Care For Terminal Cancer Patients Research Articles

Description of QOL and Cost of Home Care and Hospital Care in Terminal Cancer Patients

Description of QOL and Cost of Home Care and Hospital Care in Terminal Cancer Patients

Palliative oral care in terminal cancer patients: Integrated review.

Palliative care (PC) aims to improve quality of life in patients and its families against life threatening diseases, through suffering's prevention and relief. It is the duty of the dental surgeon to possess the knowledge needed to treat a patient with little life span, in order to establish an adequate treatment plan for each situation. To synthesize the published evidence on oral conditions, impact, management and challenges in managing oral conditions among palliative patients. Articles were selected from PubMed and Scopus electronic platforms, using a research strategy with diverse descriptors related to "palliative care", "cancer" and "oral health". The article's selection was done in two phases. The first one was performed by the main researcher through the reading of the abstracts. In the second phase two researchers selected eligible articles after reading in full those previous selected. Data was tabulated and analyzed, obtaining information about what is found in literature related to this subject and what is necessary to be approached in future researches about PC. As results, the total of 15 articles were eligible, being one a qualitative analysis, 13 (92.8%) clinical trials and one observational study. Of the 15 articles, 8 (53.4%) involved questionnaires, while the rest involved: one systematic review about oral care in a hospital environment, 2 oral exams and oral sample collection, one investigation of terminal patient's (TP) oral assessment records, 2 collection of oral samples and their respective analysis and one treatment of the observed oral complications. It can be concluded that the oral manifestations in oncologic patients in terminal stage are, oral candidiasis, dry mouth, dysphagia, dysgeusia, oral mucositis and orofacial pain. Determining a protocol for the care of these and other complications of cancer - or cancer therapy - based on scientific evidence with the latest cutting-edge research results is of fundamental importance for the multidisciplinary team that works in the care of patients in PC. To prevent complications and its needed to initial the dentist as early as possible as a multidisciplinary member. It has been suggested palliative care protocol based on the up to date literature available for some frequent oral complications in TP with cancer. Other complications in terminal patients and their treatments still need to have further studying.

Nationwide Survey on Caregiver Burden When Supporting Terminal Cancer Patients with Dementia: Bereaved Family Members' Perspective.

Objective: The prevalence of dementia and cancer has increased in recent years. The presence of dementia complicates the care of terminal cancer patients and affects their family caregivers. However, palliative care research seldom focuses on the family caregivers of patients with terminal cancer and dementia. This study aimed to evaluate the degree and factors of caregiver burden in cancer patients with dementia who died in hospice palliative care units. Methods: A nationwide cross-sectional survey was conducted among bereaved family members of patients with cancer who died in palliative care units. An anonymous self-report questionnaire was sent to bereaved family members, and they were asked if they were aware of the diagnosis of dementia. The short version of the Caregiver Consequence Inventory was used to measure caregiver burden. Results: The analysis included 670 bereaved family members. Of these, 83 (12.4%) were bereaved family members of terminal cancer patients with dementia. The caregiver burden was statistically significantly higher (3.61 ± 1.58 vs 3.22 ± 1.47; p < 0.036) among family caregivers of terminal cancer patients with dementia. Longer anti-cancer treatment duration (odd ratio, 4.63), poor mental and physical health of family caregivers (odds ratio, 2.05 and 2.20, respectively), pain (odd ratio, 1.72), and dyspnea (odds ratio, 1.67) were contributing factors for caregiver burden. Conclusions: Family caregivers of terminal cancer patients with dementia require care that considers the characteristics of the two serious diseases. Considering the goal of anti-cancer treatment and symptom relief may be a useful strategy for reducing caregiver burden.

Relationships between bereaved families' decision-making regret about end-of-life care place for patients with cancer and relevant factors

ObjectiveDecision-making regarding end-of-life care (EOLC) place causes psychological burden on families and 70% of bereaved families have regrets. Healthcare professionals need to support families to prevent regrets. This study aims to clarify the relationship between the factors related to the decision-making methods used to choose a place of care for terminal cancer patients and the regret experienced by bereaved families. MethodsParticipants were 1110 bereaved family members of patients with cancer. The questionnaire items were as follows: the agreement between patients and their families regarding their preferred place of EOLC, decision-making methods, satisfaction with the factors involved in the decision-making processes, experience regarding communication with medical personnel, and regret experienced by the bereaved families. ResultsThis analysis included 332 valid responses from 343 respondents. The regret score was significantly lower for the group wherein patients and their caregivers/families had similar preferences regarding the EOLC place (P ​< ​0.001). Regret scores were significantly higher in the physician-led decision-making group (vs. positive role group P ​= ​0.004, vs. shared role group P ​= ​0.014). The regret scores for the bereaved family members were negatively correlated with the satisfaction scores for “friend support,” “relationship with doctor,” “information,” “explanation by doctor,” “thought as oneself,” and “participation in the decision” (ρ ​= ​−0.207–0.400, P ​≤ ​0.001). ConclusionsTo reduce bereaved families' regret, family members should know the patients’ preferred place of EOLC, and patients and their families should be supported by physicians and nurses to understand their options and participate in the decision-making process.

225 (PB-049) Poster - Home based care for terminal cancer patients: study from rural part of India

Introduction & Aim: Cancer is one of the common causes of death worldwide after heart disease. Home care of the terminal cancer patients is very difficult and various challenges during their terminal stage. Our goal is to give a pain free good quality of life in these advanced stage cancer patients. Objective of this study is to identify the main difficulties in achieving the above goal in a rural village setting in India.

Cost-Effectiveness Analysis of Home-Based Hospice-Palliative Care for Terminal Cancer Patients.

We compared cost-effectiveness parameters between inpatient and home-based hospice-palliative care services for terminal cancer patients in Korea. A decision-analytic Markov model was used to compare the cost-effectiveness of hospice-palliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.

Bathing in Terminal Care of Cancer Patients and Its Relation to Perceptions of a "Good Death": A Nationwide Bereavement Survey in Japan.

Background:Bathing in a tub is integral to Japanese culture. It improves palliative care patients' symptoms and may improve quality of life.Objectives:This study aimed to determine the prevalence and impressions of bathing for terminally ill cancer patients and its relations to the evaluations of perceived end-of-life care and achievement of a good death.Design:This was a cross-sectional, anonymous, self-report questionnaire survey.Setting/Subjects:The questionnaire for this study was sent to bereaved family members who had lost loved ones in 14 general hospitals and 187 palliative care wards in Japan.Measurements:The bereaved family members of the patients who had actually bathed were asked about their impression of bathing. The short version of the Good Death Inventory (GDI) and the Care Evaluation Scale were used to evaluate “achievement of a good death.” In total, 1819 surveys were sent between July and September 2018 to bereaved family members of patients who had died between February 2014 and January 2018 in 14 general hospitals and 187 palliative care wards in Japan. Overall 885 questionnaires (valid response rate 48%) returned by bereaved family members were analyzed.Results:Overall, 85% of bereaved family members of patients who bathed evaluated the experience positively, 86% reported that the patient's face seemed to become calm after the bath, and 28% of bereaved family members whose loved one had not bathed reported regretting it. The total GDI score for the bereaved family's desired death was 82.7 ± 13.0 for the bathing group and 75.4 ± 15.7 for the no bathing group, a significant difference (effect size = 0.52, p < 0.01).Conclusions:Bathing before death was evaluated positively and was associated with the achievement of a good death.

Cost-saving prediction model of transfer to palliative care for terminal cancer patients in a Japanese general hospital

ABSTRACT Background Although medical costs need to be controlled, there are no easily applicable cost prediction models of transfer to palliative care (PC) for terminal cancer patients. Objective Construct a cost-saving prediction model based on terminal cancer patients’ data at hospital admission. Study design Retrospective cohort study. Setting A Japanese general hospital. Patients A total of 139 stage IV cancer patients transferred to PC, who died during hospitalization from April 2014 to March 2019. Main outcome measure Patients were divided into higher (59) and lower (80) total medical costs per day after transfer to PC. We compared demographics, cancer type, medical history, and laboratory results between the groups. Stepwise logistic regression analysis was used for model development and area under the curve (AUC) calculation. Results A cost-saving prediction model (AUC = 0.78, 95% CI: 0.70, 0.85) with a total score of 13 points was constructed as follows: 2 points each for age ≤ 74 years, creatinine ≥ 0.68 mg/dL, and lactate dehydrogenase ≤ 188 IU/L; 3 points for hemoglobin ≤ 8.8 g/dL; and 4 points for potassium ≤ 3.3 mEq/L. Conclusion Our model contains five predictors easily available in clinical settings and exhibited good predictive ability.

Application of Tiaoshen Jianpi acupuncture and moxibustion in hospice care for terminal cancer patients

To analyze the application feasibility of Tiaoshen Jianpi acupuncture and moxibustion in hospice care for terminal cancer patients. Tiaoshen Jianpi acupuncture and moxibustion adjusts the spirit to regulate emotions and fortifies the spleen to supplement and boost foundation of acquired (postnatal) constitution. And it could relieve adverse reactions after radiotherapy and chemotherapy, alleviate pain and regulate emotions in hospice care for terminal cancer patients, so as to promote the progress of hospice care for terminal cancer patients.

Association between Family Caregivers' Satisfaction with Care for Terminal Cancer Patients and Quality of Life of the Bereaved Family: A Prospective Pre- and Postloss Study.

Background: The quality of life (QOL) of family caregivers often deteriorates after the death of patients with terminal cancer. Although previous retrospective cross-sectional studies of the bereaved family caregivers of cancer patients have suggested that lower satisfaction with care given to terminal cancer patients was related to lower QOL of the bereaved family caregivers, the retrospective cross-sectional study design has limitations.Objectives: To clarify family caregivers' satisfaction with the care of terminal cancer patients and bereaved family caregivers' QOL.Design: A prospective pre- and postloss study.Setting/Subjects: Family caregivers of terminal cancer patients were recruited from three inpatient hospice/palliative care units in Japan.Measurements: Family caregivers completed questionnaires, including the Family Satisfaction with Advanced Cancer Care (FAMCARE) scale before loss and the 36-item Short-Form Health Survey (SF-36) questionnaire before loss and six months after the patient's death.Results: A total of 114 family caregivers were included in each analysis. After the patient's death, bereaved family caregivers' mental component summary score of SF-36 significantly differed between low- and high-satisfaction caregiver groups (n = 47 in both groups, mean difference = 3.50, p = 0.048). The proportion of family caregivers with depressive symptoms (moderate or worse) at preloss was 41% (25/61) in the low-satisfaction group and 22% (11/51) in the high-satisfaction group.Conclusions: Family caregivers' satisfaction with the care provided to terminal cancer patients at the end of their lives was associated with the bereaved family caregivers' QOL six months postloss. Enhancing family caregivers' satisfaction with care has the potential to improve their postloss QOL.

A STUDY TO ASCERTAIN THE ADVERSE EFFECTS OF MORPHINE IN CANCER PATIENTS BEING TREATED FOR SEVERE PAIN

Pain is a distressing symptom of cancer that affects the quality of life of patients, families, and caregivers. Moderate to severe pain is common throughout the disease trajectory of cancer, and its prevalence increases throughout the course of illness, it has been reported in 59% of patients undergoing anticancer treatment, in 64% of those with advanced/metastatic cancer, and in 33% of those having completed curative treatment. Adequate management of cancer pain is the cornerstone of symptom management for patients with cancer. [1] WHO guidelines on cancer pain continue to provide a framework approach for pharmacologic management of cancer pain management in terms of a Pain Ladder, wherein Step 1 for mild pain is prescribed NSAIDS, Step 2 for moderate pain is prescribed NSAIDS along with synthetic opioids and adjuvants and step 3 for severe pain is prescribed strong opioids like Morphine along with NSAIDS and adjuvants. Morphine being an excellent analgesic for severe pain is nowadays standard of care for terminal cancer patients with severe pain. However, its potency is a double edged sword and can give rise to side effects as well as much feared adverse effects. This study was undertaken to assess the undesirable effects on cancer patients being treated with Morphine. AIM To find the association of morphine and its adverse effects (by 4 point verbal rating scale) in cancer patient on long term morphine therapy. MATERIAL AND METHODS It is a hospital based longitudinal observational study, conducted in palliative care center, SMS hospital, Jaipur, after obtaining due approval from ethics committee and research review board of the institution. DURATION OF STUDY: One year. TOTAL PATIENTS: 30 patients evaluated one month after initiation of opioid therapy. ELIGIBILITY CRITERIA: Inclusion criteria 1. Cancer patients visiting palliative care OPD for distressing, somatic symptom like pain requiring treatment with strong opioids (step 3 WHO ladder). 2. Patients of all ages and both sexes. 3. Patients willing to give informed consent 4. Patients who understand the four point symptom rating scale. Exclusion Criteria: 1. Patients with deranged liver and kidney functions. 2. Patient with predominantly neuropathic pain. 3. Patients with altered sensorium. 4. Patient not willing to give informed consent.

Real-World Cost-Effectiveness of Palliative Care for Terminal Cancer Patients in a Japanese General Hospital

Background: The concept of cost-effectiveness is necessary for optimal utilization of limited health care resources. However, few studies have assessed the cost-effectiveness of palliative care using quality-adjusted life years (QALYs), considered common outcomes in health economics. Objective: We aimed to perform a cost-effectiveness analysis of palliative care for terminal cancer patients by using QALYs. Design: A retrospective cohort study was performed. Setting/Patients: We included 401 patients with stage IV cancer, who were hospitalized and died at a Japanese general hospital during the period April 2014 to March 2019. Methods: Using the hospital database, we compared the total admission costs and QALYs based on pain levels of patients admitted to the palliative care (PC) department with those of patients admitted to other usual care (UC) departments. Patients in each group were matched through propensity scores to reduce bias. Bootstrapping estimated the 95% confidence intervals (95% CIs) and the probability that PC was more cost-effective than UC. Results: After matching, 128 patients in each group were selected. Converting 1 U.S. dollar (USD) to 100 Japanese yen, PC reduced mean total admission costs by 1732 USD (95% CI: 1584-1879) and improved mean health benefits by 0.0028 QALYs (95% CI: 0.0025-0.0032) compared with UC. Based on the Japanese cost-effectiveness threshold, there was an 82% probability that PC was more cost-effective than UC. Conclusions: Our results indicated that admission of terminal cancer patients to the PC department was associated with improvement in cost-effectiveness. This finding could support the introduction of palliative care for terminal cancer patients. Our study was approved at St. Luke's International University (receipt number 18-R061 and at the Graduate School of Pharmaceutical Sciences, The Univesity of Tokyo (receipt number 31-29).

PCN59 Best Supportive Care Costs and Healthcare Use during END-of-Life Care in Terminal Cancer Patients in South Korea: A Retrospective Observational Study from Nationwide Claims Cohort DATA

Because of symptoms that affect the quality of life, terminal cancer patients who cannot be treated require the best supportive care(BSC). This study aims to analyze the healthcare use and costs of terminal cancer patients receiving BSC to present the economic burden. This study is a retrospective observational study using the National Sample Cohort data from the Korean Health Insurance Service(NHIS-NSC) between 1 January 2002 and 31 December 2015. We selected patients treated with one of the six cancers with the highest mortality rates as reported by the National Cancer Information Center. We defined the index date as the date of using the last anticancer drug based on the ATC code, and we followed up the patients from the index date to death. The follow-up period was limited to a maximum of 6 months. The average time to death after using the last anticancer drug was 72.26 days and the longest in the gallbladder and biliary cancer patients (87.90 days). The average total medical cost per patient was 6494.55 USD and was the highest in pancreatic cancer patients (7709.60 USD). The proportion of hospital admission was 86.36% which was the highest in the gallbladder and biliary cancer patients (92.68%) and was the lowest in the colon cancer patients (80.11%). The average length of hospital stay per patient was 33.66 days, and the average number of outpatient visits per patient was 6.26 times, which was the longest and the highest in pancreatic cancer patients (39.48 days and 7.74 times). Patients receiving BSC show differences in healthcare use and costs according to cancer. Therefore, customized supportive care should be performed to improve the quality of life of terminal cancer patients.

The Experience of Hospice Nurse on Caring for Terminal Cancer Patients in the Era of Convergence

The Experience of Hospice Nurse on Caring for Terminal Cancer Patients in the Era of Convergence

P334 - Better palliative care for terminal cancer patients in rural India – an NGO based approach

P334 - Better palliative care for terminal cancer patients in rural India – an NGO based approach

Better palliative care for terminal cancer patients in rural India - an NGO based approach

Better palliative care for terminal cancer patients in rural India - an NGO based approach

Embracing the setting sun: provision of palliative care via a collaborative model between hospital and community for patients with intellectual disabilities

Palliative care (PC) evolved from taking care of terminal cancer patients to modern concept of early integration into disease trajectories of patients with life limiting cancer and non-cancer diseases (1).

Valutazione degli atteggiamenti degli infermieri nelle cure dei pazienti morenti: Survey in pronto soccorso

Valutazione degli atteggiamenti degli infermieri nelle cure dei pazienti morenti: Survey in pronto soccorso

末期癌患者のケアについて : とくに抑うつ面からのアプローチ(死にゆく患者とその家族へのケア)(死の臨床)

末期癌患者のケアについて : とくに抑うつ面からのアプローチ(死にゆく患者とその家族へのケア)(死の臨床)

Aggressive care at the end of life: A study of practice based factors in patients with stage IV cancer.

80 Background: Numerous studies established that early utilization of palliative care-hospice services are beneficial to cancer patients. To reduce the incidence of aggressive care in terminal cancer patients, we conducted a quality improvement study to identify pertinent risk factors and develop interventions. Methods: Through chart review, we retrospectively identified patients with stage IV cancer that were followed by oncology clinic and were admitted to the University Hospital between 8/1/2015-10/31/15. For those patients who died during the last hospitalization or were discharged to hospice care, we obtained demographic, cancer related and practice related variables listed in Table. We used Mann Whitney U test and multivariable regression to find effects of factors related to length of stay (LOS) and cost of stay (COS). Results: Length of stay was significantly prolonged in those receiving chemotherapy within the past month (6 vs 3 p=0.035). Multivariate analyses found that patients with goals of care documented in the clinic had lower COS by 36.7% and LOS by 46.7%. On average, an ICU stay resulted in COS 2.2 times higher. No significant difference was seen in LOS based on a documented palliative care clinic visit or presence of an advanced directive. Conclusions: We identified practice based factors that need improvement including earlier goals of care conversations and less chemotherapy at the end of life. Identifying end stage patients in earlier admissions, collaborating with palliative care, and adding goals of care documentation to clinic note templates, are all interventions we are studying to improve care for end stage cancer patients. [Table: see text]