Models of Integration of Specialized Palliative Care with Oncology

Mathews, Jean; Hannon, Breffni; Zimmermann, Camilla

doi:10.1007/s11864-021-00836-1

Cited by 54 publications

(45 citation statements)

References 96 publications

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“…In line with the results reported by Mathews et al [97], where the integration of specialized palliative care with oncology patients was analysed, health professionals agreed that integrated PC services are the desired care models to facilitate integration and coordination of care using an interdisciplinary approach [74,77,78]. This study also highlighted the need to allocate more personnel, time, and training to assessing and addressing the needs of oncological patients and their families or caregivers, as identified in our review.…”

Section: Discussionsupporting

confidence: 88%

Palliative Care in Older People with Multimorbidities: A Scoping Review on the Palliative Care Needs of Patients, Carers, and Health Professionals

Llop-Medina

Garcés‐Ferrer

et al. 2022

IJERPH

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Although numerous studies have been conducted previously on the needs of cancer patients at the end of their life, there is a lack of studies focused on older patients with non-oncological complex chronic multipathologies. Examining these needs would help to gain a greater understanding of the profile of this specific population within the palliative care (PC) pathway and how the health and care systems can address them. The aim of this review was to identify the needs influencing PC among older patients with multimorbidities, their relatives or informal caregivers, and the health professionals who provide care for these patients. A scoping literature review guided by the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was carried out with literature searched in the Medline, Embase, CINAHL, WoS, Cochrane Library, PsycINFO, and Scopus databases from 2009 to 2022. Eighty-one studies were included, demonstrating a great variety of unaddressed needs for PC among chronic older patients and the complexity in detecting those needs and how to refer them to PC pathways. This review also suggested a scarcity of tools and limited pathways for professionals to satisfy their needs for these patients and their families, who often felt ignored by the system. Substantial changes will be needed in health and care systems at the institutional level, providing more specialized PC environments and systematizing PC processes.

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Section: Discussionsupporting

confidence: 88%

Palliative Care in Older People with Multimorbidities: A Scoping Review on the Palliative Care Needs of Patients, Carers, and Health Professionals

Llop-Medina

Garcés‐Ferrer

et al. 2022

IJERPH

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“…Indeed, a randomized trial showed QoL improvement and survival prolongation with early palliative care for stage IV NSCLC patients 4 . Nonetheless, while referral to palliative care after a diagnosis of metastatic NSCLC may be helpful in the management of symptom and side effects, this strategy is not feasible in broader practice due to the limited availability of specialized palliative care services (especially in lower resource settings), as well as patient/ provider hesitancy for early involvement 31,32 . Instead, clinician-initiated palliative referrals guided by institutional criteria, and/or identification of patients who may best benefit on the basis of symptom burden thresholds warrants additional evaluation 31 .…”

Section: Discussionmentioning

confidence: 99%

Province-Wide Analysis of Patient-Reported Outcomes for Stage IV Non-Small Cell Lung Cancer

et al. 2021

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Background. In Ontario, Canada, patient reported outcomes (PRO) evaluation through Edmonton Symptom Assessment System (ESAS) has been integrated into clinical workflow since 2007. As stage IV non-small cell lung cancer (NSCLC) is associated with substantial disease and treatment-related morbidity, this province-wide study investigated moderateto-severe symptom burden in this population. Methods. ESAS collected from stage IV NSCLC patients diagnosed between 2007-2018 linked to Ontario provincial healthcare system database were studied. ESAS acquired within 12 months following diagnosis were analyzed and the proportion reporting moderate-to-severe scores (ESAS ≥4) in each domain was calculated. Predictors of moderateto-severe scores were identified using multivariable Poisson regression models with robust error variance. Results. Of 22,799 patients, 13,289 (58.3%) completed ESAS (84,373 assessments) in the year following diagnosis. Patients with older age, high comorbidity, and not receiving active cancer therapy had lower ESAS completion. Majority (94.4%) reported at least 1 moderate-to-severe symptoms. Most prevalent were tiredness (84.1%), low wellbeing (80.7%), low appetite (71.7%), and shortness of breath (67.8%). Most symptoms peaked at diagnosis, while declining, remained high in the following year.On multivariable analyses, comorbidity, low income, non-immigrants, and urban residency were associated with moderate-to-severe symptoms. Moderate-to-severe scores in all ESAS domains aside from anxiety were associated with radiotherapy within 2 weeks prior, while drowsiness, low appetite and wellbeing, nausea, and tiredness were associated with systemic therapy within 2 weeks prior. Conclusion. This province-wide PRO analysis showed moderate-to-severe symptoms were prevalent and persistent among metastatic NSCLC patients, underscoring the need to address supportive measures in this population especially around treatments. The Oncologist ;9999:• • Implications for Practice: This is the largest patient reported outcome (PRO) results among lung cancer patients worldwide. Our results demonstrated the worse moderate-to-severe symptoms among stage IV non-small cell lung cancer patients compared to other patients with metastatic, other malignancies such as breast, gastric, or esophageal cancers assessed with similar methodology. These patients symptom severity also peaked early, and persistently high during 1 year follow-up. Symptoms burden was also associated with recent radiation and systemic treatments. This emphasized the importance of early and sustained PRO collection to detect actionable symptom progression, especially around treatments. Moreover, PRO

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“…Indeed, a randomized trial showed QoL improvement and survival prolongation with early palliative care for patients with stage IV NSCLC [4]. Nonetheless, although referral to palliative care after a diagnosis of metastatic NSCLC may be helpful in the management of symptom and side effects, this strategy is not feasible in broader practice owing to the limited availability of specialized palliative care services (especially in lower resource settings), as well as patient/provider hesitancy for early involvement [31,32]. Instead, clinician-initiated palliative referrals guided by institutional criteria and/or identification of patients who may best benefit on the basis of symptom burden thresholds warrants additional evaluation [31].…”

Section: Discussionmentioning

confidence: 99%

Province-wide analysis of patient reported outcomes for stage IV non-small cell lung cancer.

Tjong

Doherty

Tan

et al. 2021

JCO

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12092 Background: Stage IV NSCLC patients have significant disease and treatment-related morbidity. In Ontario, Canada, cancer patients complete Edmonton Symptom Assessment System (ESAS) questionnaires, a tool that elicits patients’ self-reported severity of common cancer-associated symptoms at clinical encounters. ESAS domains are: anxiety, depression, drowsiness, appetite, nausea, pain, shortness of breath, tiredness and well-being. The purpose of this study is to examine moderate-to-severe symptom burden in the 12 months following a diagnosis of stage IV NSCLC. Methods: Using administrative databases and unique encoded identifiers, stage IV NSCLC diagnosed between January 2007 and September 2018 were evaluated for symptom screening with ESAS in the 12 months following diagnosis. Proportion of patients reporting moderate-to-severe score (i.e. ESAS ≥4) in each domain within 12 months were calculated. Patients reporting moderate-to-severe within the different ESAS domains of were plotted over time. Multivariable (MV) Poisson regression models with potential covariates such as age, sex, Elixhauser comorbidity index, income quintiles, and lung cancer treatments received were constructed to identify factors associated with moderate-to-severe symptoms. Results: Of 22,799 stage IV NSCLC patients, 13,289 (58.3%) had completed ESAS (84,373 unique assessments) in the year following diagnosis. Patients with older age, high comorbidity, and not receiving active cancer therapy were less likely to complete ESAS. Most (94.4%) reported at least 1 moderate-to-severe score. Most prevalent moderate-to-severe ESAS symptoms within 12 months after diagnosis were tiredness (84.1%), lack of wellbeing (80.7%), low appetite (71.7%), and shortness of breath (67.8%); nausea was the least prevalent (34.6%). Most symptoms peaked at diagnosis and persisted in the year after diagnosis. On adjusted MV analyses, patients with high comorbidity, low income, and urban residency were associated with increased moderate-to-severe symptoms. Moderate-to-severe scores in all ESAS symptoms were associated with delivery of radiotherapy within 2 weeks prior, while moderate-to-severe nausea, drowsiness, tiredness, low appetite, and lack of wellbeing were associated with delivery of systemic therapy within preceding 2 weeks. Conclusions: In this population-based analysis of stage IV NSCLC PROs in the year following diagnosis, moderate-to-severe symptoms were highly prevalent and persistently high, underscoring the need to address supportive requirements in this at-risk population.

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Models of Integration of Specialized Palliative Care with Oncology

Cited by 54 publications

References 96 publications

Palliative Care in Older People with Multimorbidities: A Scoping Review on the Palliative Care Needs of Patients, Carers, and Health Professionals

Palliative Care in Older People with Multimorbidities: A Scoping Review on the Palliative Care Needs of Patients, Carers, and Health Professionals

Province-Wide Analysis of Patient-Reported Outcomes for Stage IV Non-Small Cell Lung Cancer

Province-wide analysis of patient reported outcomes for stage IV non-small cell lung cancer.

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