Snapshot of an Outpatient Supportive Care Center at a Comprehensive Cancer Center

Pimentel, Lindsey E.; Cruz, Maxine de la; Wong, Angelique; Castro, Debra; Bruera, Éduardo

doi:10.1089/jpm.2016.0370

Cited by 10 publications

(4 citation statements)

References 12 publications

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“…Moreover, the median ESAS scores for anxiety and depression achieved clinical significance, 27 which indicates that in addition to medication changes, multidisciplinary PC team interventions from psychologists, counselors, social workers, and chaplains may have benefited the patients. 30 The findings of the current study suggest that a PC intervention resulted in less use of other sedatives. These changes in prescription patterns reflect a strategy of the PC team to use neuroleptics, selective serotonin reuptake inhibitors, trazodone, and mirtazapine as much as possible instead of BZD-S, antihistamines, and skeletal muscle relaxants.…”

Section: Discussionmentioning

confidence: 56%

“…Patients reported significantly better median ESAS scores for drowsiness and the worst feeling of well‐being at follow‐up. Moreover, the median ESAS scores for anxiety and depression achieved clinical significance, which indicates that in addition to medication changes, multidisciplinary PC team interventions from psychologists, counselors, social workers, and chaplains may have benefited the patients …”

Section: Discussionmentioning

confidence: 96%

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Concurrent use of opioids with benzodiazepines or nonbenzodiazepine sedatives among patients with cancer referred to an outpatient palliative care clinic

Haider

Azhar

Nguyen

et al. 2019

Cancer

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Background The concurrent use of opioids with benzodiazepines (BZD) or nonbenzodiazepine sedatives (S) recently was found to be associated with an increased risk of overdose death compared with the use of opioids alone. In the current study, the authors examined the frequency and trend of concurrent opioid/BZD‐S use and its associated risk factors among patients with cancer. Methods Data regarding the frequency and trend of concurrent opioid/BZD‐S use were extracted for 1500 randomly selected patients referred to the outpatient palliative care clinic at The University of Texas MD Anderson Cancer Center between the calendar years of 2011 and 2016. To explore associated risk factors, the authors compared the demographic and clinical predictors of 418 patients each in the concurrent opioid/BZD‐S group and opioids‐only group. Results In 2011, at the time of referral to the palliative care clinic, 96 of 221 patients with cancer (43%) were prescribed concurrent opioids/BZD‐S. This rate progressively declined to 67 of 217 patients (31%) by 2016 (P = .0008). Patients in the concurrent opioid/BZD‐S group had a higher percentage of females (233 individuals; 55% [P = .007]) and whites (323 individuals; 77% [P = .002]), and patients reported higher scores regarding depression (P = .0001), anxiety (P ≤ .0001), drowsiness (P = .048), and worst feeling of well‐being (P = .001). The morphine equivalent daily dose was significantly higher in concurrent opioid/BZD‐S group (median of 67.5 mg/day [interquartile range (IQR), 30‐135 mg/day] vs 60 mg/day [IQR, 30‐105 mg/day]; P = .034). Multivariate analysis demonstrated that anxiety (P ≤ .0001), white race (P = .0092), and poor Eastern Cooperative Oncology Group performance status (P = .0017) were significantly associated with concurrent use. Conclusions The concurrent use of opioids with BZD‐S has declined but continues to be frequent among patients with cancer. Anxiety, white race, and poor Eastern Cooperative Oncology Group performance status were associated with its use. More research is needed to explore which medications can replace these agents.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 96%

Concurrent use of opioids with benzodiazepines or nonbenzodiazepine sedatives among patients with cancer referred to an outpatient palliative care clinic

Haider

Azhar

Nguyen

et al. 2019

Cancer

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“…Patients are seen by the SC-trained nurse who performs a complete clinical evaluation using validated tools such as the Edmonton System Assessment Scale, 12 the Memorial Delirium Assessment Scale, 13 the Eastern Cooperative Oncology Group (ECOG) performance status, 14 and the Cut Down-Annoyed-Guilty-Eye-Opener questionnaire (CAGE) adapted to include drug use (CAGE-AID). 15 The SC-trained nurse discusses the case with a board-certified palliative medicine specialist who then evaluates the patient/family and provides care recommendations. 16,17…”

Section: Methodsmentioning

confidence: 99%

Patients' Perspective of Timeliness and Usefulness of an Outpatient Supportive Care Referral at a Comprehensive Cancer Center

Wong

Vidal

Prado

et al. 2019

Journal of Pain and Symptom Management

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Context. Current guidelines recommend early referral to palliative care for patients with advanced cancer; however, no studies have examined the optimal timing of referral from the patients' perspective.Objectives. To examine patients' perceptions of timeliness of referral and its association with survival among patients with advanced cancer referred to an outpatient supportive care (SC) clinic.Methods. This cross-sectional prospective study in an SC clinic at a comprehensive cancer center included patients aged 18 years or older with locally advanced, recurrent, or metastatic cancer. Patients were asked to complete an anonymous survey regarding the timeliness and perceived usefulness of SC referral within four weeks of their first SC consultation.Results. Of 253 eligible patients, 209 (83%) enrolled in the study and 200 completed the survey. Median survival was 10.3 months. Most patients (72%) perceived that referral occurred ''just in time,'' whereas 21% felt it was ''late,'' and 7% felt ''early.'' A majority (83%) found the referral useful, and 88% would recommend it to other patients with cancer. The perception of being referred early was associated with lower reported levels of pain (P ¼ 0.043), fatigue (P ¼ 0.004), drowsiness (P ¼ 0.005), appetite loss (P ¼ 0.041), poor well-being (P ¼ 0.041), and lower physical (P ¼ 0.001) and overall symptom distress (P ¼ 0.001). No other associations were found between perceived timeliness and usefulness and patients' baseline characteristics.Conclusion. Most patients with a median survival of 10 months perceived that SC referral was timely and useful. Patient care needs rather than the timing of advanced cancer diagnosis drove this perception of referral timing. Lower symptom burden was associated with the perception of being referred to early.

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“…Multiple groups have published their supportive care clinical service model. A large number of these supportive care programs were variations of outpatient palliative care clinics delivered by palliative care teams [17–19]. Because a large proportion of oncologists perceived palliative care be to associated with end-of-life [20,21], the palliative care clinic at the University of Texas MD Anderson Cancer Center changed its name to Supportive Care in 2007 as a rebranding effort to overcome the stigma.…”

Section: Empiric Models Of Supportive Carementioning

confidence: 99%

Models of supportive care in oncology

Hui

Hoge

Bruera

2021

Current Opinion in Oncology

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Purpose of reviewSupportive care services have evolved overtime to meet the growing supportive care need of patients with cancer and their families. In this review, we summarize existing definitions of supportive care, highlight empiric studies on supportive care delivery, and propose an integrated conceptual framework on supportive cancer care. Recent findingsSupportive care aims at addressing the patients' physical, emotional, social, spiritual, and informational needs throughout the disease trajectory. Interdisciplinary teams are needed to deliver multidimensional care. Oncology teams have an important role providing supportive care in the front lines and referring patients to supportive care services such as palliative care, social work, rehabilitation, psycho-oncology, and integrative medicine. However, the current model of as needed referral and siloed departments can lead to heterogeneous access and fragmented care. To overcome these challenges, we propose a conceptual model in which supportive care services are organized under one department with a unified approach to patient care, program development, and research. Key features of this model include universal referral, systematic screening, tailored specialist involvement, streamlined care, collaborative teamwork, and enhanced outcomes. SummaryFurther research is needed to develop and test innovative supportive care models that can improve patient outcomes.

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Snapshot of an Outpatient Supportive Care Center at a Comprehensive Cancer Center

Cited by 10 publications

References 12 publications

Concurrent use of opioids with benzodiazepines or nonbenzodiazepine sedatives among patients with cancer referred to an outpatient palliative care clinic

Concurrent use of opioids with benzodiazepines or nonbenzodiazepine sedatives among patients with cancer referred to an outpatient palliative care clinic

Patients' Perspective of Timeliness and Usefulness of an Outpatient Supportive Care Referral at a Comprehensive Cancer Center

Models of supportive care in oncology

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