Symptom profiles and palliative care in advanced pancreatic cancer—a prospective study

Labori, Knut Jørgen; Hjermstad, Marianne Jensen; Wester, Torunn; Buanes, Trond; Loge, Jon Håvard

doi:10.1007/s00520-006-0067-0

Cited by 79 publications

(86 citation statements)

References 26 publications

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“…11,15 Recently, Yan et al and Wong et al showed that, 14,40 compared with standard analgesia, celiac block is associated with a significant but limited reduction of pain but does not improve either quality of life or survival. They concluded that celiac block should not replace standard pain control measures but should be used selectively as an adjunct.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] Many also will manifest pain, which is probably the most disturbing and incapacitating symptom in advanced pancreatic cancer. 11 Adequate palliation of biliary and duodenal obstruction, as well as of pain, is one of the goals in the treatment of these patients. However, optimal methods of palliation remain controversial in terms of patient benefit perception and durability.…”

Section: Introductionmentioning

confidence: 99%

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Quality of Life in Pancreatic Cancer: Analysis by Stage and Treatment

Crippa

Domínguez

Rodríguez

et al. 2008

Journal of Gastrointestinal Surgery

103

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In pancreatic cancer patients, survival and palliation of symptoms should be balanced with social and functional impairment, and for this reason, health-related quality of life measurements could play an important role in the decision-making process. The aim of this work was to evaluate the quality of life and survival in 92 patients with different stages of pancreatic adenocarcinoma who underwent surgical and/or medical interventions. Patients were evaluated with the Functional Assessment of Cancer Therapy questionnaires at diagnosis and follow-up (3 and 6 months). At diagnosis, 28 patients (30.5%) had localized disease (group 1) and underwent surgical resection, 34 (37%) had locally advanced (group 2), and 30 (32.5%) metastatic disease (Group 3). NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptImprovement in quality of life was found in group 1, while in group 3, it decreased at follow-up (p = 0.03). No changes in quality of life in group 2 were found. Chemotherapy/chemoradiation seems not to significantly modify quality of life in groups 2 and 3. Median survival time for the entire cohort was 9.8 months (range, 1-24). One-year survival was 74%, 30%, and 16% for groups 1, 2, and 3 respectively (p = 0.001). Pancreatic cancer prognosis is still dismal. In addition to long-term survival benefits, surgery impacts favorably quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quality of Life in Pancreatic Cancer: Analysis by Stage and Treatment

Crippa

Domínguez

Rodríguez

et al. 2008

Journal of Gastrointestinal Surgery

103

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“…Demographic data (ie, patient age and sex) and clinical data (ie, type of cancer and reasons for ICU admission) were collected. Symptom profile data from the day of the initial consultation were collected and assessed using the Edmonton Symptom Assessment Scale (ESAS), [16][17][18][19] which is a series of visual analogue scales that rate pain, fatigue, nausea, depression, anxiety, drowsiness, sleep, appetite, well being, and shortness of breath. The ESAS was completed by each patient independently unless the patient was unable to rate all the symptoms; in such cases, a physician or nurse assisted the patient.…”

Section: Patients and Study Designmentioning

confidence: 99%

“…Only 22 patients (25%) were able to complete both the baseline and follow-up ESAS. For the patients who did complete the ESAS, significant improvements were documented in pain ( Delirium improved in 21 patients (30%) who were able to complete the MDAS from an initial median score of 13 (range, 8-21) to a median MDAS score of 11 (range, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Of these 21 patients, 20 (95%) were discharged alive (9 patients were discharged to home with hospice services, 5 patients were discharged to an inpatient hospice unit, 4 patients were discharged to home with outpatient follow-up, and 2 patients were discharged to a skilled nursing facility).…”

Section: (26)mentioning

confidence: 99%

Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team

Delgado-Guay

Parsons

et al. 2009

Cancer

110

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BACKGROUND:The symptom burden of intensive care unit (ICU) patients who are referred to a palliative care team (PCT) has not been characterized to the authors' knowledge, and the response of these symptoms to the palliative care intervention has not been reported.METHODS:The authors retrospectively reviewed PCT consults for ICU patients who were seen between July 2006 and October 2007. To characterize symptom distress and outcomes in ICU patients who were referred to PCT in a cancer center, information and descriptive statistics about patients' demographics, comorbidities, PCT findings, interventions, and outcomes were obtained. The chi‐square test was used to analyze ICU and PCT mortality, and the signed‐rank test was used to analyze PCT interventions.RESULTS:Of 1637 PCT consults, 88 consults (5%) were from the ICU. The median patient age was 60 years (range, 22‐87 years), and 41 patients (46%) were women. The types of cancers were hematologic (19 patients; 22%), gastrointestinal (19 patients; 22%), lung (18 patients; 20%), and others (24 patients; 26%). Nineteen patients were on mechanical ventilation (MV), and 24 patients were on bilevel positive airway pressure (BIPAP). The findings were delirium (71 patients; 81%), dyspnea (67 patients; 76%), pain (74patients; 84%), fatigue (84 patients; 95%), and anxiety (57 patients; 65%). The interventions used were opioid management (99%), steroids (70%), antipsychotics (76%), and counseling (100%), do not resuscitate conversion (62 of 88 patients; 70%), withdrawal of MV (15 of 19 patients; 79%), and withdrawal of BIPAP (26 of 26 patients; 100%). Improvement was reported in pain (67 patients; 90%), dyspnea (60 patients; 90%), anxiety (51 patients; 80%), and delirium (31 patients; 44%). Thirty‐five patients (40%) were transferred to the palliative care unit (PCU). Fifty‐one ICU/PCT patients (58%) died during admission versus 130 of 1549 (8%) non‐ICU PCT patients (P < .0001). Twenty‐three of 35 patients who were transferred to the PCU (66%) died there versus 212 of 629 patients (34%) who were admitted to the PCU from another service (P < .0001). Thirty‐seven of 88 ICU/PCT patients (42%) were discharged alive.CONCLUSIONS:ICU patients who are referred to the PCT have severe symptom distress. The PCT was able to identify multiple problems and make numerous pharmacologic and nonpharmacologic recommendations that improved these symptoms, including the participation in do not resuscitate conversion and withdrawal of MV and BIPAP. Although many patients in this population died, a significant subset, including those who were transferred to the PCU, survived to discharge. Cancer 2009. © 2009 American Cancer Society.

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“…Patients with PC experience many of these symptoms and problems during the disease course [8,9]. Gastrointestinal problems such as abdominal pain, nausea, vomiting and early satiety are common and may lead to appetite loss [9,10].…”

Section: Introductionmentioning

confidence: 99%

Symptoms in advanced pancreatic cancer are of importance for energy intake

Bye

Jordhøy

Skjegstad

et al. 2012

Support Care Cancer

Self Cite

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Purpose: Cancer cachexia and low energy intake (EI) probably contribute to weight loss in advanced pancreatic cancer (PC). However, little is known about the actual EI in this disease. Aims were to assess EI, weight loss and symptoms during the disease course and investigate associations between symptoms and EI.Methods: Thirty-nine patients (21 males) with advanced PC were consecutively included and followed every 4 weeks until the end of life. A 24-hour dietary recall was used to assess EI. The Edmonton Symptom Assessment System (ESAS) and the PC-specific health-related quality of life questionnaire (QLQ-PAN26) were used for symptom assessment. Conclusion:In this study several symptoms influenced EI negatively. Low EI did not completely explain weight loss in this patient group, but careful monitoring and early follow-up of symptoms may be important interventions to reduce weight loss in advanced PC.

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Symptom profiles and palliative care in advanced pancreatic cancer—a prospective study

Cited by 79 publications

References 26 publications

Quality of Life in Pancreatic Cancer: Analysis by Stage and Treatment

Quality of Life in Pancreatic Cancer: Analysis by Stage and Treatment

Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team

Symptoms in advanced pancreatic cancer are of importance for energy intake

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