Impact of Palliative Care on Quality of End-of-Life Care Among Brazilian Patients With Advanced Cancers

Valentino, Talita Caroline de Oliveira; Paiva, Carlos Eduardo; Hui, David; Oliveira, Marco Antônio de; Paiva, Bianca Sakamoto Ribeiro

doi:10.1016/j.jpainsymman.2019.08.021

Cited by 11 publications

(14 citation statements)

References 39 publications

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“…National and international guidelines recommend early integration of palliative care in the treatment of patients with advanced cancer [1–5]. Numerous studies underscore the positive effects of early integration of palliative care [6–11]. Positive effects include improved symptom control and psychological well‐being (less depression and anxiety); better quality of life of patients, relatives, and caregivers; less overtreatment and aggressive care at the end of life [10]; reduced hospital stays; higher treatment satisfaction of patients and their relatives; diminution of the burden on caregiving relatives; and reduction of medical costs [6–8, 12–16].…”

Section: Introductionmentioning

confidence: 99%

Symptom Burden and Palliative Care Needs of Patients with Incurable Cancer at Diagnosis and During the Disease Course

et al. 2021

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Background. Although current guidelines advocate early integration of palliative care, symptom burden and palliative care needs of patients at diagnosis of incurable cancer and along the disease trajectory are understudied. Material and Methods. We assessed distress, symptom burden, quality of life, and supportive care needs in patients with newly diagnosed incurable cancer in a prospective longitudinal observational multicentre study. Patients were evaluated using validated self-report measures (NCCN Distress Thermometer (DT), FACT, SEIQoL-Q, PHQ-4, modified SCNS-SF-34) at baseline (T0), at three (T1), six (T2), and twelve months (T3) follow-up. Results. From 10/2014 to 10/2016, 500 patients (219 women, 281 men; mean age 64.2 years) were recruited at 20 study sites in Germany following diagnosis of incurable metastatic , locally advanced, or recurrent lung (217), gastrointestinal (156), head and neck (55), gynecological (57) and skin (15) cancer. Patients reported significant distress (DT score ≥5) after diagnosis, which significantly decreased over time (T0: 67.2%, T1: 51.7%, T2: 47.9%, T3: 48.7%). The spectrum of reported symptoms was broad with considerable variety between and within the cancer groups. Anxiety and depressiveness were most prevalent early in the disease course (T0: 30.8%, T1: 20.1%, T2: 14.7%, T3: 16.9%). The number of patients reporting unmet supportive care needs decreased over time (T0: 71.8 %, T1: 61.6%, T2: 58.1%, T3: 55.3%). Conclusion. Our study confirms a variable and mostly high symptom burden at the time of diagnosis of incurable cancer, suggesting early screening by using standardized tools, and underlining the usefulness of early palliative care. Implication for practice. A better understanding of symptom burden and palliative care needs of patients with newly diagnosed incurable cancer may guide clinical practice and help to improve the quality of palliative care services. Our study results provide important information for establishing palliative care programs and related guidelines. Distress, symptom burden and the need for support vary, and are often high at the time of diagnosis. These findings underscore the need for implementation of symptom screening

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Section: Introductionmentioning

confidence: 99%

Symptom Burden and Palliative Care Needs of Patients with Incurable Cancer at Diagnosis and During the Disease Course

et al. 2021

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“…Comparison with other studies Many studies have reported on the relationship between PC exposure and hospital-based acute care near the EOL in patients with cancer, [15][16][17][18][19][20][21] consistently finding that PC exposure reduces risk of hospital-based care near the EOL. Fewer studies have focused on patients without cancer, and results have been limited to the disease categories examined (heart failure, [36][37][38][39] dementia, 40 41 end-stage renal disease (ESRD), 42 43 and end-stage liver disease 44 ).…”

Section: Open Accessmentioning

confidence: 94%

“…Many studies have reported on the relationship between PC exposure and healthcare resource use near the EOL for patients with cancer, [15][16][17][18][19][20][21] consistently finding that PC exposure reduces risk of hospital-based care near the EOL. Recently, the same was found to be true for patients with many of the most common chronic diseases; however, questions remain about the role of PC timing on these outcomes.…”

Section: Introductionmentioning

confidence: 99%

Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups

et al. 2021

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ObjectiveFor eight chronic diseases, evaluate the association of specialist palliative care (PC) exposure and timing with hospital-based acute care in the last 30 days of life.DesignRetrospective cohort study using administrative data.SettingAlberta, Canada between 2007 and 2016.Participants47 169 adults deceased from: (1) cancer, (2) heart disease, (3) dementia, (4) stroke, (5) chronic lower respiratory disease (chronic obstructive pulmonary disease (COPD)), (6) liver disease, (7) neurodegenerative disease and (8) renovascular disease.Main outcome measuresThe proportion of decedents who experienced high hospital-based acute care in the last 30 days of life, indicated by ≥two emergency department (ED) visit, ≥two hospital admissions,≥14 days of hospitalisation, any intensive care unit (ICU) admission, or death in hospital. Relative risk (RR) and risk difference (RD) of hospital-based acute care given early specialist PC exposure (≥90 days before death), adjusted for patient characteristics.ResultsIn an analysis of all decedents, early specialist PC exposure was associated with a 32% reduction in risk of any hospital-based acute care as compared with those with no PC exposure (RR 0.69, 95% CI 0.66 to 0.71; RD 0.16, 95% CI 0.15 to 0.17). The association was strongest in cancer-specific analyses (RR 0.53, 95% CI 0.50 to 0.55; RD 0.31, 95% CI 0.29 to 0.33) and renal disease-specific analyses (RR 0.60, 95% CI 0.43 to 0.84; RD 0.22, 95% CI 0.11 to 0.34), but a~25% risk reduction was observed for each of heart disease, COPD, neurodegenerative diseases and stroke. Early specialist PC exposure was associated with reducing risk of four out of five individual indicators of high hospital-based acute care in the last 30 days of life, including ≥two ED visit,≥two hospital admission, any ICU admission and death in hospital.ConclusionsEarly specialist PC exposure reduced the risk of hospital-based acute care in the last 30 days of life for all chronic disease groups except dementia.

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“…Moreover, they may face multiple existential, practical, personal, relational, and social losses related to alterations in their previous relationship with the patient, their social relations, and the anticipated loss of their loved one [ 2 , 4 – 7 ]. The burden of care may be particularly great in Brazil, where palliative care services are often limited to inpatient care in hospitals [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“You begin to give more value in life, in minutes, in seconds”: spiritual and existential experiences of family caregivers of patients with advanced cancer receiving end-of-life care in Brazil

Benites

Rodin

Oliveira-Cardoso

et al. 2021

Support Care Cancer

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Impact of Palliative Care on Quality of End-of-Life Care Among Brazilian Patients With Advanced Cancers

Cited by 11 publications

References 39 publications

Symptom Burden and Palliative Care Needs of Patients with Incurable Cancer at Diagnosis and During the Disease Course

Symptom Burden and Palliative Care Needs of Patients with Incurable Cancer at Diagnosis and During the Disease Course

Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups

“You begin to give more value in life, in minutes, in seconds”: spiritual and existential experiences of family caregivers of patients with advanced cancer receiving end-of-life care in Brazil

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