Appropriate referral timing to specialized palliative care service: survey of bereaved families of cancer patients who died in palliative care units

Tagami, Keita; Masukawa, Kento; Inoue, Akira; Morita, Tatsuya; Hiratsuka, Yusuke; Sato, Mahito; Kohata, Katsunori; Satake, Noriaki; Kizawa, Yoshiyuki; Tsuneto, Satoru; Shima, Yasuo

doi:10.1007/s00520-021-06493-2

Cited by 3 publications

(6 citation statements)

References 39 publications

(32 reference statements)

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“…The high mortality and morbidity in the patients in our MM cohort suggest that some patients may have undergone overly aggressive therapies while earlier palliation might have improved quality of life and survival, as has been described in analyses of other groups of patient with malignant disease [25][26][27] . We extended our analyses beyond survival and recurrence to understand the decision making when transitioning to non-curative treatment.…”

Section: Mortality Morbidity and Non-curative Decisionsmentioning

confidence: 69%

“…We suggest that patients with MM will benefit from palliative care (PC) 3 . Randomized controlled trials (RCT) of early palliative care have shown positive effects in various advanced cancers 25,[29][30][31] and an RCT investigating early PC in patients with glioblastoma is ongoing 32 . However, one must be aware of possible discordant prognostic awareness 33 and in the case of MM, the prognosis can be heterogenous and presenting the worst case scenario for the patient might not be beneficial.…”

Section: Mortality Morbidity and Non-curative Decisionsmentioning

confidence: 99%

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Granular clinical history and outcome in 51 patients with primary and secondary malignant meningioma

Maier¹,

Mirian²,

Haslund-Vinding³

et al. 2022

Journal of Neurosurgery

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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.

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Section: Mortality Morbidity and Non-curative Decisionsmentioning

confidence: 69%

Section: Mortality Morbidity and Non-curative Decisionsmentioning

confidence: 99%

Granular clinical history and outcome in 51 patients with primary and secondary malignant meningioma

Maier¹,

Mirian²,

Haslund-Vinding³

et al. 2022

Journal of Neurosurgery

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Background and Objectivesmentioning

confidence: 99%

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Timing and contents of early palliative care preferred by patients with advanced cancer in Japan: an Internet-based questionnaire survey

Sano,

Odagiri,

Tagami

et al. 2024

Preprint

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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.

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Intensity of Symptoms and Perception of Quality of Life on Admission to Palliative Care: Reality of a Portuguese Team

Gonçalves,

Gaudêncio,

Paiva

et al. 2024

Healthcare

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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.

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Appropriate referral timing to specialized palliative care service: survey of bereaved families of cancer patients who died in palliative care units

Cited by 3 publications

References 39 publications

Granular clinical history and outcome in 51 patients with primary and secondary malignant meningioma

Granular clinical history and outcome in 51 patients with primary and secondary malignant meningioma

Timing and contents of early palliative care preferred by patients with advanced cancer in Japan: an Internet-based questionnaire survey

Intensity of Symptoms and Perception of Quality of Life on Admission to Palliative Care: Reality of a Portuguese Team

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