Character of terminal illness in the advanced cancer patient (original) (raw)
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The Supportive Care Task Force at the University of L’Aquila: 2-years experience
Supportive Care in Cancer, 2005
The Supportive Care Task Force (SCTF) was established within the Medical Oncology Department at the University of L'Aquila in May 2002. The missions of the SCTF were to allow systematic evaluation and treatment of symptoms, to warrant continuity of care in all phases of disease and to provide medical oncology residents with training in the treatment of symptoms. A medical oncologist, two senior residents in medical oncology and a registered nurse comprised the SCTF. A psychiatrist, two neurologists, a dietician, and two physiotherapists served as consultants or on a part-time basis. Four beds in two-bedded rooms inside the Medical Oncology Department were reserved to SCTF. A close integration with the physicians of the Medical Oncology Department was realised. The only criterion to admission was the presence of uncontrolled symptoms. Patients were evaluated and monitored with the visual analogue scale for pain and with the Edmonton Symptom Assessment Scale (ESAS). The Palliative Prognostic Score (PaP Score) was employed to assess the prognosis. Non-clinical needs were evaluated (26.7%) to the Home Care Service and two (0.7%) to others units of the hospital. Sixty-five (22.8%) died in our unit.
The Importance of a Home Care Program for Patients with Advanced Cancer Pain
Tumori Journal, 1985
At the Pain Clinic of the National Cancer Institute of Milan, a special Home Care Program has been set up to assist advanced cancer patients with pain and their families during their remaining survival. The Home Care Unit comprises a team of physicians, nurse clinicians, psychologists and many volunteers who are active both in the hospital and at the patient's home. This entire operation provides a continuous relationship between the family, the patient and the Home Care Unit. This Home Care Program, which is one of a kind with other forms of treatment for advanced cancer patients (i.e. hospices), has produced interesting results. Out of a sample group of 50 patients, 33 were monitored at home by the Home Care Unit while 17 had their families to do the monitoring. Over a six-week period the following results were reported: a) Improvement of psycho-emotional factors such as anxiety, weakness and mood for both patients and their families who entered the Home Care Program. b) The Q...
Hospice enrollment and pain assessment and management in nursing homes
Journal of Pain and Symptom Management, 2003
This study compared pain assessment and management in the last 48 hours of life for hospice and nonhospice nursing home residents. Included were 209 hospice and 172 nonhospice residents in 28 nursing homes in six geographic areas. Hospice patients were considered short-stay (seven days or less) (n ϭ 51), or longer-stay (over seven days) (n ϭ 158). Of residents not in a hospital or a coma (n ϭ 265), 33% of nonhospice residents, 6% of short-stay and 7% of longer-stay hospice residents had no documented pain assessment (P Ͻ 0.05). For those with pain documented (n ϭ 93), longer-stay hospice residents, compared to nonhospice residents, had a significantly greater likelihood of having received an opioid (adjusted odds ratio [AOR] 5.4; 95% CI , and an opioid at least twice a day (AOR 2.7; 95% CI 0.9, 7.7; P ϭ 0.07). Study results suggest that hospice enrollment improves pain assessment and management for nursing home residents; they also document the need for continued improvement of pain management in nursing homes.
Transitions of Care and Changes in Distressing Pain
Journal of Pain and Symptom Management, 2006
This study employed a 22-state mortality follow-back survey to examine bereaved family members' perception of the level and pattern of distressing pain in decedents with cancer at the last two sites of care. Of the 1,578 individuals interviewed, 423 of their family members had cancer listed as the leading cause of death on the decedent's death certificate. Decedents were treated at home, hospitals, hospices, or nursing homes, with more than half of the respondents (n ¼ 216) reporting that the decedent was at more than one site of care in the last month. Forty-two percent of decedents had distressing pain (defined as ''quite a bit'' or ''very much'') at their second to last place of care, with 40% having distressing pain at the last place. There was some variation in the degree of change depending on the transition between the second to last and last places of care. For many individuals, however, the transition to another place of care did not result in an improvement in the level of distressing pain. No significant differences were found in the change in distressing pain by transition of care. Increased attention is needed not only on how to adequately manage pain and pain-related distress but also on how to improve pain reduction measures in transitions between health care settings at the end of life.
Supportive Care in Cancer, 2014
Background and objective Pain is among the most important symptoms in terms of prevalence and a major cause of distress for cancer patients and their family caregivers. Thus, we conducted this study with the aim to compare assessment of pain among cancer patients and their caregivers and to determine the problems experienced by caregivers. Methods A cross-sectional and descriptive design was used. This study was conducted in a chemotherapy unit and an adult oncology clinic with 220 patients diagnosed with cancer who admitted to an oncology hospital and 220 caregivers. The study data was collected using a questionnaire and visual analogue scale (VAS, where "0: no pain," "10: severe pain"). Statistically significant levels were set at p<0.05. Results Pain severity as assessed by patients and their caregivers was 7.1±2.8 and 7.3±2.4, respectively, and the most common pain-related problems in cancer patients were fatigue (p<0.05), loss of appetite and insomnia (p>0.05) as reported by both patients and caregivers. Compared to their caregivers, patients more frequently reported financial burden associated with pain management and negative effects of cancer pain on their work life and domestic life and family relationships, all of which were statistically significant (p<0.05). The caregivers most commonly reported fatigue (56.8 %) in their role as a caregiver. Conclusion Pain assessments of both patients and caregivers and seeking their input on how to manage potential painrelated problems are crucial to achieve adequate pain control. In addition, psychological distress experienced by caregivers should not be overlooked.
Clinical Trial of a Supportive Care Team for Patients With Advanced Cancer
Journal of Pain and Symptom Management, 2013
Context. Encouraging use of hospice and minimizing the use of cure-oriented aggressive interventions that detract from quality of life in the last month of life are specific targets for improvement in cancer care. Objectives. To evaluate the effect of an interdisciplinary cancer support team (CST) on quality of care and quality of life in patients with advanced cancers. Methods. A nonrandomized clinical trial was conducted, comparing outcomes before and after the integration of an interdisciplinary CST in routine care of adults with Stage III or IV lung, gastrointestinal, or gynecologic cancer. In the control arm, patients (n ¼ 332) received usual care; after the initiation of the intervention arm, eligible patients (n ¼ 278) received the CST intervention. The intervention consisted of individualized care coordination, symptom management, education, psychosocial and spiritual supports, and advance care planning throughout the 15-month study period. Quality of end-of-life care was measured through an ''aggressiveness of care'' index. Health-related quality of life (HRQOL) was measured with the Functional Assessment of Cancer Therapy-General. Results. There were no statistically significant differences between groups on specific indicators of quality of care. Surviving subjects with higher survival expectancy (who also reported better baseline quality of life) in the intervention arm had the greatest improvement in HRQOL scores, compared with the other three groupings of survival expectancy by treatment group (high vs. low by intervention vs. control) (P ¼ 0.044). Conclusion. Individually tailored supportive services from an interdisciplinary team are associated with improved HRQOL in some patients. This has implications for the potential benefits that can be accrued from providing intensive support to all patients, even those who may appear to be at less risk for distress. There also are important methodological considerations in using aggressiveness of care indices as a measure of quality of care.
PLOS ONE, 2016
The aim of this study was to assess how an admission to an acute palliative-supportive care unit (APSCU), may influence the therapeutic trajectory of advanced cancer patients. Methods A consecutive sample of advanced cancer patients admitted to APCU was assessed. The following parameters were collected: patients demographics, including age, gender, primary diagnosis, marital status, and educational level, performance status and reasons for and kind of admission, data about care-givers, recent anticancer treatments, being on/off treatment or uncertain, the previous care setting, who proposed the admission to APSCU. Physical and psychological symptoms were evaluated at admission and at time of discharge. The use of opioids was also recorded. Hospital staying was also recorded. At time of discharge the parameters were recorded and a follow-up was performed one month after discharge. Results 314 consecutive patients admitted to the APSCU were surveyed. Pain was the most frequent reason for admission. Changes of ESAS were highly significant, as well as the use of opioids and breakthrough pain medications (p <0.0005). A significant decrease of the number of "on therapy" patients was reported, and concomitantly a significant number of "offtherapy" patients increased. At one month follow-up, 38.9% patients were at home, 19.7% patients were receiving palliative home care, and 1.6% patients were in hospice. 68.5% of patients were still living.