How Do Cancer Patients Receiving Palliative Care at Home Die? A Descriptive Study

Mercadante, Sebastiano; Valle, Alessandro; Porzio, Giampiero; Costanzo, Benedetta Veruska Pierpaola; Fusco, Flavio; Aielli, Federica; Adile, Claudio; Fara, Bruna; Casuccio, Alessandra

doi:10.1016/j.jpainsymman.2011.01.014

Cited by 37 publications

(28 citation statements)

References 23 publications

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“…Thus, no data on the efficacy of consequent treatment was recorded. Data should be repeated a few days before dying to reflect the switch of orphan symptom prevalence close to death [12]. In order to have a terminal cancer patient spending fulfilling remaining of his life, the role of home care is important.…”

Section: Discussionmentioning

confidence: 99%

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Orphan symptoms in advanced cancer patients followed at home

Mercadante¹,

Porzio²,

Valle³

et al. 2013

Support Care Cancer

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Orphan symptoms are rarely assessed, particularly at home. The aim of this multicenter prospective study was to assess the prevalence of these symptoms and eventual factors possibly associated in advanced cancer patients at admission of a home care program. A prospective study was performed at three home care programs in Italy. Patients' data were collected, including age, sex, diagnosis, and Karnofsky status. Possible contributing factors were analyzed; preexisting neurological diseases, cerebral metastases, hyperthermia, diabetes, a state of dehydration clinically evident and/or oliguria, possible biochemical parameters when available, data regarding recent chemotherapy, opioids and doses, use of neuroleptics, benzodiazepine or anticonvulsants, corticosteroids, anti-inflammatory, and antibiotics were collected.

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Section: Discussionmentioning

confidence: 99%

“…The rhythm of the hiccup, or the time between hiccups, tends to be relatively constant. Hiccup was considered as occasional, persisting, or continuous [12,13]. Finally, tenesmus was considered as a sensation of fullness or incomplete relief during urination or defecation [14,15].…”

Section: Methodsmentioning

confidence: 99%

Orphan symptoms in advanced cancer patients followed at home

Mercadante¹,

Porzio²,

Valle³

et al. 2013

Support Care Cancer

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“…6e8 The two HPCUs provide similar levels of assistance, with visits ranging between two and three a week for physicians, and three and seven a week for nurses, in addition to providing on-call visits in case of need. 6 Treatments are based on local protocols aimed at controlling psychological and physical symptoms. Physicians, nurses, psychologists, physiotherapists, and social workers are members of the multidisciplinary team, coordinated by a central agency.…”

Section: Methodsmentioning

confidence: 99%

“…In a systematic review, the frequency of PS at home was variable (13e35%), confirming data observed in a previous survey of patient assessment in the last days of life. 6 In a previous retrospective analysis of home care patients with cancer who died at home, the frequency of PS was 13.2%. 7 However, much information, including indications, mean duration, and drug used for PS, was not available from the literature or clearly structured, or no a priori definition of PS was adopted.…”

Section: Introductionmentioning

confidence: 96%

Palliative Sedation in Patients With Advanced Cancer Followed at Home: A Prospective Study

Mercadante

Porzio

Valle³

et al. 2014

Journal of Pain and Symptom Management

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Context. Home care programs in Italy.Objectives. The aim of this study was to assess a protocol for palliative sedation (PS) performed at home.Methods. A total of 219 patients were prospectively assessed to evaluate a PS protocol in patients with advanced cancer followed at home by two home care programs with different territorial facilities. The protocol was based on stepwise administration of midazolam.Results. A total of 176 of the patients died at home, and PS was performed in 24 of these patients (13.6%). Younger patients received the procedure more frequently than older patients (P ¼ 0.012). The principal reasons to start PS were agitated delirium (n ¼ 20) and dyspnea (n ¼ 4). Mean duration of PS was 42.2 AE 30.4 hours, and the mean doses of midazolam were 23e58 mg/day. Both the home care team and the patients' relatives expressed optimal or good levels of satisfaction with the procedure in all but one case, respectively.Conclusion. This protocol for PS was feasible and effective in minimizing distress for a subgroup of patients who died at home. The characteristics of patients who may be effectively sedated at home should be better explored in future studies. J Pain Symptom Manage 2014;47:860e866. Ó

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“…These two programs, which are representative of home care programs in Italy, have been shown to provide a similar level of assistance and have sufficient experience in collecting scientific data. 9 The patients received home visits from physicians (two or three weekly) and nurses (three to seven weekly) and also have access to on-call visits in case of need.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Factors of Survival in Patients With Advanced Cancer Admitted to Home Care

Mercadante

Valle²,

Porzio

et al. 2013

Journal of Pain and Symptom Management

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Context. Data regarding prognostication of life expectancy in patients with advanced cancer are of paramount importance to patients, families, and clinicians. However, data regarding patients followed at home are lacking.Objectives. The aim of this study was to evaluate the correlation between various factors recorded at the beginning of home care assistance and survival.Methods. A sample of consecutive patients admitted to two home care programs was surveyed. A preliminary consensus was achieved as to the possible variables easy to be recorded at home. These included age at the time of home care admission, gender, residence, marital status, primary cancer diagnosis, Karnofsky Performance Status (KPS) score, measures of systolic blood pressure and heart rate, cyanosis, use of oxygen, and body temperature. The Edmonton Symptom Assessment System was used to record the intensity of each symptom. Patients were divided into two groups: patients with a survival of less than 10 days (short survival) and patients with a survival of 10 days or more (medium-long survival).Results. Three hundred seventy-four consecutive patients admitted to home care programs were surveyed, of which 187 were male. The mean AE SD age was 72.1 AE 12.7 years. The mean survival was 56.2 AE 65 days. Mean survival was 71.5 AE 67 days (287 patients) and 5.6 AE 2.7 days (87 patients) in the short and medium-long survival groups, respectively. No association between type of tumor and survival was observed (P ¼ 0.162). Univariate logistic regression analysis revealed that male gender (P ¼ 0.020), older age (P ¼ 0.012), lower KPS scores (P < 0.0005), systolic blood pressure less than 100 mm Hg (P ¼ 0.003), heart rate greater than 100 beats per minute (P ¼ 0.0006), delirium (P ¼ 0.004), the use of oxygen (P ¼ 0.002), intensity of fatigue (P ¼ 0.006), drowsiness (P < 0.0005), anorexia (P < 0.0005), dyspnea (P < 0.0005), poor sense of well-being (P < 0.0005), and distress score (P < 0.0005) were associated with a survival of less than 10 days. Marital status, residence, cognitive function, fever, pain, depression, and anxiety were not found to be significantly correlated with survival. In a multiple logistic regression model, low systolic blood pressure and high heart rate, gender, delirium, use of oxygen, KPS score, drowsiness, anorexia, and dyspnea were significantly correlated with a shorter survival. Conclusion. Low systolic blood pressure and high heart rate, male gender, poor KPS score, anorexia, and dyspnea were correlated with a shorter survival. Moreover, patients with low systolic blood pressure and high heart rate, male gender, poor KPS score, and greater intensity of anorexia and dyspnea are more likely to die within one week. The combination of physical symptoms from the Edmonton Symptom Assessment System and other parameters included in this study, which are simple to assess and are repeatable at home, should be further explored in future studies to provide a simple tool for use with patients with advanced cancer admitted to a home...

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How Do Cancer Patients Receiving Palliative Care at Home Die? A Descriptive Study

Cited by 37 publications

References 23 publications

Orphan symptoms in advanced cancer patients followed at home

Orphan symptoms in advanced cancer patients followed at home

Palliative Sedation in Patients With Advanced Cancer Followed at Home: A Prospective Study

Prognostic Factors of Survival in Patients With Advanced Cancer Admitted to Home Care

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