Comparative pilot study of symptoms and quality of life in cancer patients                 and patients with end stage renal disease

Saini, Treena; Murtagh, Fliss E.M.; Dupont, Pierre; McKinnon, Pat; Hatfield, Paul; Saunders, Y

doi:10.1177/0269216306070236

Cited by 133 publications

(119 citation statements)

References 27 publications

(16 reference statements)

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“…The baseline characteristics of the remaining 63 patients are displayed in Table 1 and results of the GFI in Supplementary Table 2. Median age of included patients was 75 years (range 66-92) and 35% were women; 65% of patients were married, 27% was widower and 8% was unmarried. Median Charlson comorbidity index was 1 (range 0-6) and patients used a median of eight types of prescription medications (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Median eGFR at inclusion was 16 mL/min (range 5-34).…”

Section: Resultsmentioning

confidence: 99%

“…16,17 As patients with advanced renal failure experience a symptom burden and impairment of quality of life similar to that of patients with terminal malignancy, such tools could perhaps also be used to screen for potentially frail elderly among geriatric ESRD patients. 18 In this study, we aimed to assess whether the GFI can be used to distinguish fit older ESRD patients, likely able to tolerate and benefit from dialysis, from frail older patients who need further evaluation with a geriatrician's comprehensive assessment in a daily nephrology outpatient setting. Secondly, we compared the results of the GFI, respectively the nephrologists' evaluation with the geriatrician's assessment with regard to different geriatric domains.…”

Section: Introductionmentioning

confidence: 99%

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Groningen frailty indicator in older patients with end-stage renal disease

et al. 2015

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Background: Currently over 55% of end-stage renal disease (ESRD) patients are aged 60 years and patients 475 years represent the fastest growing segment of the dialysis population. We aimed to assess whether the Groningen frailty indicator (GFI) can be used to distinguish fit older ESRD patients, likely able to tolerate and benefit from dialysis, from frail older patients who need further evaluation with a geriatrician's comprehensive assessment. Methods: All patients aged 65 years visiting the pre-dialysis unit at the Gelre hospital between 2007 and 2013 were included and underwent the GFI (n ¼ 65). Patients with GFI 4 (frail) were referred for geriatric consultation (n ¼ 13). Results of the GFI and nephrologists' evaluation were compared with geriatrician's assessment. Survival rates and outcomes after one year of follow up were recorded. Results: Twenty patients (32%) were identified as frail. Of the problems identified by the geriatrician in 13 patients, 55% were not reported in the nephrologists' notes. The first year after inclusion, 30% of patients with a GFI 4 died, compared to 9% of fit patients (p ¼ 0.04). Moreover, 90% of frail patients had been hospitalized one or more times, compared to 53% in the fit group (p ¼ 0.005). Conclusion: Although the GFI can be a useful instrument to identify ESRD patients at risk, both the GFI and the nephrologists' assessment failed to identify specific geriatric impairments. Further research is needed to develop a specific frailty indicator for ESRD patients and to determine the value and effect of a comprehensive geriatric assessment in ESRD patients.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Groningen frailty indicator in older patients with end-stage renal disease

et al. 2015

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“…The burden of symptoms for dialysis patients and those with advanced chronic kidney disease (CKD) who choose conservative care (i.e., no dialysis) is high (2), with the number and severity of symptoms (such as pain, nausea, anorexia, shortness of breath, insomnia, anxiety, and depression) rivaling those of many cancer patients (3)(4)(5)). An increasing number of patients are dying after withdrawal of dialysis (10% to 15% in 1990; 20% in 2004) (1), representing the second leading cause of death after cardiovascular disease.…”

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confidence: 99%

End-of-Life Care Preferences and Needs

Davison¹

2010

Clinical Journal of the American Society of Nephrology

554

549

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Background and objectives: Despite high mortality rates, surprisingly little research has been done to study chronic kidney disease (CKD) patients' preferences for end-of-life care. The objective of this study was to evaluate end-of-life care preferences of CKD patients to help identify gaps between current end-of-life care practice and patients' preferences and to help prioritize and guide future innovation in end-of-life care policy.Design, setting, participants, & measurements: A total of 584 stage 4 and stage 5 CKD patients were surveyed as they presented to dialysis, transplantation, or predialysis clinics in a Canadian, university-based renal program between January and April 2008.Results: Participants reported relying on the nephrology staff for extensive end-of-life care needs not currently systematically integrated into their renal care, such as pain and symptom management, advance care planning, and psychosocial and spiritual support. Participants also had poor self-reported knowledge of palliative care options and of their illness trajectory. A total of 61% of patients regretted their decision to start dialysis. More patients wanted to die at home (36.1%) or in an inpatient hospice (28.8%) compared with in a hospital (27.4%). Less than 10% of patients reported having had a discussion about end-of-life care issues with their nephrologist in the past 12 months.Conclusions: Current end-of-life clinical practices do not meet the needs of patients with advanced CKD.

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“…This finding differs from previous studies that showed no difference in the symptom burden between patients who die from cancer compared with patients who die from other causes. 8,14,39 Our finding may be because only oncology patients with symptoms are admitted for end-of-life care, whereas patients with fewer symptoms remain at home.…”

Section: Discussionmentioning

confidence: 86%

Prevalence of symptoms at the end of life in an acute care hospital: a retrospective cohort study

et al. 2017

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Background: There is currently debate over the benefits and harms of physician-assisted death. One of the factors influencing this debate is concern about symptoms in the days before death. The objective of this study was to describe the frequency of symptoms before death and determine patient characteristics associated with these symptoms. Methods:We reviewed the medical record of every patient who died at a multisite academic teaching hospital over a 3-month period. We determined the number of episodes of pain, dyspnea, agitation and nausea during the final 48 hours of life and assessed the patient and encounter characteristics associated with 2 or more episodes of symptoms.

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Comparative pilot study of symptoms and quality of life in cancer patients and patients with end stage renal disease

Abstract: Patients with advanced renal failure experience a symptom burden and impairment of quality of life similar to that of patients with terminal malignancy.

Cited by 133 publications

References 27 publications

Groningen frailty indicator in older patients with end-stage renal disease

Groningen frailty indicator in older patients with end-stage renal disease

End-of-Life Care Preferences and Needs

Prevalence of symptoms at the end of life in an acute care hospital: a retrospective cohort study

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