Palliative care referral in cancer patients with regard to initial cancer prognosis: a population-based study

Frasca, Matthieu; Orazio, Sébastien; Amadéo, Brice; Sabathé, Camille; Berteaud, Émilie; Galvin, Angéline; Burucoa, Benoît; Coureau, Gaëlle; Baldi, Isabelle; Monnereau, Alain; Mathoulin‐Pélissier, Simone

doi:10.1016/j.puhe.2021.03.020

Cited by 5 publications

(2 citation statements)

References 52 publications

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“…Previous studies have emphasised that the need for timely access to palliative care teams is often unmet. 36 These findings support the trend toward implementation of outpatient clinics as they allow for early intervention during the disease course. 7 Nurses should be systematically involved in palliative care services as they can inform physicians of patient’s and family’s wishes.…”

Section: Discussionsupporting

confidence: 62%

Sedation practices in palliative care services across France: a nationwide point-prevalence analysis

Frasca

Jonveaux

Lhuaire

et al. 2023

BMJ Support Palliat Care

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ObjectivesTerminally ill patients may require sedation to relieve refractory suffering. The prevalence and modalities of this practice in palliative care services remain unclear. This study estimated the prevalence of all sedation leading to a deep unconsciousness, whether transitory, with an undetermined duration, or maintained until death, for terminally ill patients referred to a home-based or hospital-based palliative care service.MethodsWe conducted a national, multicentre, observational, prospective, cross-sectional study. In total, 331 centres participated, including academic/non-academic and public/private institutions. The participating institutions provided hospital-based or home-based palliative care for 5714 terminally ill patients during the study.ResultsIn total, 156 patients received sedation (prevalence of 2.7%; 95% CI, 2.3 to 3.2); these patients were equally distributed between ‘transitory’, ‘undetermined duration’ and ‘maintained until death’ sedation types. The prevalence was 0.7% at home and 8.0% in palliative care units. The median age of the patients was 70 years (Q1–Q3: 61–83 years); 51% were women and 78.8% had cancers. Almost all sedation events occurred at a hospital (90.4%), mostly in specialised beds (74.4%). In total, 39.1% of patients were unable to provide consent; only two had written advance directives. A collegial procedure was implemented in 80.4% of sedations intended to be maintained until death. Midazolam was widely used (85.9%), regardless of the sedation type.ConclusionsThis nationwide study provides insight into sedation practices in palliative care institutions. We found a low prevalence for all practices, with the highest prevalence among most reinforced palliative care providers, and an equal frequency of all practices.

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Section: Discussionsupporting

confidence: 62%

Sedation practices in palliative care services across France: a nationwide point-prevalence analysis

Frasca

Jonveaux

Lhuaire

et al. 2023

BMJ Support Palliat Care

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“…Our secondary analysis also considered initial tumour prognosis as recommended in studies on HPC referral. 5 In this population of patients with potentially high HPC needs due to tumour and/or geriatric factors, only one in five patients were referred to HPC facilities, a slightly higher rate than recent publications on the general adult population with cancer 6 . The most strongly associated determinants being initial tumour prognosis and IADL limitations.…”

Section: Discussionmentioning

confidence: 73%

Hospital-based palliative care referrals: determinants in older adults with cancer

Chanteclair,

Duc,

Amadeo

et al. 2024

BMJ Support Palliat Care

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ObjectivesEarly palliative care improves the quality of life of older patients with cancer. This work aimed to analyse the effect of sociodemographic, geriatric, and tumour-related determinants on hospital-based palliative care (HPC) referral in older patients with cancer, taking into account competing risk of death.MethodsOlder adults with diagnosed cancer from 2014 to 2018 according to the general cancer registry of Gironde (French department) were identified in three population-based cohorts on ageing (PAQUID, 3C - Three City, AMI). Cause-specific Cox models focused on 10 usual determinants in geriatric oncology and palliative care: age, gender, living alone, place of residency, tumour prognosis, activities of daily living (ADL) and instrumental-ADL (IADL) limitations, cognitive impairment, depressive disorders, and polypharmacy.Results131 patients with incident cancer (mean age: 86.2 years, men: 62.6%, poor cancer prognosis: 32.8%) were included, HPC occurring for 26 of them. Unfavourable cancer prognosis was a key determinant for HPC referral (HR 7.02, 95% CI 2.86 to 17.23). An altered IADL score was associated with precocious (first year) referral (HR 3.21, 95% CI 1.20 to 8.64, respectively). Women had a higher rate immediately (first week) after diagnosis (HR 8.64, 95% CI 1.27 to 87.27).ConclusionsCancer prognosis, functional decline and gender are independent factors of HPC referral in older patients with cancer. These findings may help for a better anticipation of the healthcare pathway.

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Serious Health-Related Suffering Impairs Treatments and Survival in Older Patients With Cancer

Frasca,

Martinez-Tapia,

Jean

et al. 2024

Journal of Pain and Symptom Management

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Palliative care referral in cancer patients with regard to initial cancer prognosis: a population-based study

Cited by 5 publications

References 52 publications

Sedation practices in palliative care services across France: a nationwide point-prevalence analysis

Sedation practices in palliative care services across France: a nationwide point-prevalence analysis

Hospital-based palliative care referrals: determinants in older adults with cancer

Serious Health-Related Suffering Impairs Treatments and Survival in Older Patients With Cancer

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