The value of embedding: integrated palliative care for patients with metastatic breast cancer

Rabow, Michael W.; Small, Rebecca; Jow, Alexander; Majure, Melanie; Chien, Amy Jo; Melisko, Michelle; Belkora, Jeffrey; Esserman, Laura J.; Rugo, Hope S.

doi:10.1007/s10549-017-4556-2

Cited by 25 publications

(23 citation statements)

References 11 publications

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“…Despite this, the majority of patients (76.83%) who died in hospitals did not receive any PC services. Rabow et al found that 20.4% mBCa patients were referred to PC before death, consistent with our result (23.17%) [17]. Shin et al reported a higher in-hospital mortality of approximately 50% in 123 mB C patients and concluded that hospitalization should be treated as a trigger for clinicians to discuss end-of-life care goals with the patients [14].…”

Section: Discussionsupporting

confidence: 90%

“…Early integration of PC for patients with advanced cancer has been recommended by the ASCO and the NCCN guidelines to improve quality of care [2,3,12]. However, timely PC use in mBCa patients was not commonplace and the existing evidence was limited by small sample size or single center design [6,13,14,17,18]. This study described the prevalence, temporal trend and predictors of PC use in mBCa patients who received CCT from a nationally representative cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, focusing on PC use in mBCa patients who received CCT was of practical clinical significance. Although early integration of PC has been increasingly recognized as the standard of care in advanced cancer, mBCa patients failed to have adequate knowledge towards the concepts and benefits of PC use according to Rabow et al [17]. Among patients enrolled in the specialty PC program, most thought that the ideal time for PC referral was when the symptoms became uncontrolled and seriously affected their quality of life.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence, trend and disparities of palliative care utilization among hospitalized metastatic breast cancer patients who received critical care therapies

et al. 2020

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Background: Early integration of palliative care (PC) for patients with advanced cancer has been recommended to improve quality of care. This study aims to describe prevalence, temporal trend and predictors of PC use in metastatic breast cancer (mBCa) patients receiving critical care therapies (CCT; included invasive mechanic ventilation, percutaneous endoscopic gastrostomy tube, total parenteral nutrition, tracheostomy and dialysis). Methods: The National Inpatient Sample was queried for mBCa patients receiving CCT between 2005 and 2014. Annual percent changes (APC) were calculated for PC prevalence in the overall cohort and subgroups. Multivariable logistic analysis was used to explore predictors of PC use. Results: Of 5833 mBCa patients receiving CCT, 880 (15.09%) received PC. Rate of PC use increased significantly from 2.53% in 2005 to 25.96% in 2014 (APC: 35.75%; p < 0.0001). Higher increase in PC use was observed in South (from 0.65% to 27.11%; APC: 59.42%; p < 0.0001), medium bedsize hospitals (from 3.75% to 26.05%; APC: 38.16%; p ¼ 0.0006) and urban teaching hospitals (from 4.13% to 29.86%; APC: 37.33%; p ¼ 0.0005). Multivariable analysis revealed that year interval, urban teaching hospitals, and invasive mechanical ventilation were associated with increased PC use, while primary diagnosis of gastrointestinal disorders, fractures, metastatic sites from lymph nodes and tracheostomy were associated with lower PC use. Conclusions: PC use in mBCa patients receiving CCT increases significantly over the period. However, it still remains low. Efforts to illustrate disparities in PC use are needed to improve quality of care for mBCa patients receiving CCT, especially for those hospitalized in rural and nonteaching hospitals.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prevalence, trend and disparities of palliative care utilization among hospitalized metastatic breast cancer patients who received critical care therapies

et al. 2020

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“…How to manage these patients is a task that we must urgently address. The desired location for receiving end-of-life care was the PCU and HPC for 61% and 11% of patients, respectively, similar to the rates reported in the United States, 9 suggesting that our patients accepted the transition to palliative care well, probably due to efforts made by the palliative team. However, we should be aware that HPC rates might differ according to medical insurance systems, with coverage varying markedly among nations.…”

Section: Discussionsupporting

confidence: 75%

Factors Affecting Decisions Regarding Terminal Care Locations of Patients With Metastatic Breast Cancer

Nogami

Nakai

Horimoto

et al. 2020

Am J Hosp Palliat Care

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Background: Metastatic breast cancer (MBC) is generally incurable, but patients can survive longer than those with other cancer types. Treatment strategies for MBC are complex, and it is difficult to establish evidence of efficacy since symptoms and patient backgrounds vary markedly. Some patients struggle to decide where to receive end-of-life care, despite palliative care intervention, and some die in unexpected places. With the aim of ascertaining the best way to intervene on behalf of patients with end-stage breast cancer, we retrospectively examined interventions provided by our palliative care team. We investigated factors influencing the decision-making processes of patients with MBC regarding end-of-life care locations and where patients actually died. Methods: Clinical records of 44 patients with MBC, all Japanese women, who received palliative care interventions at our hospital, were retrospectively investigated. We examined factors, such as age, possibly impacting decision-making processes regarding the final location and actual place of death. Results: Thirty-five (80%) patients were able to decide where to receive end-of-life care, while the others were not. For these 35 patients, desired locations were the palliative care unit (77%), home palliative care (14%), and the hospital (9%). Age and recurrence-free survival (RFS) were factors influencing patients’ decision-making processes ( P = .030 and .044, respectively). Of the 35 patients, 25 (71%) were able to receive end-of-life care at their desired locations. Conclusions: Young patients and those with short RFS struggled with making decisions regarding where to receive end-of-life care. Such patients might benefit from prompt introduction of advanced care planning.

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“…The benefit of embedding PC ANPs into oncology clinics is an area of active research, and many early studies have shown it to be well received by patients, facilitating early PC input and improving end-of-life care. [24][25][26] Typically, PC is not sought until the disease is at an advanced stage requiring hospitalization or if the patient has uncontrolled symptoms that severely impair their QOL. 27,28 Previous studies have suggested that late referrals to PC are inadequate to alter the quality and delivery of care provided to patients with cancer; thus, several organizations such as the ASCO, National Comprehensive Cancer Network, and European Society of Medical Oncology have issued clinical opinions recommending the use of PC earlier in the course of disease.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Time to Palliative Care Referrals in Patients With Small-Cell Lung Cancer: A Single-Centre Retrospective Review

Watson

Saunders

Coate

2018

Am J Hosp Palliat Care

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Palliative care treatment is a critical aspect in the oncological treatment of all patients diagnosed with advanced cancer, and this study highlights good compliance with existing national guidelines. Further research focusing on quality-of-life issues with the use of questionnaires to assess physical and psychological symptoms should be performed to further understand the impact of palliative care in these patients.

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The value of embedding: integrated palliative care for patients with metastatic breast cancer

Cited by 25 publications

References 11 publications

Prevalence, trend and disparities of palliative care utilization among hospitalized metastatic breast cancer patients who received critical care therapies

Prevalence, trend and disparities of palliative care utilization among hospitalized metastatic breast cancer patients who received critical care therapies

Factors Affecting Decisions Regarding Terminal Care Locations of Patients With Metastatic Breast Cancer

Evaluating the Time to Palliative Care Referrals in Patients With Small-Cell Lung Cancer: A Single-Centre Retrospective Review

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