Integrative Palliative Care Service Model Improved End-of-Life Care and Overall Survival of Advanced Cancer Patients in Hong Kong: A Review of Ten-Year Territory-Wide Cohort

Lam, Tai‐Chung; Chan, Sik-Kwan; Choi, Cheuk-Wai; Tsang, Ka-Chun; Yuen, Kwok-Keung; Soong, I.; Wong, Kevin; Lui, Louisa; Lo, Sing-Hung; Tong, Macy; Lo, Regina Cheuk‐Lam; Lam, Po Tin; Lam, Wai-Man; Li, Bryan

doi:10.1089/jpm.2020.0640

Cited by 10 publications

(9 citation statements)

References 15 publications

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“…A United Kingdom study demonstrated that patients with cancer who receive palliative care were more than twice as likely to receive a strong opioid in the last year of life compared to those who were not provided with palliative care in 2010–2012 ( Ziegler et al, 2018 ). The provision of palliative care in China was also associated with increased prescriptions for strong opioids ( Lam et al, 2021 ). This highlights the role of the palliative care team in ensuring appropriate access to opioids at the end-of-life.…”

Section: Discussionmentioning

confidence: 99%

Opioid Use at End-Of-Life Among Nova Scotia Patients With Cancer

et al. 2022

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Purpose: To determine the factors associated with opioid analgesic prescriptions as measured by community pharmacy dispensations to all Nova Scotia (NS) patients with cancer at end-of-life from 2005 to 2009.Methods: The NS Cancer Registry and the NS Prescription Monitoring Program (NSPMP) were used to link Nova Scotians who had a cancer diagnosis and received a prescription for opioids in their last year of life (n = 6,186) from 2005 to 2009. The association of factors with opioid dispensations at end-of-life were determined (e.g., patient demographics, type of prescriber, type of cancer, and opioid type, formulation, and dose).Results: Almost 54% (n = 6,186) of the end-of-life study population with cancer (n = 11,498) was linked to the NSPMP and therefore dispensed opioids. Most prescriptions were written by general practitioners (89%) and were for strong opioids (81%). Immediate-release formulations were more common than modified-release formulations. Although the annual average parenteral morphine equivalents (MEQ) did not change during the study period, the number of opioid prescriptions per patient per year increased from 5.9 in 2006 to 7.0 in 2009 (p < 0.0001). Patients age 80 and over received the fewest prescriptions (mean 3.9/year) and the lowest opioid doses (17.0 MEQ) while patients aged 40–49 received the most prescriptions (mean 14.5/year) and the highest doses of opioid (80.2 MEQ).Conclusion: Our study examined opioid analgesic use at end-of-life in patients with cancer for a large real-world population and determined factors, trends and patterns associated with type and dose of opioid dispensed. We provide information regarding how general practitioners prescribe opioid therapy to patients at end-of-life. Our data suggest that at the time of this study, there may have been under-prescribing of opioids to patients with cancer at end-of-life. This information can be used to increase awareness among general practitioners, and to inform recommendations from professional regulatory bodies, to aid in managing pain for cancer patients at end-of-life. Future work could address how opioid prescribing has changed over time, and whether efforts to reduce opioid prescribing in response to the opioid crisis have affected patients with cancer at end-of-life in Nova Scotia.

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Section: Discussionmentioning

confidence: 99%

Opioid Use at End-Of-Life Among Nova Scotia Patients With Cancer

et al. 2022

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“…The period was chosen following the study window suggested in previous research investigating hospital utilizations and pain management among people who died from cancer, [14] , [15] , [16] and it reflected the usual time frame of palliative care referral in late-stage cancer sufferers. [17] For cases, this was the six months prior to their date of suicide. For controls, the starting date of the six-month study period was randomly chosen between 2012 and 2016 post-dating their cancer diagnosis date.…”

Section: Methodsmentioning

confidence: 99%

Understanding the impact of clinical characteristics and healthcare utilizations on suicide among cancer sufferers: a case-control study in Hong Kong

Men

Lam

Yeung

et al. 2021

The Lancet Regional Health - Western Pacific

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Background Few studies have investigated whether hospital utilization patterns of cancer sufferers are associated with their suicide. This study aims to explore whether clinical profiles and healthcare utilization patterns are related to suicide among cancer sufferers. Methods Verified suicide cases with cancer (2012-2016) were identified. Each case was matched with two non-suicide controls suffering cancer, by birthyear, sex, and admission year. Cancer-related information, physical and psychiatric comorbidities, opioid-based painkiller usage, the number and length of inpatient admissions, and the number of outpatient and Accident & Emergency (A&E) attendances, in the six months leading up to the suicide, were identified. Conditional logistic regression models were constructed to explore the influence of clinical profiles and hospital utilization on suicide. These models were stratified by age and cancer stage. Outcomes 383 cases and 766 controls were included in the analyses. Overall, younger age, metastasis/recurrent status, suffering head and neck cancer, having psychiatric comorbidities, using opioid-based painkillers, and high frequency of A&E attendances and inpatient admissions increased the odds of suicide. Being diagnosed with liver cancer, consuming high numbers of outpatient attendances, and high numbers of inpatient days decreased the odds of suicide. Stratified analyses confirmed the influence of young age and metastatic/recurrent cancer status on risk of suicide. Interpretations Suicidal cancer sufferers had distinctive clinical profiles and hospital utilization patterns. Detecting and mitigating suicidal risk should be incorporated as an important component in treatment of cancer sufferers in the clinical setting. Funding Li Ka Shing Foundation and Hong Kong Research Grants Council

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“…Most studies included a specialist PC physician as well as another physician providing oncology or primary care (n=5). [31][32][33][34]37 With regards to the setting of PC service delivery, most papers evaluated inpatient hospital-based PC Models (n=5). [31][32][33][34]39 Other papers evaluated home-based community led PC Models (n=3) 36,[40][41] an outpatient PC Model (n=1) 35 , and a home-based PC Model that is not community led (n=1).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…38 One study mentioned a "hybrid" service across different care settings as part of a standardized national model. 37 The identified PC service delivery models are further described below.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…This paper from Hong Kong adopted a retrospective study design to evaluate the integrated territorywide PC model. 37 Despite a difference in settings, the service was described to be consistent across these, with a multidisciplinary team led by a dual qualified specialist oncologist. The model demonstrated an improvement in medium survival outcomes.…”

Section: Hybrid Standardized Modelmentioning

confidence: 99%

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A Review of Palliative Care Service Delivery Models and Patient Outcomes for Adults with Cancer in Selected East and Southeast Asian Countries

Tseng,

Calanzani

2023

Int J Med Stud

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Cancer is one of the key leading causes of deaths worldwide, with a disproportionately high burden in Asia in terms of incidence and mortality. Guidelines and recommendations published by the World Health Organization (WHO) state palliative care as an essential service for patients with cancer and other chronic diseases. Currently, there is extensive evidence regarding different models of palliative care delivery. However, development of palliative care services remains fragmented in Asia, and more research is needed to synthesize available models of care in this region and provide the latest evidence-based information for healthcare providers. This narrative review identified 11 peer-reviewed studies published after 2017 that reported both on models of palliative care service delivery and outcomes for adult patients with cancer in selected East and Southeast Asian countries. This review is beneficial by providing a detailed summary of the models of care adopted by these countries, and their impact on patient outcomes. It is hoped that the evidence will also generate momentum for continued conversation around palliative care development in Asia.

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Integrative Palliative Care Service Model Improved End-of-Life Care and Overall Survival of Advanced Cancer Patients in Hong Kong: A Review of Ten-Year Territory-Wide Cohort

Cited by 10 publications

References 15 publications

Opioid Use at End-Of-Life Among Nova Scotia Patients With Cancer

Opioid Use at End-Of-Life Among Nova Scotia Patients With Cancer

Understanding the impact of clinical characteristics and healthcare utilizations on suicide among cancer sufferers: a case-control study in Hong Kong

A Review of Palliative Care Service Delivery Models and Patient Outcomes for Adults with Cancer in Selected East and Southeast Asian Countries

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