Palliative Care For Cancer Patients Research Articles

Practice exploration of palliative care in cancer patients

Palliative care is a patient&family-centered special medical service, and it focuses on the effective management of physical, psychological, social and spiritual symptoms or problems. It provides the best quality of life for patients. Due to economic, cultural backgroud and other reasons in China, the practice of palliative care for cancer patients is still in the exploratory stage, and has not been a mature and systematic management model. This article will introduce, summarize, and analyze our palliative care team from aspects of team construction, member responsibility, work flow, work content, quality improvement and effect, so as to provide references for the development of palliative care in cancer patients in China. Key words: Cancer; Nursing; Palliative care

PRM37 - The Study of the Incidence, Etiology and Risk Factors for Constipation within Cancer Palliative Care Patients

PRM37 - The Study of the Incidence, Etiology and Risk Factors for Constipation within Cancer Palliative Care Patients

Oncology patients in the health care safety net: Is it too late for early palliative care?

128 Background: Studies have suggested that uninsured and Medicaid patients are more likely to present with late-stage cancer than Medicare patients, and may be more likely to be admitted urgently or emergently. However, studies of palliative care interventions for cancer patients suggest that the greatest impact can be achieved if these services begin “early” (≥ 90 days prior to death). In our urban public hospital, we examined where patients receive their initial cancer diagnosis, and at what stage they are diagnosed, in order to determine how to best implement community-based palliative care services. Methods: Retrospective cohort analysis of cancer patients diagnosed over a five year period. Hospital tumor registry data were used to determine the location of diagnosis (inpatient vs. outpatient), stage and type of cancer at diagnosis, and patient status at the end of the study period (alive vs. deceased). Results: Of the 2,928 patients diagnosed with cancer, 26% of patients (n = 759) were diagnosed while hospitalized. Patients who received their diagnosis while hospitalized were more likely to be diagnosed with stage 3-4 disease (49%, n = 372), vs. stage 0-1 (21%, n = 163). 25% of patients who received their diagnosis in the inpatient setting died within 90 days of initial diagnosis. Patients diagnosed in the outpatient setting were more likely to be diagnosed with stage 0-1 (40%, n = 865), vs. stage 3-4 (32%, n = 688). Patients diagnosed while hospitalized were 2.9 times more likely to be diagnosed with late stage disease, compared to those diagnosed as outpatients (95% CI 2.3-3.5, p < 0.0001). Conclusions: A large minority of patients received their cancer diagnosis while hospitalized, and were more likely to be diagnosed with late-stage disease. Additionally, a significant proportion of these patients died within 90 days of their initial diagnosis. In order to provide "early" palliative care for cancer patients in public hospitals, palliative care programs may need to offer initial consultation visits while patients are hospitalized, and then connect them with prompt outpatient follow-up. Safety net programs with palliative care services for cancer patients should emphasize continuity across inpatient and outpatient settings.

Efficacy and safety of methadone in the treatment of pain in palliative care patients with cancer: The EQUIMETH2 national, randomized, open, phase III study.

212 Background: Methadone is used more and more as a second-line treatment for refractory cancer pain in palliative care patients. Methods: The study aimed to compare the effect of two methadone titration methods (Stop and Go vs progressive titration) in 146 palliative care cancer patients with pain inadequately relieved or intolerant to level 3 opioids. The primary endpoint was the rate of success/failure at Day 4 defined by pain relief (reduction of at least two points of the numerical scale (0 - 10) AND a pain score < 5 for 2 consecutive days) AND no overdose (Rudkin scale ≥ 3 AND respiratory rate < 8/min). Results: Pain was nociceptive in 16% and mixed in 84%. 85% of the patients had breakthrough pain. Half received oxycodone, 1/5 fentanyl, 1/5 morphine and < 10% hydromorphone. Reasons for switching were lack of efficacy isolated (56%), or with intolerance to previous opioid (38%). More than 2/3 of the patients reached a pain score < 5 for two days at D4, adequate pain relief was obtained in 80% of the patients (median of 3 days in both groups (p = 0.12)) and lasted until D56. The rate of success/failure was about 40% at D4 with no difference between the two methods. Overdoses defined as respiratory rate < 8/min were observed in 13.2% patients throughout the study with no difference between groups. 9 required naloxone. The two methods were equally considered easy by about 60% of the clinicians. Conclusions: Methadone is an effective and sustainable second-line alternative opioid in the treatment of cancer pain in palliative care patients inadequately relieved or intolerant to level 3 opioids. The two methods of titration of methadone are comparable in terms of efficacy, safety and ease of use.

1323P - Palliative medicine in Iran

It is well known that palliative care is a necessity in cancer patients, as early on as the time of diagnosis. Palliative care for cancer patients is rather new in Iran and has a history of less than 8 years. Here we give an overview on the status of palliative care in Iran. We also present the demographics of our patients in the largest palliative care unit over the last two years. Iran has a population of around 80 million people and, according to the official cancer registry, a yearly cancer incidence of around 100 thousand. We currently have around 8 active palliative care units for cancer patients and one palliative care ward in Iran, all run by charities. In these palliative care units, we have oncologists, palliative care specialists, pain specialists, psychologists, spiritual care specialists, social workers and dieticians. A total number of 3677 patients, of whom 3277 (89%) had a cancer diagnosis were referred to our palliative care unit in Firoozgar Hospital, which is run by the Ala Charity, in Tehran in the last two years. 1770 female (54%) and 1457 male (46%) cancer patients were referred. A number of 388 (12%) patients had breast cancer, 339 (10%) had hematologic malignancies, 312 (10%) had esophageal or gastric cancer, 311 (10%) had colorectal cancer, 105 (3%) had a cancer of the CNS, 101 (3%) had lymphoma, 93 (3%) had renal cancer, 87 patients (3%) had ovarian cancer, 81 (2%) had lung cancer, 54 patients (2%) had prostate cancer and 50 (2%) had pancreatic cancer. The other 40% of the cancer patients had either less frequent cancers or their exact cancer site was not recorded. Iran, like many other countries, needs many more palliative care units. As palliative medicine is not financially lucrative, charities play a major role in setting up, maintaining and expanding these units.

Palliative Care as the Driving Force for Providing Psychological Comfort to Patients with Cancer: A Hermeneutic Study

Background: Palliative care is an important part of effective cancer care Objectives: The purpose of our study was to explore the lived experiences of nurses providing psychological palliative care for cancer patients in Iran. Methods: A hermeneutic phenomenological study was performed. We interviewed 11 oncology nurses to understand their lived experiences in cancer wards about psychological palliative care. We employed a seven-stage process of data analysis. Results: One constitutive pattern ‘palliative care as the driving force for providing psychological comfort to patients with cancer’ and three associated themes, namely ‘stress management’, ‘empathetic behavior’, and ‘all-embracing outlook’, were identified. Conclusions: The findings present better understanding of the lived experiences of oncology nurses in Iran regarding the phenomena under study.

Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life

ContextAnticholinergic drugs can cause several side effects, impairing cognition and quality of life (QOL). Cancer patients are often exposed to increasing cumulative anticholinergic load (ACL) as they approach death, but this burden has not been examined in patients with nonmalignant diseases. ObjectivesTo determine ACL and its impact in noncancer versus cancer palliative care patients. MethodsWe performed a secondary analysis of 244 subjects enrolled in a randomized controlled trial. ACL was quantified with the Anticholinergic Drug Scale. We used multivariable regression to calculate the effect of ACL on key outcomes, including drowsiness, fatigue, and QOL. Patients were stratified by diagnosis, and drugs were grouped as symptom management (SM) or disease management (DM). ResultsOverall, ACL in cancer and noncancer patients was not significantly different (2.6 vs. 2.4; P = 0.23). SM drugs caused greater anticholinergic exposure than DM drugs in both cancer and noncancer patients (2.3 vs. 0.5, and 1.5 vs. 1.3, respectively; both P < 0.05); however, DM drugs exposed noncancer patients to relatively more ACL than cancer patients (1.2 vs. 0.6, P < 0.0001). ACL was associated with worse fatigue (odds ratio, 1.08; CI, 1.002–1.17) and worse QOL (odds ratio, 0.89; CI, 0.80–0.98). ConclusionsACL is associated with worse fatigue and QOL and may not differ significantly between cancer and noncancer patients nearing end of life. SM drugs are more responsible for ACL in cancer and noncancer patients, although DM drugs contribute significantly to ACL in the latter group. We recommend more attention to reducing anticholinergic use in all patients with life-limiting illness.

Research updates of palliative care in cancer patients

By reviewing the latest published papers on palliative care, the article discussed the development and research progress of palliative care for people with advanced cancer, so as to provide reference for the development of palliative care specialty. According to the analysis, it suggested that by means of striving for more government support in both economic and education, raising funds through various channels, perfecting the social insurance system and volunteer′s regimen, promoting group working model, establishing standardized policies and regulations, increasing the publicity of palliative care, palliative care would move forward to a professional and normalized road, so that the people with incurable disease will receive better palliative care to improve the quality of life to the most. Key words: Neoplasms; Review; Palliative care

Effectiveness of acupuncture and related therapies for palliative care of cancer: Overview of systematic reviews

Acupuncture and related therapies such as moxibustion and transcutaneous electrical nerve stimulation are frequently used in the management of cancer-related symptoms. Their effectiveness and safety of acupuncture and related therapies are discussed controversial. The authors aim was to provide an overview to summarise the evidence on acupuncture for palliative care of cancer. A systematic review of 23 systematic reviews was conducted. The systematic review synthesised the results from clinical trials of patients with any type of cancer. The methodological quality of the 23 systematic reviews was assessed using the Methodological Quality of Systematic Reviews Instrument. The methodological quality of the 23 systematic reviews was regarded satisfactory. Evidence was found for acupuncture for the management of cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopenia in patients with cancer. For the treatment of cancer-related pain, hot flashes and hiccups, and improving patients’ quality of life there are conflicting results. There is currently insufficient evidence to support or refute the potential of acupuncture and related therapies in the management of xerostomia, dyspnea and lymphedema and in the improvement of psychological well-being. No serious adverse effects were reported in any study. The results of the study suggest that there is evidence for the use of acupuncture for the management of cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopenia in patients with cancer. As acupuncture appears to be relatively safe, it could be considered as a complementary form of palliative care for cancer patients.

Knowledge and practices of critical care nurses regarding palliative care of cancer patients and suggestion for nursing guidelines booklet

Palliative care is care for patients with serious illness that focuses on relieving suffering and improving quality of life for patients and their families. Aim of the study: assess knowledge and practices of critical care nurses regarding palliative care of cancer patients, and suggest nursing guidelines booklet about palliative care for cancer patients. Sample: The study subjects consist of all available nursing staff (60) at medical intensive care unit (30), surgical intensive care (30) unit. Research design: Descriptive exploratory research design was used to conduct this study. Tools: Two tools were included nurses' structured interview sheet, and nurse observational checklist sheet. Results: the majority of studied nurses (97%) had unsatisfactory knowledge scores regarding palliative care with Mean+SD 21 + 3.2., more than half of studied nurses (63.3%) had unsatisfactory level of practice regarding palliative care with Mean+SD 19.8 + 2.7., there were no statistically significant relation between practices and knowledge. Conclusion: The majority of studied nurses (97%) had unsatisfactory knowledge, as well more than half (63%) of studied nurses had unsatisfactory level of practices regarding palliative care of patients with cancer Recommendations: Enrichment of all nurses about knowledge and practices related to palliative care will be helpful to achieve quality of life, and reading nursing guidelines booklet.

Methadone as a Coanalgesic for Palliative Care Cancer Patients

Methadone offers many advantages for treating cancer pain. However, its pharmacokinetic profile makes its use as a full-dose opioid challenging. To evaluate the efficacy and safety of low-dose methadone as an adjunct to opioids in the treatment of cancer pain in palliative care patients. A cohort was followed retrospectively for up to 60 days after the initiation of methadone as a coanalgesic. Patients were eligible if they were prescribed methadone as a coanalgesic for cancer pain management and followed by the palliative care team. The primary efficacy end point was reduction of pain intensity (11-point numerical rating scale). Variables associated with pain intensity reduction were explored using logistic regressions. Adverse events were collected throughout the follow-up. Seventy-two of the 146 subjects (49%) qualified as significant responders (≥30% reduction in pain intensity). Median time to significant response was seven days, and pain intensity on the day of methadone initiation predicted the response to treatment. The most frequently reported adverse events were drowsiness, confusion, constipation, and nausea. As expected in a palliative care population, there was a substantial amount of missing data. A significant reduction in pain can be seen rapidly after the addition of methadone as a coanalgesic, particularly among patients with high pain intensity. More studies are needed to corroborate the efficacy of methadone as an adjunct to opioids.

Effectiveness of Hospital Palliative Care Teams for Cancer Inpatients: A Systematic Review.

Although the benefits of palliative care in the outpatient setting are well established, there has been little to support the employing of hospital palliative care services for inpatients with cancer. We conducted a systematic literature review to evaluate the effectiveness of palliative care for cancer patients in the acute inpatient hospital setting. Two electronic databases-PubMed and CINAHL Plus-were searched for articles published between 1 January 2005 and 28 May 2015. The search was augmented by hand-searches of specific journals and by examining the reference lists of short-listed articles. Studies were included if they evaluated a hospital palliative care service for cancer patients. Data extracted included study design, patient population, study setting, composition of the team, nature of the intervention, outcomes measured, and main findings. No randomized controlled trials were found. There were 14 pre-post studies that evaluated patient outcomes, of which only 2 had a control group. We also reviewed a further seven studies that evaluated other aspects of the palliative care intervention. The studies were not robust enough to confirm the efficacy of hospital palliative care services for cancer patient outcomes. Nonetheless, published studies provide a glimpse into the wider benefits of palliative care interventions. Data to support the benefit of palliative care interventions in the inpatient acute hospital setting are still lacking. Future studies should employ innovative strategies to further this field of research.

ESCALA MULTIDIMENSIONAL NA AVALIAÇÃO DA DOR E SINTOMAS DE IDOSOS EM CUIDADOS PALIATIVOS

Objetivou-se avaliar a dor e sintomas associados em idosos com câncer em cuidados paliativos em domicílio. Estudo quantitativo de corte transversal, realizado com 33 idosos, no município de Foz do Iguaçu, estado do Paraná, no período de janeiro a maio de 2015, por meio do Edmonton Symptom Assessment System e analisados pela estatística descritiva. Os idosos tinham a idade prevalente na sexta década de vida (60 a 69 anos), em sua maioria mulheres, casadas, com câncer de mama, baixa renda e baixa escolaridade, e portadoras de outras doenças associadas ao câncer. Verificou-se que 90,1% dos pacientes referem dor moderada, em queimação, diária e contínua no local acometido pelo tumor. Os sintomas associados à dor foram ansiedade, cansaço, depressão e redução do bem-estar. Conclui-se que é necessária a readequação das medidas para controle da dor e sintomas e maior investimento de gestores em saúde para possibilitar melhor assistência paliativa em domicílio.

Quality of life and satisfaction with care among palliative cancer patients in Saudi Arabia.

This study aimed to determine the relationship between quality of life and satisfaction with care among cancer patients in palliative care in Saudi Arabia. A total of 130 palliative cancer patients were invited to participate in our cross-sectional study. Patients were recruited from a large tertiary hospital within the Ministry of Health in Saudi Arabia. All eligible participants answered a three-part questionnaire that included demographic data and the validated European Organization for Research and Treatment of Cancer (EORTC QLQ-C15-PAL) and (EORTC IN-PATSAT32) questionnaires. Participants were mostly female (103/130, 79%) and married (93/130, 71%), and more than half had breast cancer (69/130, 53%). They were between 17 and 86 years of age (mean = 46.7, SD = 16.50). The correlation test showed that the relationship with physical function was weak, while emotional function and global health status had a moderate relationship with general satisfaction (r = 0.21, p < 0.01; r = 0.32, p < 0.001; r = 0.26, p < 0.01, respectively). Our results suggest that emotional function is the more important factor in predicting satisfaction with care among palliative cancer patients. An increase in emotional function leads to increased general satisfaction. The emotional function of palliative cancer patients was more closely associated with overall satisfaction with care than physical function or global health status. All palliative care team members are thus required to provide adequate psychosocial support. It is recommended that interdisciplinary and collaborative approaches be integrated in palliative care of cancer patients.

Health-related quality of life and burden of disease in chronic pain measured with the 15D instrument.

Health-related quality of life (HRQoL) measurement aims to capture the complete, subjective health state of the patients and to comprehensively evaluate treatment outcomes. The aim of this study was to assess, using the 15D HRQoL instrument, HRQoL in a sample of 1528 chronic pain patients, referred to the multidisciplinary pain clinic of the Helsinki University Hospital during 2004 to 2012. The 15D results of the chronic pain patients were compared with those of a matched general population. To analyse the properties of the 15D, the results were compared with the preadmission questionnaire of the pain clinic, containing questions about background factors, aspects of the pain, and its impact on life. The mean 15D score of the chronic pain patients was one of the lowest reported using 15D; 0.710 vs 0.922 in the general population. It equalled the score of advanced cancer patients in palliative care. The 15D scores were normally distributed, and 15D showed both statistically and clinically significant discriminative power in pain-related background factors. Visual analogue scale on pain intensity, visual analogue scale on pain-related distress, and the impact of pain on daily life correlated well with the 15D score. Pain intensity did not have independent predictive value on the score. The results indicate heavy perceived burden of illness in chronic pain patients. In light of the questions analysed, 15D appears sensitive and discriminative in chronic pain patients in tertiary care. Instead of pain intensity, the impaired HRQoL in chronic pain was mainly because of the psychosocial aspects of pain.

Clinical factors influencing death rattle breathing in palliative care cancer patients : Non-interventional study.

In the last days of life the clinical symptom of death rattle breathing is manifested in many awake or semiconscious patients in palliative care. Scientific studies on relevant influencing factors on the characteristics of the clinical symptom of death rattle breathing in patients in palliative care are rare. The design of the study is based on a non-interventional prospective study with questionnaire evaluation and was implemented at the palliative care unit at the Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care at the Clinical Center Klagenfurt, Austria. The questionnaire was developed by the authors of this study. The study had a predefined duration of 10 months (from February to November 2012) and during this period a total of 273 patients were admitted to the palliative care unit of the Clinical Center in Klagenfurt. Of these 105 (38.5 %) died and could therefore be included in the evaluation but 3 patients in palliative care (2.9 %) did not fulfil the inclusion criteria of a malignant disease. In total 102 patients, 43 females (42.2 %) and 59 males (57.9 %) were evaluated. The average age was 69 years with a range of 41-92 years. The largest proportion of the random sample (62.8 %) was in the patient age group from 61 to 80 years old and death rattle breathing could be observed in 26 patients (25.3 %) of the total sample. In a specific subgroup analysis regarding the intensity of the symptom, many of the affected patients suffered noisy breathing or severe death rattle breathing. In these cases it was primarily women in the group of patients with death rattle breathing. Gender was found to be a statistically relevant influencing factor (p= 0.034) on the intensity of the symptom. The great majority of the variables studied showed no influence on the development of the symptom of death rattle breathing; however, more intensive forms were manifested in female patients. The small study population could be a limitation of the present study although the prospective design allows valid conclusions to be drawn. In the future studies should be implemented in order to improve treatment of patients suffering from death rattle breathing.

Influence of socioeconomic status and religious belief on palliative care in terminally ill cancer patient in a private hospital of central Nepal.

e21513Background: Palliative care for cancer patients in Nepal is in infancy. Various factors like literacy, economical status, accessibility to health care facility and religious belief play a hug...

The Effect of 5 Minutes of Mindful Breathing to the Perception of Distress and Physiological Responses in Palliative Care Cancer Patients: A Randomized Controlled Study.

Palliative cancer patients suffer from high levels of distress. There are physiological changes in relation to the level of perceived distress. To study the efficacy of 5 minutes of mindful breathing (MB) for rapid reduction of distress in a palliative setting. Its effect to the physiological changes of the palliative cancer patients was also examined. This is a randomized controlled trial. Sixty palliative cancer patients were recruited. They were randomly assigned to either 5 minutes of MB or normal listening arms. The changes of perceived distress, blood pressure, pulse rate, breathing rate, galvanic skin response, and skin surface temperature of the patients were measured at baseline, after intervention, and 10 minutes post-intervention. There was significant reduction of perceived distress, blood pressure, pulse rate, breathing rate, and galvanic skin response; also, significant increment of skin surface temperature in the 5-minute MB group. The changes in the 5-minute breathing group were significantly higher than the normal listening group. Five-minute MB is a quick, easy to administer, and effective therapy for rapid reduction of distress in palliative setting. There is a need for future study to establish the long-term efficacy of the therapy.

Comparing the site of death and palliative care for cancer patients internationally

For this internationally authored retrospective cohort study, researchers appraised administrative and cancer registry data from 2010 to examine whether patients had died in acute care settings, particularly intensive care units (ICUs), and the associated costs.

The role of interventional oncology in the palliative care of cancer patients

ABSTRACTInterventional oncologists have expertise in delivery of state of the art, minimally invasive, image-guided procedures. As such, interventional oncologists are well-suited to provide palliative options for cancer patients, who often have complex comorbidities precluding them from more invasive options. The broad spectrum of procedures developed into clinical practice highlight the integral role of interventional oncology in the palliation of cancer patients. This review will focus on several of the more common procedures performed by interventional oncologists to provide symptomatic relief: 1. Tunneled peritoneal or pleural catheter placement for fluid drainage; Peritoneovenous shunt placement for fluid drainage; 2. Ablation with focus on metastatic bone ablation for pain control; 3. Neurolysis with focus on celiac neurolysis for pain control; 4. Decompressive gastrostomies or cecostomies for gastric and bowel obstruction; 5. Trans-arterial embolization for uncontrolled hemorrhage. A description o...