Integration of Palliative Medicine Into Routine Oncological Care: What Does the Evidence Show Us?

Debono, David

doi:10.1200/jop.2011.000351

Cited by 12 publications

(14 citation statements)

References 25 publications

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“…1–3 Data strongly support that patients with non-small cell lung cancer (NSCLC) experience high symptom burdens, many comorbidities, and psychosocial-spiritual concerns related to the diagnosis. 4–10 The key study by Temel and colleagues 11 , reporting on NSCLC patients receiving concurrent palliative care, gained much attention when their outcomes revealed not only improved symptoms but prolonged survival.…”

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confidence: 99%

Longitudinal Changes in Function, Symptom Burden, and Quality of Life in Patients with Early-Stage Lung Cancer

et al. 2012

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Background Emerging evidence supports the integration of palliative care concurrently with disease-focused care in patients with serious illnesses, such as lung cancer. This paper describes how longitudinal changes in physical function, symptom burden, and QOL of patients with early-stage non-small cell lung cancer (NSCLC) informed the development of an interdisciplinary, tailored palliative care intervention. Methods Patients with early stage (I-IIIB) NSCLC were accrued into the usual care phase (Phase 1) of an NCI-funded Program Project Grant. Baseline and longitudinal (up to 52 weeks post-accrual) physical function, symptoms, and QOL were assessed in the thoracic ambulatory clinics of one NCI-designated Comprehensive Cancer Center. Outcome measures included geriatric assessments, psychological distress, symptoms, and QOL. The association between disease stage (I–II vs. III) and longitudinal changes in these domains was evaluated. Results A total of 103 patients were accrued. Stage I–II patients were significantly more likely to complete the study (p = 0.005). The stages (I–II vs. III) were equivalent at baseline on all demographic variables, clinical, and functional status. Physical function fluctuated longitudinally and was higher at 6 and 24 weeks than at baseline and 12 weeks. There was a longitudinal decrease in total number of symptoms (p < 0.001). Physical and social/family QOL fluctuated longitudinally (p < 0.001 and p = 0.016, respectively). Conclusions Patients with early-stage NSCLC report a significant longitudinal decrease in physical QOL, and fluctuations in objective and subjective measures of physical function over time were observed regardless of disease stage category. An interdisciplinary palliative care intervention is currently being tested to decrease symptom burden and improve QOL.

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confidence: 99%

Longitudinal Changes in Function, Symptom Burden, and Quality of Life in Patients with Early-Stage Lung Cancer

et al. 2012

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“…Even with supporting evidence of the benefits of PC in cancer care, it is not being implemented into routine oncologic care (Ferris et al, 2009;IOM, 2001IOM, , 2013Temel et al, 2010;Debono, 2011;Smith et al, 2012;Storey et al, 2011).…”

Section: Identifying the Need For Pc In Standard Oncologic Carementioning

confidence: 99%

Improving Palliative Cancer Care

Ferraro¹,

Ferrell²,

Zyl³

et al. 2014

JADPRO

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Over a decade ago, the Institute of Medicine (IOM) presented Ensuring Quality Cancer Care in the United States, with recommendations for change (IOM, 1999). However, barriers to integrating palliative care (PC) to achieve high-quality care in cancer still remain. As novel therapeutic agents evolve, patients are living longer, and advanced cancer is now considered a chronic illness. In addition to complex symptom concerns, patients and family caregivers are burdened with psychological, social, and spiritual distress. Furthermore, data show that PC continues to be underutilized and inaccessible, and current innovative models of integrating PC into standard cancer care lack uniformity. The aim of this article is to address the existing barriers in implementing PC into our cancer care delivery system and discuss how the oncology advanced practice nurse plays an essential role in providing high-quality cancer care. We also review the IOM recommendations; highlight the work done by the National Consensus Project in promoting quality PC; and discuss a National Cancer Institute-funded program project currently conducted at a National Comprehensive Cancer Center, "Palliative Care for Quality of Life and Symptoms Concerns in Lung Cancer," which serves as a model to promote high-quality care for patients and their families.

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“…3 The subspecialty of Hospice and Palliative Medicine has been formally recognized by the American Board of Internal Medicine. 4 The American Society of Clinical Oncology (ASCO) also published an update on the current state of the science in palliative cancer care. 5 In this article, palliative cancer care has been defined as the “integration into cancer care of therapies that address multiple issues that cause suffering for patients and their families and impact their life quality.” 5 The article further states that the effective provision of palliative cancer care “requires an interdisciplinary team that can provide care in all patient settings, including outpatient clinics.” 5 According to the report, comprehensive cancer care must include palliative care as an integral part of patient and family care.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the ever-expanding evidence that supports the efficacy of palliative care in improving key patient-reported outcomes such as quality of life (QOL), depression, and overall survival 4, 7 , challenges and barriers remain in the integration of models of palliative care into routine oncologic care in ambulatory settings. 4, 6, 8–10 A survey conducted by Hui and colleagues found that in all NCI-designated cancer centers, only 60% had a formal outpatient palliative medicine clinic, and this number is even smaller for non-NCI designated cancer centers (22%).…”

Section: Introductionmentioning

confidence: 99%

“…4, 6, 8–10 A survey conducted by Hui and colleagues found that in all NCI-designated cancer centers, only 60% had a formal outpatient palliative medicine clinic, and this number is even smaller for non-NCI designated cancer centers (22%). 9 It has been postulated that challenges remain because palliative care as a model of care is inherently diverse, and that one model may not be feasible in other cancer settings and/or systems.…”

Section: Introductionmentioning

confidence: 99%

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Interdisciplinary Palliative Care Intervention in Metastatic Non–Small-Cell Lung Cancer

Koczywas

Cristea

Thomas

et al. 2013

Clinical Lung Cancer

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Introduction/Background Challenges and barriers continue to hinder the integration of palliative care models into comprehensive, ambulatory oncology care. This paper aims to describe how symptoms, distress, and quality of life (QOL) data from the usual care phase of a NCI-supported Program Project informed the development of an interdisciplinary, tailored palliative care intervention for patients with metastatic non-small-cell lung cancer (NSCLC). Patient and Methods Patients receiving usual care for metastatic NSCLC were recruited into this prospective longitudinal study over a one-year period of time. A total of 130 patients with stage IV NSCLC were accrued, and 114 patients had evaluable data. Research nurses assisted patients in completing the clinical section of the data forms, and patients completed surveys and self-reports at baseline, 6, 12, and 24 weeks. Results Patients ranged in age from 40–84 years, 61% were Caucasian non-Hispanic, Sixty-six former (N=59) and current smokers had an average of 38 pack-year history of smoking. KPS, IADL, and Cognitive scores deteriorated significantly (p=.001, .009, and .042, respectively). Social Activity was stable, while Social Support increased significantly. Overall symptom distress score and Total symptom score both significantly increased at 24 weeks (p=.003 and .017, respectively). Physical Well-Being decreased significantly (p=.036), while the FACT-L, Facit-SP12, and Distress scores remained statistically stable over time. Conclusion Patients with metastatic NSCLC continue to experience high symptom burden and diminished physical well-being over time while receiving cancer treatments. An interdisciplinary palliative care intervention is currently being tested to improve symptom burden and overall QOL.

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Integration of Palliative Medicine Into Routine Oncological Care: What Does the Evidence Show Us?

Abstract: There is phase III evidence that formal assessment of patients' symptoms and quality of life can lead to measurable improvements in quality of life. Quality of life assessments using validated tools should become routine in cancer centers.

Cited by 12 publications

References 25 publications

Longitudinal Changes in Function, Symptom Burden, and Quality of Life in Patients with Early-Stage Lung Cancer

Longitudinal Changes in Function, Symptom Burden, and Quality of Life in Patients with Early-Stage Lung Cancer

Improving Palliative Cancer Care

Interdisciplinary Palliative Care Intervention in Metastatic Non–Small-Cell Lung Cancer

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