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29 Apr, 17 | by James Smallbone, Publishing Assistant

Cost analysis of a prospective multi-site cohort study of palliative care consultation teams for adults with advanced cancer: Where do cost-savings come from?

May P, Garrido MM, Cassel JB, Kelley AS, Meier DE, Normand C, Smith TJ, Morrison RS.

Palliat Med. 2017 Apr;31(4):378-386.

 

A prospective multi-site cohort study in three US hospitals included 863 patients with advanced cancer and analysed the cost-differences associated with early palliative care consultation (within 2 days of admission), later palliative care and usual care. 226 were seen by a palliative care team during their hospital admission (177 seen within 2 days of admission) and 637 received usual care only. This study showed that patients receiving early palliative care had less treatment and shorter length of stay; however there was minimal cost differences between the early and late palliative care consultations groups.

 

Composed by Elaine Boland.

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22 Apr, 17 | by James Smallbone, Publishing Assistant

Comparing the symptom experience of cancer patients and non-cancer patients.

Deshields TL, Penalba V, Liu J, Avery J.

Support Care Cancer. 2017 Apr;25(4):1103-1109.

 

This study focussed on symptom burden of 301 consecutive patients from a general medical clinic and 558 cancer patients from a tumour registry who completed the Memorial Symptom Assessment Scale. Results showed that pain was more prevalent in non-cancer patients (p<0.05) and was reported as more frequent, severe and distressing. The overall symptom burden was higher for cancer patients (p=0.01) together with the psychological subscale scores (p<0.05).

The prevalence of dry mouth, mouth sores, feeling nervous, worry, cough, and dizziness was not significant between the groups of patients. There was no difference in the physical or the global distress index sub-scale scores when comparing both groups.

 

Composed by Elaine Boland.

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15 Apr, 17 | by James Smallbone, Publishing Assistant

Predictors of Complicated Grief and Depression in Bereaved Caregivers: A Nationwide Prospective Cohort Study.

Nielsen MK, Neergaard MA, Jensen AB, et al.

J Pain Symptom Manage. 2017 Mar;53(3):540-550

 

A prospective survey of 3635 caregivers to terminally ill patients in Denmark was conducted. 2420 were bereaved within six months and of the survey, 2125 (88%) [mean age 62 years, 70% female] completed a post-loss follow-up questionnaire

At baseline, around 15% were identified as having severe pre-loss grief symptoms and experienced moderate to severe depressive symptoms. Six months after the bereavement, complicated grief was reported in 7.6% and 12.1% had moderate to severe depressive symptoms. The predictors of complicated grief and post-loss depressive symptom were pre-loss depressive symptoms (adjusted OR=5.6), being a partner (adjusted OR=2.2) and low educational level (adjusted OR=2.0). 26% of caregivers who reported severe pre-loss grief symptoms developed complicated grief and 33% developed post-loss depressive symptom.

 

Composed by Elaine Boland.

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7 Apr, 17 | by James Smallbone, Publishing Assistant

A systematic review of prognostic factors at the end of life for people with a hematological malignancy.

Button E, Chan RJ, Chambers S, Butler J, Yates P.

BMC Cancer. 2017 Mar 23;17(1):213.

 

This systematic review looked at identifying prognostic factors in the last 3 months of life that are associated with increased risk of mortality for haematological malignancy; most patients were predominantly treated with aggressive curative or life-prolonging intent. This included 28 studies; mostly were in the intensive care unit settings and retrospective. The prognostic factors were categorised into 5 groups, mainly: demographics; interventions (eg: vasopressor support or mechanical ventilation), physiological complications (eg: bone marrow or multi-organ failure); disease characteristics; and laboratory blood values. Using the QUIPS tool, most studies were of moderate quality, three were high quality and one study was rated to be of low quality.

 

Composed by Elaine Boland.

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4 Mar, 17 | by bbutcher

Caregivers’ Perspectives on the Use of Long-Term Oxygen Therapy for the Treatment of Refractory Breathlessness: A Qualitative Study

Aileen Collier, Katrina Breaden, Jane L. Phillips, Meera Agar, Caroline Litster, David C. Currow.

J Pain Symptom Manage. 2017 Jan;53(1):33-39.

 

A qualitative study of the perspectives of 20 caregivers in the palliative setting of patients on long-term oxygen therapy (LTOT) for the treatment of refractory breathlessness was conducted using semi-structured interviews.

The main theme reported was that caregivers felt helpless and regarded oxygen as a life sustaining for people on LTOT and was vital in managing distressing symptoms and quality of life. However it also had financial costs and burdens including equipment, the noise from the concentrator, struggling with independence and leaving the house. The authors conclude that the possible harms of LTOT are underrated and highlight the importance of providing information and education about the appropriate use of LTOT.

 

Composed by Elaine Boland.

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20 Feb, 17 | by bbutcher

Prevalence of cancer chemotherapy-related problems, their relation to health-related quality of life and associated supportive care: a cross-sectional survey.

Wagland, Richardson A, Ewings S, Armes J, Lennan E, Hankins M, Griffiths P.

Support Care Cancer. 2016 Dec;24(12):4901-4911.

 

This study surveyed the prevalence of 17 problems whilst undergoing chemotherapy and people’s experiences of supportive care in 363 patients from six cancer centres in the UK. The EQ5D measure was also used. The response rate was 43%. The most common problem was tiredness/fatigue with 90% responders. Over 50% reported changes in sense of taste, difficulty managing everyday tasks, trouble sleeping, constipation, low mood, feeling sick, anxious, loss of appetite and unable to concentrate/forgetful.  In a multivariate model, difficulty with everyday tasks and work was significantly associated with health-related quality of life. Patients experienced less severe problems if they received supportive care; over a fifth stated that they never received support for emotional and social problems.

 

Composed by Elaine Boland.

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31 Jan, 17 | by bbutcher

Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis.

Kavalieratos D, Corbelli J, Zhang D, Dionne-Odom JN, Ernecoff NC, Hanmer J, Hoydich ZP, Ikejiani DZ, Klein-Fedyshin M, Zimmermann C, Morton SC, Arnold RM, Heller L, Schenker Y.

JAMA. 2016 Nov 22;316(20):2104-2114. doi: 10.1001/jama.2016.16840.

A narrative meta-analysis of randomized clinical trials (RCT) of palliative care interventions in adults with life-limiting illness was performed. 43 RCTs were included and involved 12,731 patients and 2479 caregivers (cancer and non-cancer). 23 RCTs were included in the meta-analysis. Palliative care interventions were associated with statistically and clinically significant improvements in physical symptoms and quality of life at 1 to 3 months. There was no association between palliative care and survival. There were improvements in patient and caregiver satisfaction with care, advance care planning and lower health care utilization with palliative care. When only the low risk of bias RCTs were meta-analysed, no statistically significant and clinically important associations remained.

 

Composed by Elaine Boland

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15 Jan, 17 | by bbutcher

Relationship between Opioid Treatment and Rate of Healing in Chronic Wounds.

Shanmugam VK, Couch KS, McNish S, Amdur RL.

Wound Repair Regen. 2016 Nov 16. doi: 10.1111/wrr.12496. [Epub ahead of print]

450 people participated in this longitudinal observational study to investigate the relationship between opioids and wound healing.  Using fixed-effects models and time-to-event analysis, opioid dose was significantly associated with total wound surface area (p<0.0001); subjects with mean opioid dose ≥10mg were significantly less likely to heal than those with no opioid (HR 0.67 [0.49-0.91], p=0.011) after adjusting for wound size. People who never had opioids healed faster than those who received opioids (p=0.0009). The authors plan to correlate the exposure of opioids and clinical outcome data with tissue mRNA expression array data which might help understand the molecular mechanisms that may contribute to delayed wound healing.

 

Composed by Elaine Boland

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31 Aug, 16 | by Jenny Thomas

JAMA Neurol. 2016 May 16. doi: 10.1001/jamaneurol.2016.0383. [Epub ahead of print]

The Association of Chemotherapy-Induced Peripheral Neuropathy Symptoms and the Risk of Falling.

Kolb NA, Smith AG, Singleton JR, et al

A secondary analysis of a prospective study was performed to determine the association between the symptoms of taxane/platinum chemotherapy-induced peripheral neuropathy (CIPN) and the risk of falls. From 116 patients with breast, ovarian, or lung cancer, 32 had CIPN symptoms. Seventy-four falls or near falls were reported over an average follow-up of 2 months. Those with CIPN were nearly 3 times more likely to report a fall or near fall than those without, with 8/32 (25%) with CIPN obtaining medical care for falls, compared to 6/84 (7%) without CIPN. The authors suggest education and monitoring of patients receiving neurotoxic chemotherapy may facilitate fall prevention strategies.

Shortcuts are compiled by Jason Boland

Shortcuts

22 Aug, 16 | by Jenny Thomas

Nephrol Dial Transplant. 2016

End-of-life care for people with chronic kidney disease: cause of death, place of death and hospital costs.

Kerr M, Matthews B, Medcalf JF, O’Donoghue D.

Associations between chronic kidney disease (CKD), place of death and hospital costs in adults with CKD in England in the final 3 years of life.

Using Hospital Episode Statistics data linked to Office for National Statistics mortality data, associations between place of death and hospital costs in adults with chronic kidney disease (CKD) in England was evaluated. From over 1.6 million adults, 13% had CKD. 11% of people with CKD died at home compared with 17% matched non-CKD group. CKD was associated with an increase in hospital costs of £3380 in the last year of life and a home death was associated with a reduction in hospital costs of £2811 in the CKD group in the last year of life. The most commonly recorded cause of death in people with CKD was heart disease and CKD was not on two-thirds of the death certificates.

Shortcuts are compiled by Jason Boland

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