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Symptoms of Depression and Anxiety in Adults with High-Grade Glioma: A Literature Review and Findings in a Group of Patients before Chemoradiotherapy and One Year Later. Cancers (Basel) 2022; 14:cancers14215192. [PMID: 36358611 PMCID: PMC9659261 DOI: 10.3390/cancers14215192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary High-grade glioma (HGG) is the most severe type of brain cancer. At different stages of the disease, affected persons are at high risk of symptoms of depression and anxiety. If undiagnosed and untreated, these symptoms might become severe and compromise the patient’s quality of life. Improved knowledge on the prevalence, mechanisms and clinical risk factors underlying the etiology of depression and anxiety in this population is required. This may help to increase awareness on the importance of integrating consistent assessment of mood symptoms with the clinical follow-up and provide insights for developing personalized psychosocial interventions. Abstract High-grade glioma (HGG) is associated with several external and internal stressors that may induce mood alterations at all stages of the disease. Symptoms of depression and anxiety in persons with glioma have multifactorial etiology and require active follow-up. We reviewed the literature data on the prevalence, mechanisms likely involved in the etiology of mood alterations in persons with HGG and psychosocial interventions found beneficial in treating these symptoms. We also investigated the prevalence and clinical variables that could increase the risk of depression and anxiety symptoms in a group of patients with HGG at two disease time-points: after surgery, before and 1 year after chemoradiotherapy. Literature findings revealed complex mechanisms underlying these symptoms and highlighted the importance of providing early access to palliative care. Our results show a high rate of anxiety and depression symptoms in the first stage of the disease and increased concomitance of these symptoms at the 1-year follow-up. Depression and anxiety symptoms at 1 year after the end of chemoradiotherapy were associated with the presence of symptoms at the first stage of the disease and tumor progression. Antiepileptic drugs and corticosteroid intake did not increase the risk of depressive and anxious symptoms among patients. Active management of mood alterations is an essential part of the care and contributes to patients’ well-being and quality of life.
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Rogers JL, De La Cruz Minyety J, Vera E, Acquaye AA, Payén SS, Weinberg JS, Armstrong TS, Weathers SPS. Assessing mobility in primary brain tumor patients: A descriptive feasibility study using two established mobility tests. Neurooncol Pract 2022; 9:219-228. [PMID: 35601968 PMCID: PMC9113321 DOI: 10.1093/nop/npac013] [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] [Indexed: 11/12/2022] Open
Abstract
Background Patients with primary brain tumors (PBT) face significant mobility issues related to their disease and/or treatment. Here, the authors describe the preliminary utility and feasibility of two established mobility measures, the Timed-Up-and-Go (TUG) and Five-Times Sit-to-Stand (TSS) tests, in quickly and objectively assessing the mobility status of PBT patients at a single institution's neuro-oncology clinic. Methods Adult patients undergoing routine PBT care completed the TUG/TSS tests and MD Anderson Symptom Inventory-Brain Tumor module (MDASI-BT), which assessed symptom burden and interference with daily life, during clinic visits over a 6-month period. Research staff assessed feasibility metrics, including test completion times/rates, and collected demographic, clinical, and treatment data. Mann-Whitney tests, Kruskal-Wallis tests, and Spearman's rho correlations were used to interrogate relationships between TUG/TSS test completion times and patient characteristics. Results The study cohort included 66 PBT patients, 59% male, with a median age of 47 years (range: 20-77). TUG/TSS tests were completed by 62 (94%) patients. Older patients (P < .001) and those who were newly diagnosed (P = .024), on corticosteroids (P = .025), or had poor (≤80) KPS (P < .01) took longer to complete the TUG/TSS tests. Worse activity-related (work, activity, and walking) interference was associated with longer TUG/TSS test completion times (P < .001). Conclusions The TUG/TSS tests are feasible for use among PBT patients and may aid in clinical care. Older age, being newly diagnosed, using corticosteroids, poor (≤80) KPS, and high activity-related interference were associated with significant mobility impairment, highlighting the tests' potential clinical utility. Future investigations are warranted to longitudinally explore feasibility and utility in other practice and disease settings.
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Affiliation(s)
- James L Rogers
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA,Corresponding Author: James L. Rogers, BS, Cancer Research Training Award Fellow, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd., Bethesda, MD 20892, USA ()
| | - Julianie De La Cruz Minyety
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alvina A Acquaye
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Samuel S Payén
- Center for Nursing Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shiao-Pei S Weathers
- Department of Neuro-Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Byrne A, Torrens-Burton A, Sivell S, Moraes FY, Bulbeck H, Bernstein M, Nelson A, Fielding H. Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers. Cochrane Database Syst Rev 2022; 1:CD013440. [PMID: 34988973 PMCID: PMC8733789 DOI: 10.1002/14651858.cd013440.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Primary malignant brain tumours can have an unpredictable course, but high-grade gliomas typically have a relentlessly progressive disease trajectory. They can cause profound symptom burden, affecting physical, neurocognitive, and social functioning from an early stage in the illness. This can significantly impact on role function and on the experiences and needs of informal caregivers. Access to specialist palliative and supportive care early in the disease trajectory, for those with high-grade tumours in particular, has the potential to improve patients' and caregivers' quality of life. However, provision of palliative and supportive care for people with primary brain tumours - and their informal caregivers - is historically ill-defined and ad hoc, and the benefits of early palliative interventions have not been confirmed. It is therefore important to define the role and effectiveness of early referral to specialist palliative care services and/or the effectiveness of other interventions focused on palliating disease impact on people and their informal caregivers. This would help guide improvement to service provision, by defining those interventions which are effective across a range of domains, and developing an evidence-based model of integrated supportive and palliative care for this population. OBJECTIVES To assess the evidence base for early palliative care interventions, including referral to specialist palliative care services compared to usual care, for improving outcomes in adults diagnosed with a primary brain tumour and their carers. SEARCH METHODS We conducted searches of electronic databases, CENTRAL, MEDLINE, CINAHL, Web of Science, and PsycINFO (last searched 16 November 2021). We conducted searches to incorporate both qualitative and quantitative search terms. In addition to this, we searched for any currently recruiting trials in ClinicalTrials.gov and in the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, and undertook citation tracking via Scopus. We also handsearched reference lists of potentially eligible systematic review articles to identify any other relevant studies, contacted experts in the field and searched key authors via Web of Science and searched SIGLE (System of Information on Grey Literature in Europe). SELECTION CRITERIA We included studies looking at early referral to specialist palliative care services - or early targeted palliative interventions by other healthcare professionals - for improving quality of life, symptom control, psychological outcomes, or overall survival as a primary or secondary outcome measure. Studies included randomised controlled trials (RCTs), non-randomised studies (NRS), as well as qualitative and mixed-methods studies where both qualitative and quantitative data were included. Participants were adults with a confirmed radiological and/or histological diagnosis of a primary malignant brain tumour, and/or informal adult carers (either at individual or family level) of people with a primary malignant brain tumour. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodological procedures for data extraction, management, and analysis. We used GRADE to assess the certainty of the evidence for symptom control, i.e. cognitive function. MAIN RESULTS We identified 9748 references from the searches, with 8337 remaining after duplicates were removed. After full-text review, we included one trial. There were no studies of early specialist palliative care interventions or of early, co-ordinated generalist palliative care approaches. The included randomised trial addressed a single symptom area, focusing on early cognitive rehabilitation, administered within two weeks of surgery in a mixed brain tumour population, of whom approximately half had a high-grade glioma. The intervention was administered individually as therapist-led computerised exercises over 16 one-hour sessions, four times/week for four weeks. Sessions addressed several cognitive domains including time orientation, spatial orientation, visual attention, logical reasoning, memory, and executive function. There were no between-group differences in outcome for tests of logical-executive function, but differences were observed in the domains of visual attention and verbal memory. Risk of bias was assessed and stated as high for performance bias and attrition bias but for selective reporting it was unclear whether all outcomes were reported. We considered the certainty of the evidence, as assessed by GRADE, to be very low. AUTHORS' CONCLUSIONS Currently there is a lack of research focusing on the introduction of early palliative interventions specifically for people with primary brain tumours, either as co-ordinated specialist palliative care approaches or interventions focusing on a specific aspect of palliation. Future research should address the methodological shortcomings described in early palliative intervention studies in other cancers and chronic conditions. In particular, the specific population under investigation, the timing and the setting of the intervention should be clearly described and the standardised palliative care-specific components of the intervention should be defined in detail.
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Affiliation(s)
- Anthony Byrne
- Cardiff and Vale University Health Board, Llandough Hospital, Penarth, UK
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Anna Torrens-Burton
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Fabio Ynoe Moraes
- Department of Oncology, Division of Radiation Oncology, Kingston Health Sciences Centre, Kingston, Canada
| | | | - Mark Bernstein
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Helen Fielding
- Palliative Medicine, Abertawe Bro Morgannwg University Health Board, Swansea, UK
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Barbaro M, Blinderman CD, Iwamoto FM, Kreisl TN, Welch MR, Odia Y, Donovan LE, Joanta-Gomez AE, Evans KA, Lassman AB. Causes of Death and End-of-Life Care in Patients With Intracranial High-Grade Gliomas: A Retrospective Observational Study. Neurology 2021; 98:e260-e266. [PMID: 34795049 PMCID: PMC8792811 DOI: 10.1212/wnl.0000000000013057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To understand patterns of care and circumstances surrounding end of life in patients with intracranial gliomas. METHODS We retrospectively analyzed end-of-life circumstances in patients with intracranial high-grade gliomas at Columbia University Irving Medical Center who died from January 2014 through February 2019, including cause of death, location of death, and implementation of comfort measures and resuscitative efforts. RESULTS There were 152 patients (95 men, 57 women; median age at death 61.5 years, range 24-87 years) who died from 1/2014-2/2019 with adequate data surrounding end-of-life circumstances. Clinical tumor progression (n=117, 77.0%) was the most common cause of death with all patients transitioned to comfort measures. Other causes included, but were not limited to, infection (19, 12.5%); intratumoral hemorrhage (5, 3.3%); seizures (8, 5.3%); cerebral edema (4, 2.6%); pulmonary embolism (4, 2.6%); autonomic failure (2, 1.3%); and hemorrhagic shock (2, 1.3%). Multiple mortal events were identified in 10 (8.5%). Seventy-three patients (48.0%) died at home with hospice. Other locations were inpatient hospice (40, 26.3%); acute care hospital (34, 22.4%) including 27 (17.8%) with and 7 (4.6%) without comfort measures; skilled nursing facility (4, 3.3%) including 3 (2.0%) with and 1 (0.7%) without comfort measures; or religious facility (1, 0.7%) with comfort measures. Acute cardiac and/or pulmonary resuscitation was performed in 20 patients (13.2%). DISCUSSION Clinical tumor progression was the most common (77.0%) cause of death followed by infection (12.5%). Hospice or comfort measures were ultimately implemented in 94.7% of patients, though resuscitation was performed in 13.2%. Improved understanding of circumstances surrounding death, frequency of use of hospice services, and frequency of resuscitative efforts in patients with gliomas may allow physicians to more accurately discuss end-of-life expectations with patients and caregivers, facilitating informed care planning.
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Affiliation(s)
- Marissa Barbaro
- Division of Neuro-Oncology, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA.,Perlmutter Cancer Center at NYU Langone Hematology Oncology Associates-Mineola, NYU Long Island School of Medicine, NYU Langone Health, Mineola, NY, USA
| | - Craig D Blinderman
- Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA.,Division of Hematology/Oncology, Palliative Care Service Section, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Fabio M Iwamoto
- Division of Neuro-Oncology, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Teri N Kreisl
- Division of Neuro-Oncology, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA.,Novartis AG, East Hanover, NJ, USA
| | - Mary R Welch
- Division of Neuro-Oncology, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Yazmin Odia
- Division of Neuro-Oncology, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA.,Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Laura E Donovan
- Division of Neuro-Oncology, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA.,James J. Peters Department of Veterans Affairs Medical Center
| | - Adela E Joanta-Gomez
- Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Katharine A Evans
- Division of Neuro-Oncology, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA.,Montefiore Health System, New York, NY, USA
| | - Andrew B Lassman
- Division of Neuro-Oncology, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA .,Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, NY, USA
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5
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Reed-Guy L, Miranda SP, Alexander TD, Biggiani G, Grady MS, Jones JA, Bagley SJ, Kumar P, O'Connor NR. Serious Illness Communication Practices in Glioblastoma: An Institutional Perspective. J Palliat Med 2021; 25:234-242. [PMID: 34424777 DOI: 10.1089/jpm.2021.0121] [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: 11/13/2022] Open
Abstract
Background: Early, high-quality advance care planning discussions are essential for supporting goal-concordant care among glioblastoma (GBM) patients. Objective: Using mixed methods, we sought to characterize current serious illness (SI) communication practices at our institution. Methods: The electronic medical records of 240 deceased GBM patients cared for at the Abramson Cancer Center in Philadelphia, PA between 2017 and 2019 were systematically reviewed for documented SI conversations about four domains: prognosis, goals, end-of-life planning, and code status. Patient outcomes and SI conversation characteristics were analyzed using descriptive statistics. Standardized interviews about GBM care were held with five clinicians. Interview transcripts were analyzed using grounded-theory coding to identify emergent themes. Results: Nearly all patients (96%) had at least one documented SI conversation (median: 4, interquartile range [IQR] 2-7), mostly outpatient with medical oncology physicians. Median timing of first SI conversation was 360 days before death. SI conversations were not significantly associated with patient outcomes, including inpatient death and hospice enrollment. Seven themes emerged from clinician interviews: balancing hope and reality, anticipatory guidance, neglect of the "big picture," need for earlier conversations, care coordination, the role of clinical expertise, and communication training. Conclusion: SI conversations were documented early and often in our sample, but their quality was difficult to assess. Contrary to our quantitative findings, interviewees reported that SI conversations were late, infrequent, inadequate, and fragmented across specialties, failing to explore critical issues such as prognosis and functional decline.
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Affiliation(s)
- Lauren Reed-Guy
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen P Miranda
- Department of Neurosurgery, and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tyler D Alexander
- Department of Neurosurgery, and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory Biggiani
- Department of Neurosurgery, and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M Sean Grady
- Department of Neurosurgery, and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua A Jones
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen J Bagley
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pallavi Kumar
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nina R O'Connor
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kubendran S, Schockett E, Jackson E, Huynh-Le MP, Roberti F, Rao YJ, Ojong-Ntui M, Goyal S. Trends in inpatient palliative care use for primary brain malignancies. Support Care Cancer 2021; 29:6625-6632. [PMID: 33945016 DOI: 10.1007/s00520-021-06255-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Primary brain malignancies (PBMs) pose significant morbidity and poor prognosis. Despite NCCN recommendations that palliative care should be integrated into general oncologic care plans, it has been historically underused in patients with PBM. We sought to examine trends and factors associated with inpatient palliative care use in patients with PBM. METHODS Data from the 2007-2016 National (Nationwide) Inpatient Sample was analyzed for descriptive statistics and trends. Multivariable logistic regression was used to identify factors associated with inpatient palliative care in patients with PBMs. RESULTS Of the 510,238 observed hospitalizations of adults with PBM in a 10-year period, 37,365 (7.3%) had an associated inpatient palliative care consult. Rates of inpatient palliative care have increased significantly over the 10-year period, from 2.3 in 2007 to 11.9% in 2011. Patients receiving inpatient palliative care were less likely to receive inpatient oncologic treatment such as brain surgery, chemotherapy, or radiation compared to those without palliative care (14.6% with palliative care vs. 42.4% without, p < 0.001). They were more likely to receive life-sustaining treatments such as intubation, mechanical ventilation, tracheostomy, nutritional support, hemodialysis, or CPR (21.0% with palliative care vs. 10.4% without, p < 0.001). Palliative care was associated with decreased cost of admission ($18,602 with palliative care vs. $20,077 without). In a multiple variable logistic regression, age, non-elective admission, comorbidities, history of chemotherapy and radiation, and mechanical ventilation were associated with significantly increased odds of receiving palliative care. CONCLUSIONS Inpatient palliative care utilization for patients hospitalized with PBM significantly increased between 2007 and 2016, though the service is still underutilized in the context of the severe symptoms and poor prognosis associated with PBM.
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Affiliation(s)
- Sindhu Kubendran
- George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue, NW, DC Level, Washington, DC, 20037, USA
| | - Erica Schockett
- George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue, NW, DC Level, Washington, DC, 20037, USA
| | - Erin Jackson
- George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue, NW, DC Level, Washington, DC, 20037, USA
| | - Minh Phuong Huynh-Le
- George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue, NW, DC Level, Washington, DC, 20037, USA
| | - Fabio Roberti
- George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue, NW, DC Level, Washington, DC, 20037, USA
| | - Yuan James Rao
- George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue, NW, DC Level, Washington, DC, 20037, USA
| | - Martin Ojong-Ntui
- George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue, NW, DC Level, Washington, DC, 20037, USA
| | - Sharad Goyal
- George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue, NW, DC Level, Washington, DC, 20037, USA.
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Salmi L, Lum HD, Hayden A, Reblin M, Otis-Green S, Venechuk G, Morris MA, Griff M, Kwan BM. Stakeholder engagement in research on quality of life and palliative care for brain tumors: a qualitative analysis of #BTSM and #HPM tweet chats. Neurooncol Pract 2020; 7:676-684. [PMID: 33304602 PMCID: PMC7716141 DOI: 10.1093/nop/npaa043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Research is needed to inform palliative care models that address the full spectrum of quality of life (QoL) needs for brain tumor patients and care partners. Stakeholder engagement in research can inform research priorities; engagement via social media can complement stakeholder panels. The purpose of this paper is to describe the use of Twitter to complement in-person stakeholder engagement, and report emergent themes from qualitative analysis of tweet chats on QoL needs and palliative care opportunities for brain tumor patients. Methods The Brain Cancer Quality of Life Collaborative engaged brain tumor (#BTSM) and palliative medicine (#HPM) stakeholder communities via Twitter using tweet chats. The #BTSM chat focused on defining and communicating about QoL among brain tumor patients. The #HPM chat discussed communication about palliative care for those facing neurological conditions. Qualitative content analysis was used to identify tweet chat themes. Results Analysis showed QoL for brain tumor patients and care partners includes psychosocial, physical, and cognitive concerns. Distressing concerns included behavioral changes, grief over loss of identity, changes in relationships, depression, and anxiety. Patients appreciated when providers discussed QoL early in treatment, and emphasized the need for care partner support. Communication about QoL and palliative care rely on relationships to meet evolving patient needs. Conclusions In addition to providing neurological and symptom management, specialized palliative care for brain tumor patients may address unmet patient and care partner psychosocial and informational needs. Stakeholder engagement using Twitter proved useful for informing research priorities and understanding stakeholder perspectives on QoL and palliative care.
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Affiliation(s)
- Liz Salmi
- Department of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Hillary D Lum
- VA Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,Division of Geriatric Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Adam Hayden
- Philosophy, Indiana University-Purdue University, Indianapolis, Indiana
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, Florida
| | | | - Grace Venechuk
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Megan A Morris
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Family Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Megan Griff
- Division of Geriatric Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Bethany M Kwan
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Family Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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8
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Byrne A, Sivell S, Moraes FY, Bulbeck H, Torrens-Burton A, Bernstein M, Nelson A, Fielding H. Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers. Hippokratia 2019. [DOI: 10.1002/14651858.cd013440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anthony Byrne
- Llandough Hospital; Cardiff and Vale University Health Board; Penlan Road Penarth Vale of Glamorgan UK CF64 2XX
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Stephanie Sivell
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Fabio Ynoe Moraes
- Kingston Health Sciences Centre; Department of Oncology, Division of Radiation Oncology; Queen's University 25 King St W Kingston ON Canada K7L 5P9
| | - Helen Bulbeck
- brainstrust; Director of Services; 4 Yvery Court Castle Road Cowes Isle of Wight UK PO31 7QG
| | - Anna Torrens-Burton
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Mark Bernstein
- University of Toronto; Faculty of Medicine; Toronto Ontario Canada
| | - Annmarie Nelson
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Helen Fielding
- Abertawe Bro Morgannwg University Health Board; Palliative Medicine; Singleton Hospital Sketty Lane Swansea UK SA2 8QA
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9
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Rosenberg J, Massaro A, Siegler J, Sloate S, Mendlik M, Stein S, Levine J. Palliative Care in Patients With High-Grade Gliomas in the Neurological Intensive Care Unit. Neurohospitalist 2019; 10:163-167. [PMID: 32549938 DOI: 10.1177/1941874419869714] [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] [Indexed: 11/16/2022] Open
Abstract
Background Palliative care improves quality of life in patients with malignancy; however, it may be underutilized in patients with high-grade gliomas (HGGs). We examined the practices regarding palliative care consultation (PCC) in treating patients with HGGs in the neurological intensive care unit (NICU) of an academic medical center. Methods We conducted a retrospective cohort study of patients admitted to the NICU from 2011 to 2016 with a previously confirmed histopathological diagnosis of HGG. The primary outcome was the incidence of an inpatient PCC. We also evaluated the impact of PCC on patient care by examining its association with prespecified secondary outcomes of code status amendment to do not resuscitate (DNR), discharge disposition, 30-day mortality, and 30-day readmission rate, length of stay, and place of death. Results Ninety (36% female) patients with HGGs were identified. Palliative care consultation was obtained in 16 (18%) patients. Palliative care consultation was associated with a greater odds of code status amendment to DNR (odds ratio [OR]: 18.15, 95% confidence interval [CI]: 5.01-65.73), which remained significant after adjustment for confounders (OR: 27.20, 95% CI: 5.49-134.84), a greater odds of discharge to hospice (OR: 24.93, 95% CI: 6.48-95.88), and 30-day mortality (OR: 6.40, 95% CI: 1.96-20.94). Conclusion In this retrospective study of patients with HGGs admitted to a university-based NICU, PCC was seen in a minority of the sample. Palliative care consultation was associated with code status change to DNR and hospice utilization. Further study is required to determine whether these findings are generalizable and whether interventions that increase PCC utilization are associated with improved quality of life and resource allocation for patients with HGGs.
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Affiliation(s)
- Jon Rosenberg
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Allie Massaro
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - James Siegler
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stacey Sloate
- Wharton School of the University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew Mendlik
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Division of Palliative Care, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Joshua Levine
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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10
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Vierhout M, Daniels M, Mazzotta P, Vlahos J, Mason WP, Bernstein M. The views of patients with brain cancer about palliative care: a qualitative study. ACTA ACUST UNITED AC 2017; 24:374-382. [PMID: 29270049 DOI: 10.3747/co.24.3712] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Palliative care, a specialty aimed at providing optimal care to patients with life-limiting and chronic conditions, has several benefits. Although palliative care is appropriate for neurosurgical conditions, including brain cancer, few studies have examined the views of brain cancer patients about palliative care. We aimed to explore the thoughts of brain cancer patients about palliative care, their opinions about early palliative care, and their preferred care setting. Methods Semi-structured interviews and the qualitative research methodologies of grounded theory were used to explore perceptions of palliative care on the part of 39 brain cancer outpatients. Results Seven overarching actions emerged: ■Patients would prefer to receive palliative care in the home.■Increased time with caregivers and family are the main appeals of home care.■Patients express dissatisfaction with brief and superficial interactions with health care providers.■Patients believe that palliative care can contribute to their emotional well-being.■Patients are open to palliative care if they believe that it will not diminish optimism.■There is a preconceived idea that palliative care is directly linked to active dying, and that supposed link generates fear in some patients.■Patients prefer to be educated about palliative care as an option early in their illness, even if they are fearful of it. Conclusions Overall, when educated about the true meaning of palliative care, most patients express interest in accessing palliative care services. Although the level of fear concerning palliative care varies in patients, most recognize the associated benefits.
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Affiliation(s)
| | - M Daniels
- Princess Margaret Cancer Centre, and
| | - P Mazzotta
- Temmy Latner Center for Palliative Care, Mount Sinai Hospital, and University of Toronto, Toronto, ON
| | | | - W P Mason
- Princess Margaret Cancer Centre, and
| | - M Bernstein
- Toronto Western Hospital.,Temmy Latner Center for Palliative Care, Mount Sinai Hospital, and University of Toronto, Toronto, ON
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11
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Kuchinad KE, Strowd R, Evans A, Riley WA, Smith TJ. End of life care for glioblastoma patients at a large academic cancer center. J Neurooncol 2017; 134:75-81. [PMID: 28528421 DOI: 10.1007/s11060-017-2487-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
Abstract
Glioblastoma (GBM) is a universally fatal disease, complicated by significant cognitive and physical disabilities, inherent to the disease course. The purpose of this study was to retrospectively analyze end-of-life care for GBM patients at an academic center and compare utilization of these services to national quality of care guidelines, with the goal of identifying opportunities to improve end-of-life care. Single center retrospective cohort study of GBM patients at Johns Hopkins Hospital (JHH) between 2009 and 2014, using electronic medical records and hospice records. Comprehensive medical record review of 100 randomly selected patients with GBM, who were actively treated at JHH. Secondary analysis of all JHH GBM patients (n = 45) who received hospice care at Gilchrist Services, our largest provider, during this time period. Of 100 patients, 76 were referred to hospice. Despite the poor survival and changes in mental capacity associated with this disease, only 40% of individuals had documentation of code status and only 17% had any documentation of advance directives (ADs). None had documentation by a health care provider of a formal symptom, psychosocial, or spiritual assessment at greater than 50% of clinic visits. Only 17% used chemotherapy in their last month of life. 37% were hospitalized in the last month of life for an average of 9 days. Of the Gilchrist Services patients, the median length of stay in hospice was 21 days and 64% of these patients died in their residence with hospice services. Documentation of palliative care and end-of-life measures could improve quality of care for GBM patients, especially in the use of ADs, symptom, spiritual, and psychosocial assessments, with earlier use of hospice to prevent end-of-life hospitalizations.
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Affiliation(s)
| | - Roy Strowd
- Brain Tumor Program, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | | | - Thomas J Smith
- Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Harry J. Duffey Family Professor of Palliative Medicine, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Blalock 369, Baltimore, MD, 21287-0005, USA.
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12
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Screening for symptom burden and supportive needs of patients with glioblastoma and brain metastases and their caregivers in relation to their use of specialized palliative care. Support Care Cancer 2017; 25:2761-2770. [PMID: 28357650 DOI: 10.1007/s00520-017-3687-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/21/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE Patients with brain tumors have a high symptom burden and multiple supportive needs. Needs of caregivers are often unattended. This study aims to determine screening-based symptom burden and supportive needs of patients and caregivers with regard to the use of specialized palliative care (SPC). METHODS Seventy-nine patients with glioblastoma and brain metastases and 46 caregivers were screened with standardized questionnaires following diagnosis and 2 months later. The screening assessed symptom burden, quality of life (QoL), distress, and supportive needs. RESULTS The most relevant symptoms were drowsiness, tiredness, and low well-being (53-58%). The most prevalent patient supportive needs were the need for information about available resources, the illness, and possible lifestyle changes (50-56%). The most prevalent caregiver needs were information about the illness, lifestyle changes, and about available resources (56-74%). Patients who received SCP and their caregivers had higher symptom burden and supportive needs than those without SPC. They reported moderate improvement in pain, distress, and QoL, while patients without SPC also improved their QoL, but had small to moderate deteriorations in pain, drowsiness, nauseas, well-being, and other problems. Distress of caregivers with SPC improved with moderate to large effect sizes but still was on a high level and remained stable for those without SPC. CONCLUSIONS Symptom burden and supportive needs were high, but even more caregivers than patients expressed high distress and supportive needs. SPC appears to reach the target group, both patients and caregivers with elevated symptom burden. Targeted interventions are needed to improve tiredness and drowsiness.
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13
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Song K, Amatya B, Voutier C, Khan F. Advance Care Planning in Patients with Primary Malignant Brain Tumors: A Systematic Review. Front Oncol 2016; 6:223. [PMID: 27822458 PMCID: PMC5075571 DOI: 10.3389/fonc.2016.00223] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/07/2016] [Indexed: 11/13/2022] Open
Abstract
Advance care planning (ACP) is a process of reflection and communication of a person's future health care preferences, and has been shown to improve end-of-life (EOL) care for patients. The aim of this systematic review is to present an evidence-based overview of ACP in patients with primary malignant brain tumors (pmBT). A comprehensive literature search was conducted using medical and health science electronic databases (PubMed, Cochrane, Embase, MEDLINE, ProQuest, Social Care Online, Scopus, and Web of Science) up to July 2016. Manual search of bibliographies of articles and gray literature search were also conducted. Two independent reviewers selected studies, extracted data, and assessed the methodologic quality of the studies using the Critical Appraisal Skills Program's appraisal tools. All studies were included irrespective of the study design. A meta-analysis was not possible due to heterogeneity amongst included studies; therefore, a narrative analysis was performed for best evidence synthesis. Overall, 19 studies were included [1 randomized controlled trial (RCT), 17 cohort studies, 1 qualitative study] with 4686 participants. All studies scored "low to moderate" on the methodological quality assessment, implying high risk of bias. A single RCT evaluating a video decision support tool in facilitating ACP in pmBT patients showed a beneficial effect in promoting comfort care and gaining confidence in decision-making. However, the effect of the intervention on quality of life and care at the EOL were unclear. There was a low rate of use of ACP discussions at the EOL. Advance directive completion rates and place of death varied between different studies. Positive effects of ACP included lower hospital readmission rates, and intensive care unit utilization. None of the studies assessed mortality outcomes associated with ACP. In conclusion, this review found some beneficial effects of ACP in pmBT. The literature still remains limited in this area, with lack of intervention studies, making it difficult to identify superiority of ACP interventions in pmBT. More robust studies, with appropriate study design, outcome measures, and defined interventions are required to inform policy and practice.
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Affiliation(s)
- Krystal Song
- Department of Rehabilitation Medicine, Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia
- Department of Medicine (RMH), University of Melbourne, Melbourne, VIC, Australia
| | - Bhasker Amatya
- Department of Rehabilitation Medicine, Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia
| | - Catherine Voutier
- Department of Medicine (RMH), University of Melbourne, Melbourne, VIC, Australia
| | - Fary Khan
- Department of Rehabilitation Medicine, Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia
- Department of Medicine (RMH), University of Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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14
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Morgan ER, Mason WP, Maurice C. A critical balance: managing coagulation in patients with glioma. Expert Rev Neurother 2016; 16:803-14. [PMID: 27101362 DOI: 10.1080/14737175.2016.1181542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cancer-associated thrombosis, including both arterial and venous thromboembolism (VTE), is a significant source of morbidity and mortality in patients with glioma. This risk is highest in the immediate postoperative period and is increased by chemotherapy, radiation, and corticosteroids. Systemic anticoagulation with low molecular weight heparin is the treatment of choice in both the therapeutic and prophylactic settings. However, these patients are also at risk of intracranial hemorrhage, a potentially catastrophic complication of anticoagulation, and this risk must be carefully balanced against the risk of VTE. In this review we outline the incidence, pathophysiology and management of thrombosis in patients with glioma, with a focus on clinical considerations including perioperative management, chemotherapy-induced thrombocytopenia, and end-of-life management.
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Affiliation(s)
- Erin R Morgan
- a Pencer Brain Tumor Centre , Princess Margaret Hospital Cancer Centre , Toronto , Canada.,b Department of Medical Oncology and Hematology , University of Toronto , Toronto , Canada
| | - Warren P Mason
- a Pencer Brain Tumor Centre , Princess Margaret Hospital Cancer Centre , Toronto , Canada.,b Department of Medical Oncology and Hematology , University of Toronto , Toronto , Canada
| | - Catherine Maurice
- a Pencer Brain Tumor Centre , Princess Margaret Hospital Cancer Centre , Toronto , Canada.,b Department of Medical Oncology and Hematology , University of Toronto , Toronto , Canada
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15
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Holmes ACN, Adams SJ, Hall S, Rosenthal MA, Drummond KJ. Liaison psychiatry in a central nervous system tumor service. Neurooncol Pract 2015; 2:88-92. [PMID: 31386066 DOI: 10.1093/nop/npv001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Indexed: 11/13/2022] Open
Abstract
Background Tumors of the central nervous system (CNS) have physical and psychological effects that commonly interact and change over time. Although well suited to addressing problems at the interface between physical and psychological medicine, the role of the consultation-liaison psychiatrist has not been previously described in the management of these patients. The purpose of this paper is to summarize the experience of psychiatry liaison attachment within a CNS tumor service and to reflect on its utility within a complex multidisciplinary environment. Methods A retrospective file review was performed on all cases seen by a psychiatrist in a CNS tumor service over the previous 5 years. A simple thematic inductive analysis was conducted of the common problems experienced by patients and their management by the psychiatrist and within the team. Results Five common themes were identified: (i) facilitating adaptation to diagnosis; (ii) supporting living with lower-grade tumors; (iii) managing mental disorders; (iv) neuropsychiatric symptoms of tumor progression; and (v) grief and uncertainty in the advanced stages of illness. The capacity of the psychiatrist to understand and integrate the clinical, pathological, radiological, and treatment information, in communication with colleagues, helped address these challenges. Conclusions Psychological challenges in CNS tumor patients have both psychological and neurological underpinnings. In our experience, the addition of a liaison psychiatrist to a CNS tumor service was efficient and effective in improving patient management and led to enhanced communication and decision-making within the team.
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Affiliation(s)
- Alex C N Holmes
- Consultation-liaison Psychiatry, Royal Melbourne Hospital, Parkville, Australia (A.C.N.H., S.J.A., S.H.); Department of Psychiatry, University of Melbourne, Parkville, Australia (A.C.N.H.); Department of Medicine, University of Melbourne, Parkville, Australia (M.A.R.); Department of Oncology, Royal Melbourne Hospital, Parkville,Australia (M.A.R.); Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia (K.J.D.); Department of Surgery, University of Melbourne, Parkville, Australia (K.J.D.)
| | - Sophia J Adams
- Consultation-liaison Psychiatry, Royal Melbourne Hospital, Parkville, Australia (A.C.N.H., S.J.A., S.H.); Department of Psychiatry, University of Melbourne, Parkville, Australia (A.C.N.H.); Department of Medicine, University of Melbourne, Parkville, Australia (M.A.R.); Department of Oncology, Royal Melbourne Hospital, Parkville,Australia (M.A.R.); Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia (K.J.D.); Department of Surgery, University of Melbourne, Parkville, Australia (K.J.D.)
| | - Scott Hall
- Consultation-liaison Psychiatry, Royal Melbourne Hospital, Parkville, Australia (A.C.N.H., S.J.A., S.H.); Department of Psychiatry, University of Melbourne, Parkville, Australia (A.C.N.H.); Department of Medicine, University of Melbourne, Parkville, Australia (M.A.R.); Department of Oncology, Royal Melbourne Hospital, Parkville,Australia (M.A.R.); Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia (K.J.D.); Department of Surgery, University of Melbourne, Parkville, Australia (K.J.D.)
| | - Mark A Rosenthal
- Consultation-liaison Psychiatry, Royal Melbourne Hospital, Parkville, Australia (A.C.N.H., S.J.A., S.H.); Department of Psychiatry, University of Melbourne, Parkville, Australia (A.C.N.H.); Department of Medicine, University of Melbourne, Parkville, Australia (M.A.R.); Department of Oncology, Royal Melbourne Hospital, Parkville,Australia (M.A.R.); Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia (K.J.D.); Department of Surgery, University of Melbourne, Parkville, Australia (K.J.D.)
| | - Katharine J Drummond
- Consultation-liaison Psychiatry, Royal Melbourne Hospital, Parkville, Australia (A.C.N.H., S.J.A., S.H.); Department of Psychiatry, University of Melbourne, Parkville, Australia (A.C.N.H.); Department of Medicine, University of Melbourne, Parkville, Australia (M.A.R.); Department of Oncology, Royal Melbourne Hospital, Parkville,Australia (M.A.R.); Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia (K.J.D.); Department of Surgery, University of Melbourne, Parkville, Australia (K.J.D.)
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16
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Mummudi N, Jalali R. Palliative care and quality of life in neuro-oncology. F1000PRIME REPORTS 2014; 6:71. [PMID: 25165570 PMCID: PMC4126540 DOI: 10.12703/p6-71] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Health-related quality of life has become an important end point in modern day clinical practice in patients with primary or secondary brain tumors. Patients have unique symptoms and problems from diagnosis till death, which require interventions that are multidisciplinary in nature. Here, we review and summarize the various key issues in palliative care, quality of life and end of life in patients with brain tumors, with the focus on primary gliomas.
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17
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Clinical presentation and patterns of care for short-term survivors of malignant glioma. J Neurooncol 2014; 119:333-41. [PMID: 24889839 DOI: 10.1007/s11060-014-1483-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
Abstract
Palliative care provision for patients with high-grade malignant glioma is often under-utilised. Difficulties in prognostication and inter-patient variability in survival may limit timely referral. This study sought to (1) describe the clinical presentation of short-term survivors of malignant glioma (survival time <120 days); (2) map their hospital utilisation, including palliative and supportive care service use, and place of death; (3) identify factors which may be important to serve as a prompt for palliative care referral. A retrospective cohort study of incident malignant glioma cases between 2003-2009 surviving <120 days in Victoria, Australia was undertaken (n = 482). Cases were stratified according to the patient's survival status (dead vs. alive) at the end of the diagnosis admission, and at 120 days from diagnosis. Palliative care was received by 78 % of patients who died during the diagnosis admission. Only 12 % of patients who survived the admission and then deteriorated rapidly dying in the following 120 days were referred to palliative care in their hospital admission, suggesting an important clinical subgroup that may miss out on being linked into palliative care services. The strongest predictor of death during the diagnosis admission was the presence of cognitive or behavioural symptoms, which may be an important prompt for early palliative care referral.
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18
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Lin E, Rosenthal MA, Eastman P, Le BH. Inpatient palliative care consultation for patients with glioblastoma in a tertiary hospital. Intern Med J 2014; 43:942-5. [PMID: 23919337 DOI: 10.1111/imj.12211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/25/2013] [Indexed: 11/27/2022]
Abstract
Glioblastoma (GBM) is an uncommon disease with significant mortality and morbidity, but there is a lack of published evidence on palliative care involvement with this population. This audit highlights the heavy symptom burden, extensive allied health involvement and discharge outcomes of GBM inpatients referred to the palliative care service at The Royal Melbourne Hospital. This information can provide an important framework for further research and also supports the role of multidisciplinary palliative care in the care of patients with GBM.
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Affiliation(s)
- E Lin
- Department of Palliative Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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