Anticancer therapies in specialized palliative care—a multicenter survey

Abstract

IntroductionAnticancer therapies gain increasing attention and discussion in specialized palliative care institutions. Frequency, indication, attitude of team members, and modes of these therapies implemented in specialized palliative care settings are still under investigation.MethodsDescriptive analysis of the nationwide Hospice and Palliative Care Evaluation 2007 that collected data from palliative medicine, hospice care, and oncology institutions concerning the use of anticancer therapies.ResultsThree thousand one hundred eighty-four patients from 67 palliative care units, eight oncology wards, and other in- and outpatient institutions were registered. Two hundred eleven therapeutic interventions, mostly i.v. chemotherapy (28.9%), have been documented in all institutions except from inpatient hospices. Although all institutions were asked to keep records from “palliative patients”, those patients treated in oncology services differed from patients on palliative care units with respect to prognosis, therapeutic intention (symptom control versus tumor remission), and team attitude.DiscussionAnticancer therapies are incorporated into palliative care concepts. The described differences in palliative patients that are treated in specialized palliative care as compared to oncology services will have to be discussed with regard to selection of patients for specialized palliative care and the range of suitable treatment modalities in palliative care concepts.

Thromboprophylaxis for inpatients with advanced cancer in palliative care settings: A systematic review and narrative synthesis

“…One full-text paper and seven abstracts assessed the use of thromboprophylaxis in palliative care units, with all demonstrating low rates of initiation or continuation of thromboprophylaxis. 39,44,45,47–50 Overall, thromboprophylaxis was initiated in 4%–53% of admitted patients. 39,45…”

“…44 Brabin et al 45 also found low rates of thromboprophylaxis initiation (3 of 75 patients) with documentation of decision-making recorded only in approximately one-third. Alt-Epping et al’s 48 survey of nine palliative care units and one residential hospice ( N = 233) in Germany reported thromboprophylaxis use in 68 patients (29%): 4 developed venous thromboembolism and 1 bleeding. Ciuhu et al 46 retrospectively reviewed the use of anticoagulants on a palliative care unit over a 6-month period ( N = 2642); 13.6% of admissions were considered for antithrombotic therapy, which was thromboprophylaxis in 81%.…”

“…Three full-text studies and two abstracts explored factors influencing clinician decision-making around the use of thromboprophylaxis for inpatients in palliative care units, demonstrating low rates of consideration of thromboprophylaxis among palliative care physicians in general. 30,32,34,43,48 An Austrian study presented a single case with nine alternative scenarios (based on previous venous thromboembolism, atrial fibrillation, thromboprophylaxis with either low-molecular-weight heparin or warfarin, and varying performance status) to a convenience sample of 20 academic physicians working in palliative care, oncology, thrombosis and intensive care, respectively, to explore differences in thromboprophylaxis prescribing practices. There was unanimous agreement to withdraw thromboprophylaxis when the patient was recognised as actively dying based on their performance status.…”

“…One full-text paper and seven abstracts assessed the use of thromboprophylaxis in palliative care units, with all demonstrating low rates of initiation or continuation of thromboprophylaxis. 39,44,45,[47][48][49][50] Overall, thromboprophylaxis was initiated in 4%-53% of admitted patients. 39,45 The most recently published and largest study, from France, explored the bleeding risk of inpatients in palliative care units in a multi-centre observational study of almost 1200 patients.…”

Charakteristika von Palliativpatienten mit Atemnot

“…Daten aus HOPE wurden bereits mehrfach für wissenschaftliche Studien herangezogen [2,21,24,29,33]. Die vorliegende Untersuchung beruht auf HOPE-Daten aus spezialisierten stationären Hospiz-und Palliativeinrichtungen aus den Jahren 2006 -2008.…”