Support Care Cancer. 2015 Mar 21. [Epub ahead of print]
What bothers lung cancer patients the most? A prospective, longitudinal electronic patient-reported outcomes study in advanced non-small cell lung cancer.
LeBlanc TW, Nickolich M, Rushing CN, Samsa GP, Locke SC, Abernethy AP.
In a longitudinal single-site symptom study in 2008, 97 patients with advanced non-small cell lung cancer completed an electronic symptom assessment tool at up to four clinic visits. They had a mean time from the initial lung cancer diagnosis of 534 days and a median survival from study enrolment of 354 days. Their main concerns were difficulty with doing hard activity, household work, running as well as fatigue, pain, dyspnoea and insomnia. Over half of the patients reported moderate/severe fatigue and one-third reported dyspnoea, this remained reasonably constant over the clinic visits. Psychosocial symptoms and their prevalence were: anxiety (25%), worry (22%), helplessness (18%), depression (18 %), worthlessness (14%) and hopelessness (10 %). The number of moderate/severe symptoms increased as patients approached death; with just under half reporting moderate/severe fatigue when they had longer than 1 year to live and 84% in the last 3 months of life. This study shows that patients with advanced non-small cell lung cancer have a substantial symptom burden, especially those relating to physical movement or functioning, which increase as they become closer to death. These patients need a comprehensive assessment and personalised management.
http://link.springer.com/article/10.1007%2Fs00520-015-2699-4
PLoS One. 2015 Mar 26;10(3):e0120827. doi: 10.1371/journal.pone.0120827. eCollection 2015.
Hospital admission of cancer patients: avoidable practice or necessary care?
Numico G, Cristofano A, Mozzicafreddo A, Cursio OE, Franco P, Courthod G, Trogu A, Malossi A, Cucchi M, Sirotovà Z, Alvaro MR, Stella A, Grasso F, Spinazzé S, Silvestris N.
Admissions to a single medical oncology inpatient unit in Italy over a 16-month period (until 31st December 2012) were analysed. This included 454 patients having 672 admissions (66% had one admission, 25% had two and 9% had three or more). Data were collected retrospectively and retrieved consecutively from the electronic medical records. Three-quarters of admissions were urgent with 80% of these due to uncontrolled symptoms (16% dyspnoea, 15% pain and 15% neurological symptoms). The remaining 20% were for cancer diagnosis or treatment. Over 60% of the patients admitted were discharged home, 27% of the patients died and 11% were transferred to a hospice. The authors suggest that hospital admission is not necessarily inappropriate, avoidable or an indicator of overly aggressive care, but often unavoidable in patients with cancer and the focus should be on optimisation of inpatient supportive oncology procedures with rapid symptom control and management of acute conditions.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374858/
J Pain Symptom Manage. 2015 Mar 27. pii: S0885-3924(15)00153-0. doi: 10.1016/j.jpainsymman.2015.02.017. [Epub ahead of print]
Different Experiences and Goals in Different Advanced Diseases: Comparing Serial Interviews with Patients with Cancer, Organ Failure or Frailty and Their Family and Professional Carers.
Kendall M, Carduff E, Lloyd A, Kimbell B, Cavers D, Buckingham S, Boyd K, Grant L, Worth A, Pinnock H, Sheikh A, Murray SA.
In this article, data was synthesized from eight qualitative longitudinal studies using serial in-depth interviews using a narrative approach over the past 10 years, with patients nearing the end of life, their family caregivers and key professionals. Over 800 in-depth interviews were included in the data set and used to understand how patients in Scotland with different advanced conditions (different cancers, organ failures and physical frailty) and their family caregivers and health professionals perceive their deteriorating health and the services they need. There were clear differences between the three groups. In general, patients with cancer, their family caregivers, and professionals described a beginning, middle and an anticipated end to the illness. Alongside having a fear of dying, they hoped for recovery. People with organ failure struggled to say when their illness began, or to speak openly about death, hoping instead to avoid further deterioration. Frail older people their family caregivers and service providers all struggled to recall exactly when their health began to deteriorate. They tended to focus on staying as well as they could and maintaining autonomy despite losing independence, and were frustrated by their progressive loss of independence, fearing dementia or nursing home admission more than dying. These contrasting illness narratives affect and shape the experiences, thoughts and fears of patients and their carers in the last months of life. Care delivered to patients with advanced illness should be flexible and equitable, responding to the diverse concerns and needs of these patients and families.
http://www.jpsmjournal.com/article/S0885-3924(15)00153-0/abstract
Support Care Cancer. 2015 Apr 3. [Epub ahead of print]
Prevalence of oral mucositis, dry mouth, and dysphagia in advanced cancer patients.
Mercadante S, Aielli F, Adile C, Ferrera P, Valle A, Fusco F, Caruselli A, Cartoni C, Massimo P, Masedu F, Valenti M, Porzio G.
In this study 669 consecutive patients with advanced cancer over 6 months admitted to home care, palliative care unit, or hospice were assessed for oral problems in a multicentre prospective observational study. Over 40% of the patients reported a dry mouth, common medications patients were taking included opioids, corticosteroids and diuretics. It was associated with current or recent chemotherapy and haematological tumours. Nearly one-quarter had mucositis, who in over 60% reduced the ingestion of food or fluids and was associated with a worse performance status. Over 15% had dysphagia which was also associated with a worse performance status. Nearly 90% of these patients had dysphagia which limited oral nutrition, in half of whom it was severe or complete. The occurrence of these three oral symptoms was associated. As oral problems in patients with advanced cancer may impair physical, social, and psychological well-being, as well as oral intake, these symptoms should be assessed and managed throughout the patients’ illness.
http://link.springer.com/article/10.1007%2Fs00520-015-2720-y
J Pain Symptom Manage. 2015 Mar 31. pii: S0885-3924(15)00159-1. doi: 10.1016/j.jpainsymman.2015.02.022. [Epub ahead of print]
Music Therapy Is Associated with Family Perception of More Spiritual Support and Decreased Breathing Problems in Cancer Patients Receiving Hospice Care.
Burns DS, Perkins SM, Tong Y, Hilliard RE, Cripe LD.
In a retrospective, cross-sectional analysis of electronic medical records from over 10,000 patients with cancer in a national hospice with divisions in 13 states of the USA, the effect of music therapy was estimated using logistic regression and propensity scores to adjust for non-randomisation. Nearly 40% of patients with cancer received music therapy between 2006 and 2010. Using univariate and multivariable models, these patients were more likely to report discussions about spirituality, and had a trend for less trouble breathing and were more likely to report receiving the right amount of spiritual support. There were no differences in pain, anxiety, or overall satisfaction with care. The findings need to be confirmed in a prospective trial to optimise music therapy in the clinical setting.
http://www.jpsmjournal.com/article/S0885-3924(15)00159-1/abstract
Shortcuts are compiled by Jason Boland