Quality of end-of-life care for patients with metastatic non-small-cell lung cancer in general wards and palliative care units in Japan

Nakano, Kikuo; Yoshida, Takashi; Furutama, Junko; Sunada, Shoji

doi:10.1007/s00520-011-1374-7

Cited by 26 publications

(15 citation statements)

References 26 publications

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“…Cancer patients are more likely to sign a DNR order than noncancer patients. [17] Previous studies in Taiwan reported that the percentage of critically ill patients signing DNR orders in the intensive care unit was 65.8% to 77.0% in total and 99.8% in cancer patients, respectively. [18,19] Although hospice and palliative medicine was primarily developed to support incurable cancer patients, the need for hospice and palliative care in noncancer patients increases rapidly and becomes a very important issue in this field.…”

Section: Discussionmentioning

confidence: 99%

Implementing a novel model for hospice and palliative care in the emergency department

Weng

Yang²,

Chen

et al. 2017

Medicine

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Hospice and palliative care has been recognized as an essential part of emergency medicine; however, there is no consensus on the optimal model for the delivery of hospice and palliative care in the emergency department (ED). Therefore, we conducted a novel implementation in a tertiary medical center in Taiwan. In the preintervention period, we recruited a specialist for hospice and palliative medicine in the ED to lead our intervention. In the early stage of the intervention, starting on July 1, 2014, we encouraged and funded ED physicians and nurses to receive training for hospice and palliative medicine and residents of emergency medicine to rotate to the hospice ward. In the late stage of the intervention, we initiated educational programs in the ED, an interdisciplinary meeting with the hospice team every month, sharing information and experience via a cell phone communication app, and setting aside an emergency hospice room for end-of-life patients. We compared the outcomes among pre-, during, and postintervention periods. Compared with 4 in the preintervention period, the cases of do not resuscitate (DNR) per month increased significantly to 30.1 in the early stage of intervention, 23.9 in late stage of intervention, and 34.6 in the postintervention period (all P < .001 compared with the preintervention period). Compared with 10.8% in the preintervention period, the ratio of DNR orders signed in the ED/total DNR orders signed in the study hospital was increased to 17.1% in early stage of intervention, 12.5% in late stage of intervention, and 22.8% in postintervention. Compared with zero in preintervention and early intervention, the cases of consultation with the hospice team increased significantly to 19 cases per month in the late stage of intervention and postintervention. The ability of nurses in hospice and palliative care, including knowledge and the timing and method of consultation with the hospice team, was also significantly improved. We successfully implemented a novel model of hospice and palliative care in the ED via a champion, education, and close collaboration with the hospice team, which could be an important reference for other EDs and intensive care unit in the future.

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Section: Discussionmentioning

confidence: 99%

Implementing a novel model for hospice and palliative care in the emergency department

Weng

Yang²,

Chen

et al. 2017

Medicine

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“…Previous studies have demonstrated that early intervention with palliative treatment improves the quality of life, including quality of terminal care, in patients with non-small cell lung cancer (20,25). According to the abovementioned studies, there were no differences in the number of regimens of chemotherapy administered, between those who were provided early intervention with palliative treatment and those without early intervention with palliative treatment.…”

Section: Discussionmentioning

confidence: 91%

“…However, patients who discontinued treatment early exhibited a longer survival time. Nakano et al (25) reported that the rate of cancer progression and adverse events of chemotherapy are the major causes of differences in the period from discontinuation of chemotherapy to death; they also reported that it is possible to predict the disease progression to some extent during chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Effect of the timing of discontinuation of last‑line chemotherapy on patient prognosis in advanced and recurrent gastric cancer

Kimura

Kawachi

et al. 2018

mol clin onc

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The present study aimed to determine the effect of the timing of treatment discontinuation on the prognosis of patients with advanced and recurrent gastric cancer chemotherapy. Between July 2014 and March 2017, 127 patients who underwent chemotherapy for advanced and recurrent gastric cancer at Ogaki Municipal Hospital (Ogaki, Japan) were examined. To determine factors associated with survival, multivariate analysis using the Cox proportional hazards model, and hazard ratios and their 95% confidence intervals (95% CI) were calculated. The reasons for discontinuation of last-line chemotherapy and the last hospitalization prior to mortality were surveyed. Age (≤51 years), number of treatment lines (≤1 line), and days between last dose of the final chemotherapy regimen and death (≤79 days) were independently and significantly associated with survival in the multivariate analysis. Compared with patients who did not receive chemotherapy in the last 79 days of life, those who received chemotherapy in the last 79 days of life days had a hazard ratio of 1.858 (95% CI, 1.059-3.261; P=0.031) for mortality. A decrease in the performance status was responsible for treatment discontinuation in 51 of 75 cases among patients who received chemotherapy in the last 79 days of life and 9 of 26 cases among patients who did not receive chemotherapy in this duration (P<0.001). Among patients who received chemotherapy in the last 79 days of life, 67 patients were hospitalized prior to mortality; among patients who did not receive chemotherapy in this duration, 15 patients were hospitalized prior to mortality (P<0.001). In conclusion, continuation of chemotherapy until just prior to mortality does not prolong the survival time in patients with advanced and recurrent gastric cancer.

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“…This has led to an increased interest with regards to the earlier integration as well as official endorsement by clinical guidelines [43]. Yet, many patients with advanced (lung) cancer either receive such care at a late stage and the quality of such care may not be optimal [44,45]. Although the use of a short screening tool cannot substitute careful clinical assessment and management, routine use of the DT may aid clinicians in identifying those patients at risk for poor outcomes and provide a vantage point from which to earlier engage patients and caregivers in patient-centered conversations about advance care planning and palliative care options.…”

Section: Discussionmentioning

confidence: 99%

The distress thermometer as a prognostic tool for one-year survival among patients with lung cancer

et al. 2019

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The use of patient-reported outcome measures is increasingly advocated to support high-quality cancer care. We therefore investigated the added value of the Distress Thermometer (DT) when combined with known predictors to assess one-year survival in patients with lung cancer. Methods: All patients had newly diagnosed or recurrent lung cancer, started systemic treatment, and participated in the intervention arm of a previously published randomised controlled trial. A Cox proportional hazards model was fitted based on five selected known predictors for survival. The DT-score was added to this model and contrasted to models including the EORTC-QLQ-C30 global QoL score (quality of life) or the HADS total score (symptoms of anxiety and depression). Model performance was evaluated through improvement in the-2 log likelihood, Harrell's C-statistic, and a risk classification. Results: In total, 110 patients were included in the analysis of whom 97 patients accurately completed the DT. Patients with a DT score ≥5 (N = 51) had a lower QoL, more symptoms of anxiety and depression, and a shorter median survival time (7.6 months vs 10.0 months; P = 0.02) than patients with a DT score < 5 (N = 46). Addition of the DT resulted in a significant improvement in the accuracy of the model to predict one-year survival (P < 0.001) and the discriminatory value (C-statistic) marginally improved from 0.69 to 0.71. The proportion of patients correctly classified as high risk (≥85% risk of dying within one year) increased from 8% to 28%. Similar model performance was observed when combining the selected predictors with QoL and symptoms of anxiety or depression. Conclusions: Use of the DT allows clinicians to better identify patients with lung cancer at risk for poor outcomes, to further explore sources of distress, and subsequently personalize care accordingly.

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Quality of end-of-life care for patients with metastatic non-small-cell lung cancer in general wards and palliative care units in Japan

Abstract: Patients with metastatic NSCLC in general wards receive inappropriate care near the end of life. Further studies are needed to develop interventions for making decisions regarding end-of-life care.

Cited by 26 publications

References 26 publications

Implementing a novel model for hospice and palliative care in the emergency department

Implementing a novel model for hospice and palliative care in the emergency department

Effect of the timing of discontinuation of last‑line chemotherapy on patient prognosis in advanced and recurrent gastric cancer

The distress thermometer as a prognostic tool for one-year survival among patients with lung cancer

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