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Fernando RA. Improving Supportive and Palliative Care Integration in Adolescent and Young Adult Cancer. J Adolesc Young Adult Oncol 2024; 13:271-280. [PMID: 37878271 DOI: 10.1089/jayao.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Purpose: Timely supportive and palliative care (SPC) integration in adolescent and young adult (AYA) cancer management is recommended in curative and palliative settings. However, multiple barriers exist to implementing this goal. Liverpool Cancer Therapy Center (LCTC) serviced a growing AYA (15-39 years) population without AYA-dedicated services and the vast majority receiving no SPC engagement. Concerned this was placing AYA patients' wellbeing at risk, we determined a cultural change was required and that the newly established AYA Supportive and Palliative Care (AYASPC) Service could facilitate this. Methods: The AYASPC Service conducted a 6-month quality improvement project aiming to increase its referrals from a baseline average of one per month to four per month, to increase confidence in making SPC referrals and to enhance appreciation for specialized AYA care. Interventions included formalizing an AYASPC referral pathway with broad indications, and educating clinicians on holistic AYA care, the AYASPC Service's model of care (MoC) and AYASPC referral benefits. Results: During the project, 27 AYASPC referrals were made. Referrals consistently exceeded the Service's baseline, and from 3 months onward exceeded the project target. Additionally, referrals were made earlier (29.6% at diagnosis), for a variety of cancer diagnoses with varied prognoses, and for indications beyond traditional issues of complex symptoms and end-of-life care. Clinicians also expressed greater confidence in supporting AYAs and making SPC referrals. Conclusion: In a brief timeframe, the AYASPC Service's innovative and adaptable MoC and project interventions sustainably improved AYASPC access and affected a positive cultural shift around AYA care and advocacy.
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Benmiloud F, Le Bihan C, Rebaudet S, Marino P, Bousquet PJ, Bouée-Benhamiche E. Hypoparathyroidism-related health care utilization and expenditure during the first postoperative year after total thyroidectomy for cancer: a comprehensive national cohort study. Front Endocrinol (Lausanne) 2023; 14:1193290. [PMID: 37448467 PMCID: PMC10338088 DOI: 10.3389/fendo.2023.1193290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/09/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives Hypoparathyroidism is the most common complication of total thyroidectomy for cancer, and requires calcium and/or vitamin D supplementation for an unpredictable period of time. The additional cost associated with this complication has not hitherto been assessed. The aim of this study was to assess the economic burden of postoperative hypoparathyroidism after total thyroidectomy for cancer in France. Methods Based on the French national cancer cohort, which extracts data from the French National Health Data System (SNDS), all adult patients who underwent a total thyroidectomy for cancer in France between 2011 and 2015 were identified, and their healthcare resource use during the first postoperative year was compared according to whether they were treated postoperatively with calcium and/or vitamin D or not. Univariate and multivariate cost analyses were performed with the non-parametric Wilcoxon test and generalized linear model (gamma distribution and log link), respectively. Results Among the 31,175 patients analyzed (75% female, median age: 52y), 13,247 (42%) started calcium and/or vitamin D supplementation within the first postoperative month, and 2,855 patients (9.1%) were still treated at 1 year. Over the first postoperative year, mean overall and specific health expenditures were significantly higher for treated patients than for untreated patients: €7,233 vs €6,934 per patient (p<0.0001) and €478.6 vs €332.7 per patient (p<0.0001), respectively. After adjusting for age, gender, Charlson Comorbidity index, ecological deprivation index, types of thyroid resection, lymph node dissection and complications, year and region, the incremental cost of overall health care utilization was €142 (p<0.004). Conclusion Our study found a significant additional cost in respect of health expenditures for patients who had hypoparathyroidism after thyroidectomy for cancer, over the first postoperative year. Five-year follow-up is planned to assess the impact of more severe long-term complications on costs.
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Affiliation(s)
- Fares Benmiloud
- Department of Endocrine Surgery, Hôpital Privé de Provence, Aix-en-Provence, France
- Department of Endocrine Surgery, Hôpital Européen Marseille, Marseille, France
| | - Christine Le Bihan
- Department of Health Data and Assessment, French National Cancer Institute (Institut National du Cancer, INCa), Boulogne-Billancourt, France
| | - Stanislas Rebaudet
- Department of Endocrine Surgery, Hôpital Européen Marseille, Marseille, France
- Aix-Marseille Institute of Public Health, Institut des sciences de la santé publique d’Aix-Marseille (ISSPAM), Sciences économiques et sociales de la santé & traitement de l’information médicale Unité mixte de recherche (SESSTIM), Aix-Marseille Univ, Institut national de la santé et de la recherche médicale (INSERM), Institut de recherche pour le développement (IRD), Marseille, France
| | - Patricia Marino
- Institut Paoli-Calmettes Sciences économiques et sociales de la santé & traitement de l’information médicale Unité mixte de recherche (SESSTIM UMR) 1252, Institut national de la santé et de la recherche (INSERM), Institut de recherche pour le développement (IRD), Aix Marseille University, Marseille, France
| | - Philippe-Jean Bousquet
- Department of Health Data and Assessment, French National Cancer Institute (Institut National du Cancer, INCa), Boulogne-Billancourt, France
- Institut Paoli-Calmettes Sciences économiques et sociales de la santé & traitement de l’information médicale Unité mixte de recherche (SESSTIM UMR) 1252, Institut national de la santé et de la recherche (INSERM), Institut de recherche pour le développement (IRD), Aix Marseille University, Marseille, France
| | - Elsa Bouée-Benhamiche
- Department of Health Data and Assessment, French National Cancer Institute (Institut National du Cancer, INCa), Boulogne-Billancourt, France
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Chiaruttini MV, Corli O, Pizzuto M, Nobili A, Fortini G, Fortino I, Leoni O, Bosetti C. Palliative medicine favourably influences end-of-life cancer care intensity: a large retrospective database study. BMJ Support Palliat Care 2022:spcare-2022-004050. [PMID: 36522144 DOI: 10.1136/spcare-2022-004050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Hospice and home palliative care have been associated to a reduction of aggressive treatments in the end-of-life, but data in the Italian context are scanty. Therefore, we aim to investigate the role of palliative care on indicators of end-of-life intensity of care among patients with cancer in Lombardy, the largest Italian region. METHODS Within a retrospective study using the healthcare utilisation databases of Lombardy, Italy, we selected all residents who died in 2019 with a diagnosis of cancer. We considered as exposure variables admission to palliative care and time at palliative care admission, and as indicators of aggressive care hospitalisations, diagnostic/therapeutic procedures, in-hospital death, emergency department visits and chemotherapy over a time window of 30 days before death; chemotherapy in the last 14 days was also considered. RESULTS Our cohort included 26 539 individuals; of these, 14 320 (54%) were admitted to palliative care before death. Individuals who were admitted to palliative care had an odds ratio (OR) of 0.27 for one hospitalisation, 0.14 for ≥2 hospitalisations, 0.25 for hospital stay ≥12 days, 0.38 for minor diagnostic/therapeutic procedures, 0.18 for major diagnostic/therapeutic procedures, 0.02 for in-hospital death, 0.35 for one emergency department visit, 0.29 for ≥2 emergency department visits and 0.66 for chemotherapy use in the last 30 days; the OR was 0.56 for chemotherapy use in the last 14 days. CONCLUSIONS This large real-world analysis confirms and further support the importance of palliative care assistance for patients with cancer in the end- of- life; this is associated to a significant reduction in unnecessary treatments.
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Affiliation(s)
| | - Oscar Corli
- Dipartimento di Oncologia, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Alessandro Nobili
- Dipartimento di Politiche per la Salute, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Ida Fortino
- Regione Lombardia Direzione Generale Welfare, Milano, Italy
| | - Olivia Leoni
- Regione Lombardia Direzione Generale Welfare, Milano, Italy
| | - Cristina Bosetti
- Dipartimento di Oncologia, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Akoo C, McMillan K. An Evolutionary Concept Analysis of Palliative Care in Oncology Care. ANS Adv Nurs Sci 2022; 46:199-209. [PMID: 36006006 DOI: 10.1097/ans.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This evolutionary concept analysis reports on the concept of palliative care in oncology. Despite its relevance to oncology, the concept of palliative care remains misunderstood, resulting in erroneous interpretations by nurses and health care providers alike. Consequently, integration of palliative care remains heterogeneous and highly contextual. Findings highlight the complexity and ambiguity of the concept of palliative care in the context of oncology care. The nuances and complexity of when to integrate palliative care for patients living with cancer, as well as its evolution from its origins in the hospice movement, have led to its ambiguity in clinical practice.
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Affiliation(s)
- Chaman Akoo
- School of Nursing, University of Ottawa, Ottawa, Canada
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Frasca M, Orazio S, Amadeo B, Sabathe C, Berteaud E, Galvin A, Burucoa B, Coureau G, Baldi I, Monnereau A, Mathoulin-Pelissier S. Palliative care referral in cancer patients with regard to initial cancer prognosis: a population-based study. Public Health 2021; 195:24-31. [PMID: 34034002 DOI: 10.1016/j.puhe.2021.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/23/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES More than half of cancer patients require palliative care; however, inequality in access and late referral in the illness trajectory are major issues. This study assessed the cumulative incidence of first hospital-based palliative care (HPC) referral, as well as the influence of patient-, tumor-, and care-related factors. STUDY DESIGN This is a retrospective population-based study. METHODS The study included patients from the 2014 population-based cancer registry of Gironde, France. International Classification of Diseases, Tenth Revision, coding for palliative care identified HPC referrals from 2014 to 2018. The study included 8424 patients. Analyses considered the competing risk of death and were stratified by initial cancer prognosis (favorable vs unfavorable [if metastatic or progressive cancer]). RESULTS The 4-year incidence of HPC was 16.7% (95% confidence interval, 16.6-16.8). Lung cancer led to more referrals, whereas breast, colorectal, and prostatic locations were associated to less frequent HPC compared with other solid tumors. Favorable prognosis central nervous system tumors and unfavorable prognosis hematological malignancies also showed less HPC. The incidence of HPC was higher in tertiary centers, particularly for older patients. In the favorable prognosis subgroup, older and non-deprived patients received more HPC. In the unfavorable prognosis subgroup, the incidence of HPC was lower in patients who lived in rural areas than those who lived in urban areas. CONCLUSIONS One-sixth of cancer patients require HPC. Some factors influencing referral depend on the initial cancer prognosis. Our findings support actions to improve accessibility, especially for deprived patients, people living in rural areas, those with hematological malignancies, and those treated outside tertiary centers. In addition, consideration of age as factor of HPC may allow for improved design of the referral system.
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Affiliation(s)
- Matthieu Frasca
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France; Department of Palliative Medicine, CHU Bordeaux, 33000, Bordeaux, France.
| | - Sébastien Orazio
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Brice Amadeo
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Camille Sabathe
- Biostatistic team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Biostatistic Team, UMR 1219, 33000, Bordeaux, France
| | - Emilie Berteaud
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Angeline Galvin
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Benoît Burucoa
- Department of Palliative Medicine, CHU Bordeaux, 33000, Bordeaux, France
| | - Gaelle Coureau
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Isabelle Baldi
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Alain Monnereau
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Simone Mathoulin-Pelissier
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France; Unité d'épidémiologie et de recherche cliniques, Institut Bergonié, 33000, Bordeaux, France
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