Palliative Care and Supportive Medicine in Cancer

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Palliative and Supportive Care".

Deadline for manuscript submissions: 15 August 2024 | Viewed by 8627

Special Issue Editor


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Guest Editor
Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
Interests: cancer care integration; palliative care; healthcare service delivery; healthcare provider education; supportive care

Special Issue Information

Dear Colleagues,

Cancer care systems in Canada and elsewhere have made commendable strides in integrating supportive care into cancer treatment and instating palliative care as a right of the dying. Supportive care and palliative care reside on a continuum to maintain quality of life, from the sequelae of cancer treatment through to and beyond the advancement of disease. However, too often, the transition from the supportive care pathway to that of palliative care is not initiated until weeks or days before death, if at all. This delay can lead patients to a veritable cul-de-sac with needless symptom burden and opportunities missed to prepare the individual and their family. The cultural shift needs to continue in accepting that supportive care will evolve into a palliative approach to care, and that this p-word does not mean end-of-life.

This Special Issue will feature original research, reviews, and novel case reports that move the knowledge base forward towards realizing smoother transitions for patients in supportive and palliative care. This includes illuminating the challenges facing cancer patients and providers in initiating these transitions and offering practical solutions. Studies examining innovations in care delivery and education for introducing supportive palliative care earlier in the disease trajectory and better integrating primary care will also be highlighted.

Dr. Daryl Bainbridge
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cancer care transitions
  • early palliative care
  • supportive care
  • quality of life
  • risk stratification

Published Papers (8 papers)

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Research

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11 pages, 522 KiB  
Article
Outpatient Embedded Palliative Care for Patients with Advanced Thoracic Malignancy: A Retrospective Cohort Study
by Mary C. Boulanger, Margaret D. Krasne, Ethan K. Gough, Samantha Myers, Ilene S. Browner and Josephine L. Feliciano
Curr. Oncol. 2024, 31(3), 1389-1399; https://doi.org/10.3390/curroncol31030105 - 07 Mar 2024
Viewed by 588
Abstract
Although cancer care is often contextualized in terms of survival, there are other important cancer care outcomes, such as quality of life and cost of care. The ASCO Value Framework assesses the value of cancer therapies not only in terms of survival but [...] Read more.
Although cancer care is often contextualized in terms of survival, there are other important cancer care outcomes, such as quality of life and cost of care. The ASCO Value Framework assesses the value of cancer therapies not only in terms of survival but also with consideration of quality of life and financial cost. Early palliative care for patients with advanced cancer is associated with improved quality of life, mood, symptoms, and overall survival for patients, as well as cost savings. While palliative care has been shown to have numerous benefits, the impact of real-world implementation of outpatient embedded palliative care on value-based metrics is not fully understood. We sought to describe the association between outpatient embedded palliative care in a multidisciplinary thoracic oncology clinic and inpatient value-based metrics. We performed a retrospective cohort study of 215 patients being treated for advanced thoracic malignancies with non-curative intent. We evaluated the association between outpatient embedded palliative care and inpatient clinical outcomes including emergency room visits, hospitalizations, intensive care unit admissions, hospital charges, as well as hospital quality metrics including 30-day readmissions, admissions within 30 days of death, inpatient mortality, and inpatient hospital charges. Outpatient embedded palliative care was associated with lower hospital charges per day (USD 3807 vs. USD 4695, p = 0.024). Furthermore, patients who received outpatient embedded palliative care had lower hospital admissions within 30 days of death (O.R. 0.45; 95% CI 0.29, 0.68; p < 0.001) and a lower inpatient mortality rate (IRR 0.67; 95% CI 0.48, 0.95; p = 0.024). Our study further supports that outpatient palliative care is a high-value intervention and alternative models of palliative care, including one embedded into a multidisciplinary thoracic oncology clinic, is associated with improved value-based metrics. Full article
(This article belongs to the Special Issue Palliative Care and Supportive Medicine in Cancer)
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13 pages, 1672 KiB  
Article
High Symptom Burden in Patients Receiving Radiotherapy and Factors Associated with Being Offered an Intervention
by Allison Rau, Demetra Yannitsos, Petra Grendarova, Siwei Qi, Linda Watson and Lisa Barbera
Curr. Oncol. 2024, 31(3), 1253-1265; https://doi.org/10.3390/curroncol31030094 - 27 Feb 2024
Viewed by 607
Abstract
Patient report outcomes are commonly collected during oncology visits to elicit symptom burden and guide management. We aimed to determine the frequency of intervention for patients undergoing radiotherapy with high symptom complexity scores and identify which factors are associated with being offered an [...] Read more.
Patient report outcomes are commonly collected during oncology visits to elicit symptom burden and guide management. We aimed to determine the frequency of intervention for patients undergoing radiotherapy with high symptom complexity scores and identify which factors are associated with being offered an intervention. A retrospective chart audit was completed of adult patients with cancer who had at least one radiotherapy appointment and were assigned a high symptom complexity. A total of 200 patients were included; 150 (75.0%) patients were offered an intervention for the main symptom. The most offered intervention was medications. Multivariable logistic regression showed factors associated with being offered an intervention were the following: symptom score of 9 (OR = 9.56, 95% CI 1.64–62.8) and 10 (OR = 7.90, 95% CI 1.69–38.2); palliative intent radiation (OR 3.87, 96% CI 1.46–11.1); and last review appointment (OR 6.22, 95% CI 1.84–23.3). Symptoms associated with being offered an intervention included pain (OR 22.6, 95% CI 6.47–91.1), nausea (OR 15.7, 95% CI 1.51–412), shortness of breath (OR 7.97, 95% CI 1.20–63.7), and anxiety (OR 6.69, 95% CI 1.58–31.6). This knowledge will help guide clinical practice to understand symptom burden and how we can improve our management of patients’ symptoms. Full article
(This article belongs to the Special Issue Palliative Care and Supportive Medicine in Cancer)
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7 pages, 535 KiB  
Communication
Involvement of Palliative Care in Malignant Pleural Mesothelioma Patients and Associations with Survival and End-of-Life Outcomes
by Andrew Baird, Abdullah Nasser, Peter Tanuseputro, Colleen Webber, Paul Wheatley-Price and Camille Munro
Curr. Oncol. 2024, 31(2), 1028-1034; https://doi.org/10.3390/curroncol31020076 - 14 Feb 2024
Viewed by 917
Abstract
Malignant pleural mesothelioma is a rare, aggressive, and incurable cancer with a poor prognosis and high symptom burden. For these patients, little is known about the impact of palliative care consultation on outcomes such as mortality, hospital admissions, or emergency department visits. The [...] Read more.
Malignant pleural mesothelioma is a rare, aggressive, and incurable cancer with a poor prognosis and high symptom burden. For these patients, little is known about the impact of palliative care consultation on outcomes such as mortality, hospital admissions, or emergency department visits. The aim of this study is to determine if referral to supportive and palliative care in patients with malignant pleural mesothelioma is associated with survival and decreased hospital admissions and emergency department visits. This is a retrospective chart review. Study participants include all malignant pleural mesothelioma patients seen at The Ottawa Hospital—an acute care tertiary center—between January 2002 and March 2019. In total, 223 patients were included in the study. The mean age at diagnosis was 72.4 years and 82.5% were male. Of the patients diagnosed between 2002 and 2010, only 11 (9.6%) were referred to palliative care. By comparison, of those diagnosed between 2011 and 2019, 49 (45.4%) were referred to palliative care. Median time from diagnosis to referral was 4.1 months. There was no significant difference in the median survival of patients referred for palliative care compared to those who did not receive palliative care (p = 0.46). We found no association between receiving palliative care and the mean number of hospital admissions (1.04 vs. 0.91) from diagnosis to death, and an increase in mean number of emergency department visits in the palliative care group (2.30 vs. 1.18). Although there was increased utilization of palliative care services, more than half of the MPM patients did not receive palliative care despite their limited survival. There was an increase in emergency department visits in the palliative care group; this may represent an increase in the symptom burden (i.e., indication bias) in those referred to palliative care. Full article
(This article belongs to the Special Issue Palliative Care and Supportive Medicine in Cancer)
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11 pages, 247 KiB  
Article
Breakthrough and Episodic Cancer Pain from a Palliative Care Perspective
by Erik Torbjørn Løhre, Gunnhild Jakobsen, Tora Skeidsvoll Solheim, Pål Klepstad and Morten Thronæs
Curr. Oncol. 2023, 30(12), 10249-10259; https://doi.org/10.3390/curroncol30120746 - 30 Nov 2023
Cited by 1 | Viewed by 910
Abstract
Cancer pain intensity (PI) fluctuates, but the relationship between pain flares and background pain with respect to pain management is not settled. We studied how flare and background PIs corresponded with treatment results for background cancer pain. Patients admitted to an acute palliative [...] Read more.
Cancer pain intensity (PI) fluctuates, but the relationship between pain flares and background pain with respect to pain management is not settled. We studied how flare and background PIs corresponded with treatment results for background cancer pain. Patients admitted to an acute palliative care unit with average and/or worst PI ≥ 1 on the 11-point numeric rating scale were included. Average and worst PI at admission and average PI at discharge were collected. We examined how the difference and ratio between worst and average PI and average PI at admission, were associated with average PI development during hospitalization. Positive differences between worst and average PI at admission were defined as pain flares. Ninety out of 131 patients had pain flares. The reduction in average PI for patients with flares was 0.9 and for those without, 1.9 (p = 0.02). Patients with large worst minus average PI differences reported the least improvement, as did those with large worst/average PI ratios. Patients with pain flares and average PI ≤ 4 at admission had unchanged average PI during hospitalization, while those with pain flares and average PI > 4 experienced pain reduction (2.1, p < 0.001). Large pain flares, in absolute values and compared to background PI, were associated with inferior pain relief. Full article
(This article belongs to the Special Issue Palliative Care and Supportive Medicine in Cancer)
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15 pages, 705 KiB  
Article
Predictors and Consequences of Cancer and Non-Cancer-Related Pain in Those Diagnosed with Primary and Metastatic Cancers
by Kriti Shah, David A. Geller, Samer Tohme, Michael Antoni, Cramer J. Kallem, Yoram Vodovotz, Rekha Ramanathan, Raam Naveen, MacKenzie Geroni, LaNita Devine, Aarshati Amin, Gauri J. Kiefer, Dan P. Zandberg, Vincent Reyes and Jennifer L. Steel
Curr. Oncol. 2023, 30(10), 8826-8840; https://doi.org/10.3390/curroncol30100637 - 27 Sep 2023
Viewed by 1130
Abstract
Objectives: The aims of the study were to (1) describe types of pain in cancer patients, (2) examine the predictors and consequences of pain, (3) investigate the association between type of pain and survival, and (4) examine potential biological mediators of pain and [...] Read more.
Objectives: The aims of the study were to (1) describe types of pain in cancer patients, (2) examine the predictors and consequences of pain, (3) investigate the association between type of pain and survival, and (4) examine potential biological mediators of pain and survival. Methods: This was a secondary analysis of baseline data from patients diagnosed with cancer. Patients answered questionnaires that assessed sociodemographic characteristics, pain, depression, sleep, and fatigue. Blood was collected and cytokine assays were performed. Analysis of variance, Kaplan–Meier, and Cox regression survival analyses were used to test the aims. Results: Of the 779 patients diagnosed with cancer, the mean age was 63.5 years, 57.8% male, and 90.6% White. Of those who reported pain (total 70.3%), 46.5% stated their pain was cancer-related while 53.5% stated their pain was non-cancer-related. While both cancer and non-cancer-related pain was associated with depressive symptoms, fatigue, and sleep duration, those with cancer-related pain had significantly higher rates of depressive symptoms (F(1,516) = 21.217, p < 0.001) and fatigue (F(1,516) = 30.973, p < 0.001) but not poorer sleep (F(1,497) = 0.597, p = 0.440). After adjusting for sociodemographic, disease-related characteristics, depression, sleep duration, and morphine milligram equivalent, patient reports of cancer-related pain were significantly associated with poorer survival (HR = 0.646, 95% CI = 0.459–0.910, p = 0.012) compared to those with non-cancer-related pain, which was not associated with survival (HR = 1.022, 95% CI = 0.737–1.418, p = 0.896). Cytokines did not significantly mediate the link between pain and survival. Conclusion: While nearly half of the pain reported was cancer-related, both types of pain resulted in greater symptom burden, but only cancer-related pain was associated with survival. Full article
(This article belongs to the Special Issue Palliative Care and Supportive Medicine in Cancer)
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11 pages, 277 KiB  
Article
The Impact of Frailty on Palliative Care Receipt, Emergency Room Visits and Hospital Deaths in Cancer Patients: A Registry-Based Study
by Peter Strang and Torbjörn Schultz
Curr. Oncol. 2023, 30(7), 6623-6633; https://doi.org/10.3390/curroncol30070486 - 11 Jul 2023
Cited by 1 | Viewed by 1293
Abstract
Background. Eastern Cooperative Oncology Group (ECOG) performance status is used in decision-making to identify fragile patients, despite the development of new and possibly more reliable measures. This study aimed to examine the impact of frailty on end-of-life healthcare utilization in deceased cancer patients. [...] Read more.
Background. Eastern Cooperative Oncology Group (ECOG) performance status is used in decision-making to identify fragile patients, despite the development of new and possibly more reliable measures. This study aimed to examine the impact of frailty on end-of-life healthcare utilization in deceased cancer patients. Method. Hospital Frailty Risk Scores (HFRS) were calculated based on 109 weighted International Classification of Diseases 10th revision (ICD-10) diagnoses, and HFRS was related to (a) receipt of specialized palliative care, (b) unplanned emergency room (ER) visits during the last month of life, and (c) acute hospital deaths. Results. A total of 20,431 deceased cancer patients in ordinary accommodations were studied (nursing home residents were excluded). Frailty, as defined by the HFRS, was more common in men than in women (42% vs. 38%, p < 0.001) and in people residing in less affluent residential areas (42% vs. 39%, p < 0.001). Patients with frailty were older (74.1 years vs. 70.4 years, p < 0.001). They received specialized palliative care (SPC) less often (76% vs. 81%, p < 0.001) but had more unplanned ER visits (50% vs. 35%, p < 0.001), and died more often in acute hospital settings (22% vs. 15%, p < 0.001). In multiple logistic regression models, the odds ratio (OR) was higher for frail people concerning ER visits (OR 1.81 (1.71–1.92), p < 0.001) and hospital deaths (OR 1.66 (1.51–1.81), p < 0.001), also in adjusted models, when controlled for age, sex, socioeconomic status at the area level, and for receipt of SPC. Conclusion. Frailty, as measured by the HFRS, significantly affects end-of-life cancer patients and should be considered in oncologic decision-making. Full article
(This article belongs to the Special Issue Palliative Care and Supportive Medicine in Cancer)
11 pages, 251 KiB  
Article
Nature-Based Virtual Reality Feasibility and Acceptability Pilot for Caregiver Respite
by Mohammed Owayrif Alanazi, Arienne Patano, Gary Bente, Andrew Mason, Dawn Goldstein, Sina Parsnejad, Gwen Wyatt and Rebecca Lehto
Curr. Oncol. 2023, 30(7), 5995-6005; https://doi.org/10.3390/curroncol30070448 - 22 Jun 2023
Viewed by 1544
Abstract
Home-based informal caregivers (CGs), such as the family members and friends of cancer patients, often suffer averse emotional symptoms, such as anxiety and depression, due to the burden associated with providing care. The natural environment has been valued as a healing sanctuary for [...] Read more.
Home-based informal caregivers (CGs), such as the family members and friends of cancer patients, often suffer averse emotional symptoms, such as anxiety and depression, due to the burden associated with providing care. The natural environment has been valued as a healing sanctuary for easing emotional pain, promoting calmness, relaxation, and restoration. The use of virtual reality (VR) nature experiences offers an alternative option to CGs to manage emotional symptoms and improve their quality of life. The aim of this mixed-method pilot was to evaluate the feasibility and acceptability of a nature-based VR experience for home-based CGs. Nine informal CGs participated in a 10 min nature-based VR session and completed feasibility, acceptability, and VR symptom measures in the laboratory. Semi-structured interviews with five of the CGs provided qualitative data regarding their experiences with VR. The CGs (mean age 64.78 years) were mostly female (n = 7). Our analysis showed high feasibility (15.11 ± 1.76; range 0–16) and acceptability (15.44 ± 1.33; range 0–16), as well as low VR Symptoms (1.56 ± 1.33; range 0–27). Participants primarily expressed positive perceptions regarding VR feasibility and acceptability during interviews. Our findings show promise for the use of VR nature experiences. In the next phase of the study, the intervention will be tested on home-based informal CGs of patients at end of life. Full article
(This article belongs to the Special Issue Palliative Care and Supportive Medicine in Cancer)

Review

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13 pages, 730 KiB  
Review
Positive Psychological Well-Being in Early Palliative Care: A Narrative Review of the Roles of Hope, Gratitude, and Death Acceptance
by Elena Bandieri, Eleonora Borelli, Sarah Bigi, Claudia Mucciarini, Fabio Gilioli, Umberto Ferrari, Sonia Eliardo, Mario Luppi and Leonardo Potenza
Curr. Oncol. 2024, 31(2), 672-684; https://doi.org/10.3390/curroncol31020049 - 24 Jan 2024
Viewed by 997
Abstract
In the advanced cancer setting, low psychological functioning is a common symptom and its deleterious impact on health outcomes is well established. Yet, the beneficial role of positive psychological well-being (PPWB) on several clinical conditions has been demonstrated. Early palliative care (EPC) is [...] Read more.
In the advanced cancer setting, low psychological functioning is a common symptom and its deleterious impact on health outcomes is well established. Yet, the beneficial role of positive psychological well-being (PPWB) on several clinical conditions has been demonstrated. Early palliative care (EPC) is a recent value-based model consisting of the early integration of palliative care into standard care for solid tumors and hematologic malignancies. While the late palliative care primary offers short-term interventions, predominantly pharmacological in nature and limited to physical symptom reduction, EPC has the potential to act over a longer term, enabling specific interventions aimed at promoting PPWB. This narrative review examines nine English studies retrieved from MEDLINE/PubMed, published up to October 2023, focusing on EPC and three dimensions of PPWB: hope, gratitude, and death acceptance. These dimensions consistently emerge in our clinical experience within the EPC setting for advanced cancer patients and appear to contribute to its clinical efficacy. The choice of a narrative review reflects the novelty of the topic, the limited existing research, and the need to incorporate a variety of methodological approaches for a comprehensive exploration. Full article
(This article belongs to the Special Issue Palliative Care and Supportive Medicine in Cancer)
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