Clinical Characteristics of Cancer Patients Referred Early to Supportive and Palliative Care.
ABSTRACT Abstract Background: Palliative care is evolving from end-of-life care to care provided earlier in the disease trajectory. We compared clinical characteristics between patients referred late in the course of their disease (late referrals, LRs) with patients referred earlier (early referrals, ERs). Method: Six hundred and ninety-five patients referred to the Supportive Care Center (SCC) with follow-up within 30 days were enrolled. One hundred ERs (expected survival ≥2 years or receiving treatment for curative intent, 14.4%) were compared with a random sample of 100/595 consecutive LRs (all others). Results: ERs were younger (54.4 versus 59.5, p=0.009), more likely to have head and neck cancer (67% versys 6%, p<0.0001), alcoholism (15% versus 4%, p=0.014), and shorter disease duration until first palliative care consultation (3.8 months versus 16.2 months, p<0.0001). They were also more likely to be referred by radiation oncologists (49% versus 3%, p<0.0001), be referred for treatment-related side effects (70% versus 9%, p<0.0001), and receive more anticancer treatment (74% versus 48%, p=0.0002). Head and neck cancer and reason for referral were independent predictors for ERs (p<0.0001) in multivariate analysis. Baseline Edmonton Symptom Assessment System (ESAS) symptoms were similar between ERs and LRs. Both groups exhibited improved ESAS scores at follow-up; LRs experienced greater improvement in the symptom distress score (-5.5 versus -3, p=0.007). The median total number of medical visits was higher in ERs (p<0.001); however, the median number of visits per month was higher in LRs (p<0.001). Conclusions: ERs had different patient characteristics than LRs, and although ERs experience distress similar to that of LRs, their needs and outcomes differ.
- SourceAvailable from: Sebastiano Mercadante
Article: The pain, the oncologist.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 06/2014;
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ABSTRACT: INTRODUCTION: The factors associated with successful opioid discontinuation after cancer treatment are not well-known. We determined the proportion of patients with advanced head and neck cancer who continued using opioids 3 months after the completion of radiation therapy with or without chemotherapy. METHODS: We included 70 patients with head and neck cancer referred to our institution's supportive care center between January 1, 2008, and December 31, 2010. Patients who no longer used opioids 3 months after the completion of radiation therapy were classified as stoppers; patients who continued using opioids were considered nonstoppers. We compared demographics, cancer-related characteristics, alcoholism, substance abuse history, use of psychoactive drugs, and opioid-related factors between stoppers and nonstoppers. RESULTS: In all, 44 of 70 patients (63%) and 23 of 70 patients (33%) continued opioids 3 months and 6 months after the completion of radiation therapy, respectively. A total of 18 of 44 nonstoppers (41%) and 3 of 26 stoppers (12%) were positive for alcoholism based on the CAGE questionnaire (i.e., Cut down, Annoying, Guilty, Eye opener; odds ratio: 5.3). Demographic and clinical characteristics did not differ between stoppers and nonstoppers. The median duration of any type of opioid use of CAGE-positive patients was significantly longer than that of CAGE-negative patients (median: 261 days vs. 93 days; hazard ratio: 2.5). CONCLUSION: CAGE positivity is a risk factor for opioid use beyond 3 months after the completion of radiation therapy and for duration of opioid treatment. Routine CAGE screening and meticulous follow-up are needed for these patients.Patients with head and neck cancer receiving chemoradiation suffer from side effects of treatment, especially pain. Severe pain is usually managed with opioids; however, in cancer survivors, specific groups of patients with risk factors cannot take opioids even to resolve treatment-related side effects. In this study, 63% and 33% of patients still used opioids 3 months and 6 months after the completion of radiation therapy, respectively. Patients who continued opioids at 3 months had higher positive CAGE than those who stopped opioids. CAGE-positive patients had longer median overall survival than CAGE-negative patients. Routine screening of CAGE for alcoholism, careful assessment of pain syndrome, longitudinal monitoring, and psychological intervention are needed for these patients.The Oncologist 05/2013; · 4.54 Impact Factor
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ABSTRACT: Persons aged 65 and over are the fastest growing segment of the population in most Western countries. Although cancer-related death occurs far more commonly in older people than in any age group, studies on palliative care in older adults are lacking. This paper aims at evaluating the needs in elderly patients affected by cancer and the state of the art of the research in palliative care in this setting. A literature search was performed (PubMed) to identify relevant studies. Papers were reviewed for relevance to palliative care in the elderly. Results Elderly who need palliative care are frequently disregarded as individuals and may experience discrimination because of their age. Palliative care for older patients relates particularly to multiple treatments for various conditions. This causes extra complexities for the researchers. Conclusions The aim of the study was not fully achieved due to the paucity of literature focusing upon these issues. The areas of investigation that need to be addressed comprise: establishing the prevailing symptoms in elderly patients, understanding patients' psychological/spiritual well-being and quality of life and elucidating the sources of caregiver burden, adapting research methodologies specifically for palliative care and comparing the needs and the outcomes of this age group to younger patients.Journal of Geriatric Oncology 01/2014; · 1.12 Impact Factor