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Explanation of SPC*3 in questionnaire. Specialized palliative care service was defined as an outpatient palliative care clinic or inpatient palliative care team comprising certified palliative care physicians, advanced-practice nurses, and multidisciplinary palliative care staff (psycho-oncology physicians, pharmacists, medical social workers, rehabilitation specialists, dentists, etc.) who support the patients. *1Activities of daily living, *2functional stats as Karnofsky Performance Status Scale ≤ 40, *3specilized palliative care service
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Few studies have investigated appropriate referral timing of specialized palliative care (SPC) from the perspective of cancer patients’ and families’ experiences. We aimed to clarify appropriate SPC referral timing for patients with advanced cancer and their families. We used data from a nationwide bereaved family survey in Japan. We sent a questio...
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Timely integration of specialized palliative care (SPC) has been shown to improve cancer patients’ quality of life (QoL) and reduced the use of medical services. To evaluate the level of integration of SPC services for patients with advanced small-cell lung cancer (SCLC), we retrospectively analyzed medical records of patients from 2019 to 2021. Re...
Citations
... Tagami et al. conducted a study investigating the timing of palliative care referral for patients with advanced cancer [41]. It was reported that 20.9% (n = 102) of patients were referred at diagnosis, 11.4% (n = 56) during anti-cancer treatment, and 36.2% ...
... It was reported that 20.9% (n = 102) of patients were referred at diagnosis, 11.4% (n = 56) during anti-cancer treatment, and 36.2% (n = 177) when there were no further treatment options [41]. An additional 5.1% reported that they had never been referred to specialized palliative care (SPC) during their lifetime [41]. ...
... (n = 177) when there were no further treatment options [41]. An additional 5.1% reported that they had never been referred to specialized palliative care (SPC) during their lifetime [41]. The lack of symptomatic control and the suffering caused by the disease are best understood by a PC team that can accompany the patient both during standard oncology treatments and at the end of life [42]. ...
Background: Palliative care (PC) corresponds to an approach that enhances the quality of life for patients facing life-threatening diseases, such as cancer, as well as for their families. There are various models for providing palliative care. Early referral to PC of patients with advanced cancer has a significant positive impact on their quality of life. However, the criteria for early referral still remain controversial. Objectives: To evaluate patients' symptomatic intensity and perception of quality of life on admission to a PC unit and to analyze these two variables according to different models of approach (outpatient and inpatient care). Methods: A cross-sectional, descriptive, and correlational study was conducted with a sample of 60 patients sequentially admitted to a PC unit from palliative outpatient consultations or other inpatient services in a tertiary hospital dedicated to oncology care. The evaluation protocol included a sociodemographic and medical questionnaire, the Edmonton Symptom Assessment Scale (ESAS), and the Palliative Care Outcome Scale (POS) completed by patients within the first 24 h after admission. Results: The participants were mostly male (61.7%), with a median age of 72 years. The majority of patients (n = 32; 53.3%) were undergoing outpatient treatment, while the remaining individuals (n = 28; 46.7%) were transferred from other hospital services (inpatient care). In the outpatient care group, higher scores for fatigue and dyspnea were observed. Conversely, in the inpatient care group, higher scores were observed for pain, depression, and anxiety. There were significant differences between the two groups regarding the POS dimensions of meaning of life, self-feelings, and lost time. In the inpatient group, there was a longer time between diagnosis and referral to PC; however, it was also in the inpatient group that there was less time between PC referral and first PC evaluation, between PC referral and PC unit admission, and between PC referral and death. There were no significant correlations between referral times and ESAS/POS scores in the inpatient and outpatient groups. Conclusions: The patients admitted to the Palliative Care Unit presented a high symptom burden and changes in the perception of quality of life. However, there are no statistically significant differences between one model of approach in relation to the other. It was found that poorer symptom control and quality of life were associated with a shorter referral time for PC, because this was only initiated after curative care was suspended, particularly in our institutional context. Early referrals to the PC team are essential not only to relieve symptom-related distress but also to improve treatment outcomes and quality of life for people with cancer.
... However, no studies have investigated the preferences of patients with advanced cancer for early palliative care. Our previous study was conducted among bereaved families of patients with cancers who died in palliative care units [9]. Thus, early palliative care from a patient's perspective is not fully understood. ...
... The preferred timing was selected from the following [9]: when the disease was con rmed incurable or recurrent, during treatment or follow-up, when treatment became ineffective or the disease worsened, or when they became unable to take care of themselves. ...
... However, palliative care interventions were provided to only 21.8% of patients in this study. In our previous study [9], in which we surveyed bereaved families of cancer patients, 32.3% of patients received palliative care during cancer treatment, and a large percentage of patients' relatives judged the timing of palliative care referral as appropriate compared with the families of patients who received palliative care after cancer treatment, and appropriateness of timing and good quality of death were signi cantly associated. The present study also suggests that the timing of palliative care interventions should be earlier. ...
Purpose
To clarify the preferred timing and contents of early palliative care and preference for continued care delivery among patients with advanced cancer in Japan.
Methods
We conducted an Internet-based anonymous questionnaire survey on adult patients with advanced cancer. We assessed the patients’ wishes for palliative care delivered by a team or at outpatient clinics while asymptomatic, as well as the preferred intervention timing and preference for continuing care lifelong. Palliative care contents, cancer status, understanding and goals of cancer treatment, symptoms, and background factors were compared among these three preferences.
Results
In total, 531 patients responded (mean age, 61 years; men, 70%; major primary cancer sites, urological tract and breast), of whom 345 patients (65%) wished for palliative care while asymptomatic, and multivariate analysis revealed that a desire to address daily living and financial issues; wishing for consultations regarding illness, treatment, and end-of-life care; young age; primary sites other than hematological or urological sites; and increased physical distress were significantly associated with this wish. Approximately 51.3% of patients preferred palliative care before completing cancer treatment, while 40% preferred continuing palliative care lifelong. Young patients preferred early palliative care, and patients with a desire to address social distress preferred continuing palliative care.
Conclusion
The results highlight the importance of early palliative care planning in patients with advanced cancer; however, evaluating the eligibility for palliative care is essential.
Objective:
WHO grade III meningiomas, also known as malignant meningiomas (MMs), are rare, and the heterogenous clinical course in patients with MM is not well described. To characterize the clinical course of patients with MM, granular clinical data were gathered from 51 patients treated at the Department of Neurosurgery and Radiation Oncology, Rigshospitalet, in Copenhagen, Denmark, between 2000 and 2020.
Methods:
The authors investigated outcome and timing in terms of 1) tumor progression and grade transformation in patients previously diagnosed with WHO grade I or II meningiomas (patients with a secondary MM [sMM]); 2) performance status and complications following surgery; and 3) transition to noncurative treatment and ultimately death. Complications, time between recurrences, and outcome (modified Rankin Scale [mRS] score) for every surgery were analyzed, both malignant and premalignant.
Results:
Of the 51 patients, 24 (47%) had an sMM. The time to WHO grade III transformation in the sMM group varied widely (median 5.5 years, range 0.5-22 years), but after transformation to a WHO grade III tumor, patients with an sMM and those with a primary MM (pMM) did not differ significantly in overall survival and cumulative risk of progression. Median overall survival for all 51 patients was 4.2 years (95% CI 2.6-7.2 years). Time from the decision to shift from curative to noncurative treatment until death was 3.8 months and the 30-day mortality rate following surgery was 11.8%. From a cumulative number of 151 surgeries, 10 surgeries were followed by improvement on the mRS, mRS score was unchanged in 70, and it worsened in 71. The MM was the underlying cause of death in 30 of 31 patients who had died at the end of follow-up.
Conclusions:
Together, these findings clearly show a significant morbidity and mortality from the disease itself and from the treatment. These findings warrant studies of prognostic factors for earlier support and adjuvant measures in MM and identify a need for better palliative strategies in this patient group.
