The palliative care needs of lung transplant candidates

Pawlow, Patricia; Blumenthal, Nancy P.; Christie, Jason D.; Matura, Lea Ann; Courtright, Katherine R.; Aryal, Subhash; Ersek, Mary

doi:10.1111/ctr.14092

Cited by 7 publications

(5 citation statements)

References 30 publications

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“…Patients with ILD were more likely to be delisted or die pre-LTx, and report a higher symptom burden, highlighting the importance of PC in this population. There is increasing support for the role of PC to aid in symptom management in the pre-transplantation period and we suspect that this will only become more important in the future (52,53). The ESAS has a role in identifying severe symptom burden in those with advanced lung disease on the LTx waiting list and may serve as a complement to traditional markers of disease severity.…”

Section: Discussionmentioning

confidence: 99%

Symptoms and disease severity in lung transplant candidates co-managed with palliative care

Minuk¹,

Chohan²,

Kumbhare³

et al. 2023

Ann Palliat Med

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Background: Lung transplant (LTx) candidates experience significant respiratory symptoms often necessitating palliative care (PC) support. We aimed to describe symptoms experienced by interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) LTx candidates referred for PC using the Edmonton Symptom Assessment Scale (ESAS) and to assess the change in ESAS in relation to pre-LTx exercise capacity, oxygen requirements, and respiratory exacerbations. Understanding symptom trajectory of these two patient groups will help inform PC management. Methods: Single centre, retrospective cohort of 102 ILD and 24 COPD LTx candidates who were assessed in the Toronto Transplant PC Clinic (TPCC) from 2014-2017. Chi-square and t-tests were used to compare clinical characteristics, physiological parameters, and ESAS scores. Results:The most common symptom in ILD and COPD patients was dyspnea (median score of 8, cough 7, fatigue 6). ILD patients reported higher cough scores (7 vs. 4, P<0.001). There was no association between the change in ESAS domains and six-minute walk distance (6MWD), oxygen requirements, or respiratory exacerbations, despite increased oxygen requirements and a greater decline in 6MWD in ILD compared to COPD pre-LTx (−47 vs. −8 meters, P=0.01). ILD candidates who were delisted/died compared to those transplanted, experienced worse depression (median ESAS; 4.5 vs. 1), anxiety (5.5 vs. 2) and dyspnea (9.5 vs. 8); P<0.05.Conclusions: ILD patients had similar symptoms as COPD patients, despite increased oxygen requirements and decreasing 6MWD pre-LTx. This study highlights the importance of symptom management of LTx candidates co-managed with PC, independent of traditional measures of disease severity.

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Section: Discussionmentioning

confidence: 99%

Symptoms and disease severity in lung transplant candidates co-managed with palliative care

Minuk¹,

Chohan²,

Kumbhare³

et al. 2023

Ann Palliat Med

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“…Eleven papers were included in our narrative review [125][126][127][128][129][130][131][132][133][134][135], as well as three systematic reviews [124,136,137]. Within these papers, 23 tools are discussed, of which 9 tools aimed to identify unmet needs of patients (7 tools) [125,[127][128][129][130][131][132][133][134][135] or carers (2 tools) [132,136] (online supplement).…”

Section: Summary Of Evidencementioning

confidence: 99%

“…Of the 9 included NATs, only two were specifically developed for people with serious respiratory illness; the Needs Assessment Tool -Progressive Disease: Interstitial Lung Disease (NAT:PD-ILD) for people with ILD [127][128][129], and the Needs Near the End of Life Scale modified version (NEST-13) for people awaiting lung transplant [130]. Three were not specific to, but had been investigated in, a cohort of people with serious respiratory illness; the Supportive Needs Approach for Patients (SNAP) in people with COPD [125], the Supportive Care Needs Survey Short Form 34 (SCNS-SF34) in people with cystic fibrosis [131], and the Measure Yourself Medical Outcome Profile (MYMOP) in people with acute exacerbations of bronchitis [135].…”

Section: Summary Of Evidencementioning

confidence: 99%

European Respiratory Society clinical practice guideline on symptom management for adults with serious respiratory illness

Holland,

Spathis,

Marsaa

et al. 2024

Eur Respir J

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Respiratory symptoms are ubiquitous and impair health-related quality of life in people with respiratory disease. This European Respiratory Society (ERS) task force aimed to provide recommendations for symptomatic treatment in people with serious respiratory illness.The ERS task force comprised 16 members, including representatives of people with serious respiratory illness and informal caregivers. Seven questions were formulated, six in the “Population, Intervention, Comparison, Outcome” (PICO) format, which were addressed with full systematic reviews and evidence assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). One question was addressed narratively. An “evidence-to-decision” framework was used to formulate recommendations.To treat symptoms in people with serious respiratory illness, the task force suggests the use of graded exercise therapy (conditional recommendation, low certainty of evidence); and suggests the use of a multicomponent services, handheld fan and breathing techniques (conditional recommendations, very low certainty of evidence). The task force suggests not to use opioids (conditional recommendation, very low certainty of evidence); and suggests either administering or not administering supplemental oxygen therapy (conditional recommendation, low certainty of evidence). The task force suggests that needs assessment tools may be used as part of a comprehensive needs assessment, but do not replace patient centred care and shared decision making (conditional recommendation, low certainty of evidence). The low certainty of evidence, modest impact of interventions on patient-centred outcomes, and absence of effective strategies to ameliorate cough highlight the need for new approaches to reduce symptoms and enhance wellbeing for individuals who live with serious respiratory illness.

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“…PC has emerged as a valuable intervention in addressing the complex needs of patients with advanced lung disease. These patients have several distressing symptoms including breathlessness, fatigue, pain, anxiety, and depression, which can significantly diminish their HRQL [8,9]. However, a growing body of evidence has shown PC in both interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) is associated with a reduced risk of hospital admissions, emergency room visits, and hospital duration [10 ▪ ,11 ▪▪ ,12 ▪▪ ,13].…”

Section: Advanced Lung Diseasementioning

confidence: 99%

An update of palliative care in lung transplantation with a focus on symptoms, quality of life and functional outcomes

Rozenberg,

Andrawes,

Wentlandt

2024

Current Opinion in Pulmonary Medicine

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Purpose of review Palliative care (PC) in lung transplantation is increasingly acknowledged for its important role in addressing symptoms, enhancing functionality, and facilitating advance care planning for patients, families, and caregivers. The present review provides an update in PC management in lung transplantation. Recent findings Research confirms the effectiveness of PC for patients with advanced lung disease who are undergoing transplantation, showing improvements in symptoms and reduced healthcare utilization. Assessment tools and patient-reported outcome measures for PC are commonly used in lung transplant candidates, revealing discrepancies between symptom severity and objective measures such as exercise capacity. The use of opioids to manage dyspnea and cough in the pretransplant period is deemed safe and does not heighten risks posttransplantation. However, the integration of PC support in managing symptoms and chronic allograft dysfunction in the posttransplant period has not been as well described. Summary Palliative care support should be provided in the pretransplant and select peri-operative and posttransplant periods to help support patient quality of life, symptoms, communication and daily function.

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The palliative care needs of lung transplant candidates

Cited by 7 publications

References 30 publications

Symptoms and disease severity in lung transplant candidates co-managed with palliative care

Symptoms and disease severity in lung transplant candidates co-managed with palliative care

European Respiratory Society clinical practice guideline on symptom management for adults with serious respiratory illness

An update of palliative care in lung transplantation with a focus on symptoms, quality of life and functional outcomes

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