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Takahashi R, Nakazawa Y, Miyashita M, Morita T, Okumura Y, Kizawa Y, Kawagoe S, Yamamoto H, Takeuchi E, Yamazaki R, Ogawa A. Enhancing end-of-life care quality and achieving a good death for the elderly in Japan. Arch Gerontol Geriatr 2024; 124:105471. [PMID: 38728824 DOI: 10.1016/j.archger.2024.105471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND In the context of an aging populations, there is an escalating need for palliative care tailored to the needs of the elderly. This study aimed to assess differences in symptoms and good death among the elderly, along with the structures and processes involved in end-of life care, and to explore the impact of age on achieving a good death. METHODS We conducted a questionnaire survey for bereaved family members of patients with cancer, heart disease, stroke, pneumonia, and kidney failure in 2019 and 2020. The study population was categorized into the following age groups: ≤64, 65-74, 75-84, and ≥85. The outcomes included symptom intensity, achievement of a good death, and receipt of quality care. RESULTS In total, 62,576 bereaved family members agreed to participate in the survey (response rate; 54.0 %). The weighted percentages of 'severe' and 'very severe' symptoms decreased with age. These trends were observed across age groups, even among the elderly. The strongest effect of age on achieving a good death was found for 'feeling that life is complete' with reference to those aged ≤64 years: 65-74 years (odds ratio [OR]; 2.09, 95 % CI; 1.94 to 2.25), 75-84 years (OR; 4.86, 95 % CI; 4.52 to 5.22) and ≥85 years (OR; 12.8, 95 % CI; 11.9 to 13.8). CONCLUSION Age-specific differences were observed in quality of death, quality of care, and symptom intensity. It is important to provide individualized consideration for each age group rather than categorizing them broadly as the elderly when caring for them.
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Affiliation(s)
- Richi Takahashi
- Division of Quality Assurance Programs, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan; Division of Policy Evaluation, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Yoko Nakazawa
- Division of Quality Assurance Programs, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan; Division of Policy Evaluation, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Hamamatsu, Shizuoka, 433-8558, Japan; Research Association for Community Health, 3-24-2 Somejidai, Hamakita-ku, Hamamatsu, 434-0046, Japan
| | - Yasuyuki Okumura
- Initiative for Clinical Epidemiological Research, 1-2-5 Nakamachi, Machida,Tokyo, 194-0021, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shohei Kawagoe
- Aozora Clinic, 2-35 Midorigaoka, Matsudo, 271-0074, Japan
| | - Hiroshi Yamamoto
- Department of Respiratory Medicine, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Emi Takeuchi
- Division of Quality Assurance Programs, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Risa Yamazaki
- Department of Medical Psychology, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan
| | - Asao Ogawa
- Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577 Japan
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Kwete XJ, Bhadelia A, Arreola-Ornelas H, Mendez O, Rosa WE, Connor S, Downing J, Jamison D, Watkins D, Calderon R, Cleary J, Friedman JR, De Lima L, Ntizimira C, Pastrana T, Pérez-Cruz PE, Spence D, Rajagopal MR, Vargas Enciso V, Krakauer EL, Radbruch L, Knaul FM. Global Assessment of Palliative Care Need: Serious Health-Related Suffering Measurement Methodology. J Pain Symptom Manage 2024:S0885-3924(24)00708-5. [PMID: 38636816 DOI: 10.1016/j.jpainsymman.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/05/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
CONTEXT Inequities and gaps in palliative care access are a serious impediment to health systems especially in low- and middle-income countries and the accurate measurement of need across health conditions is a critical step to understanding and addressing the issue. Serious Health-related Suffering (SHS) is a novel methodology to measure the palliative care need and was originally developed by The Lancet Commission on Global Access to Palliative Care and Pain Relief. In 2015, the first iteration - SHS 1.0 - was estimated at over 61 million people worldwide experiencing at least 6 billion days of SHS annually as a result of life-limiting and life-threatening conditions. OBJECTIVES In this paper, an updated methodology - SHS 2.0 - is presented building on the work of the Lancet Commission and detailing calculations, data requirements, limitations, and assumptions. METHODS AND RESULTS The updates to the original methodology focus on measuring the number of people who die with (decedents) or live with (non-decedents) SHS in a given year to assess the number of people in need of palliative care across health conditions and populations. Detail on the methodology for measuring the number of days of SHS that was pioneered by the Lancet Commission, is also shared, as this second measure is essential for determining the health system responses that are necessary to address palliative care need and must be a priority for future methodological work on SHS. CONCLUSIONS The methodology encompasses opportunities for applying SHS to future policy making assessment of future research priorities particularly in light of the dearth of data from low- and middle-income countries, and sharing of directions for future work to develop SHS 3.0.
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Affiliation(s)
- Xiaoxiao J Kwete
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA; Yangzhou Philosophy and Social Science Research and Communication Center (X.J.K.), Yangzhou, China.
| | - Afsan Bhadelia
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA; Department of Public Health, College of Health and Human Sciences (A.B.), Purdue University, West Lafayette, Indiana, USA
| | - Héctor Arreola-Ornelas
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA; Institute for Obesity Research, Tecnologico de Monterrey (H.A.-O.), Monterrey, Mexico; School of Government and Public Transformation, Tecnologico de Monterrey, Mexico City, Mexico; Tómatelo a Pecho, A.C. (H.A-O., O.M., F.M.K.), Mexico City, Mexico; Fundación Mexicana para la Salud (FUNSALUD) (H.A.-O.), Mexico City, México
| | - Oscar Mendez
- Tómatelo a Pecho, A.C. (H.A-O., O.M., F.M.K.), Mexico City, Mexico
| | - William E Rosa
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA; Department of Psychiatry and Behavioral Sciences (W.E.R.), Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephen Connor
- Worldwide Hospice Palliative Care Alliance (S.C.), London, UK
| | - Julia Downing
- International Children's Palliative Care Network (J.D.), Bristol, UK
| | - Dean Jamison
- University of California (D.J.), San Francisco, California, USA
| | - David Watkins
- Department of Global Health, University of Washington (D.W.), Seattle, Washington, USA
| | - Renzo Calderon
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA
| | - Jim Cleary
- Indiana University School of Medicine (J.C.), Indianapolis, Indiana, USA
| | - Joseph R Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, California, USA
| | - Liliana De Lima
- International Association of Hospice and Palliative Care (L.D.L.), Houston, Texas, USA
| | | | - Tania Pastrana
- International Association of Hospice and Palliative Care (L.D.L.), Houston, Texas, USA; Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Pedro E Pérez-Cruz
- Sección Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro para la Prevención y el Control del Cáncer (CECAN), Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Valentina Vargas Enciso
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA
| | - Eric L Krakauer
- Department of Global Health & Social Medicine, Harvard Medical School (E.L.K.), Boston, Massachusetts, USA
| | - Lukas Radbruch
- International Association of Hospice and Palliative Care (L.D.L.), Houston, Texas, USA; Department of Palliative Medicine, University Hospital Bonn, Germany
| | - Felicia Marie Knaul
- University of Miami Institute for Advanced Study of the Americas, University of Miami (X.J.K., A.B., H.A.-O., W.E.R., R.C., V.V.E., F.M.K.), Miami, Florida, USA; Tómatelo a Pecho, A.C. (H.A-O., O.M., F.M.K.), Mexico City, Mexico; Sylvester Comprehensive Cancer Center, Miller School of Medicine (F.M.K.), University of Miami, Miami, Florida, USA; Leonard M. Miller School of Medicine (F.M.K.), University of Miami, Miami, Florida, USA
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Wilson EA, King-Oakley E, Richfield EW. Parkinson's disease: symptoms and medications at the end of life. BMJ Support Palliat Care 2024; 13:e912-e915. [PMID: 37463763 DOI: 10.1136/spcare-2023-004389] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES People with Parkinson's disease (PwP) have a high palliative symptom burden throughout their disease course, equivalent to advanced malignancy. We aim to establish trends in symptom frequency and prescribing in the 72 hours prior to death for PwP. METHODS Retrospective case note review of PwP who died between February 2019 and September 2020. RESULTS 51 patients were included. 60.78% of patients (n=31) had agitation and 58.82% (n=30) had pain in the final 72 hours. Patients with cognitive impairment were 4.67 times more likely to experience agitation (p=0.035) compared with those without, with higher total midazolam doses (29.18 mg vs 11.4 mg, p=0.21). Terminal motor symptoms were recorded in three patients. 28.57% of patients received the recommended dose of rotigotine for dopaminergic therapy. CONCLUSIONS PwP have a significant symptom burden at the end of life (EOL) with levels of terminal agitation at the higher end of those expected in the general population. There was a trend towards higher doses of sedation, rather than analgesia, in people with coexistent cognitive impairment.Terminal stiffness, despite being seldom documented in the literature, is an important although infrequent symptom.Rotigotine use at EOL remains commonplace and better understanding of its effect and dosing is required.
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Walsh M, Fagan N, Davies A. Xerostomia in patients with advanced cancer: a scoping review of clinical features and complications. BMC Palliat Care 2023; 22:178. [PMID: 37950188 PMCID: PMC10638744 DOI: 10.1186/s12904-023-01276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The aim of this project was to review the literature on dry mouth / xerostomia in patients with advanced cancer, with the objectives being to determine its prevalence, clinical features, and complications. METHODS Standard methodology was used to conduct this scoping review. Detailed searches of the Medline, Embase, CINAHL, and PsycInfo databases were conducted to identify relevant studies: eligible studies had to include patients with advanced cancer, and to contain details of clinical features and/or complications of xerostomia. Commercial bibliographic / systematic review software was used to support the process. RESULTS Forty-three studies were discovered from the database and hand searches. The studies included 23 generic symptom studies, eight "symptom cluster" studies, nine oral symptom / problem studies, and three xerostomia-specific studies. In depth data is described on the clinical features and complications of xerostomia, and on the "symptom clusters" including xerostomia, in this cohort of patients. CONCLUSION This review discovered a relatively small number of focused studies (involving a similarly small number of patients). Nonetheless, it demonstrates that xerostomia is a very common problem in patients with advanced cancer and is often associated with significant morbidity (and impairment of quality of life).
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Affiliation(s)
- Maria Walsh
- Marymount University Hospital & Hospice, Curraheen, Ireland
| | - Norah Fagan
- Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Andrew Davies
- Trinity College Dublin, University College Dublin & Our Lady's Hospice Dublin, Dublin, Ireland.
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5
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Cavalcante VN, Mesquita ET, Cavalcanti ACD, Miranda JSDS, Jardim PP, Bandeira GMDS, Guimarães LMR, Venâncio ICDDL, Correa NMC, Dantas AMR, Tress JC, Romano AC, Muccillo FB, Siqueira MEB, Vieira GCA. Impact of a Stress Reduction, Meditation, and Mindfulness Program in Patients with Chronic Heart Failure: A Randomized Controlled Trial. Arq Bras Cardiol 2023; 120:e20220768. [PMID: 37909602 PMCID: PMC10586813 DOI: 10.36660/abc.20220768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 07/10/2023] [Accepted: 08/16/2023] [Indexed: 11/03/2023] Open
Abstract
Heart Failure is a significant public health problem leading to a high burden of physical and psychological symptoms despite optimized therapy. To evaluate primarily the impact of a Stress Reduction, Meditation, and Mindfulness Program on stress reduction of patients with Heart Failure. A randomized and controlled clinical trial assessed the effect of a stress reduction program compared to conventional multidisciplinary care in two specialized centers in Brazil. The data collection period took place between April and October 2019. Thirty-eight patients were included and allocated to the intervention or control groups. The intervention took place over 8 weeks. The protocol assessed the scales of perceived stress, depression, quality of life, anxiety, mindfulness, quality of sleep, a 6-minute walk test, and biomarkers analyzed by a blinded team, considering a p-value <0.05 statistically significant. The intervention resulted in a significant reduction in perceived stress from 22.8 ± 4.3 to 14.3 ± 3.8 points in the perceived stress scale-14 items in the intervention group vs. 23.9 ± 4.3 to 25.8 ± 5.4 in the control group (p-value<0.001). A significant improvement in quality of life (p-value=0.013), mindfulness (p-value=0.041), quality of sleep (p-value<0.001), and the 6-minute walk test (p-value=0.004) was also observed in the group under intervention in comparison with the control. The Stress Reduction, Meditation, and Mindfulness Program effectively reduced perceived stress and improved clinical outcomes in patients with chronic Heart Failure.
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Affiliation(s)
- Vaisnava Nogueira Cavalcante
- Universidade Federal FluminenseNiteróiRJBrasilUniversidade Federal Fluminense, Niterói, RJ – Brasil
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ – Brasil
| | - Evandro Tinoco Mesquita
- Universidade Federal FluminenseNiteróiRJBrasilUniversidade Federal Fluminense, Niterói, RJ – Brasil
| | | | | | - Paola Pugian Jardim
- Universidade Federal FluminenseNiteróiRJBrasilUniversidade Federal Fluminense, Niterói, RJ – Brasil
| | | | | | | | | | - Angela Maria Rodrigues Dantas
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ – Brasil
| | - João Carlos Tress
- Complexo Hospitalar de NiteróiNiteróiRJBrasilComplexo Hospitalar de Niterói (CHN), Niterói, RJ – Brasil
| | - Ana Catarina Romano
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ – Brasil
| | - Fabiana Bergamin Muccillo
- Instituto Nacional de CardiologiaRio de JaneiroRJBrasilInstituto Nacional de Cardiologia, Rio de Janeiro, RJ – Brasil
| | - Marina Einstoss Barbosa Siqueira
- Universidade Federal FluminenseDepartamento de Fundamentos de Enfermagem e AdministraçãoRio de JaneiroRJBrasilUniversidade Federal Fluminense - Departamento de Fundamentos de Enfermagem e Administração, Rio de Janeiro, RJ – Brasil
| | - Glaucia Cristina Andrade Vieira
- Universidade Federal FluminenseDepartamento de Fundamentos de Enfermagem e AdministraçãoRio de JaneiroRJBrasilUniversidade Federal Fluminense - Departamento de Fundamentos de Enfermagem e Administração, Rio de Janeiro, RJ – Brasil
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6
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Hannon M, Shaw A, Connolly M, Davies A. Taste disturbance in patients with advanced cancer: a scoping review of clinical features and complications. Support Care Cancer 2023; 31:562. [PMID: 37672147 PMCID: PMC10482768 DOI: 10.1007/s00520-023-08012-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE The purpose of this scoping review is to appraise the published literature on taste disturbance in patients with advanced cancer, with the specific objectives being to determine its prevalence, clinical features and complications. METHODS This scoping review was conducted using the recommended methodological framework. A detailed search of databases (Medline, Embase, CINAHL and PsycInfo) was conducted to identify eligible studies: eligible studies needed to include patients with advanced cancer and needed to include details of clinical features and/or complications of taste disturbance. Standard bibliographic/systematic review software was used to store the records and manage the review process, respectively. RESULTS Twenty-five studies were identified from the database searches. The studies identified included eight physical and/or psychological symptom studies, six symptom cluster studies, five oral symptom studies and six taste and/or smell specific studies. Detailed data is presented on the clinical features and complications of taste disturbance and on the symptom clusters involving taste disturbance in this cohort of patients. CONCLUSION This scoping review identified a relatively small number of relevant studies involving a relatively small number of participants. Nevertheless, it confirms that taste disturbance is a common problem in patients with advanced cancer and is associated with significant morbidity because of the primary condition and the associated complications.
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Affiliation(s)
- Marie Hannon
- University College Dublin, Dublin, Ireland.
- Our Lady's Hospice & Care Services, Dublin, Ireland.
| | | | - Michael Connolly
- University College Dublin, Dublin, Ireland
- Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Andrew Davies
- University College Dublin, Dublin, Ireland
- Our Lady's Hospice & Care Services, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
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7
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Sousa MS, Martin P, Johnson MJ, Lind M, Maddocks M, Bullock A, Agar M, Chang S, Kochovska S, Kinchin I, Morgan D, Fazekas B, Razmovski-Naumovski V, Lee JT, Itchins M, Bray V, Currow DC. Phase II, double blind, placebo controlled, multi-site study to evaluate the safety, feasibility and desirability of conducting a phase III study of anamorelin for anorexia in people with small cell lung cancer: A study protocol (LUANA trial). PLoS One 2023; 18:e0285850. [PMID: 37195996 DOI: 10.1371/journal.pone.0285850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
Anorexia is experienced by most people with lung cancer during the course of their disease and treatment. Anorexia reduces response to chemotherapy and the ability of patients to cope with, and complete their treatment leading to greater morbidity, poorer prognosis and outcomes. Despite the significant importance of cancer-related anorexia, current therapies are limited, have marginal benefits and unwarranted side effects. In this multi-site, randomised, double blind, placebo controlled, phase II trial, participants will be randomly assigned (1:1) to receive once-daily oral dosing of 100mg of anamorelin HCl or matched placebo for 12 weeks. Participants can then opt into an extension phase to receive blinded intervention for another 12 weeks (weeks 13-24) at the same dose and frequency. Adults (≥18 years) with small cell lung cancer (SCLC); newly diagnosed with planned systemic therapy OR with first recurrence of disease following a documented disease-free interval ≥6 months, AND with anorexia (i.e., ≤ 37 points on the 12-item Functional Assessment of Anorexia Cachexia Treatment (FAACT A/CS) scale) will be invited to participate. Primary outcomes are safety, desirability and feasibility outcomes related to participant recruitment, adherence to interventions, and completion of study tools to inform the design of a robust Phase III effectiveness trial. Secondary outcomes are the effects of study interventions on body weight and composition, functional status, nutritional intake, biochemistry, fatigue, harms, survival and quality of life. Primary and secondary efficacy analysis will be conducted at 12 weeks. Additional exploratory efficacy and safety analyses will also be conducted at 24 weeks to collect data over longer treatment duration. The feasibility of economic evaluations in Phase III trial will be assessed, including the indicative costs and benefits of anamorelin for SCLC to the healthcare system and society, the choice of methods for data collection and the future evaluation design. Trial registration. The trial has been registered with the Australian New Zealand Clinical Trials Registry [ACTRN12622000129785] and approved by the South Western Sydney Local Health District Human Research Ethics Committee [2021/ETH11339]. https://clin.larvol.com/trial-detail/ACTRN12622000129785.
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Affiliation(s)
- Mariana S Sousa
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Peter Martin
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Palliative Care, Barwon Health, Geelong, Victoria, Australia
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, England
| | - Michael Lind
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, England
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, United Kingdom
| | - Alex Bullock
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, England
| | - Meera Agar
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- Department of Medical Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
- South West Sydney Clinical Campuses, University of New South Wales Sydney, Kensington, Australia
| | - Sungwon Chang
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Slavica Kochovska
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Irina Kinchin
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Deidre Morgan
- RePaDD, Flinders University, Adelaide, South Australia, Australia
| | - Belinda Fazekas
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Valentina Razmovski-Naumovski
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- South West Sydney Clinical Campuses, University of New South Wales Sydney, Kensington, Australia
| | - Jessica T Lee
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord West, New South Wales, Australia
- Concord Clinical school, University of Sydney, Camperdown, New South Wales, Australia
| | - Malinda Itchins
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Victoria Bray
- Department of Medical Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - David C Currow
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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8
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Cleary N, Mulkerrin OM, Davies A. Oral symptom assessment tools in patients with advanced cancer: a scoping review. Support Care Cancer 2022; 30:7481-7490. [PMID: 35657401 PMCID: PMC9385820 DOI: 10.1007/s00520-022-07169-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Oral symptoms are common in patients with advanced cancer. The aim of this scoping review was to identify oral symptom assessment tools that have been specifically utilised in patients with "advanced cancer". METHODS The review was conducted/reported according to international guidelines for undertaking scoping reviews. PubMed, Embase, and CINAHL were searched for articles involving adult patients with advanced cancer, which involved assessment of ≥ 2 oral symptoms, and which involved patients with > 1 type of cancer. RESULTS The review identified four validated symptom assessment scales, including one cancer-specific quality of life scale (EORTC QLQ OH-15), one generic tool for assessing the "social impact" of specific oral problems (OHIP), one cancer-specific generic symptom assessment scale (MSAS), and one cancer-specific oral symptom assessment scale (OSAS). CONCLUSION Symptom assessment tools can facilitate good symptom control in clinical practice, and are an integral component of clinical research. The review identified four validated symptom assessment scales that could be utilised to assess oral symptoms in patients with advanced cancer.
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Affiliation(s)
- Niamh Cleary
- Trinity College Dublin, Dublin, Ireland.
- Our Lady of Lourdes Hospital, Drogheda, Drogheda, Ireland.
- Our Lady's Hospice Dublin, Dublin, Ireland.
| | | | - Andrew Davies
- Trinity College Dublin, Dublin, Ireland
- Our Lady's Hospice Dublin, Dublin, Ireland
- University College Dublin, Dublin, Ireland
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9
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Queiroz AL, Dantas E, Ramsamooj S, Murthy A, Ahmed M, Zunica ERM, Liang RJ, Murphy J, Holman CD, Bare CJ, Ghahramani G, Wu Z, Cohen DE, Kirwan JP, Cantley LC, Axelrod CL, Goncalves MD. Blocking ActRIIB and restoring appetite reverses cachexia and improves survival in mice with lung cancer. Nat Commun 2022; 13:4633. [PMID: 35941104 PMCID: PMC9360437 DOI: 10.1038/s41467-022-32135-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/13/2022] [Indexed: 12/30/2022] Open
Abstract
Cancer cachexia is a common, debilitating condition with limited therapeutic options. Using an established mouse model of lung cancer, we find that cachexia is characterized by reduced food intake, spontaneous activity, and energy expenditure accompanied by muscle metabolic dysfunction and atrophy. We identify Activin A as a purported driver of cachexia and treat with ActRIIB-Fc, a decoy ligand for TGF-β/activin family members, together with anamorelin (Ana), a ghrelin receptor agonist, to reverse muscle dysfunction and anorexia, respectively. Ana effectively increases food intake but only the combination of drugs increases lean mass, restores spontaneous activity, and improves overall survival. These beneficial effects are limited to female mice and are dependent on ovarian function. In agreement, high expression of Activin A in human lung adenocarcinoma correlates with unfavorable prognosis only in female patients, despite similar expression levels in both sexes. This study suggests that multimodal, sex-specific, therapies are needed to reverse cachexia.
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Affiliation(s)
- Andre Lima Queiroz
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Ezequiel Dantas
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Shakti Ramsamooj
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Anirudh Murthy
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Mujmmail Ahmed
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, 10065, USA
| | | | - Roger J Liang
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Jessica Murphy
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, 10065, USA
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Corey D Holman
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Curtis J Bare
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Gregory Ghahramani
- Weill Cornell Graduate School of Medical Sciences, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Zhidan Wu
- Internal Medicine Research Unit, Pfizer Global R&D, Cambridge, MA, USA
| | - David E Cohen
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - John P Kirwan
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Lewis C Cantley
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, 10065, USA
| | | | - Marcus D Goncalves
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA.
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, 10065, USA.
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10
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Detopoulou P, Voulgaridou G, Papadopoulou S. Cancer, Phase Angle and Sarcopenia: The Role of Diet in Connection with Lung Cancer Prognosis. Lung 2022; 200:347-379. [PMID: 35616720 DOI: 10.1007/s00408-022-00536-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
Lung cancer is the most common cause of cancer death and is associated with malnutrition and sarcopenia. The detection of sarcopenia and conduction of simple body composition measurements, such as the phase angle (PhA) deriving from bioelectrical impedance analysis (BIA), can help to early identify, monitor, prevent and treat malnutrition. The present review aims to clarify the relationship between PhA and sarcopenia with the pathophysiology, clinical outcomes, and therapeutic aspects of lung cancer. PhA and sarcopenia are connected to lung cancer prognosis through various mechanisms including inflammation and oxidative stress, although more research is needed to identify the critical thresholds for increased mortality risk. Moreover, emphasis is given on the role of dietary interventions (oral nutritional supplementation, and dietary counseling) to manage sarcopenia and related variables in patients with lung cancer. Oral nutritional supplements and/or those containing n - 3 polyunsaturated fatty acids may have a positive effect on physical strength measures and muscle mass if administered at the beginning of chemotherapy. Data on sole dietary counseling or multimodal interventions are less promising so far. In the future, sophisticated body composition phenotypes deriving from the described methods along with artificial intelligence techniques could be used to design personalized nutrition interventions and timely treat these patients.
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Affiliation(s)
- Paraskevi Detopoulou
- Department of Clinical Nutrition, General Hospital Korgialenio Benakio, Athens, Greece.,Department of Nutritional Science and Dietetics, University of the Peloponnese, Kalamata, Greece
| | - Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Sindos, Thessaloniki, Greece
| | - Sousana Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Sindos, Thessaloniki, Greece.
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11
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ElMokhallalati Y, Alaloul E, Shatat M, Shneewra T, El Massri S, Shaer O, Relton S, Abu-Odah H, Allsop MJ. The Symptom Burden and Quality of Life in Cancer Patients in the Gaza Strip, Palestine: A Cross-Sectional Study. PLoS One 2022; 17:e0262512. [PMID: 35025966 PMCID: PMC8758072 DOI: 10.1371/journal.pone.0262512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Cancer is the second leading cause of death in the Gaza Strip, Palestine, but there is an absence of evidence systematically assessing symptom burden and quality of life (QoL) using validated tools. Our objective was to assess associations between socio-demographic and disease-related characteristics, symptom burden and QoL in a sample of cancer patients accessing outpatient services in the Gaza Strip. DESIGN A cross-sectional, descriptive survey using interviews and medical record review involving patients with cancer accessing oncology outpatient services at Al Rantisi Hospital and European Gaza Hospital (EGH) in the Gaza Strip was employed. Socio-demographic and disease-related data, the Lebanese version of the Memorial Symptom Assessment Scale (MSAS-Leb), and the Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) were collected. Multiple linear regression was used to judge the relative influence of determinants of QoL. RESULTS Of 414 cancer patients approached, 385 patients consented to participation. The majority were women (64.7%) with a mean age of 52 years (SD = 16.7). Common cancer diagnoses were breast (32.2%), haematological (17.9%) and colorectal (9.1%). The median number of symptoms was 10 (IQR 1.5-18.5). Mean overall QoL was 70.5 (SD 19.9) with common physical and psychological symptoms identified. A higher burden of symptoms was associated with marital status, education and income. Limited access to both opioids and psychological support were reported. CONCLUSIONS A high symptom burden was identified in outpatients with cancer. Increasing provision and access to supportive care for physical and psychological symptoms should be prioritised alongside exploring routine assessment of symptom burden and QoL.
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Affiliation(s)
- Yousuf ElMokhallalati
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Enas Alaloul
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | | | | | - Saad El Massri
- Faculty of Medicine, Islamic University, Gaza, occupied Palestinian territory
| | - Omar Shaer
- Faculty of Medicine, Islamic University, Gaza, occupied Palestinian territory
| | - Samuel Relton
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Matthew J. Allsop
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
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12
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Wilburn D, Ismaeel A, Machek S, Fletcher E, Koutakis P. Shared and distinct mechanisms of skeletal muscle atrophy: A narrative review. Ageing Res Rev 2021; 71:101463. [PMID: 34534682 DOI: 10.1016/j.arr.2021.101463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/30/2021] [Accepted: 09/11/2021] [Indexed: 12/15/2022]
Abstract
Maintenance of skeletal muscle mass and function is an incredibly nuanced balance of anabolism and catabolism that can become distorted within different pathological conditions. In this paper we intend to discuss the distinct intracellular signaling events that regulate muscle protein atrophy for a given clinical occurrence. Aside from the common outcome of muscle deterioration, several conditions have at least one or more distinct mechanisms that creates unique intracellular environments that facilitate muscle loss. The subtle individuality to each of these given pathologies can provide both researchers and clinicians with specific targets of interest to further identify and increase the efficacy of medical treatments and interventions.
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Affiliation(s)
- Dylan Wilburn
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX 76706, USA
| | - Ahmed Ismaeel
- Department of Biology, Baylor University, Waco, TX 76706, USA
| | - Steven Machek
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX 76706, USA
| | - Emma Fletcher
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX 76706, USA; Department of Biology, Baylor University, Waco, TX 76706, USA
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13
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Dreidi M, Alrimawi I, Atout M. Evaluating the relationships between multiple symptoms; altered nutritional status, and their effects on the quality of life of patients diagnosed with cancer in Palestine: an explorative study. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1981566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mutaz Dreidi
- Nursing Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Ramallah, Palestine
| | - Intima Alrimawi
- School of Nursing and Health Professions, Trinity Washington University, Washington, DC 20017, USA
| | - Maha Atout
- Nursing School, Philadelphia University, Amman, Jordan
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14
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Weaver MS, Shostrom VK, Neumann ML, Robinson JE, Hinds PS. Homestead together: Pediatric palliative care telehealth support for rural children with cancer during home-based end-of-life care. Pediatr Blood Cancer 2021; 68:e28921. [PMID: 33522720 DOI: 10.1002/pbc.28921] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/14/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Children with terminal cancer and their families describe a preference for home-based end-of-life care. Inadequate support outside of the hospital is a limiting factor in home location feasibility, particularly in rural regions lacking pediatric-trained hospice providers. METHODS The purpose of this longitudinal palliative telehealth support pilot study was to explore physical and emotional symptom burden and family impact assessments for children with terminal cancer receiving home based-hospice care. Each child received standard of care home-based hospice care from an adult-trained rural hospice team with the inclusion of telehealth pediatric palliative care visits at a scheduled minimum of every 14 days. RESULTS Eleven children (mean age 11.9 years) received pediatric palliative telehealth visits a minimum of every 14 days, with an average of 4.8 additional telehealth visits initiated by the family. Average time from enrollment to death was 21.6 days (range 4-95). Children self-reported higher physical symptom prevalence than parents or hospice nurses perceived the child was experiencing at time of hospice enrollment with underrecognition of the child's emotional burden. At the time of hospice enrollment, family impact was reported by family caregivers as 46.4/100 (SD 18.7), with noted trend of improved family function while receiving home hospice care with telehealth support. All children remained at home for end-of-life care. CONCLUSION Pediatric palliative care telehealth combined with adult-trained rural hospice providers may be utilized to support pediatric oncology patients and their family caregivers as part of longitudinal home-based hospice care.
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Affiliation(s)
- Meaghann S Weaver
- Department of Pediatrics, Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Valerie K Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Marie L Neumann
- Department of Pediatrics, Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Jacob E Robinson
- Department of Pediatrics, Division of Pediatric Palliative Care, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Pamela S Hinds
- Department of Nursing Science, Professional Practice and Quality, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, George Washington University, Washington, District of Columbia
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15
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Pham Van B, Nguyen Thi Thanh H, Le Thi H, Nguyen Le Tuan A, Dang Thi Thu H, Dang Viet D. Nutritional Status and Feeding Regimen of Patients with Esophagus Cancer-A Study from Vietnam. Healthcare (Basel) 2021; 9:healthcare9030289. [PMID: 33800823 PMCID: PMC8000479 DOI: 10.3390/healthcare9030289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/09/2022] Open
Abstract
Background: Esophagus cancer patients are at high risk of malnutrition. This study was performed to assess the nutritional status and dietary intake of newly diagnosed esophageal cancer patients in Vietnam National Cancer Hospital (NCH). Methods: A cross-sectional study was conducted on 206 early esophageal cancer inpatients after gastrostomy from September 2017 to June 2018. The chi-squared test, Fisher exact test, and Mann–Whitney test were performed. The software of the Vietnam National Institute of Nutrition was used to evaluate the dietary intake of patients. Results: All the participants were male with a mean age of 57.1 ± 8.5 years. Overall, 87.4% of patients had dysphagia. Furthermore, 82.5% and 90.8% of patients reported weight loss one and six months pre-diagnosis, respectively. Moreover, 52.9% of patients suffered from mild/moderate malnutrition and 29.6% of patients had severe malnutrition according to the Patient-Generated Subjective Global Assessment (PG-SGA). The body mass index (BMI) and mid upper arm circumference (MUAC) measurement revealed 47.6% and 50% of undernourished patients, respectively. The proportions of patients having malnutrition were 10.7%, 55.8%, and 27.2% according to albumin, prealbumin, and total lymphocyte counts, respectively. The means of energy, protein, lipid, and carbohydrate in the patients’ 24 h preoperative diets were 973.6 ± 443.0 kcal/day, 42.4 ± 21.6 g/day, 31.0 ± 15.5 g/day, and 130.0 ± 64.5 g/day. The total energy, total protein, animal protein, total lipid, and plant lipid in the dietary intake of patients were strongly correlated with age, economic classification, and PG-SGA (each p < 0.05). The total energy intake increased day by day, with the average energy intake of 1343.9 ± 521.3 kcal on the seventh day. Energy and protein response rates increased day by day and were highest at 7 days post-operation at 18.0% and 19.4%. Conclusion: Malnutrition and insufficient intake are noteworthy in esophageal cancer patients. The PG-SGA is strongly correlated with the dietary intake of patients. The results from this study will help medical staff to prevent malnutrition and improve the nutritional status of esophageal cancer inpatients. Furthermore, public awareness should be raised on recognizing weight loss as an early symptom of esophageal cancer and the utilization of preoperative assessment tools for nutritional assessment and malnutrition management.
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Affiliation(s)
- Binh Pham Van
- Abdominal Surgery Department 1 and Robotic Surgery Center, Vietnam National Cancer Hospital, Hanoi 12511, Vietnam
- Correspondence: or (B.P.V.); (H.L.T.)
| | - Hoa Nguyen Thi Thanh
- Clinical Nutrition Center, Vietnam National Cancer Hospital, Hanoi 12511, Vietnam; (H.N.T.T.); (H.D.T.T.)
| | - Huong Le Thi
- Clinical Nutrition Center, Vietnam National Cancer Hospital, Hanoi 12511, Vietnam; (H.N.T.T.); (H.D.T.T.)
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 11521, Vietnam;
- Correspondence: or (B.P.V.); (H.L.T.)
| | - Anh Nguyen Le Tuan
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 11521, Vietnam;
| | - Hang Dang Thi Thu
- Clinical Nutrition Center, Vietnam National Cancer Hospital, Hanoi 12511, Vietnam; (H.N.T.T.); (H.D.T.T.)
| | - Dung Dang Viet
- Gastrointestinal Surgery Center, 103 Military Hospital, Military Medical Academy, Hanoi 12109, Vietnam;
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16
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Yeom E, Shin H, Yoo W, Jun E, Kim S, Hong SH, Kwon DW, Ryu TH, Suh JM, Kim SC, Lee KS, Yu K. Tumour-derived Dilp8/INSL3 induces cancer anorexia by regulating feeding neuropeptides via Lgr3/8 in the brain. Nat Cell Biol 2021; 23:172-183. [PMID: 33558728 DOI: 10.1038/s41556-020-00628-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 12/16/2020] [Indexed: 01/30/2023]
Abstract
In patients with advanced-stage cancer, cancer-associated anorexia affects treatment success and patient survival. However, the underlying mechanism is poorly understood. Here, we show that Dilp8, a Drosophila homologue of mammalian insulin-like 3 peptide (INSL3), is secreted from tumour tissues and induces anorexia through the Lgr3 receptor in the brain. Activated Dilp8-Lgr3 signalling upregulated anorexigenic nucleobinding 1 (NUCB1) and downregulated orexigenic short neuropeptide F (sNPF) and NPF expression in the brain. In the cancer condition, the protein expression of Lgr3 and NUCB1 was significantly upregulated in neurons expressing sNPF and NPF. INSL3 levels were increased in tumour-implanted mice and INSL3-treated mouse hypothalamic cells showed Nucb2 upregulation and Npy downregulation. Food consumption was significantly reduced in intracerebrospinal INSL3-injected mice. In patients with pancreatic cancer, higher serum INSL3 levels increased anorexia. These results indicate that tumour-derived Dilp8/INSL3 induces cancer anorexia by regulating feeding hormones through the Lgr3/Lgr8 receptor in Drosophila and mammals.
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Affiliation(s)
- Eunbyul Yeom
- Metabolism and Neurophysiology Research Group, Disease Target Structure Research Center, KRIBB, Daejeon, Korea
- Tunneling Nanotube Research Center, Korea University, Seoul, Korea
| | - Hyemi Shin
- Graduate School of Medical Science and Engineering, KAIST, Daejeon, Korea
| | - Wonbeak Yoo
- Environmental Disease Research Center, KRIBB, Daejeon, Korea
| | - Eunsung Jun
- Department of Convergence Medicine and Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Institute for Life Sciences, AMIST, Asan Medical Center, Seoul, Korea
| | - Seokho Kim
- Department of Medicinal Biotechnology, College of Health Sciences, Dong-A University, Busan, Korea
| | - Seung Hyun Hong
- Metabolism and Neurophysiology Research Group, Disease Target Structure Research Center, KRIBB, Daejeon, Korea
| | - Dae-Woo Kwon
- Metabolism and Neurophysiology Research Group, Disease Target Structure Research Center, KRIBB, Daejeon, Korea
- Department of Functional Genomics, UST, Daejeon, Korea
| | - Tae Hoon Ryu
- Metabolism and Neurophysiology Research Group, Disease Target Structure Research Center, KRIBB, Daejeon, Korea
- Department of Functional Genomics, UST, Daejeon, Korea
| | - Jae Myoung Suh
- Graduate School of Medical Science and Engineering, KAIST, Daejeon, Korea.
| | - Song Cheol Kim
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Asan Biomedical Engineering Research Center, AMIST, Seoul, Korea.
| | - Kyu-Sun Lee
- Metabolism and Neurophysiology Research Group, Disease Target Structure Research Center, KRIBB, Daejeon, Korea.
- Department of Functional Genomics, UST, Daejeon, Korea.
| | - Kweon Yu
- Metabolism and Neurophysiology Research Group, Disease Target Structure Research Center, KRIBB, Daejeon, Korea.
- Department of Functional Genomics, UST, Daejeon, Korea.
- Convergence Research Center of Dementia, KIST, Seoul, Korea.
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17
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Oral symptoms in patients with advanced cancer: an observational study using a novel oral symptom assessment scale. Support Care Cancer 2021; 29:4357-4364. [PMID: 33416995 DOI: 10.1007/s00520-020-05903-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/16/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study was to utilise a novel oral assessment tool (the Oral Symptom Assessment Scale/OSAS) to investigate oral symptoms in a cohort of advanced cancer patients receiving specialist palliative care. METHODS Participants were asked to complete the OSAS, which asks about the presence of 20 oral symptoms in the previous week (and, if present, about the frequency, the severity, and the amount of distress caused by the symptoms). Patients were also asked to complete the Memorial Symptom Assessment Scale - Short Form, and to rate their performance status. RESULTS Two hundred fifty participants completed the study, and 244 (97.5%) participants reported at least one oral symptom on the OSAS. The median number of oral symptoms reported was five (range, 1 to 18), with dry mouth being the most common symptom (83.5% participants). The total number of oral symptoms was higher in younger participants (p = 0.012), female participants (p = 0.048), and those with a worse performance status (p < 0.001). No other oral symptoms were reported by more than two participants. Statistical analysis identified a number of potential oral symptom clusters. CONCLUSIONS Oral symptoms (and related oral problems) are common in patients with advanced cancer, and are associated with significant morbidity in this group of patients. TRIAL REGISTRATION CancerTrials.gov registry reference number: NCT04404920.
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18
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What symptoms tell us: A multiple case study of oncology consultations. Palliat Support Care 2020; 19:421-436. [PMID: 32912373 DOI: 10.1017/s1478951520000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES While patients' symptom experiences have been widely investigated, there is a lack of contextualized studies investigating how symptoms circulate in the medical consultation, how patients present them, what they convey, how physicians respond, and how patients and physicians negotiate with each other to find ways to address them. The aim of this study is to explore patients and physicians handling of symptoms throughout oncological consultations with a multiple case study approach. METHODS Five consultations, purposively selected from an existing dataset of audiotaped consultations with patients with advanced cancer, were analyzed by means of an inductive analytical approach based on a sensitive framework from the literature. RESULTS Patients' symptoms showed multiple dimensions such as medical, cognitive, emotional, psychological, interactional, symbolic, experiential, and existential. SIGNIFICANCE OF RESULTS Different symptom dimensions remained unnoticed and unaddressed in the consultations. The physician-centered symptom approach that was observed leads to consumed time and missed opportunities for relationship building with the patient. Physicians showed a lack of sensitivity regarding the multiple dimensions of symptoms. Based on the findings, strategies for a more comprehensive symptom approach can be conceived.
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19
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Böling S, Berlin JM, Berglund H, Öhlén J. No ordinary consultation - a qualitative inquiry of hospital palliative care consultation services. J Health Organ Manag 2020; ahead-of-print. [PMID: 32744038 DOI: 10.1108/jhom-04-2020-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Considering the great need for palliative care in hospitals, it is essential for hospital staff to have palliative care knowledge. Palliative consultations have been shown to have positive effects on in-hospital care. However, barriers to contact with and uptake of palliative consultation advice are reported, posing a need for further knowledge about the process of palliative consultations. The purpose of this study therefore was to examine how palliative consultations in hospitals are practised, as perceived by consultants and health care professionals on receiving wards. DESIGN/METHODOLOGY/APPROACH Focus groups with palliative care consultation services, health care personnel from receiving wards and managers of consultation services. Interpretive description and constant comparative method guided the analysis. FINDINGS Variations were seen in several aspects of practice, including approach to practice and represented professions. The palliative consultants were perceived to contribute by creating space for palliative care, adding palliative knowledge and approach, enhancing cooperation and creating opportunity to ameliorate transition. Based on a perception of carrying valuable perspectives and knowledge, a number of consultation services utilised proactive practices that took the initiative in relation to the receiving wards. ORIGINALITY/VALUE A lack of policy and divergent views on how to conceptualise palliative care appeared to be associated with variations in consultation practices, tentative approaches and a bottom-up driven development. This study adds knowledge, implying theoretical transferability as to how palliative care consultations can be practised, which is useful when designing and starting new consultation services.
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Affiliation(s)
- Susanna Böling
- The Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan M Berlin
- Department of Social and Behavioural Studies, University West, Trollhättan, Sweden
| | - Helene Berglund
- The Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Öhlén
- The Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital Region Västra Götaland, Gothenburg, Sweden
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20
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Flint KM, Fairclough DL, Spertus JA, Bekelman DB. Does heart failure-specific health status identify patients with bothersome symptoms, depression, anxiety, and/or poorer spiritual well-being? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 5:233-241. [PMID: 30649237 DOI: 10.1093/ehjqcco/qcy061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/03/2018] [Accepted: 12/29/2018] [Indexed: 01/06/2023]
Abstract
AIMS Patients with heart failure often have under-recognized symptoms, depression, anxiety, and poorer spiritual well-being ('QoL domains'). Ideally all patients should have heart failure-specific health status and quality of life (QoL) domains routinely evaluated; however, lack of time and resources are limiting in most clinical settings. Therefore, we aimed to evaluate whether heart failure-specific health status was associated with QoL domains and to identify a score warranting further evaluation of QoL domain deficits. METHODS AND RESULTS Participants (N = 314) enrolled in the Collaborative Care to Alleviate Symptoms and Adjust to Illness trial completed measures of heart failure-specific health status [Kansas City Cardiomyopathy Questionnaire, KCCQ (score 0-100, 0 = worst health status)], additional symptoms (Memorial Symptom Assessment Scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and spiritual well-being (Facit-Sp) at baseline. Mean ± standard deviation (SD) KCCQ score was 46.9 ± 19.3, mean age was 65.5 ± 11.4, and 79% were male. Prevalence of QoL domain deficits ranged from 11% (nausea) to 47% (depression). Sensitivity/specificity of KCCQ for each QoL domain ranged from 20-40%/80-96% for KCCQ ≤ 25, 61-84%/48-62% for KCCQ ≤ 50, 84-97%/26-40% for KCCQ ≤ 60, and 96-100%/8-13% for KCCQ ≤ 75. Patients with KCCQ ≤ 60 had mean ± SD 4.5 ± 2.5 QoL domain deficits (maximum 12), vs. 1.6 ± 1.6 for KCCQ > 60 (P < 0.001). Similar results were seen for KCCQ ≤25 (6.6 ± 2.4 vs. 3.3 ± 2.4), KCCQ ≤ 50 (4.8 ± 2.6 vs. 2.5 ± 2) and KCCQ ≤ 75 (4.0 ± 2.6 vs. 1.0 ± 1.2) (all P < 00001). CONCLUSION KCCQ ≤ 60 had good sensitivity for each QoL domain deficit and for patients with at least one QoL domain deficit. Screening for QoL domain deficits should target patients with lower KCCQ scores based on a clinic's KCCQ score distribution and clinical resources for addressing QoL domain deficits.
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Affiliation(s)
- Kelsey M Flint
- Rocky Mountain Regional VA Medical Center, Cardiology, Department of Medicine, 1700 North Wheeling Street, Aurora, CO, USA.,Colorado Cardiovascular Outcomes Research Consortium, 13199 E Montview Blvd, Suite 300, Mail Stop F443, Denver, CO, USA
| | - Diane L Fairclough
- Department of Biostatics and Informatics, Colorado School of Public Health, 13199 E Montview Blvd, Suite 339, Aurora, CO, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO, USA
| | - David B Bekelman
- Colorado Cardiovascular Outcomes Research Consortium, 13199 E Montview Blvd, Suite 300, Mail Stop F443, Denver, CO, USA.,Rocky Mountain Regional VA Medical Center, Palliative Care, Department of Medicine, 1700 North Wheeling Street, Aurora, CO, USA.,Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, 12631 E 17th Ave, Anschutz Medical Campus, Aurora, CO, USA
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Vestergaard AHS, Neergaard MA, Christiansen CF, Nielsen H, Lyngaa T, Laut KG, Johnsen SP. Hospitalisation at the end of life among cancer and non-cancer patients in Denmark: a nationwide register-based cohort study. BMJ Open 2020; 10:e033493. [PMID: 32595146 PMCID: PMC7322325 DOI: 10.1136/bmjopen-2019-033493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES End-of-life hospitalisations may not be associated with improved quality of life. Studies indicate differences in end-of-life care for cancer and non-cancer patients; however, data on hospital utilisation are sparse. This study aimed to compare end-of-life hospitalisation and place of death among patients dying from cancer, heart failure or chronic obstructive pulmonary disease (COPD). DESIGN A nationwide register-based cohort study. SETTING Data on all in-hospital admissions obtained from nationwide Danish medical registries. PARTICIPANTS All decedents dying from cancer, heart failure or COPD disease in Denmark between 2006 and 2015. OUTCOME MEASURES Data on all in-hospital admissions within 6 months and 30 days before death as well as place of death. Comparisons were made according to cause of death while adjusting for age, sex, comorbidity, partner status and residential region. RESULTS Among 154 235 decedents, the median total bed days in hospital within 6 months before death was 19 days for cancer patients, 10 days for patients with heart failure and 11 days for patients with COPD. Within 30 days before death, this was 9 days for cancer patients, and 6 days for patients with heart failure and COPD. Compared with cancer patients, the adjusted relative bed day use was 0.65 (95% CI, 0.63 to 0.68) for heart failure patients and 0.68 (95% CI, 0.66 to 0.69) for patients with COPD within 6 months before death. Correspondingly, this was 0.65 (95% CI, 0.63 to 0.68) and 0.70 (95% CI, 0.68 to 0.71) within 30 days before death.Patients had almost the same risk of dying in hospital independently of death cause (46.2% to 56.0%). CONCLUSION Patients with cancer, heart failure and COPD all spent considerable part of their end of life in hospital. Hospital use was highest among cancer patients; however, absolute differences were small.
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Affiliation(s)
| | | | | | - Henrik Nielsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Lyngaa
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
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Abeywickrama HM, Wimalasiri S, Koyama Y, Uchiyama M, Shimizu U, Kakihara N, Chandrajith R, Nanayakkara N. Quality of Life and Symptom Burden among Chronic Kidney Disease of Uncertain Etiology (CKDu) Patients in Girandurukotte, Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4041. [PMID: 32517110 PMCID: PMC7312904 DOI: 10.3390/ijerph17114041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022]
Abstract
Symptom burden and health-related quality of life (HRQOL) are important predictors of how a disease affects patients' lives, especially for endemic health problems such as chronic kidney disease of uncertain etiology (CKDu). Our study describes symptom burden, HRQOL, and associated demographic and clinical variables in CKDu patients in the Girandurukotte area, Sri Lanka. A cross-sectional study included 120 CKDu patients attending the renal clinic in the endemic area. The instruments applied were the Kidney Disease Quality of Life-Short Form (KDQOL-SFTM) version 1.3 and CKD Symptom Index-Sri Lanka. Socio-demographic, disease-related, and anthropometric variables were also investigated. The mean age of patients was 61.87 (SD 11.31), while 69.2% were male. The mean glomerular filtration rate was 28.17 (SD 14.03) mL/min/1.73 min2, and 70.8% were anemic. Bone/joint pain was the most experienced symptom while the median number of symptoms reported by patients was 5 (IQR 3-7). The mean symptom burden, physical component summary, mental component summary, and kidney-disease-specific component scores were 12.71 (SD 10.45), 68.63 (SD 19.58), 78.53 (SD 18.78), and 81.57 (SD 5.86), respectively. Age was found to be a significant predictor of HRQOL, while hemoglobin level and being a farmer were significant predictors of symptom burden. Our data indicate that CKDu patients in all stages experience at least one symptom affecting all aspects of HRQOL.
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Affiliation(s)
- Hansani Madushika Abeywickrama
- Graduate School of Health Sciences, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746, Asahimachi, Niigata 951-8518, Japan; (M.U.); (U.S.); (N.K.)
| | - Swarna Wimalasiri
- Department of Food Science and Technology, Faculty of Agriculture, University of Peradeniya, Kandy 20400, Sri Lanka;
| | - Yu Koyama
- Graduate School of Health Sciences, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746, Asahimachi, Niigata 951-8518, Japan; (M.U.); (U.S.); (N.K.)
| | - Mieko Uchiyama
- Graduate School of Health Sciences, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746, Asahimachi, Niigata 951-8518, Japan; (M.U.); (U.S.); (N.K.)
| | - Utako Shimizu
- Graduate School of Health Sciences, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746, Asahimachi, Niigata 951-8518, Japan; (M.U.); (U.S.); (N.K.)
| | - Nahoko Kakihara
- Graduate School of Health Sciences, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746, Asahimachi, Niigata 951-8518, Japan; (M.U.); (U.S.); (N.K.)
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy 20400, Sri Lanka;
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Benítez-Rosario MA, Ascanio-León B. Palliative sedation: beliefs and decision-making among Spanish palliative care physicians. Support Care Cancer 2020; 28:2651-2658. [PMID: 31637516 DOI: 10.1007/s00520-019-05086-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe physician attitudes to deep palliative sedation. METHODS A nationwide e-survey of Spanish palliative care specialists was performed using vignettes which described patients close to death with intractable symptoms. Sedation levels were defined according to the Richmond Agitation-Sedation Scale. Multivariate analyses were performed to assess the explanatory factors involved in decision-making. RESULTS Responses of 292 palliative care specialists were analyzed (response rate 40%). Ninety-four percent, 87%, and 81% of the respondents supported the use of palliative sedation in cases of irreversible refractory symptoms as hyperactive delirium and dyspnea at rest secondary to lung cancer and GOLD stage IV COPD; 60% agreed with the use of palliative sedation in cases of existential suffering. Logistic regression analysis found as the explanatory factor in not performing palliative sedation the physicians' belief that sedation therapy constitutes undercover euthanasia (OR = 12, p < 0.01). Around 80% of physicians who decided on palliative sedation chose deep/complete sedation for every vignette; there were no common explanatory factors for decision-making for every vignette. The belief that sedation therapy equates to undercover euthanasia justifies not performing deep sedation in cases of irreversible refractory agitated delirium (OR = 7) and irreversible intractable dyspnea (OR = 6). Physician background in palliative care and sedation were associated with the selection of deep/complete sedation in cases of refractory delirium and cancer-associated dyspnea. CONCLUSIONS Spanish palliative physicians generally agree with the use of deep sedation as a proportionate treatment in dying patients with refractory symptoms. Decision-making is associated with physician beliefs regarding euthanasia and with the physician's background in palliative care and sedation.
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Affiliation(s)
- Miguel Angel Benítez-Rosario
- Palliative Care Unit, La Candelaria Hospital, Canary Health Service, Facultad de Medicina, Universidad de La Laguna, Crtra del Rosario 145, 38010, Santa Cruz de Tenerife, Spain.
| | - Belén Ascanio-León
- Palliative Care Unit, La Candelaria Hospital, Canary Health Service, Facultad de Medicina, Universidad de La Laguna, Crtra del Rosario 145, 38010, Santa Cruz de Tenerife, Spain
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Nzwalo I, Aboim MA, Joaquim N, Marreiros A, Nzwalo H. Systematic Review of the Prevalence, Predictors, and Treatment of Insomnia in Palliative Care. Am J Hosp Palliat Care 2020; 37:957-969. [DOI: 10.1177/1049909120907021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction:The primary function of palliative care is to improve quality of life. The recognition and treatment of symptoms causing suffering is central to the achievement of this goal. Insomnia reduces quality of life of patients under palliative care. Knowledge about prevalence, associated factors, and treatment of insomnia in palliative care is scarce.Methodology:Literature review about the prevalence, predictors, and treatment options of insomnia in palliative care patients. Primary sources of investigation were identified and selected through Pubmed and Scopus databases. The research was complemented by reference search in identified articles and selected reviews. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale.Results:A total of 65 studies were included in the review. Most studies had acceptable /good quality. The prevalence of insomnia in the included studies ranged from 2.1% to 100%, with a median overall prevalence of 49.5%. Sociodemographic factors such as age; clinical characteristics such as functional status, disease stage, pain, and use of specific drugs, including opioids; psychological factors such as anxiety/depression; and spiritual factors such as feelings of well-being were identified as predictors. The treatment options identified were biological (pharmacological and nonpharmacological), psychological (visualization, relaxation), and spiritual (prayer).Conclusions:The systematic review showed that the prevalence of insomnia is high, with at least one in 3 patients affected in most studies. Insomnia’s risk factors and treatment in palliative care are both associated to physical, psychological, social, and spiritual factors, reflecting its true holistic nature.
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Affiliation(s)
- Isa Nzwalo
- Institute for Health Sciences, Catholic University of Portugal, Lisbon, Portugal
- Unidade de Cuidados de Saúde Personalizados Mar, Tavira, Portugal
| | | | - Natércia Joaquim
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Algarve, Portugal
- Algarve Biomedical Center, Algarve, Portugal
| | - Ana Marreiros
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Algarve, Portugal
- Algarve Biomedical Center, Algarve, Portugal
| | - Hipólito Nzwalo
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Algarve, Portugal
- Algarve Biomedical Center, Algarve, Portugal
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Kenny C, Regan J, Balding L, Higgins S, O'Leary N, Kelleher F, McDermott R, Armstrong J, Mihai A, Tiernan E, Westrup J, Thirion P, Walsh D. Dysphagia Prevalence and Predictors in Cancers Outside the Head, Neck, and Upper Gastrointestinal Tract. J Pain Symptom Manage 2019; 58:949-958.e2. [PMID: 31445137 DOI: 10.1016/j.jpainsymman.2019.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 01/14/2023]
Abstract
CONTEXT Dysphagia is usually associated with malignancies of the head, neck, and upper gastrointestinal tract but also occurs in those with tumors outside anatomic swallow regions. It can lead to aspiration pneumonia, malnutrition, reduced quality of life, and psychosocial distress. No studies have yet reliably described dysphagia prevalence in those with malignancies outside anatomic swallow regions. OBJECTIVE The objective of this study was to establish the prevalence and predictors of dysphagia in adults with solid malignancies outside the head, neck, and upper gastrointestinal tract. METHODS A cross-sectional, observational study using consecutive sampling was conducted. There were 385 participants (mean age 66 ± 12 years) with 21 different primary cancer sites from two acute hospitals and one hospice. Locoregional disease was present in 33%, metastatic in 67%. Dysphagia was screened by empirical questionnaire and confirmed through swallow evaluation. Demographic and clinical predictors were determined by univariate and multivariate binary regression. RESULTS Dysphagia occurred in 19% of those with malignancies outside anatomic swallow regions. Prevalence was 30% in palliative care and 32% in hospice care. Dysphagia was most strongly associated with cough, nausea, and worse performance status. It was also associated with lower quality of life and nutritional difficulties. CONCLUSION Dysphagia was common and usually undiagnosed before study participation. It occurred at all disease stages but coincided with functional decline. It may therefore represent a cancer frailty marker. Oncology and palliative care services should routinely screen for this symptom. Timely dysphagia identification and management may improve patient well-being and prevent adverse effects like aspiration pneumonia and weight loss.
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Affiliation(s)
- Ciarán Kenny
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland; Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland.
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Lucy Balding
- Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Stephen Higgins
- Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Norma O'Leary
- Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
| | | | - Ray McDermott
- Tallaght University Hospital, Dublin, Ireland; Beacon Hospital, Dublin, Ireland
| | | | | | | | | | | | - Declan Walsh
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland; Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
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Abstract
OBJECTIVE Demoralization is prevalent in patients with life-limiting chronic illnesses, many of whom reside in rural areas. These patients also have an increased risk of disease-related psychosocial burden due to the unique health barriers in this population. However, the factors affecting demoralization in this cohort are currently unknown. This study aimed to examine demoralization amongst the chronically ill in Lithgow, a town in rural New South Wales, Australia, and identify any correlated demographic, physical, and psychosocial factors in this population. METHOD A cross-sectional survey of 73 participants drawn from Lithgow Hospital, the adjoining retirement village and nursing home, assessing correlating demographic, physical, psychiatric, and psychosocial factors. RESULTS The total mean score of the DS-II was 7.8 (SD 26.4), and high demoralization scores were associated with the level of education (p = 0.01), comorbid condition (p = 0.04), severity of symptom burden (p = <0.001), depression (p = <0.001), and psychological distress (p = <0.001). Prevalence of serious demoralization in this population was 27.4% according to a cutoff of a DS-II score ≥11. Of those, 11 (15%) met the criteria for clinical depression, leaving 9 (12.3%) of the cohort demoralized but not depressed. SIGNIFICANCE OF RESULTS Prevalence of demoralization was high in this population. In line with the existing literature, demoralization was associated with the level of education, symptom burden, and psychological distress, demonstrating that demoralization is a relevant psychometric factor in rural populations. Further stratification of the unique biopsychosocial factors at play in this population would contribute to better understanding the burdens experienced by people with chronic illness in this population and the nature of demoralization.
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Adeboye OO. Nonpain Symptom Management. Prim Care 2019; 46:335-351. [PMID: 31375185 DOI: 10.1016/j.pop.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The burden of nonpain symptoms such as anorexia, constipation, nausea, and vomiting contribute to patient suffering throughout the course of advanced illness. It is important to address symptom control throughout the disease trajectory, and especially at the end of life. Primary care clinicians must recognize these symptoms early, provide ongoing assessment, and keep abreast of evidence-based management strategies, including valid clinical protocols.
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Affiliation(s)
- Olumuyiwa O Adeboye
- Palliative Care, Ascension Wisconsin, Ascension St. Elizabeth Hospital Campus, 1611 South Madison Street, Office 1A005, Appleton, WI 54915, USA.
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Abstract
Advanced chronic obstructive pulmonary disease (COPD), is characterized by high morbidity and mortality. Patients with COPD and their families experience a range of stresses and suffering from a variety of sources throughout the disease's progression. COPD is the fourth leading cause of death in the world. It exists as a significant contributor to global morbidity and mortality, and it results in substantial economic and social burden. This review provides some key facts regarding disease burden and encourages clinician to familiarize themselves and use both conventional and palliative approach early in the disease progression for a better quality of life.
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Heyland DK, Groll D, Rocker G, Dodek P, Gafni A, Tranmer J, Pichora D, Lazar N, Kutsogiannis J, Shortt S, Lam M. End-of-Life Care in Acute Care Hospitals in Canada: A Quality Finish? J Palliat Care 2019. [DOI: 10.1177/082585970502100306] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Understanding patients’ and family members’ perspectives on the relative importance of elements of end-of-life (EOL) care and their satisfaction with those elements will help prioritize quality improvement initiatives. We administered a face-to-face questionnaire containing a selection of 28 elements of care to eligible in patients with advanced lung, heart, or liver disease, or metastatic cancer, and available family caregivers (FCGs) in five tertiary care hospitals across Canada. 440 of 569 (78%) eligible patients and 160 of 176 (91%) FCGs participated. No respondent reported complete satisfaction with all elements of care. The average satisfaction score was 4.6 on a 26 point scale. Medical patients reported lower levels of satisfaction than cancer patients. Elements rated as “extremely important” and anything other than “completely satisfied” most frequently by respondents related to discharge planning, availability of home health services, symptom relief, not being a burden, physician trust, and communication. In conclusion, most patients and their family members in our survey were not completely satisfied with EOL care. Improvement initiatives to target key elements identified by patients and FCGs have the potential to improve satisfaction with EOL care across care settings.
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Affiliation(s)
- Daren K. Heyland
- Department of Medicine, Kingston General Hospital, and Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario
| | - Dianne Groll
- Department of Medicine, Kingston General Hospital, Kingston, Ontario
| | - Graeme Rocker
- Department of Medicine, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia
| | - Peter Dodek
- Program in Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia
| | - Amiram Gafni
- Center for Health Economics and Policy Analysis, and Department of Clinical Epidemiology, McMaster University, Hamilton, Ontario
| | - Joan Tranmer
- Department of Community Health and Epidemiology, Queen's University, and Department of Nursing, Kingston General Hospital, Kingston, Ontario
| | - Deb Pichora
- Department of Medicine, Kingston General Hospital, Kingston, Ontario
| | - Neil Lazar
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario
| | - Jim Kutsogiannis
- Department of Critical Care, University of Alberta, Edmonton, Alberta
| | - Sam Shortt
- Department of Community Health and Epidemiology, Queen's University, and Center for Health Services and Policy Research, Queen's University, Kingston, Ontario
| | - Miu Lam
- Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada, for the Canadian Researchers at the End of Life Network (CARENET)*
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Lira AL, de Freitas TC, Martins T, Guimarães D, Silva MR, Drumond C, Guimarães RM. Global and Multidimensional Symptom Assessments in Patients Presenting Abdominal Neoplasms. AQUICHAN 2019. [DOI: 10.5294/aqui.2019.19.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: To evaluate symptoms among patients with abdominal cancer and associated factors. Materials and methods: A cross-sectional study with 100 patients. The prevalence of symptoms was evaluated through the Memorial Symptom Assessment Scale (MSAS) and its association with demographic and clinical variables using chi-square and ANOVA tests. Results: The most prevalent symptoms were weight loss (64.0 %), pain (56.0 %), dry mouth (50.0 %), “I do not look more myself” (48.0 %) and lack of energy (45.0 %). There was a significant difference between sex and high-frequency (PHYS-H) (p = 0.001) and low-frequency (PHYS-L) physical symptoms (p = 0.004), and for general scale (TMSAS) (p = 0.002); (p = 0.001), general range (p = 0.027) and borderline significance for the global scale (GDI) (p = 0.051); high-frequency physical symptoms (p = 0.022), low-frequency physical symptoms (p = 0.034) and the overall scale (p = 0.034). There was one major complaint regarding the severity of high-frequency physical symptoms in patients with liver cancer (p = 0.018). Conclusion: Symptoms of physical and psychological aspects in cancer patients were associated with gender, race, marital status and tumor location. There is a need for tools to assess symptoms and enable health professionals to intervene more effectively.
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Affiliation(s)
- Ana Lucia Lira
- Instituto Nacional de Câncer José Alencar Gomes da Silva
| | | | - Thais Martins
- Instituto Nacional de Câncer José Alencar Gomes da Silva
| | | | | | - Camila Drumond
- Instituto Nacional de Câncer José Alencar Gomes da Silva
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Smith TA, Ingham JM, Jenkins CR. Respiratory Failure, Noninvasive Ventilation, and Symptom Burden: An Observational Study. J Pain Symptom Manage 2019; 57:282-289.e1. [PMID: 30389607 DOI: 10.1016/j.jpainsymman.2018.10.505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Noninvasive ventilation (NIV) is commonly used to manage acute respiratory failure due to decompensated cardiorespiratory disease. We describe symptom burden in this population. MEASURES Fifty consecutive, consenting, English-speaking, cognitively intact patients, admitted to wards other than the intensive care unit in a tertiary teaching hospital and treated with NIV for hypercapnic respiratory failure, were recruited. The 14-item Condensed Memorial Symptom Assessment Scale was used to assess physical and psychological symptoms within 36 hours of commencing NIV. Breathlessness (using Borg score), pain location and intensity using a numerical rating scale, and four symptoms potentially prevalent in patients undergoing NIV (cough, sputum, gastric bloating, and dry eyes) were also assessed. OUTCOMES Patients reported a median of 10 symptoms (IQR 9-13). A median of five symptoms (IQR 3-7) were rated as severe. Breathlessness was the most prevalent and most distressing symptom, with participants reporting a mean maximum Borg score of 7.55 over the 24 hours before admission. Dry mouth, lack of energy, cough, sputum, difficulty sleeping, and psychological symptoms were prevalent. Pain, when reported, was of moderate intensity and contributed to distress. CONCLUSIONS/LESSONS LEARNED This study describes the patient-reported symptoms occurring during an episode of acute respiratory failure. Understanding the symptom profile of patients in this setting may allow clinicians to target symptom relief while simultaneously managing respiratory failure, enhancing care.
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Affiliation(s)
- Tracy A Smith
- UNSW Sydney, Faculty of Medicine, St Vincent's Clinical School, Sydney, Australia; Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, Australia.
| | - Jane M Ingham
- UNSW Sydney, Faculty of Medicine, St Vincent's Clinical School, Sydney, Australia; St Vincent's Health Network, Sydney, Australia
| | - Christine R Jenkins
- Concord Hospital, Thoracic Medicine, Sydney, Australia; The George Institute, Sydney, Australia
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Tofthagen C, Visovsky C, Dominic S, McMillan S. Neuropathic symptoms, physical and emotional well-being, and quality of life at the end of life. Support Care Cancer 2019; 27:3357-3364. [PMID: 30623244 DOI: 10.1007/s00520-018-4627-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/27/2018] [Indexed: 01/09/2023]
Abstract
The purpose of this cross-sectional, descriptive study was to assess differences in neuropathic symptoms, physical and emotional well-being, and quality of life in cancer patients at the end of life compared to those without neuropathic symptoms. Neuropathic symptoms were defined as numbness and tingling in the hands and/or feet. A secondary analysis of data from two hospices in Central Florida was performed. Adults (n = 717) with a cancer diagnosis, an identified family caregiver, and who were receiving hospice services, were eligible. The prevalence of numbness/tingling in the hands or feet was 40% in this sample of hospice patients with cancer. Participants with neuropathic symptoms of numbness/tingling had a significantly higher prevalence of pain (76.7% vs. 67.0%; p = .006), difficulty with urination (29.4% vs. 20.3%; p = .007), shortness of breath (64.9% vs. 54.1%; p = .005), dizziness/lightheadedness (46.0% vs. 28.2%; p < .001), sweats (35.5% vs. 20.3%; p < .001), worrying (50.7% vs. 37.3%; p = .001), feeling irritable (38.5% vs. 28.7%; p = .008), feeling sad (48.2% vs. 37.8%; p = .008), and difficulty concentrating (46.2% vs. 32.5%; p < .001). They also reported significantly higher overall symptom intensity and symptom distress scores (p = < .001), higher pain severity (p = .001) and pain distress (p = .002), and decreased quality of life (p = .002) compared to those without numbness/tingling. Neuropathic symptoms are emotionally distressing at the end of life and associated with higher symptom burden and diminished quality of life.
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Affiliation(s)
- Cindy Tofthagen
- Mayo Clinic Florida, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA.
| | - Constance Visovsky
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL, 33612, USA
| | - Sara Dominic
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL, 33612, USA
| | - Susan McMillan
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL, 33612, USA
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Ansari AA, Pomerantz DH, Jayes RL, Aguirre EA, Havyer RD. Promoting Primary Palliative Care in Severe Chronic Obstructive Pulmonary Disease: Symptom Management and Preparedness Planning. J Palliat Care 2018; 34:85-91. [PMID: 30587083 DOI: 10.1177/0825859718819437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) poses challenges not only in symptom management but also in prognostication. Managing COPD requires clinicians to be proficient in the primary palliative care skills of symptom management and communication focused on eliciting goals and preferences. Dyspnea should initially be managed with the combination of long-acting muscarinic antagonists and long-acting β-agonist inhalers, adding inhaled corticosteroids if symptoms persist. Opioids for the relief of dyspnea are safe when used at appropriate doses. Oxygen is only effective for relieving dyspnea in patients with severe hypoxemia. The relapsing-remitting nature of COPD makes prognostication challenging; however, there are tools to guide clinicians and patients in making plans both with respect to prognosis and symptom burden. Preparedness planning techniques promote detailed culturally appropriate conversations which allow patients and clinicians to consider disease-specific complications and develop goal-concordant treatment plans.
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Affiliation(s)
- Aziz A Ansari
- 1 Division of Hospital Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Daniel H Pomerantz
- 2 Division of General Internal Medicine and Department of Family Medicine (Palliative Care), Albert Einstein College of Medicine Bronx, New York, NY, USA.,3 Department of Medicine, Montefiore New Rochelle Hospital, New Rochelle, NY, USA
| | - Robert L Jayes
- 4 Division of Geriatrics and Palliative Medicine, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Eric A Aguirre
- 5 Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rachel D Havyer
- 6 Division of Community Internal Medicine and Center for Palliative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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Cantin B, Rothuisen LE, Buclin T, Pereira J, Mazzocato C. Referrals of Cancer versus Non-Cancer Patients to A Palliative Care Consult Team: Do They Differ? J Palliat Care 2018. [DOI: 10.1177/082585970902500203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This retrospective study compared 100 consecutive non-cancer (NC) patients referred to a palliative care consult team (PCT) in a Swiss university hospital to 506 cancer (C) patients referred during the same period. The frequencies of reported symptoms were similar in both groups. The main reasons for referral in the NC group were symptom control, global evaluation, and assistance with discharge. Requests for symptom control predominated in the C group. Prior to the first visit, 50% of NC patients were on opioids, compared to 58% of C patients. After the first visit, the proportion of NC patients on opioids increased to 64% and the proportion of C patients to 73%. The median daily oral morphine equivalent dose for NC patients taking opioids prior to the first PCT visit was higher than that for C patients (60 mg versus 45 mg). At the time of death or discharge, the percentage of NC patients on opioids was 64%, while that of C patients was 76%. Moreover, NC patients were on significantly lower median doses of opioids than C patients (31 mg versus 60 mg). Over half the NC patients died during hospitalization, as compared to 33% of C patients. Only 6% of NC patients were discharged to palliative care units, as compared to 22% of C patients.
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Affiliation(s)
- Boris Cantin
- Palliative Care Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Laura E. Rothuisen
- Clinical Pharmacology Division, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Thierry Buclin
- Clinical Pharmacology Division, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - José Pereira
- Department of Medicine, University of Ottawa, Division of Palliative Medicine, Bruyère Continuing Care, and Division of Palliative Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Claudia Mazzocato
- Palliative Care Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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Pain in patients with newly diagnosed or relapsed acute leukemia. Support Care Cancer 2018; 27:2789-2797. [PMID: 30535882 DOI: 10.1007/s00520-018-4583-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Acute leukemia (AL) is associated with substantial morbidity and mortality. We assessed the prevalence and correlates of pain in patients with newly diagnosed or relapsed AL. METHODS Patients with newly diagnosed or relapsed AL admitted to a comprehensive cancer center completed the Memorial Symptom Assessment Scale (MSAS), which assesses prevalence, severity, and distress associated with pain and other symptoms. Factors associated with severe pain were assessed using logistic regression. Two raters completed chart reviews in duplicate for patients with severe pain (MSAS severity ≥ 3/4) to determine the site of pain. RESULTS Three hundred eighteen patients were recruited from January 2008 to October 2013: 245 (77.0%) had acute myeloid or acute promyelocytic leukemia (AML/APL) and 73 (23.0%) had acute lymphoblastic leukemia (ALL); 289 (90.9%) were newly diagnosed and 29 (9.1%) had relapsed disease. Pain was reported in 156/318 (49.2%), of whom 55/156 (35.3%) reported severe pain (≥ 3/4). Pain was associated with all psychological symptoms (all p < 0.005) and some physical symptoms. Severe pain was associated with younger age (p = 0.02), worse performance status (p = 0.04), ALL diagnosis (p = 0.04), and time from onset of chemotherapy (p = 0.03), with pain peaking at 4 weeks after chemotherapy initiation. The most common sites of severe pain were oropharynx (22; 40%), head (12; 21.8%), and abdomen (11; 20%). Only 3 patients (0.9%) were referred to the symptom control/palliative care team during the month prior to or following assessment. CONCLUSIONS Pain is frequent, distressing, and predictable in patients undergoing induction chemotherapy for AL. Further research is needed to assess the efficacy of early supportive care in this population.
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Zhu R, Liu Z, Jiao R, Zhang C, Yu Q, Han S, Duan Z. Updates on the pathogenesis of advanced lung cancer-induced cachexia. Thorac Cancer 2018; 10:8-16. [PMID: 30461213 PMCID: PMC6312840 DOI: 10.1111/1759-7714.12910] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022] Open
Abstract
Advanced lung cancer is becoming a chronic disease threatening human life and health. Cachexia has been recognized as the most common problem associated with advanced lung cancer. Lung cancer‐induced cachexia seriously affects patients’ quality of life. The present article summarizes the pathogenesis of advanced lung cancer‐induced cachexia from three aspects: anorexia, cytokines, and energy and metabolic abnormalities. In addition, the present article proposes corresponding nursing measures based on cachexia pathogenesis to improve the quality of life and survival rate of cachectic patients with advanced lung cancer by combining continuously advancing treatment regimens and effective nursing. The present article also provides references for healthcare professionals when administering related treatments and nursing care.
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Affiliation(s)
- Ruifang Zhu
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Zhihong Liu
- Department of Respiratory and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ran Jiao
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Chichen Zhang
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Qi Yu
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Shifan Han
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Zhiguang Duan
- School of Nursing, Shanxi Medical University, Taiyuan, China
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Hansen L, Dieckmann NF, Kolbeck KJ, Naugler WE, Chang MF. Symptom Distress in Patients With Hepatocellular Carcinoma Toward the End of Life. Oncol Nurs Forum 2018; 44:665-673. [PMID: 29052660 DOI: 10.1188/17.onf.665-673] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe the presence, frequency, severity, and distress of symptoms in outpatients with advanced hepatocellular carcinoma toward the end of life, and the variability in psychological and physical symptom distress between and within patients over time.
. DESIGN A prospective, longitudinal, descriptive design.
. SETTING Outpatient clinics at two healthcare institutions.
. SAMPLE 18 patients (15 men and 3 women) with hepatocellular carcinoma and a mean age of 63.3 years (range = 54-81 years).
. METHODS Data were collected monthly for six months. Patients completed the Memorial Symptom Assessment Scale, which reports a total score, and three subscales that provide global distress, psychological distress, and physical distress scores.
. MAIN RESEARCH VARIABLES Global, psychological, and physical distress.
. FINDINGS Patients reported lack of energy and pain as the most frequent and distressing symptoms. Problems with sexual interest or activity was the fourth most present symptom after drowsiness. Global Distress Index mean scores had notable variability between and within patients over time. During data collection, six patients died. None were referred to palliative care.
. CONCLUSIONS Gaining knowledge about symptom distress and prevalent symptoms experienced by patients with advanced hepatocellular carcinoma is critical for designing symptom management strategies that are comprehensive and tailored to patients to optimize their quality of life as they approach death.
. IMPLICATIONS FOR NURSING Nurses play a vital role in advocating for, initiating, and providing comprehensive holistic care based on individual patient needs by facilitating discussions about apparent and less apparent distressing symptoms, including those related to sexuality.
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Wang CH, Huang PW, Hung CY, Lee SH, Kao CY, Wang HM, Hung YS, Su PJ, Kuo YC, Hsieh CH, Chou WC. Clinical Factors Associated With Adherence to the Premedication Protocol for Withdrawal of Mechanical Ventilation in Terminally Ill Patients: A 4-Year Experience at a Single Medical Center in Asia. Am J Hosp Palliat Care 2018; 35:772-779. [DOI: 10.1177/1049909117732282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chao-Hui Wang
- Department of Nursing, Chang Gung Medical Foundation at Linkou, Guishan, Taoyuan, Taiwan
| | - Pei-Wei Huang
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan
| | - Chia-Yen Hung
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan
- Department of Hema-Oncology, Division of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-Hui Lee
- Department of Nursing, Chang Gung Medical Foundation at Linkou, Guishan, Taoyuan, Taiwan
| | - Chen-Yi Kao
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan
| | - Yu-Shin Hung
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan
| | - Po-Jung Su
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan
| | - Yung-Chia Kuo
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan
| | - Chia-Hsun Hsieh
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Guishan, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan
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Okamoto Y, Morita T, Tsuneto S, Aoyama M, Kizawa Y, Shima Y, Miyashita M. Bereaved Family Members' Perceptions of the Distressing Symptoms of Terminal Patients With Cancer. Am J Hosp Palliat Care 2018; 35:972-977. [PMID: 29609469 DOI: 10.1177/1049909118765409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Few data are available on bereaved family members' perspective on the frequency of symptoms and degree of distress among terminal patients with cancer. METHODS We sent a questionnaire to 1472 bereaved family members of terminal patients with cancer in 20 general hospitals. The questionnaire asked them (1) to indicate which symptoms the patients had, (2) to rate on a 4-point scale the extent to which the symptom was distressing, as follows: 1 = not distressing, 2 = slightly distressing, 3 = quite distressing, and 4 = very distressing at the point of 2 weeks before the patient had died. RESULTS We analyzed 805 questionnaires for this study. Anorexia was the commonest symptom among terminal patients with cancer experienced by bereaved family members, followed by somnolence, weight loss, fatigue, and pain. Anorexia was the most distressing symptom among terminal patients with cancer experienced by bereaved family members, followed by weight loss, pain, edema, and dyspnea. CONCLUSIONS Anorexia and weight loss were frequent symptoms and bereaved family members felt very distressing. Furthermore, there are not means of effective treatment now. Thus, we think that further study in this field is necessary.
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Affiliation(s)
- Yoshiaki Okamoto
- 1 Department of Hospital Pharmacy Education, Osaka University, Osaka, Japan
| | - Tatsuya Morita
- 2 Pallaitive and Supportive Care devision, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Satoru Tsuneto
- 3 Department of Palliative Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Maho Aoyama
- 4 Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Kizawa
- 5 Department of Palliative Medicine, Kobe University School of Medicine, Ibaraki, Japan
| | - Yasuo Shima
- 6 Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Mitsunori Miyashita
- 4 Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Kenny C, Gilheaney Ó, Walsh D, Regan J. Oropharyngeal Dysphagia Evaluation Tools in Adults with Solid Malignancies Outside the Head and Neck and Upper GI Tract: A Systematic Review. Dysphagia 2018; 33:303-320. [PMID: 29607447 DOI: 10.1007/s00455-018-9892-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/28/2018] [Indexed: 12/14/2022]
Abstract
Dysphagia is often associated with head and neck and upper gastrointestinal (GI) tract cancers. Evidence suggests that those with solid malignancies in other primary sites may also have swallowing difficulties. Timely and accurate identification of dysphagia is important given the impact it has on hydration, medical treatment, nutrition, prognosis, and quality of life. A systematic review was conducted to identify swallow screening, evaluation, and quality of life tools for those with solid malignancies outside the head and neck and upper GI tract. Ten electronic databases, one journal and two published conference proceedings were searched. Following deduplication, 7435 studies were examined for relevance. No tools were validated solely in this cancer population, though some included this group in larger cohorts. Comments are provided on the diagnostic properties and applicability of these tools. In the absence of appropriate diagnostic instruments, the exact prevalence of dysphagia and its impact on clinical and psychosocial well-being remain unknown. Accurate and adequate measurement of therapeutic intervention is also compromised. This review establishes the need for validated dysphagia evaluation tools for this clinical population.
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Affiliation(s)
- Ciarán Kenny
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Harold's Cross, Dublin 6W, Ireland.
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland.
| | - Órla Gilheaney
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin 2, Ireland
| | - Declan Walsh
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Harold's Cross, Dublin 6W, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- School of Medicine & Medical Science, University College Dublin, Dublin 4, Ireland
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin 2, Ireland
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Omran S, Mcmillan S. Symptom Severity, Anxiety, Depression, Self- Efficacy and
Quality of Life in Patients with Cancer. Asian Pac J Cancer Prev 2018; 19:365-374. [PMID: 29479979 PMCID: PMC5980921 DOI: 10.22034/apjcp.2018.19.2.365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Despite advances in cancer disease prevention, diagnosis, and treatment patients with cancer suffer from a variety of sometimes severe physical and psychological symptoms regardless of the stage of the disease. The aim is to determine the relationship of antecedent factors and mediating variables to the quality of life (QOL) of patients with cancer. Materials and Methods: The study included 341 patients with cancer and symptoms. Data collection used the Cancer Symptom Scale, State-Trait Anxiety Inventory, Centers for Epidemiologic Study-Depression, Cancer Behavior Inventory, Multidimensional Quality of Life Index, and a Demographic Form. Results: A multiple regression equation containing all the variables explained 68% of the variance in QOL. Overall four variables accounted for the majority of the total variance: anxiety, depression, self-efficacy, and symptom severity. Three of these variables were mediating variables. Of the antecedent factors symptom severity had a significant indirect effect on QOL through the mediating variables. Symptom severity also had direct effect on QOL. Conclusion: Data indicate that anxiety, depression, and self-efficacy play major roles in determining the perception of QOL of cancer patients. These mediating variables either buffered or enhanced the impact of the antecedent factors of symptom severity on QOL. Nursing interventions should focus on enhancing self-efficacy. Nurses can use health promoting programs to assist patients who are physically impaired. Further research should be aimed at identifying other influential variables, with the ultimate goal of developing interventions to aid patients in their efforts to maintain their QOL while living with cancer.
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Affiliation(s)
- Suha Omran
- Adult Health Department, Faculty of Nursing, Jordan University of Science and Technology, Jordan.
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Dhingra L, Barrett M, Knotkova H, Chen J, Riggs A, Lee B, Hiney B, McCarthy M, Portenoy R. Symptom Distress Among Diverse Patients Referred for Community-Based Palliative Care: Sociodemographic and Medical Correlates. J Pain Symptom Manage 2018; 55:290-296. [PMID: 28844624 DOI: 10.1016/j.jpainsymman.2017.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/21/2017] [Accepted: 08/17/2017] [Indexed: 11/29/2022]
Abstract
CONTEXT Community-based palliative care programs are appearing in the U.S. Many of these programs, particularly those in large cities, serve highly diverse populations. Information about the sources of variation in the conditions that drive illness burden, like symptom distress, may be useful in program planning. OBJECTIVES To characterize variation in symptom distress among highly diverse patients referred for palliative care in an urban setting. METHODS This is a retrospective cross-sectional survey of data obtained from patients at the time of enrollment in a community-based palliative care program. Symptom distress was measured using the Condensed Memorial Symptom Assessment Scale. Severe distress was defined as reporting either "quite a bit"/"very much" or "frequently"/"almost constantly" for one or more symptoms. Multivariate analysis evaluated the associations between symptom distress and sources of patient variability. RESULTS Patients (n = 1532) were aged 72.2 years on average; 60.0% were women, 56.4% were African-American or Hispanic, and 30.8% were non-English speaking. Most had cancer or congestive heart failure (68.6%); 90.2% had a Karnofsky Performance Status score of 40-70. The most prevalent symptoms were fatigue (71.8%), pain (47.3%), and sadness (41.6%); the most distressing symptoms were fatigue (58.5%), worrying (54.8%), and weight loss (52.1%). In multivariate analyses, Caucasian race, non-Asian language, low Karnofsky Performance Status scores, and cancer diagnosis predicted severe symptom distress. CONCLUSION In a diverse urban population receiving community-based palliative care, symptoms were highly prevalent and distressing, and both sociodemographic and medical factors predicted severe distress. Program planning should consider the needs of subpopulations at risk for high symptom burden.
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Affiliation(s)
- Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Malcolm Barrett
- University of Southern California, Los Angeles, California, USA
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jack Chen
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
| | - Alexa Riggs
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
| | - Bernard Lee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA; MJHS Hospice and Palliative Care, New York, New York, USA
| | - Barbara Hiney
- MJHS Hospice and Palliative Care, New York, New York, USA
| | - Maureen McCarthy
- The Center for Hospice & Palliative Care, New York, New York, USA
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
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Omran S, Khader Y, McMillan S. Symptom Clusters and Quality of Life in Hospice Patients with Cancer. Asian Pac J Cancer Prev 2017; 18:2387-2393. [PMID: 28950683 PMCID: PMC5720641 DOI: 10.22034/apjcp.2017.18.9.2387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Symptom control is an important part of palliative care and important to achieve optimal quality
of life (QOL). Studies have shown that patients with advanced cancer suffer from diverse and often severe physical
and psychological symptoms. The aim is to explore the influence of symptom clusters on QOL among patients with
advanced cancer. Materials and Methods: 709 patients with advanced cancer were recruited to participate in a clinical
trial focusing on symptom management and QOL. Patients were adults newly admitted to hospice home care in one of
two hospices in southwest Florida, who could pass mental status screening. The instruments used for data collection
were the Demographic Data Form, Memorial Symptom Assessment Scale (MSAS), and the Hospice Quality of Life
Index-14. Results: Exploratory factor analysis and multiple regression were used to identify symptom clusters and their
influence on QOL. The results revealed that the participants experienced multiple concurrent symptoms. There were
four symptom clusters found among these cancer patients. Individual symptom distress scores that were the strongest
predictors of QOL were: feeling pain; dry mouth; feeling drowsy; nausea; difficulty swallowing; worrying and feeling
nervous. Conclusions: Patients with advanced cancer reported various concurrent symptoms, and these form symptom
clusters of four main categories. The four symptoms clusters have a negative influence on patients’ QOL and required
specific care from different members of the hospice healthcare team. The results of this study should be used to guide
health care providers’ symptom management. Proper attention to symptom clusters should be the basis for accurate
planning of effective interventions to manage the symptom clusters experienced by advanced cancer patients. The
health care provider needs to plan ahead for these symptoms and manage any concurrent symptoms for successful
promotion of their patient’s QOL.
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Affiliation(s)
- Suha Omran
- Adult Health Department, Faculty of Nursing, Jordan University of Science and Technology, Jordan.
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Senanayake S, Gunawardena N, Palihawadana P, Bandara P, Haniffa R, Karunarathna R, Kumara P. Symptom burden in chronic kidney disease; a population based cross sectional study. BMC Nephrol 2017; 18:228. [PMID: 28693434 PMCID: PMC5504715 DOI: 10.1186/s12882-017-0638-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/26/2017] [Indexed: 11/15/2022] Open
Abstract
Background Physical and psychological symptoms are among main manifestations of Chronic Kidney Disease (CKD). This study aimed to assess the symptom burden and self-perceived severity of symptoms among CKD patients living in a district in Sri Lanka. Method A community based cross-sectional study included a sample of randomly selected 1174 CKD patients from all 19 Medical Officer of Health areas in the district of Anuradhapura. Trained para-medical staff visited the households and administered the locally validated questionnaire to assess the presence and severity of symptoms. The inquiry was on 25 symptoms in a 5 point Likert scale indicating the severity during the previous week. Symptom burden score was constructed by summing each symptom severity score which ranged from 0 to 125. Results A total of 1118 CKD patients participated with a response rate of 95.2%. The mean age was 58.3 (SD 10.8) years and 62.7% were males. A majority were in CKD stage 4 (58.3%). Bone/joint pain was the most experienced symptom (87.6%; 95%CI 85.6–89.5). Loss of libido was the most severe symptom. The median symptom burden score was 35.0 (IQR 20.0–50.0). Multiple linear regression revealed education up to Advanced Level (β −9.176), CKD stage V (β 3.373), being dialyzed (β 20.944), comorbidities (β 4.241) and being employed (β −9.176) to be significant predictors of symptom burden. Conclusions Patients in all stages of CKD experience high symptom burden warranting rigorous measures to relieve symptoms and to improve the well-being of CKD patients. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0638-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Palitha Bandara
- North Central Provincial Directors Office, Anuradhapura, Sri Lanka
| | - Rashan Haniffa
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - R Karunarathna
- North Central Provincial Directors Office, Anuradhapura, Sri Lanka
| | - Priyantha Kumara
- North Central Provincial Directors Office, Anuradhapura, Sri Lanka
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Chan LS, Macdonald ME, Carnevale FA, Cohen SR. 'I'm only dealing with the acute issues': How medical ward 'busyness' constrains care of the dying. Health (London) 2017; 22:451-468. [PMID: 28552003 DOI: 10.1177/1363459317708822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute hospital units are a common location of death. Curative characteristics of the acute medical setting make it difficult to provide adequate palliative care; these characteristics include an orientation to life-prolonging treatment, an emphasis on routine or task-oriented care and a lack of priority on emotional engagement with patients. Indeed, research shows that dying patients in acute medical units often experience unmet needs at the end of life, including uncontrolled symptoms (e.g. pain, breathlessness), inadequate emotional support and poor communication. A focused ethnography was conducted on an acute medical ward in Canada to better understand how this curative/life-prolonging care environment shapes the care of dying patients. Fieldwork was conducted over a period of 10 months and included participant-observation and interviews with patients, family members and staff. On the acute medical ward, a 'logic of care' driven by discourses of limited resources and the demanding medical unit created a context of busyness. Staff experienced an overwhelming workload and felt compelled to create priorities, which reflected taken-for-granted values regarding the importance of curative/life-prolonging care over palliative care. This could be seen through the way staff prioritized life-prolonging practices and rationalized inconsistent and less attentive care for dying patients. These values influenced care of the dying through delaying a palliative approach to care, limiting palliative care to those with cancer and providing highly interventive end-of-life care. Awareness of these taken-for-granted values compels a reflective and critical approach to current practice and how to stimulate change.
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Affiliation(s)
- Lisa S Chan
- McGill University, Canada; Lady Davis Institute for Medical Research, Canada
| | - Mary Ellen Macdonald
- McGill University, Canada; Montreal Children's Hospital and McGill University Health Centre, Canada
| | - Franco A Carnevale
- McGill University, Canada; Montreal Children's Hospital and McGill University Health Centre, Canada
| | - S Robin Cohen
- McGill University, Canada; Lady Davis Institute for Medical Research, Canada
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Yeh CH, Chien LC, Lin WC, Bovbjerg DH, van Londen GJ. Pilot Randomized Controlled Trial of Auricular Point Acupressure to Manage Symptom Clusters of Pain, Fatigue, and Disturbed Sleep in Breast Cancer Patients. Cancer Nurs 2017; 39:402-10. [PMID: 26390073 DOI: 10.1097/ncc.0000000000000303] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Current management for a symptom cluster of pain, fatigue, and disturbed sleep in breast cancer patients has limited effects. OBJECTIVE The purposes of this prospective, randomized controlled pilot study were to (1) assess the feasibility and tolerability of auricular point acupressure (APA) intervention to manage pain, fatigue, and sleep disturbance in breast cancer patients and (2) provide an initial appraisal of effect size as compared with a control intervention. METHODS Thirty-one participants were randomized into either an active APA group (n = 16) or a control APA group (n = 15), which included the sham APA treatment not related to the symptoms. All participants received the APA once a week for 4 weeks. Self-report measures were obtained at baseline, weekly during intervention, at end of intervention, and at a 1-month follow-up. RESULTS For the 4-week of APA treatment, the retention rate was 88% for the active APA group and 73% for the control APA group. After 4 weeks of APA, participants in the active APA treatment had reported a reduction of 71% in pain, 44% in fatigue, 31% in sleep disturbance, and 61% in interference with daily activities. The control APA group experienced some moderate reduction in these symptoms. CONCLUSION Given that this was a pilot study with a small sample size, results must be interpreted with caution. IMPLICATIONS FOR PRACTICE Our results suggest that APA may provide an inexpensive and effective complementary approach for the management of symptom clusters for breast cancer patients, and further study is warranted.
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Affiliation(s)
- Chao Hsing Yeh
- Author Affiliations: School of Nursing, University of Pittsburgh, Pennsylvania (Drs Yeh and Lin); Department of Biostatistics, University of Texas, San Antonio (Dr Chien); Biobehavioral Oncology Program, University of Pittsburgh, Pennsylvania (Dr Bovbjerg); and Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pennsylvania (Dr van Londen)
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Kenne Sarenmalm E, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med 2017; 6:1108-1122. [PMID: 28421677 PMCID: PMC5430085 DOI: 10.1002/cam4.1052] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/03/2017] [Accepted: 02/08/2017] [Indexed: 12/26/2022] Open
Abstract
Many breast cancer survivors have to deal with a variety of psychological and physiological sequelae including impaired immune responses. The primary purpose of this randomized controlled trial was to determine the efficacy of a mindfulness‐based stress reduction (MBSR) intervention for mood disorders in women with breast cancer. Secondary outcomes were symptom experience, health status, coping capacity, mindfulness, posttraumatic growth, and immune status. This RTC assigned 166 women with breast cancer to one of three groups: MBSR (8 weekly group sessions of MBSR), active controls (self‐instructing MBSR) and non‐MBSR. The primary outcome measure was the Hospital Anxiety and Depression Scale. Secondary outcome measures were: Memorial Symptom Assessment Scale, SF‐36, Sense of Coherence, Five Facets of Mindfulness Questionnaire, and Posttraumatic Growth Index. Blood samples were analyzed using flow cytometry for NK‐cell activity (FANKIA) and lymphocyte phenotyping; concentrations of cytokines were determined in sera using commercial high sensitivity IL‐6 and IL‐8 ELISA (enzyme‐linked immunosorbent assay) kits. Results provide evidence for beneficial effects of MBSR on psychological and biological responses. Women in the MBSR group experienced significant improvements in depression scores, with a mean pre‐MBSR HAD‐score of 4.3 and post‐MBSR score of 3.3 (P = 0.001), and compared to non‐MBSR (P = 0.015). Significant improvements on scores for distress, symptom burden, and mental health were also observed. Furthermore, MBSR facilitated coping capacity as well as mindfulness and posttraumatic growth. Significant benefits in immune response within the MBSR group and between groups were observed. MBSR have potential for alleviating depression, symptom experience, and for enhancing coping capacity, mindfulness and posttraumatic growth, which may improve breast cancer survivorship. MBSR also led to beneficial effect on immune function; the clinical implications of this finding merit further research.
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Affiliation(s)
| | - Lena B Mårtensson
- School of Health and Education, University of Skövde; Skövde, Sweden
| | - Bengt A Andersson
- Department of Clinical immunology and transfusion medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Sweden University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Bergh
- School of Health and Education, University of Skövde; Skövde, Sweden
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Tobey M, Manasson J, Decarlo K, Ciraldo-Maryniuk K, Gaeta JM, Wilson E. Homeless Individuals Approaching the End of Life: Symptoms and Attitudes. J Pain Symptom Manage 2017; 53:738-744. [PMID: 28042064 DOI: 10.1016/j.jpainsymman.2016.10.364] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/27/2016] [Accepted: 10/12/2016] [Indexed: 11/17/2022]
Abstract
CONTEXT Over a million individuals in the United States experience homelessness annually and homeless individuals die at a higher rate than domiciled peers. Homeless individuals often have unique experiences at the end of life (EOL). OBJECTIVES This study examined the symptoms experienced by homeless individuals nearing the EOL and explored social background, attitudes, and experiences. METHODS Investigators conducted surveys of homeless individuals approaching the EOL at a medical respite home. Eligibility required a serious medical condition and for the patient's medical provider to answer "no" to the question "Would you be surprised if this patient were not alive in one year?" Interviews explored symptoms using the Memorial Symptom Assessment Survey. Symptoms were compared with those of relevant comparator groups in other studies. RESULTS Participants (n = 20) were young to face the EOL (median age = 58) and suffered high rates of substance use disorders (n = 18; 90%) and psychiatric diagnoses (n = 16; 80%). Symptom frequency was high, especially as regarded pain and psychological symptoms. Previous experience with death among family and peers was universal (n = 20; 100%). Mistrust of others' decisions about the EOL was common, as was concern about receiving too little (n = 11; 55%) or too much (n = 8; 40%) care at the EOL. The frequency of symptoms was higher than in three comparator studies and those studies' subgroups (P < 0.01 for each comparison). CONCLUSION Homeless individuals may experience a high frequency of pain and other symptoms as they approach the EOL. Care for such individuals may require a tailored approach.
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Affiliation(s)
- Matthew Tobey
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, USA.
| | - Julia Manasson
- Division of Rheumatology, New York University Langone Medical Center, New York, USA
| | - Kristen Decarlo
- Division of Rheumatology, New York University Langone Medical Center, New York, USA
| | | | - Jessie M Gaeta
- New York University Langone Medical Center, New York, USA; Department of Family Medicine, Boston University, Boston, USA
| | - Erica Wilson
- Boston Health Care for the Homeless Program, Boston, USA; and Division of Palliative Care, Massachusetts General Hospital, Boston, USA
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Kobewka D, Ronksley P, McIsaac D, Mulpuru S, Forster A. Prevalence of symptoms at the end of life in an acute care hospital: a retrospective cohort study. CMAJ Open 2017; 5:E222-E228. [PMID: 28401138 PMCID: PMC5378541 DOI: 10.9778/cmajo.20160123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is currently debate over the benefits and harms of physician-assisted death. One of the factors influencing this debate is concern about symptoms in the days before death. The objective of this study was to describe the frequency of symptoms before death and determine patient characteristics associated with these symptoms. METHODS We reviewed the medical record of every patient who died at a multisite academic teaching hospital over a 3-month period. We determined the number of episodes of pain, dyspnea, agitation and nausea during the final 48 hours of life and assessed the patient and encounter characteristics associated with 2 or more episodes of symptoms. RESULTS A total of 480 patients died during the study period. Of these patients, 29.2% (140/480) had 2 or more symptoms in the final 48 hours of life. Higher Elixhauser comorbidity scores (relative risk [RR] 1.35, 95% confidence interval [CI] 1.23-1.49), having a family doctor (RR 2.33, 95% CI 1.02-5.38), being admitted to the medical oncology service (RR 1.51, 95% CI 1.11-2.05) and having a documented order for no resuscitation written early during the stay in hospital (RR 1.38, 95% CI 1.01-1.89) were independently associated with symptoms. Admission to intensive care was associated with fewer symptoms (RR 0.39, CI 95% 0.19-0.80). INTERPRETATION Symptoms are common in the final 48 hours of life, particularly in patients with multimorbidity who want limitations on the aggressiveness of their care. An integrated palliative approach is needed for select at-risk patients.
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Affiliation(s)
- Daniel Kobewka
- Department of Medicine (Kobewka, Mulpuru, Forster), Division of General Internal Medicine, The Ottawa Hospital, University of Ottawa; Ottawa Hospital Research Institute (Kobewka, McIsaac, Mulpuru, Forster), Ottawa, Ont.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Department of Anesthesiology and Pain Medicine (McIsaac) - The Ottawa Hospital, University of Ottawa; Performance Measurement (Forster), The Ottawa Hospital, Ottawa, Ont
| | - Paul Ronksley
- Department of Medicine (Kobewka, Mulpuru, Forster), Division of General Internal Medicine, The Ottawa Hospital, University of Ottawa; Ottawa Hospital Research Institute (Kobewka, McIsaac, Mulpuru, Forster), Ottawa, Ont.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Department of Anesthesiology and Pain Medicine (McIsaac) - The Ottawa Hospital, University of Ottawa; Performance Measurement (Forster), The Ottawa Hospital, Ottawa, Ont
| | - Dan McIsaac
- Department of Medicine (Kobewka, Mulpuru, Forster), Division of General Internal Medicine, The Ottawa Hospital, University of Ottawa; Ottawa Hospital Research Institute (Kobewka, McIsaac, Mulpuru, Forster), Ottawa, Ont.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Department of Anesthesiology and Pain Medicine (McIsaac) - The Ottawa Hospital, University of Ottawa; Performance Measurement (Forster), The Ottawa Hospital, Ottawa, Ont
| | - Sunita Mulpuru
- Department of Medicine (Kobewka, Mulpuru, Forster), Division of General Internal Medicine, The Ottawa Hospital, University of Ottawa; Ottawa Hospital Research Institute (Kobewka, McIsaac, Mulpuru, Forster), Ottawa, Ont.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Department of Anesthesiology and Pain Medicine (McIsaac) - The Ottawa Hospital, University of Ottawa; Performance Measurement (Forster), The Ottawa Hospital, Ottawa, Ont
| | - Alan Forster
- Department of Medicine (Kobewka, Mulpuru, Forster), Division of General Internal Medicine, The Ottawa Hospital, University of Ottawa; Ottawa Hospital Research Institute (Kobewka, McIsaac, Mulpuru, Forster), Ottawa, Ont.; Department of Community Health Sciences (Ronksley), University of Calgary, Calgary, Alta.; Department of Anesthesiology and Pain Medicine (McIsaac) - The Ottawa Hospital, University of Ottawa; Performance Measurement (Forster), The Ottawa Hospital, Ottawa, Ont
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50
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Deshields TL, Penalba V, Liu J, Avery J. Comparing the symptom experience of cancer patients and non-cancer patients. Support Care Cancer 2016; 25:1103-1109. [PMID: 27966024 DOI: 10.1007/s00520-016-3498-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Symptom burden is an established concept in oncology encompassing the presence and severity of symptoms experienced by cancer patients. Few studies have examined differences in symptom burden between cancer patients and non-cancer patients. This study seeks to examine the differences in symptom burden between cancer patients (CP) and non-cancer patients (NCP) in order to better understand symptom burden in both populations. METHODS Two groups of patients completed the Memorial Symptom Assessment Scale: 301 patients from a general medical clinic and 558 cancer patients from a cancer tumor registry. Participants provided demographic information-age, race/ethnicity, and sex and completed the Memorial Symptom Assessment Scale. Medical comorbidity was also measured. RESULTS Most symptoms were more common in CP, except for pain, which was more prevalent in the NCP (45% of CP vs. 54% of NCP, p < .05). There was no difference in prevalence for the following symptoms: dry mouth, mouth sores, feeling nervous, worry, cough, and dizziness. The CP had greater mean MSAS Total scores (0.53 vs. 0.43, p < .01), number of symptoms (9.11 vs. 6.13, p < .01), and psychological subscale scores (0.77 vs. 0.64, p < .05). There was no difference by group in the physical nor the GDI subscale scores. CONCLUSION The results of this study support the perception that cancer patients have greater symptom burden. There were some unexpected results, particularly in terms of pain, which was more common in NCP and other symptoms that were experienced equally in both patient populations.
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Affiliation(s)
- Teresa L Deshields
- Siteman Cancer, Barnes-Jewish Hospital, Washington University School of Medicine, 4921 Parkview Place, MS: 90-35-703, St. Louis, MO, 63110, USA.
| | - Valentina Penalba
- Siteman Cancer, Barnes-Jewish Hospital, Washington University School of Medicine, 4921 Parkview Place, MS: 90-35-703, St. Louis, MO, 63110, USA
| | - Jingxa Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - James Avery
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
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