Palliative Situation Research Articles

FAMILY CAREGIVER SATISFACTION WITH HOME-BASED PALLIATIVE CARE SERVICES IN NORTH RHINE-WESTPHALIA, GERMANY

Aim: The aim of this study was to give an overview of family caregiver satisfaction within the home palliative care situation in North Rhine-Westphalia, Germany. Design: A cross-sectional study. Methods: An anonymous questionnaire, with seven validated scales, and comprising of 71 items, was used. The items investigated perceived needs and burdens of families within a home-based palliative care situation. The satisfaction of the family caregivers with the services delivered by palliative care teams was measured by the FAMCARE-2 Scale. Descriptive statistics and analysis of covariance (ANCOVA) were performed. Results: A convenience sample of 106 family members agreed to participate in the study. Overall, we found high satisfaction within our sample. There was high satisfaction with how the services respected the dignity of families, and how they provided comfort to patients. Satisfaction was lower with regard to information about patients. Conclusion: High or low satisfaction with palliative care, tells us little about the quality of services. The high satisfaction within this study could be interpreted as a sign that palliative care was important to families at the time of availability. Regular and continuous assessment can serve to inform the continuous quality of care provision for patients and their families.

Bone Metastases - Pathophysiology, Diagnostic Testing and Therapy (Part 1)

In Germany and other European countries, cancer is the second most common cause of death after cardiovascular disease. Although 5-year survival rates for several types of cancer have significantly improved over the last 30 years, metastasis to the bone almost always leads to incurable disease. Aside from the rare primary bone tumours, the treatment of bone metastases now accounts for a major part of tumour orthopaedic workload and requires close interdisciplinary coordination between specialists in oncology, radiology and the discipline of the primary tumour entity. Due to improvements in oncological treatment regimes, long survival times can be achieved. Therefore, the management of so-called "SRE" (skeletal-related events) has gained importance, even in palliative situations. On the basis of a selective literature review, the following article points out the underlying pathophysiological processes of bone metastases and outlines different diagnostic approaches and their relevance in the current clinical setting.

The Oncological Patient in the Palliative Situation.

Palliative care approaches patients and their suffering with a bio-psycho-social-spiritual model. Thus, it is the strength of palliative care to complement the diagnosis driven approach of medical cancer care by a problem and resources-based assessment, participatory care plan and person-directed interventions. Interventions need to reflect timely prognosis, target population (the patient, the family carer, the professional) and level of trust and remaining energy. In palliative care the relevance of psycho-oncological aspects in the care of the terminally ill is considerable in the understanding of the overall suffering of patients approaching death and their loved ones and in their care and support. There is little evidence to date in terms of clinical benefit of specific psycho-oncological interventions in the last months or weeks of life, but there is evidence on effects of stress reduction and reduced anxiety if locus of control can stay within the patient as long as possible. One major challenge in psychosocial and palliative care research, however, is defining patient relevant outcomes.

La formation en soins palliatifs en Europe

Education and training in palliative care are a challenging issue needing to be addressed to meet the need of patients and families, across a range of clinical setting as home, hospital, nursing home. Since 1992 the EAPC has been aware of the importance of education for the development of palliative care and suggested some recommendations for health professionals in order for them to give the best palliative care. Three levels of education are required, from basic to specialist level, for skill, knowledge and attitudes. The training should provide competencies in the field of symptoms management but also in psychosocial suffering, decision making and legal aspects of palliative care, with attention to the patient and families beliefs and experience during the disease. This global approach needs to have the multi-disciplinary aspects and team working included in the training regardless of the student’s profession. This specific approaches benefit to the health care professional and give an ability to provide better care for all patients, in palliative situation or not.

Expanding the borders: Image-guided procedures for the treatment of musculoskeletal tumors.

Interventional radiology has revolutionized the local management of bone tumours, offering new minimal invasive alternatives to surgery and radiotherapy. Its role has continuously increased over the past years for the treatment of benign tumors and also of some malignant ones, especially in palliative situations. The development of protective techniques and new ablative technologies, such as cryoablation, contributes to expand the role of the interventional radiologist to new fields of applications in musculoskeletal oncology.

Utilisation de la voie sous-cutanée en soins palliatifs néonatals : revue de la littérature et enquête de pratique en France

Subcutaneous hydration (hypodermoclysis) and drug administration is a widely used method of analgesic therapy in adult palliative care medicine. Very little is known about its use in neonatal medicine. Evidence-based guidelines do not exist due to a lack of data. In this study, the advantages of subcutaneous analgesic therapy in terms of comfort in neonatal palliative care situations were investigated. This report details the results of a systematic review associated with a survey in neonatal intensive care units (NICUs) and pediatric palliative care departments (PPCTs) in France. No article was available in the Medline database. In Google®, we found six guidelines that described the use of the subcutaneous route in the pediatric palliative population. The participation rate in the survey was approximately 83% for French NICUs and 74% for PPCTs. Eleven percent of NICUs and 27% of PPCTs had already used subcutaneous drug administration for palliative care, mainly for analgesia and terminal sedation. Limiting factors of its use were mainly alternative options and the lack of data. Nevertheless, 76% of NICUs and 73% of PPCTs expressed an interest in the use of the subcutaneous route in NICUs. Ninety-one percent of French NICUs and 80% of PPCTs were interested in elaborating a protocol using the subcutaneous route for analgesia, anxiolysis, or terminal sedation. The subcutaneous route can be advantageous for comfort care in the neonatal palliative population. Studies are needed to define the modalities, pharmacodynamics, and pharmacokinetics of therapeutics in this population.

Patients in palliative care-Development of a predictive model for anxiety using routine data.

IntroductionAnxiety is one of the most common psychological symptoms in patients in a palliative care situation. This study aims to develop a predictive model for anxiety using data from the standard documentation routine.MethodsData sets of palliative care patients collected by the German quality management benchmarking system called Hospice and Palliative Care Evaluation (HOPE) from 2007 to 2011 were randomly divided into a training set containing two-thirds of the data and a test set with the remaining one-third. We dichotomized anxiety levels, proxy rated by medical staff using the validated HOPE Symptom and Problem Checklist, into two groups with no or mild anxiety versus moderate or severe anxiety. Using the training set, a multivariable logistic regression model was developed by backward stepwise selection. Predictive accuracy was evaluated by the area under the receiver operating characteristic curve (AUC) based on the test set.ResultsAn analysis of 9924 data sets suggests a predictive model for anxiety in patients receiving palliative care which contains gender, age, ECOG, living situation, pain, nausea, dyspnea, loss of appetite, tiredness, need for assistance with activities of daily living, problems with organization of care, medication with sedatives/anxiolytics, antidepressants, antihypertensive drugs, laxatives, and antibiotics. It results in a fair predictive value (AUC = 0.72).ConclusionsRoutinely collected data providing individual-, disease- and therapy-related information contain valuable information that is useful for the prediction of anxiety risks in patients receiving palliative care. These findings could thus be advantageous for providing appropriate support for patients in palliative care settings and should receive special attention in future research.

Spinal bone metastases in colorectal cancer: a retrospective analysis of stability, prognostic factors and survival after palliative radiotherapy

BackgroundThis retrospective analysis aimed to analyse the stability of spinal bone metastases in colorectal cancer (CRC) patients following radiotherapy (RT) by use of a validated score and to assess prognostic factors for stability and survival.MethodsNinety-four patients with osteolytic spinal bone metastases from CRC were treated at the Department of Radiation Oncology at the University Hospital Heidelberg between 2000 and 2014. The stability of each affected vertebral body was assessed according to the validated Taneichi bone stability score on the basis of the treatment planning CT scan prior to RT and also based on the follow-up CT examinations at 3 and 6 months after RT. Additionally, bone survival rates (time between first day of RT and death from any cause) as well as prognostic factors for bone survival were evaluated for all study patients.ResultsBefore RT, 59 patients (63%) were rated unstable according to the Taneichi score. Pathological fractures within the irradiated region were diagnosed in 43 patients (46%) prior to RT. New fractures or progression of previously collapsed vertebrae were diagnosed in 4 patients (4%) after irradiation. Significant re-calcification and stabilization of former unstable bone metastases was only observed in 3/59 patients (3%) and 5/59 patients (9%). The median bone survival was 4.2 months (range 0.5–67.3 months) and 6 months after RT 61% of the patients were dead. Karnofsky performance score (KPS) (< 70% vs. ≥ 70%), chemotherapy and bisphosphonate therapy were predictive prognostic factors for bone survival.ConclusionsOur study population is characterized by poor bone survival and low re-calcification rates of unstable spinal bone lesions 3 and 6 months after RT. To avoid unnecessary hospitalisation and improve remaining QoL, short fractionated treatment schedules of RT may be prefered in this highly palliative situation, particularly for patients with a KPS < 70%.

Effect of Massage Therapy in Cancer Patients in Palliative Situation

Effect of Massage Therapy in Cancer Patients in Palliative Situation

Global geriatric evaluation is feasible during interactive telemedicine in nursing homes

Summary Introduction The aim of this study was to describe the implementation of interactive telemedicine in nursing homes (NHs) and to describe geriatric assessment performed during these acts. Patients and methods The design of the study was a retrospective descriptive study based on acts of interactive telemedicine in a total of 39 NHs located in the departments of Gironde and Dordogne, France. A total of 304 nursing home residents who benefited from interactive telemedicine acts because of complex situations such as behavioral disturbance related to dementia, chronic wounds, psychiatric disorders, chronic spasticity, or palliative care were included in this study. The following variables were collected: mean age, ADL (Katz) score, MMSE score, CIRS-G score, number of drugs intake per day, rate of avoided specialists request (consultation, planned or unplanned hospitalization) and rate of treatment optimizations during telemedicine. Data were analyzed with the statistical software SPSS 23. Results A total of 500 interactive telemedicine acts were analyzed and concerned: behavioral disturbance related to dementia (28.4%), complex chronic wounds (27.8%), dermatological pathologies (9.2%), psychiatric disorders (19.0%), situations of chronic spasticity (10%) and complex palliative care situations (2.8%). Interactive telemedicine avoided transfer to hospital in 378 (75.6%) cases [specialized consultations ( n = 264, 52.8%); programmed hospitalizations (day hospital and hospitalization, n = 110, 22.0%), and emergency admission ( n = 4, 0.8%)]. Inappropriate prescriptions were corrected in 351 cases (70.2%). Discussion and conclusion Telemedicine should be a relevant option to avoid and decrease return trips to the hospital for nursing home residents. These preliminary results also showed that beyond the reason for telemedicine, interactive telemedicine acts make it possible to carry out a global geriatric evaluation.

Urothelial cancer: update on systemic treatment options

Perioperative chemotherapy is likely to improve survival in both the neoadjuvant and the adjuvant setting. Therefore, it is an integral part of the modern treatment of patients with muscle-invasive urothelial bladder cancer. All patients who are suitable for cisplatin-based chemotherapy should be involved in a corresponding concept.Cisplatin-based combinations are standard regimens in the perioperative and palliative systemic treatment of urothelial cancer. Carboplatin is only an inferior substitute for "unfit" patients in the palliative treatment situation. Vinflunine may be used as a second-line agent in case of recurrence after palliative first-line treatment or in patients presenting with rapid progression after perioperative treatment. Alternatively, taxane or taxane-based combinations can be used in these situations.New therapeutic options may include the use of immune checkpoint inhibitors, which have shown promising results in early studies. Two substances have already been approved by the FDA for the treatment of advanced/metastatic urothelial cancer following platin-based upfront treatment. Other future options may be "tailored" treatment concepts based on the molecular pathogenesis of the individual patient. However, extensive pre-clinical work is still required for this approach.

Gastric cancer in young patients: Prognostics factors and therapeutic results

Introduction: Gastric cancers occurring in young subjects are rare. Their anatomo-clinical characteristics and their evolution are poorly understood and the therapeutic results in this situation remain controversial. Gastric cancers occurring in young subjects are rare. Their anatomo-clinical characteristics and their evolution are poorly understood and the therapeutic results in this situation remain controversial. Methods: During the period from January 2010 to December 2016, a series of 355 patients were admitted to the department of medical oncology of HASSAN II university hospital of Fes for the treatment of gastric cancer. Of these, 80 were aged 45 or younger. The aim of this study was to identify the clinical, pathological characteristics and prognosis of gastric cancer in young patients. Results: The average age of patients was 39 years (range: 25-45 years). The male/female ratio was 1,1. Familial history of gastric cancer was fond in ten patients. Fifty-eight patients (72.5%) were stage III or IV of the disease, while twenty-two patients. 73% of cases in the series had a slightly differentiated tumor. Curative resection was performed in 26 patients. Perioperative chemotherapy was performed in 10 cases (32,2%), adjuvant radio-chemotherapy in 8 cases (25,8%) and adjuvant chemotherapy was performed in 13 cases (41,93%). 54% were still alive after a median follow-up period of 3 years. In the palliative situation, chemotherapies were administered in forty-nine patients (61%) based on the protocol ECX. Response rate was 37%. In these patients, median survival was 6 months (range 3-14 months). Conclusion: The clinical and pathological features of the patients in our study seem to be consistent with an aggressive disease with a predominance of advanced disease and undifferentiated subtype. In addition, according to our study the prognosis of stomach cancer in young patients appear to be poorer than older patients.

Management of Loco-Regional Interventions in HCC

: Some patients are more susceptible to HCC (like HBV, Cirrhosis and ). In these patientsscreening imaging (ultrasound) is highly recommended. In positive cases next step would be 4-phasic CT scan or dynamic MRI for confirm diagnosis and also staging. If there are typical signs of HCC (wash in, wash out), biopsy is not necessary in susceptible populations. Gold standard treatment of HCC is surgery (resection or liver transplantation). In thosecases which are not candidate for surgery, Loco-Regional treatments are key players. The mostnoticeable of these are: TACE (Trans Arterial Chemoembolization) and Local Ablations (RF, Microwave, Alcohol injections and ). Site and Size of tumors should be considered in decision forablative techniques. Limitations for RF are 1) tumors more than 3 cm or 2) subcapsular locationor 3) neighboring to large vessels, but there are less limitations in Microwave. TACE is one of thetreatment of choice in cases which are not candidate for surgery or thermal ablations (intermediate stage). There are also some limitations for TACE which the most important one is decompensated cirrhosis (child B8, 9 and C). In this technique there are two factors (ischemia and chemotherapy) attenuating the tumors with synergistic effect. Generally TACE has a palliative situation in the guidelines but could be used as a bridge for curative plan (surgery or liver transplantation) alone or in combination with ablation techniques.

Other non-surgical treatments for liver cancer

Interventional radiology plays a major role in the modern management of liver cancers, in primary hepatic malignancies or metastases and in palliative or curative situations. Radiological treatments are divided in two categories based on their approach: endovascular treatment and direct transcapsular access.Endovascular treatments include mainly three applications: transarterial chemoembolization (TACE), transarterial radioembolization (TARE) and portal vein embolization (PVE). TACE and TARE share an endovascular arterial approach, consisting of a selective catheterization of the hepatic artery or its branches. Subsequently, either a chemotherapy (TACE) or radioembolic (TARE) agent is injected in the target vessel to act on the tumor. PVE raises the volume of the future liver remnant in extended hepatectomy by embolizing a portal vein territory which results in hepatic regeneration.Direct transcapsular access treatments involve mainly three techniques: radiofrequency thermal ablation (RFA), microwave thermal ablation (MWA) and percutaneous ethanol injection (PEI). RFA and MWA procedures are almost identical, their clinical applications are similar. A probe is deployed directly into the tumor to generate heat and coagulation necrosis. PEI has known implications based on the chemical toxicity of intra-tumoral injection with highly concentrated alcohol by a thin needle.

Palliative Care Situation in French Speaking African Countries: Example of the Sakoira Integrated Health Center in Republic of Niger (West Africa)

In Niger, palliative care is a necessity in everyday medical practice. However, the setting up of structures and / or mobile teams specifically dedicated to palliative medicine still faces enormous challenges. Most patients who consult for non-communicable disease or specifically for tumors or other incurable illnesses as some neurological diseases come advanced stages, requiring palliative care whereas there is as yet no national structure specifically dedicated to palliative care. No domain of research in palliative care is developed in Niger. No specific scientific work on palliative care have been conducted and published in Niger. This testifies to the lack of promotion of this specialty in Niger. So the ignorance of palliative care, access to morphine and ordinary molecules fight against pain are a real obstacle to the practice of palliative medicine in Sakoira Integrated Health Center (Tillabéri) in republic of Niger.

Radiothérapie pratique des métastases osseuses : indications et techniques

Bone metastases are common in the evolution of cancers. Their management should be multidisciplinary. Radiotherapy keeps a special place in the treatment of pain in cases of spinal cord compression and postoperatively. Many randomized trials have proved the effectiveness of single fraction (8Gy/1 fraction) which are rarely used. These protocols allow to indicate these treatments even in palliative situation. The use of analgesic and dexamethasone improves patient comfort during these treatments. Stereotactic radiotherapy can deliver with precision very high doses that can sterilize tumors considered radioresistant. His place may be discussed in case of spinal cord compression or in situation of re-irradiation. Ongoing trials will determine the place of irradiation of oligometastases or in situation of concurrent evolution of the primary tumor and metastasis.

P177 Assistant Nurses’ Experiences and Perceptions of Palliative Care Situations in Residential Care

P177 Assistant Nurses’ Experiences and Perceptions of Palliative Care Situations in Residential Care

Anti‑proliferative activity of epigallocatechin‑3‑gallate and silibinin on soft tissue sarcoma cells.

Disseminated soft tissue sarcomas (STS) present a therapeutic dilemma. The first-line cytostatic doxorubicin demonstrates a response rate of 30% and is not suitable for elderly patients with underlying cardiac disease, due to its cardiotoxicity. Well-tolerated alternative treatment options, particularly in palliative situations, are rare. Therefore, the present study assessed the anti-proliferative effects of the natural compounds epigallocatechin-3-gallate (EGCG), silibinin and noscapine on STS cells. A total of eight different human STS cell lines were used in the study: Fibrosarcoma (HT1080), liposarcoma (SW872, T778 and MLS-402), synovial sarcoma (SW982, SYO1 and 1273) and pleomorphic sarcoma (U2197). Cell proliferation and viability were analysed by 5-bromo-2′-deoxyuridine and MTT assays and real-time cell analysis (RTCA). RTCA indicated that noscapine did not exhibit any inhibitory effects. By contrast, EGCG decreased proliferation and viability of all cell lines except for the 1273 synovial sarcoma cell line. Silibinin exhibited anti-proliferative effects on all synovial sarcoma, liposarcoma and fibrosarcoma cell lines. Liposarcoma cell lines responded particularly well to EGCG while synovial sarcoma cell lines were more sensitive to silibinin. In conclusion, the green tea polyphenol EGCG and the natural flavonoid silibinin from milk thistle suppressed the proliferation and viability of liposarcoma, synovial sarcoma and fibrosarcoma cells. These compounds are therefore potential candidates as mild therapeutic options for patients that are not suitable for doxorubicin-based chemotherapy and require palliative treatment. The findings from the present study provide evidence to support in vivo trials assessing the effect of these natural compounds on solid sarcomas.

Ziconotide intrathecal delivery as treatment for secondary therapeutic failure of motor cortex stimulation after 6 years

IntroductionMotor cortex stimulation is a well-known treatment modality for refractory neuropathic pain. Nevertheless, some cases of therapeutic failure have been described but alternative therapies for these cases are rarely reported. Case reportThe patient presented with neuropathic pain in his right arm due to a cervical syrinx which was surgically treated by a shunt in 2003 with no clinical improvement. As alternative therapy, after an evaluation by repetitive magnetic transcranial stimulation with significant benefit, motor cortex stimulation was successfully implanted in 2004. In 2010, a similar pain occurred in the same territory. Local mean pain visual analogical scale (VAS) increased to 82/100. A newer generation stimulation device was then implanted and, within a period of 8months, different stimulation parameter settings were tested, without any pain relief. An intrathecal drug delivery pump was then implanted in 2011, and the upper extremity catheter was located at the cervicothoracic junction. There was no postoperative complication. A bitherapy was initiated at a daily dosage of 0.2mg morphine and 1.3μg ziconotide, not modified since August 2013. At 43months follow-up, mean VAS was 21/100 with improvement of daily life and spare-time activities, anxiety and depression, quality of life (as measured by the SF-36 survey and EQ5D-3L questionnaire). DiscussionRefractory neuropathic pain treated by motor cortex stimulation may be considered in palliative situations, and secondary therapeutic failure offers only a few perspectives. Intrathecal ziconotide, indicated as a first-line drug in non-cancer pain, could be proposed in such cases. ConclusionIntrathecal drug delivery including ziconotide in refractory neuropathic pain represents a reasonable option with a good clinical tolerance.

Transfusion de globules rouges en situation oncologique palliative

Anemia is frequent in oncology. We debate the decision-making process of erythrocyte transfusion in palliative care situation from a case report. A patient with a prostatic metastatic cancer was in palliative situation with asthenia and coronary symptom. We analyze, in this particular case that does not describe reality of normal practice, the decision-making process of erythrocyte transfusion. These transfusions were based, in this case, on the evaluation of oncology prognosis, the short-term vital threats, life project and clinical safety of the transfusion. The patient has received 5 erythrocyte transfusions in 4 months until a multidisciplinary meeting decided to stop transfusion because of poor prognostic situation and bad tolerance of the act. This patient could be a collegial model used to measure the reasonable nature of prescription depending on the purpose and the goal of the patient but does not allow generalization. Although there is low risk of erythrocyte shortage, it seems important to train doctors to reduce abusive transfusion and define transfusion thresholds. Different levels of erythrocyte transfusion security would raise the issue of management of several stocks. Erythrocyte transfusion in palliative care can be considered subject to prognostic information and the palliative aim of the transfusions, multidisciplinary decision-making, during short hospitalizations and with evaluation of the act and consequences for the patient.