601 PCU and 851 PCCS patients treated in 2009 and 2010 were retrospectively analyzed. RESULTS Patients admitted to the PCU versus those consulted by the PCCS: (a) had a significantly worse performance status (odds ratio [OR], 1.48); (b) were significantly more likely to suffer from severe symptoms and psychosocial problems (OR, 2.05), in particular concerning physical suffering and complexity of care; and (c) were significantly much more likely to die during hospital stay (OR, 11.03). For patients who were dying or in other challenging clinical situations (suffering from various severe symptoms), self-rated team satisfaction was significantly higher for the PCU than the PCCS. CONCLUSION This study presents a direct comparison between patients in a PCU and a PCCS. Results strongly support the hypothesis that the coexistence of both institutions in one hospital contributes to the goal of ensuring optimal high-quality PC for patients in complex and challenging clinical situations.
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Affiliation(s)
- Jan Gaertner
- Department of Palliative Care, University Hospital Cologne, 50924 Cologne, Germany.
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