This pilot study aimed to investigate quality of life, psychological burden, unmet needs, and care satisfaction in family caregivers of advanced cancer patients (FCs) during specialized inpatient palliative care (SIPC) and to test feasibility and acceptance of the questionnaire survey.
During a period of 12 weeks, FCs were recruited consecutively within 72 h after the patient’s admission. They completed validated scales on several outcomes: quality of life (SF-8), distress (DT), anxiety (GAD-7), depression (PHQ-9), supportive needs (FIN), palliative care outcome (POS), and satisfaction with care (FAMCARE-2). We used non-parametric tests, t-tests and correlation analyses to address our research questions.
FCs showed high study commitment: 74 FCs were asked to participate whereof 54 (73%) agreed and 51 (69%) returned the questionnaire. Except for “bodily pain”, FCs’ quality of life (SF-8) was impaired in all subscales. Most FCs (96%) reported clinically significant own distress (DT), with sadness, sorrows and exhaustion being the most distressing problems (80–83%). Moderate to severe anxiety (GAD-7) and depression (PHQ-9) were prevalent in 43% and 41% of FCs, respectively. FCs scored a mean number of 16.3 of 20 needs (FIN) as very or extremely important (SD 3.3), 20% of needs were unmet in >50% of FCs. The mean POS score assessed by FCs was 16.6 (SD 5.0) and satisfaction (FAMCARE-2) was high (73.4; SD 8.3).
This pilot study demonstrated feasibility of the questionnaire survey and showed relevant psychosocial burden and unmet needs in FCs during SIPC. However, FCs’ satisfaction with SIPC seemed to be high.
DeSanto-Madeya, S. et al. BMJ Supportive & Palliative Care | Published Online: 03 March 2017.
Objectives: Describe the development and key features of a model for embedded palliative care (PC) for patients with advanced kidney cancer or melanoma seen in a cancer clinic.
Conclusions: The initial phase demonstrated acceptability and feasibility of a model for embedded PC for patients and the oncology team. Establishment of specific eligibility criteria and screening to identify eligible patients in the model phase led to an increased uptake of PC for patients with advanced kidney cancer and melanoma in a cancer clinic.
Pottle, J. et al. BMJ Supportive & Palliative Care. Published online: 16 January
Objectives: Supporting patients to die in the place of their choosing is an important aspect of end of life care. Our study set out to answer the question: ‘How does the home environment influence perceptions of quality of death, and the experience of caring for the dying at home, for family carers and healthcare professionals (HCPs)?
Conclusions: We have shed light on the complexity of balancing the demands and the satisfaction of caring for someone dying at home. The ability to manage these conflicting needs influenced whether carers perceived the home setting as the best place for the person to have received care in their last days of life.
Objective: To assess the efficacy of active treatment targeted at underlying disease (TTD)/potentially curative treatments versus palliative care (PC) in improving overall survival (OS) in terminally ill patients.
Results: Initial search identified 8252 citations of which 10 RCTs (15 comparisons, 1549 patients) met inclusion criteria. All RCTs included patients with cancer. OS was reported in 7 RCTs (8 comparisons, 1158 patients). The pooled results showed no statistically significant difference in OS between TTD and PC (HR (95% CI) 0.85 (0.71 to 1.02)). The heterogeneity between pooled studies was high (I2=62.1%). Overall rates of adverse events were higher in the TTD arm.
Conclusions: Our systematic review of available RCTs in patients with terminal illness due to cancer shows that TTD compared with PC did not demonstrably impact OS and is associated with increased toxicity. The results provide assurance to physicians, patients and family that the patients’ survival will not be compromised by referral to hospice with focus on PC.
Sathornviriyapong, A. et al. BMC Palliative Care. Published online: 21 November 2016
Background: Concerns that opioids may hasten death can be a cause of the physicians’ reluctance to prescribe opioids, leading to inadequate symptom palliation. Our aim was to find if there was an association between different opioid doses and the survival of the cancer patients that participated in our palliative care program.
Conclusions: Our study has demonstrated that different opioid doses in advanced cancer patients are not associated with shortened survival period.
The clinical management of patients with advanced breast cancer is complex and patients’ progress is often unpredictable, creating challenges for nursing care in this specialty. However, there is strong evidence that patients who progress quickly through two lines of treatment for secondary breast cancer may be in the last year of their life.
New national drivers for end of life care highlight the importance of identifying patients who are in their last year of life to determine their needs, concerns and priorities for care, and to ensure appropriate community support is in place. At one cancer centre this has led to changes in clinical practice using an integrated approach with palliative care and holistic needs assessments.
There have been significant benefits for patients and their families, including a reduction in hospital admissions during end of life and improved symptom management. Communication with GPs and community nurses has also been enhanced, which provides benefits for patients and clinical staff.
Poort, H. et al. (2016) Palliative Medicine. 30(9) pp. 897-898
Background: Fatigue is a prevalent and burdensome symptom for patients with advanced cancer. The long-term use of pharmacological interventions for fatigue is not supported by evidence, although non pharmacological and behavioral interventions are promising approaches to reducing fatigue based on their effectiveness in early-stage cancer patients. Behavioral factors, like sleeping problems and being less physically active, can also contribute to fatigue in advanced cancer patients. Interventional studies for the management of fatigue in advanced cancer patients are needed.
However, it is a notorious challenge to identify patients for interventional studies aimed at fatigue or symptom control while patients are undergoing cancer treatment with palliative intent. One of the barriers to successful identification of these patients is professional gatekeeping, due to the care professionals’ perception that study participation might be too burdensome for the patient. Although gatekeeping is done in order to prevent additional burden for patients who are seriously ill, it also limits access for patients to potentially effective interventions for fatigue and makes it difficult to develop evidence-based interventions for fatigue in advanced cancer patients.