Palliative care and rehabilitation

Santiago-Palma, Juan; Payne, Richard

doi:10.1002/1097-0142(20010815)92:4+<1049::aid-cncr1418>3.0.co;2-h

Cited by 105 publications

(75 citation statements)

References 13 publications

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“…7 Home care models have been proposed in different countries for cancer patients. 6,11 There are very few studies specifically addressing palliative care and EOL issues in patients with GBM. 14,16 Better knowledge of clinical, social, and ethical aspects could improve the training and quality of neuro-oncology units.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Strategies to improve continuity of care and decrease the rehospitalization rate are becoming increasingly important in oncology, both to improve the quality of care for cancer patients and to reduce costs for the health care system. 11,17 Our neuro-oncology group assisted 848 patients with malignant brain tumor at home during the whole duration of the disease in the years 2002-2012. The data demonstrated a very high degree of patient and family satisfaction, and a low incidence of death in hospital (22.2%) and/ or hospice (16.8%) versus death at home (61%).…”

mentioning

confidence: 99%

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Home palliative care and end of life issues in glioblastoma multiforme: results and comments from a homogeneous cohort of patients

Pompili¹,

Telera²,

Villani³

et al. 2014

FOC

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Object Glioblastoma multiforme (GBM) is a rare tumor whose prognosis has remained poor over the years despite innovative radio- and chemotherapies, and important technical advances in neurosurgery such as intraoperative imaging, fluorescence, Cavitron ultrasonic surgical aspirator, and neuronavigation. Particular attention has been dedicated in the last years to the end of life (EOL) period in cancer patients for both ethical and socioeconomic issues. Good palliative care at home avoids improper and expensive hospitalizations, and helps and trains families, caregivers, and patients in facing a difficult situation. Methods In 2012–2013 the authors' group cared for 197 patients with brain tumors. Of these there were 122 with GBMs: 64 died and 58 are still receiving assistance. The clinical conditions are periodically evaluated with the following scales: Barthel Index, Karnofsky Performance Scale, and Mini-Mental State Examination. Home care staff includes 2 neurologists, 5 nurses, 2 psychologists, 3 rehabilitation therapists, and 1 social worker. The intensity of care changes at the different stages of disease, ranging from low to medium levels of intensity at the progression stage (more than 1 access weekly) to high levels of intensity at the EOL stage (at least 3 accesses weekly). Control MRI studies are obtained every 3 months before terminal progression. Results Overall in this sample of patients there were 2838 home visits and 11,714 days of assistance. Thirty-four patients (14 female and 20 male) died at home (53.1%); 22 (13 female and 9 male) at the hospice (34.4%); and 8 (4 female and 4 male) at the hospital (12.5%). A positive impact on caregivers for home assistance was recorded in 97% of cases, for nursing in 95%, communication in 90%, rehabilitation at home in 92%, and social work help in 85%. Also, 72% had an improvement in their quality of life scores due to rehabilitation. End of life palliative sedation with midazolam was necessary in 11% of cases to obtain good control of symptoms such as uncontrolled delirium, agitation, death rattle, or refractory seizures. Intramuscular phenobarbital is the authors' drug of choice for the severe seizures that occurred in 30% of cases. The reduction of steroid dosage is also used to decrease wakefulness. Steroids were withdrawn in 45% of patients dying at home, mild hydration was done in 87%, and tube feeding in 13%. The decision-making process at the EOL stage is time consuming, but the degree of distress of the family is inversely proportional to the extent of the preparatory period. Conclusions A previous paper showed the positive cost-effectiveness of home assistance for a larger group of patients dealing with any kind of malignant brain tumors. The same is enhanced for patients with GBM. This requires a well-trained neuro-oncology team that manages neurological deterioration, clinical complications, rehabilitation, and psychosocial problems with a multidisciplinary approach.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Home palliative care and end of life issues in glioblastoma multiforme: results and comments from a homogeneous cohort of patients

Pompili¹,

Telera²,

Villani³

et al. 2014

FOC

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“…The goal of rehabilitation in the palliative care patient is to eliminate or reduce disability by optimizing functional status, physical independence, and quality of life through appropriate treatment [47]. The use of rehabilitation in palliative care should be individualized and account for the overall life expectancy and the patient's desire to actively participate in therapy.…”

Section: Physical Medicine and Rehabilitation Approachesmentioning

confidence: 99%

Pain and palliative medicine

Chang

Sorger²,

Rosenfeld

et al. 2007

JRRD

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Abstract-Severe pain is highly prevalent, with rates of 40% to 70% in patients with advanced cancer, liver disease, heart failure, human immunodeficiency virus, and renal failure. Wide variations in pain assessment and reporting methods and the measurement of multiple symptoms should be addressed in future studies. Regarding psychological approaches, determining whether hypnotherapy or other individual psychotherapeutic interventions reduce pain and/or psychological distress in a palliative care population is difficult. Interest is increasing in the concept of demoralization syndromes and the role of posttraumatic stress disorder in modulating responses to pain at the end of life. We review evidence from multiple studies that the use of rehabilitative therapy improves functional status and pain control among patients with advanced cancer, and we raise the possibility that rehabilitation therapy will be helpful in patients with other advanced diseases. We summarize ongoing clinical trials of electronic order sets, clinical care pathways, and care management pathways to improve pain management in palliative care. Wagner's Chronic Illness Model provides a way of analyzing how healthcare systems can be changed to provide adequate and continuing pain management in palliative care. Much work remains to ensure that pain is recognized, treated, and monitored effectively.

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“…Disease-modifying or symptom-relieving treatments might induce fatigue or sedation, leading to physical inactivity and thereby reducing physical functioning and capacity. Loss of mobility may reduce independence in daily life and can lead to hospitalization, thereby further reducing patient autonomy and QoL [11][12][13]. Theoretically, interventions that enhance physical activity and decelerate the reduction in physical performance might therefore be relevant parts of palliative care programs.…”

Section: Introductionmentioning

confidence: 99%