scholarly journals Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis

2020 ◽  
Vol 9 (6) ◽  
pp. 1960
Author(s):  
Maria Isabel Carrasco-Zafra ◽  
Rafael Gómez-García ◽  
Ricardo Ocaña-Riola ◽  
Maria Luisa Martín-Roselló ◽  
Encarnación Blanco-Reina
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Multinomial Logistic Regression ◽  
Performance Status ◽  
Current Treatment ◽  
Advanced Cancer Patients ◽  
Multinomial Logistic Regression Analysis ◽  
Logistic Analysis ◽  
High Level ◽  
The Impact

The current treatment approach for patients in palliative care (PC) requires a health model based on shared and individualised care, according to the degree of complexity encountered. The aims of this study were to describe the levels of complexity that may be present, to determine their most prevalent elements and to identify factors that may be related to palliative complexity in advanced-stage cancer patients. An observational retrospective study was performed of patients attended to at the Cudeca Hospice. Socio-demographic and clinical data were compiled, together with information on the patients’ functional and performance status (according to the Palliative Performance Scale (PPS)). The level of complexity was determined by the Diagnostic Instrument of Complexity in Palliative Care (IDC-Pal©) and classified as highly complex, complex or non-complex. The impact of the independent variables on PC complexity was assessed by multinomial logistic regression analysis. Of the 501 patients studied, 44.8% presented a situation classed as highly complex and another 44% were considered complex. The highly complex items most frequently observed were the absence or insufficiency of family support and/or caregivers (24.3%) and the presence of difficult-to-control symptoms (17.3%). The complex item most frequently observed was an abrupt change in the level of functional autonomy (47.6%). The main factor related to the presence of high vs. non-complexity was that of performance status (odds ratio (OR) = 10.68, 95% confidence interval (CI) = 2.81–40.52, for PPS values < 40%). However, age was inversely related to high complexity. This study confirms the high level of complexity present in patients referred to a PC centre. Determining the factors related to this complexity could help physicians identify situations calling for timely referral for specialised PC, such as a low PPS score.

scholarly journals Palliative Care and COVID-19 Pandemic: Retrospective Study of Factors Associated With Infection and Death at an Oncological Palliative Care Reference Center

2021 ◽  
pp. 104990912098696
Author(s):  
Livia Costa de Oliveira ◽  
Karla Santos da Costa Rosa ◽  
Ana Luísa Durante ◽  
Luciana de Oliveira Ramadas Rodrigues ◽  
Daianny Arrais de Oliveira da Cunha ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Tumor Type ◽  
Advanced Cancer Patients ◽  
Factors Associated ◽  
Reactive Protein

Background: Advanced cancer patients are part of a group likely to be more susceptible to COVID-19. Aims: To describe the profile of advanced cancer inpatients to an exclusive Palliative Care Unit (PCU) with the diagnosis of COVID-19, and to evaluate the factors associated with death in these cases. Design: Retrospective cohort study with data from advanced cancer inpatients to an exclusive PCU, from March to July 2020, with severe acute respiratory syndrome. Diagnostic of COVID-19 and death were the dependent variables. Logistic regression analyses were performed, with the odds ratio (OR) and 95% confidence interval (CI). Results: One hundred fifty-five patients were selected. The mean age was 60.9 (±13.4) years old and the most prevalent tumor type was breast (30.3%). Eighty-three (53.5%) patients had a diagnostic confirmation of COVID-19. Having diabetes mellitus (OR: 2.2; 95% CI: 1.1-6.6) and having received chemotherapy in less than 30 days before admission (OR: 3.8; 95% CI: 1.2-12.2) were associated factors to diagnosis of COVID-19. Among those infected, 81.9% died and, patients with Karnofsky Performance Status (KPS) < 30% (OR: 14.8; 95% CI 2.7-21.6) and C-reactive protein (CRP) >21.6mg/L (OR: 9.3; 95% CI 1.1-27.8), had a greater chance of achieving this outcome. Conclusion: Advanced cancer patients who underwent chemotherapy in less than 30 days before admission and who had diabetes mellitus were more likely to develop Coronavirus 2019 disease. Among the confirmed cases, those hospitalized with worse KPS and bigger CRP were more likely to die.

Differences in performance status assessments between palliative care specialists, nurses, and oncologists.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 19-19
Author(s):  
YuJung Kim ◽  
Yi Zhang ◽  
Ji Chan Park ◽  
David Hui ◽  
Gary B. Chisholm ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Well Being ◽  
Assessment Tools ◽  
Advanced Cancer Patients ◽  
Care Clinic ◽  
Edmonton Symptom Assessment Scale ◽  
Ecog Ps

19 Background: The Eastern Cooperative Oncology Group (ECOG) performance status (PS) is one of the most commonly used assessment tools among oncologists and palliative care specialists caring advanced cancer patients. However, the inter-observer difference between the oncologist and palliative care specialist has never been reported. Methods: We retrospectively reviewed the medical records of all patients who were first referred to an outpatient palliative care clinic in 2013 and identified 278 eligible patients. The ECOG PS assessments by palliative care specialists, nurses, and oncologists, and the symptom burden measured by Edmonton Symptom Assessment Scale (ESAS) were analyzed. Results: According to the pairwise comparisons using Sign tests, palliative care specialists rated the ECOG PS grade significantly higher than oncologists (median 0.5 grade, P<0.0001) and nurses also rated significantly higher (median 1.0 grade, P<0.0001). The assessments of palliative care specialists and nurses were not significantly different (P=0.10). Weighted kappa values for inter-observer agreement were 0.26 between palliative care specialists and oncologists, and 0.61 between palliative care specialists and nurses. Palliative care specialists’ assessments showed a moderate correlation with fatigue, dyspnea, anorexia, feeling of well-being, and symptom distress score measured by ESAS. The ECOG PS assessments by all three groups were significantly associated with survival (P<0.001), but the assessments by oncologists could not distinguish survival of patients with PS 2 from 3. Independent predictors of discordance in PS assessments between palliative care specialists and oncologists were the presence of an effective treatment option (odds ratio [OR] 2.39, 95% confidence interval [CI] 1.09-5.23) and poor feeling of well-being (≥4) by ESAS (OR 2.38, 95% CI 1.34-4.21). Conclusions: ECOG PS assessments by the palliative care specialists and nurses were significantly different from the oncologists. Systematic efforts to increase regular interdisciplinary meetings and communications might be crucial to bridge the gap and establish a best care plan for each advanced cancer patients.

The impact of home palliative care on symptoms in advanced cancer patients

2000 ◽  
Vol 8 (4) ◽  
pp. 307-310 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Fabio Fulfaro ◽  
Alessandra Casuccio
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients ◽  
The Impact

Toward proven and prioritized quality measures: Which ASCO QOPI and other supportive care measures associate with improved quality of life (QOL)?

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 165-165
Author(s):  
Arif Kamal ◽  
Janet Bull ◽  
Amy Pickar Abernethy
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Supportive Care ◽  
Cancer Patients ◽  
Clinical Care ◽  
Performance Status ◽  
Quality Measures ◽  
Well Being ◽  
Care Quality ◽  
The Impact

165 Background: An expanding array of quality measures, including the Quality Oncology Practice Initiative (QOPI) metrics, is being developed for oncology. To date, evidence demonstrating the impact of each metric on outcomes, ultimately aiding in prioritization of individual measures, remains immature. We investigated the relationship between conformance with quality measures and higher patient QOL among cancer patients receiving palliative care. Methods: A comprehensive systematic review of PUBMED and the gray literature (1995-2012) identifed all described supportive care quality measures. Patients receiving palliative care in 4 community-based programs were entered into a longitudinal quality registry; analyses focused on cancer patients registered between 6/08-10/11. To find predictors of higher QOL, conformance cohorts were examined for demographic variables, performance status (measured by palliative performance scale, PPS) and provider estimation of prognosis and included in univariate and multivariate regression. Results: The systematic review yielded 303 quality measures. Of these, 18 measures, representing components of the ASCO QOPI, Hospice PEACE, and Cancer-ASSIST measure sets, were evaluable using registry data. 460 cancer patients were included. 60% of patients had weeks to 6 months expected prognosis. Among QOPI measures, conformance with two measures was significantly associated with better QOL: constipation assessment at time of narcotic prescription and emotional well-being assessment (both p<0.05). Other significant findings were conformance with screening of symptoms at first visit (p=0.017), timely treatment for uncontrolled dyspnea (p=0.005), and assessment of fatigue (p=0.007). In a multivariate model predicting higher QOL, measures involving emotional well-being assessment (OR 1.60; p=0.026) and screening of symptoms (OR 1.74, p=0.008) remained significant. Conclusions: Clinical care that conforms to quality measures reflecting regular symptom and emotional assessment is significantly associated with better patient experiences (QOL) and should be prioritized in quality assessment efforts.

Multidisciplinary tumor board for improvement of oncology collaboration in advanced cancer patients.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 175-175
Author(s):  
Sanders Chang ◽  
Amish Doshi ◽  
Cardinale B. Smith ◽  
Bethann Scarborough ◽  
Stelian Serban ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Tumor Board ◽  
Cancer Site ◽  
Primary Cancer ◽  
Advanced Cancer Patients ◽  
Primary Cancer Site ◽  
Supportive Oncology ◽  
The Impact

175 Background: The Palliative and Supportive Oncology Tumor Board was developed in 2015 to provide an interdisciplinary forum for discussion and management of patients with complex or refractory symptoms from advanced cancer. The board meets monthly and consists of medical, surgical, and radiation oncologists, interventional radiologists, pain management, palliative care specialists, residents, and fellows. Here, we assess the impact of the tumor board on the care of these patients. Methods: Electronic records of advanced cancer patients discussed at the tumor board from January 2015 to December 2015 were analyzed. We extracted data regarding sociodemographics, primary cancer site, pain interventions delivered, palliative care services utilized, and readmissions. Results: Thirty-two patients were presented at the tumor board over twelve months. The median age was 60 years (range 26-89); 47% were male. Primary cancer site included multiple myeloma (n = 11), gastrointestinal (n = 9), genitourinary (n = 5), breast (n = 2), lung (n = 2), skin (n = 1), and unknown origin (n = 2). At the time of discussion, 16 patients were hospitalized and 18 were in the ambulatory setting. Recommendations from the tumor board included altering medication regimen (n = 4), discussing eligibility to receive an anesthetic block (n = 7), undergoing vertebroplasty (n = 9), and planning palliative radiation treatment (n = 19). Patients were seen by specialists from pain (n = 21), interventional radiology (n = 14), neurosurgery (n = 9), palliative care (n = 20), radiation oncology (n = 21), or medical oncology (n= 32) within one day of their case presentation at the tumor board. Seven patients were transferred to the inpatient palliative care unit within a day of their tumor board discussion. Five patients were readmitted to the hospital within 30 days due to uncontrolled pain or other symptoms. Conclusions: The palliative and supportive oncology tumor board was well received by clinicians overall. It fostered interdisciplinary collaboration and supported comprehensive management of pain and other symptoms, as evidenced by the mix of cases discussed and the short time within which patients were seen after presentation by the participating specialists.

Cost Savings Associated With Palliative Care Among Older Adults With Advanced Cancer

2021 ◽  
pp. 104990912098680
Author(s):  
Paige E. Sheridan ◽  
Wendi G. LeBrett ◽  
Daniel P. Triplett ◽  
Eric J. Roeland ◽  
Andrew R. Bruggeman ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Healthcare Costs ◽  
Healthcare Expenditure ◽  
Advanced Cancer Patients ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

Background: There is inconsistent evidence that palliative care intervention decreases total healthcare expenditure at end-of-life for oncology patients. This inconsistent evidence may result from small sample sizes at single institution studies and disparate characterization of costs across studies. Comprehensive studies in population-based datasets are needed to fully understand the impact of palliative care on total healthcare costs. This study analyzed the impact of palliative care on total healthcare costs in a nationally representative sample of advanced cancer patients. Methods: We conducted a matched cohort study among Medicare patients with metastatic lung, colorectal, breast and prostate cancers. We matched patients who received a palliative care consultation to similar patients who did not receive a palliative care consultation on factors related to both the receipt of palliative care and end of life costs. We compared direct costs between matched patients to determine the per-patient economic impact of a palliative care consultation. Results: Patients who received a palliative care consultation experienced an average per patient cost of $5,834 compared to $7,784 for usual care patients (25% decrease; p < 0.0001). Palliative care consultation within 7 days of death decreased healthcare costs by $451, while palliative care consultation more than 4 weeks from death decreased costs by $4,643. Conclusion: This study demonstrates that palliative care has the capacity to substantially reduce healthcare expenditure among advanced cancer patients. Earlier palliative care consultation results in greater cost reductions than consultation in the last week of life.

Perception of curability in an international cohort of advanced cancer patients receiving palliative care.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 5-5
Author(s):  
Sriram Yennu ◽  
Omar M. Shamieh ◽  
Luis Fernando Rodrigues ◽  
Columbe Tricou ◽  
Marilène Filbet ◽  
...  
Keyword(s):  
Palliative Care ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Logistic Regression Analysis ◽  
Performance Status ◽  
Advanced Cancer Patients ◽  
Education Performance ◽  
Understanding Of Illness

5 Background: There is limited data on the illness understanding and perception of cure among advanced cancer patients (ACP) receiving palliative care around the world. The aim of the study was to determine the frequency and factors associated with perception of curability in countries in North and South Americas , Europe, Asia and Africa. Methods: Secondary analysis of a study to determine the decisional control preferences in different countries. ACP receiving palliative care were surveyed to assess the patients’ Understanding of Illness using a Understanding Of Illness questionnaire. Descriptive statistics and Logistic regression analysis were performed. Results: A total 1390 ACPs were evaluated. The median age was 58, 55% were female, 59% were married, 47% were catholic, 36.2% were educated college or higher degree. 681/1390 (49%) reported that their cancer is curable, 60% felt perceived that the goals of therapy was “to get rid of their cancer,” 79% perceived that the goals of the therapy was to “make them feel better.” 62 % perceived they were relatively healthy. Logistic regression analysis (Table 1) shows that better Karnosfsky performance status (OR 1.009, P = 0.04), higher education (OR 0.52, P = 0.0001), ACP's belonging to Brazil, France and S. Africa were less likely and ACPs from Philippines, Jordan were more likely to have a perception of curability. Age, gender, marital status, religion and passive decision control preferences were not significantly associated with perception of curability. Conclusions: The perception of curability in ACP's is 49% and significantly differs by education, performance status, and country of origin. Integration of Palliative Care can be more complex in these patients. Further studies are needed to develop strategies to reduce this misperception so as to have early integration of palliative care. [Table: see text]

Patient-reported symptom profiles: A tool to direct palliative care referral.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 93-93
Author(s):  
Tara L. Kaufmann ◽  
Jesse Y. Hsu ◽  
Kelly D. Getz ◽  
Arif Kamal ◽  
Angela DeMichele
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Latent Profile Analysis ◽  
Profile Analysis ◽  
Multinomial Logistic Regression ◽  
Tumor Type ◽  
Advanced Cancer Patients ◽  
Symptom Profile ◽  
Existential Distress ◽  
Patient Reported

93 Background: Both routine PRO monitoring and specialty palliative care are associated with a survival benefit in advanced cancer patients, yet the integration of these efforts has not been described. As PRO collection becomes standard of care, there is a need to understand how PROs may be leveraged to identify patients who could benefit from palliative care referral. Methods: We applied latent profile analysis (LPA) to PROs from a national palliative care registry collected from 2008 – 2017 on 745 solid tumor patients at the time of initial outpatient palliative care visit. LPA is an established method to identify unobserved groups from variables of interest. We used patients’ responses to 11 questions across 4 palliative care domains (9 ESAS items and 2 items for social and existential distress) to generate “PRO profiles” and examined their clinical and demographic correlates using multinomial logistic regression. Results: Four PRO profiles were identified using 9 ESAS items (Table). Young age, metastatic disease, and tumor type (including breast, GYN, GI) differed across PRO profiles compared to lung. Patients with PPS < 70% were 4.5 times more likely to be in the High vs. Low symptom profile compared to those with PPS > 70%. Subgroup analyses showed correlation of social and existential distress PROs with Mood and High profiles. Conclusions: Cancer patients referred to outpatient palliative care can be differentiated into clinically meaningful PRO profiles using brief, routinely collected data in the real-world setting. PRO profiles provide richer data on patient needs compared to prognosis estimates or cancer stage, and synthesize big data for use in clinical practice and epidemiologic research. PRO profiles should include comprehensive palliative domains and be tested as screening thresholds for palliative care referral. [Table: see text]

The impact of GOLD (Geriatric Oncology Liaison Development) service in oncology patients with significant co-morbidities and/or borderline performance status.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 90-90
Author(s):  
Matthaios Kapiris ◽  
Janine Mansi ◽  
Eleni Karapanagiotou
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Social Issues ◽  
Performance Status ◽  
Geriatric Oncology ◽  
Holistic Approach ◽  
Best Supportive Care ◽  
One Stop ◽  
Set Up ◽  
The Impact

90 Background: ASCO guidelines suggest patients > 65 should have a formal geriatric assessment [1]. We set up a new service in a London Cancer Centre. Cancer patients > 65 were reviewed in a one-stop GOLD clinic. Their focus was to provide a holistic approach to improve the oncology management. Nevertheless, not all cancer patients are fit to receive SACT. The aim of this study was to retrospectively review this group of patients. Methods: From October 2016 to April 2018, 596 patients were reviewed by GOLD. We analysed data for 298 (50%), including GOLD interventions and oncology management. In this cohort, 73% were between70-84 years (median 78). While most patients had SACT, 36 (12.4%) were deemed unfit by the oncology teams and had best supportive care only. These patients had a median age of 78.7 (64-93) and 20 (55.5%) were between 70-84. We also collected data on palliative care referral. Results: The main referrers were GI (10, 28%) and Urology (9, 25%). The rest included haematology (7, 19.4%), lung (5, 13.9%), gynaecology (3, 8.3%), melanoma and H&N (1, 2.8%) each. Referrals came mainly from the oncology teams (22, 61.1%). The remainder were identified from screening due to age (10, 27.8%) or following inpatient admission/Acute Oncology attendance (4, 11.1%). Co-morbidities and borderline performance status for systemic treatment were the two most common reasons for GOLD reviews (47.2% each), 8.3% involved polypharmacy and 2 (5.5%) cases involved social issues. Medication changes were advised for 52.8%. 41.6% did not have any changes to their management. One patient (2.8%) was referred to AHP and one (2.8%) to community palliative care. Fifteen (41.7%) had been referred to the Palliative Care team at the time of their review by GOLD. Conclusions: Despite multi-professional input, there are patients who remain unfit for SACT. It remains unclear whether a one-stop GOLD review added to the management of this group. Further evaluation is required to correctly identify patients who do not require multiple reviews. [1] Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology Hurria et al.

scholarly journals Economic impact of palliative care among elderly cancer patients.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 91-91
Author(s):  
Wendi G. Lebrett ◽  
Eric Roeland ◽  
Andrew Bruggeman ◽  
Heidi Yeung ◽  
James Don Murphy
Keyword(s):  
Palliative Care ◽  
Economic Impact ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Healthcare Costs ◽  
Advanced Cancer Patients ◽  
Care Intervention ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

91 Background: Randomized trials among advanced cancer patients demonstrate that early palliative care integration into usual oncology care reduces symptom burden, improves quality of life and caregiver outcomes, and may improve survival. The impact of palliative care on health economics remains poorly defined and reported cost savings are an unintentional consequence of providing care aligned with patient goals. This study determined the impact of palliative care on healthcare costs among elderly patients with advanced cancer. Methods: We conducted a matched case-control study among Medicare beneficiaries with metastatic lung, colorectal, breast and prostate cancers. We matched patients who received a palliative care consultation to similar patients who did not receive a palliative care consultation. To determine the economic impact of a palliative care consultation we compared costs between cases and controls before and after the palliative care intervention. Costs included inpatient, outpatient, home health care, hospice, and medical equipment, and were adjusted to 2011 dollars. Results: Among the 2,576 patients in this study the total healthcare costs per patient in the 30 days before palliative care consultation was balanced between palliative care ($12,881) and non-palliative care control patients ($12,335). Palliative care intervention reduced total healthcare costs after the intervention. The total cost of care per patient in the 120 days after palliative care exposure was $6,880 compared to $9,604 for controls (28% decrease; p < 0.001). The economic effect of palliative care depended on timing of the consult. Palliative care consultation within 7 days of death decreased healthcare costs by $975, whereas palliative care consultation more than 4 weeks from death decreased costs by $5,362. Conclusions: This study demonstrates that palliative care has the capacity to substantially reduce healthcare expenditures among advanced cancer patients. Furthermore, the cost reduction depends on timing of the palliative care consult.

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