Palliative radiotherapy with or without additional care by a multidisciplinary palliative care team in patients with newly diagnosed cancer: a retrospective matched pairs comparison

Nieder, Carsten; Dalhaug, Astrid; Pawinski, Adam; Haukland, Ellinor; Mannsåker, Bård; Engljähringer, Kirsten

doi:10.1186/s13014-015-0365-0

Cited by 13 publications

(18 citation statements)

References 16 publications

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“…[9,10] The role of chemotherapy and choice of agents has not been defined for this entity. To the best of our knowledge, we could come across only three case reports of myoepithelial cancer who had response to chemotherapy, among which two had site of primary in breast and one in vulva: a 52-year-old female with metastatic breast cancer (MBC) who had PR to paclitaxel and carboplatin; [8] a 61-year-old female with MBC who had stable disease post three cycles of paclitaxel and carboplatin, [10] and a 37-year-old female with metastatic carcinoma vulva who had complete response to the same chemotherapy regimen. [3] One case report had shown progressive disease following neoadjuvant TAC (docetaxel, doxorubicin, cyclophosphamide) chemotherapy.…”

Section: Resultsmentioning

confidence: 99%

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Profile of patients undergoing palliative radiotherapy: A single-institute study from a tertiary care oncology center

Suhag

Vats

et al. 2017

South Asian J Cancer

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Background:Palliative radiotherapy (PRT) plays a significant role in the palliation of symptoms in patients with cancer and constitutes nearly 50% of the workload in different settings.Aims:The aim is to study patient-, disease-, and treatment-related characteristics in locoregionally advanced and metastatic malignancies meriting palliative management.Setting and Design:This was a retrospective observational study in a tertiary care government institute with academic and research potential.Methodology:The electronic medical records, medical documents, and radiotherapy (RT) treatment charts were retrieved and studied.Observations:A total of 460 patients were included in the study over 2 years, forming 30% of the total number of patients treated during the study period. Three hundred and ninety-six patients received PRT to the metastatic sites, while 64 patients received extremely hypofractionated PRT to the primary for symptomatic relief. Totally 442 patients showed good symptomatic response to PRT. One hundred and thirty-eight patients underwent re-irradiation. Lung was the most common primary site seen in 155 cases. The most common indication for PRT was palliation of pain from painful metastases as seen in 240 cases, and the next common indication was palliative whole-brain RT for brain metastases as seen in 159 cases.Conclusion:PRT forms an integral and important aspect of palliative care to the vast number of patients harboring metastatic disease that warrants some form of treatment for symptomatic relief. Short course of PRT in outdoor setting is a preferred mode of treatment to improve the quality of life of these distressed patients.

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Section: Resultsmentioning

confidence: 99%

“…Radiation oncologists often have an excellent opportunity to involve palliative care professionals, pain medicine providers, and hospice specialists in a patient's life when they are most in need. [6][7][8]…”

Section: Introductionmentioning

confidence: 99%

Profile of patients undergoing palliative radiotherapy: A single-institute study from a tertiary care oncology center

Suhag

Vats

et al. 2017

South Asian J Cancer

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“…It has been employed in different clinical settings, including the registration of the patient-reported symptoms before the palliative radiotherapy [ 2 - 4 ]. The main purpose is to improve the clinical care, e.g., by adjusting medications and referring the patients to palliative care specialists, psycho-oncologists and other experts who might be able to enhance the quality of life [ 5 - 6 ]. Several aspects of the clinical research have also been addressed with this tool [ 7 - 8 ].…”

Section: Introductionmentioning

confidence: 99%

Frequency and Prognostic Impact of Consistently Low Edmonton Symptom Assessment System Score in the Patients Treated with Palliative Radiotherapy

Nieder¹,

Kämpe²

2018

Cureus

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IntroductionOur department's standard work-flow includes assessment of all the patients with the Edmonton Symptom Assessment System (ESAS), a one-sheet questionnaire addressing 11 major symptoms and wellbeing on a numeric scale of zero-10, before the palliative radiotherapy (PRT). Based on previous research, we hypothesized that the patients with minimal or moderate total symptom burden might have better overall survival after the PRT than those with at least one higher symptom score.MethodsWe performed a retrospective analysis of 94 patients and calculated actuarial survival from the first day of the PRT (Kaplan-Meier method). We identified the patients with the score zero for all ESAS items (no symptoms), at least one item with score one-two (minimal symptoms), and at least one item with the score three (moderate symptoms).ResultsHigh proportions of the patients had ESAS scores zero- two for nausea (80%), sadness/depression (65%) and constipation (64%). The mean values were often in the range of two-four. Only one patient reported scores of zero throughout the questionnaire. He was treated for hematuria, a symptom that is not part of the ESAS. Three patients reported scores of zero-two throughout the questionnaire. Except for the performance status zero-one, their baseline characteristics were heterogeneous. Two patients reported scores not exceeding three for all items. These patients had excellent performance status, too. None of the six patients (6%) with relatively low ESAS scores of zero-three received care by the hospital's multidisciplinary palliative team. Only one was using opioid analgesics. The median survival for this small subset of six patients was six months, identical to the result for all the patients with higher symptom burden (p = 0.62).ConclusionThe proportion of the patients with ESAS scores zero-three throughout the questionnaire was 6%, which resulted in the limited statistical power for the survival comparisons. The survival outcomes were similar. Before PRT, 94% of the patients reported at least one ESAS item of severity four-10. The symptoms not included in the questionnaire, e.g., hematuria might result in erroneous assignment to the low-symptom-burden group and obscure the prognostic impact of low ESAS symptom burden.

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“…Die andere Gruppe erhielt erst nach 3 Monaten eine palliativmedizinische Versorgung. Im Rahmen Letzterer erfolgte zunächst eine standardisierte ambulante persönliche Konsultation mit einem Palliativmediziner, danach waren 6 [2,3]. Je mehr Organe betroffen sind, desto schlechter wird die Prognose.…”

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“…Man sollte also das Thema nicht einfach ad acta legen [5]. Für palliativ bestrahlte Patienten konnte in einer weiteren, ziemlich kleinen retrospektiven Studie kein Überlebensvorteil durch Hinzuziehen eines palliativen Teams gefunden werden [6]. Auch die Rate der Therapieabbrüche war vergleichbar.…”

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Frühe oder verzögerte Einleitung einer Palliativbetreuung

Nieder

2015

Strahlenther Onkol

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ihres Onkologen eine Lebenserwartung von 6-24 Monaten hatten. Die Diagnose einer fortgeschrittenen, rezidivierten oder progredienten Erkrankung war in den vorangegangenen 30-60 Tagen erfolgt (solide oder hämatologische Tumoren). Die frühe Gruppe wurde simultan onkologisch und palliativmedizinisch betreut. Die andere Gruppe erhielt erst nach 3 Monaten eine palliativmedizinische Versorgung. Im Rahmen Letzterer erfolgte zunächst eine standardisierte ambulante persönliche Konsultation mit einem Palliativmediziner, danach waren 6 nichtärztliche, telemedizinische Termine in wöchentlichem Abstand geplant. Auch hier waren die Inhalte vorgegeben. Danach wurden monatliche Telefongespräche durchgeführt. Der Zeitrahmen betrug immer 30-45 min. Die Studienfragebögen wurden ebenfalls telefonisch bearbeitet und erfassten z. B. die Lebensqualität (FACIT-Pal-Skala) und Symptombelastung. Die statistischen Planungen beruhten auf erwarteten Unterschieden in der Lebensqualität und sahen 380 Patienten vor. Nach zögerlicher Rekrutierung wurde die Studie aber nach Randomisierung von 207 Patienten vorzeitig geschlossen und ausgewertet. Insgesamt waren 545 Patienten kontaktiert worden, von denen leider viele eine Teilnahme ablehnten. In beiden Armen gab es Abweichungen von den geplanten Interventionen, teilweise verursacht durch frühe Todesfälle. Zum Beispiel starteten im verzögerten Arm nur 81 Patienten (79 %) mit dem geplanten Programm. Davon beendeten 27 ihre Teilnahme früher als vorgesehen. Im frühen Arm lag die Startrate bei 88 %, aber 33 Patienten beendeten die Intervention vorzeitig. Die häufigsten Grunderkrankungen waren Bronchial-und gastrointestinale Karzinome (43 bzw. 24 %). Das durchschnittliche Alter betrug 64 bzw. 65 Jahre. Ergebnisse Es wurden keine statistisch signifikanten Unterschiede bezüglich der Lebensqualität, des Symptombilds und des Verbrauchs verschiedener Ressourcen Early versus delayed initiation of palliative care Results of the randomized controlled ENABLE III trial Fragestellung und Hintergrund Im Alltag strahlentherapeutischer Einrichtungen spielen Behandlungen mit palliativer Zielsetzung eine bedeutende Rolle, sowohl was die Zahl der Patienten als auch die Anforderungen an das Behandlungsteam angeht. Selbst wenn eine unheilbare Erkrankung vorliegt, kann die Lebenserwartung manchmal noch im Bereich einiger Jahre liegen. Andererseits leiden aber auch viele Patienten unter einer weit fortgeschrittenen Erkrankung, sind intensiv vorbehandelt und erwarten sich für die verbleibenden Monate hauptsächlich eine Symptomlinderung und einen positiven Einfluss auf ihr Funktionsniveau. Das Symptombild sowie die Fragen und Bedürfnisse der Patienten und ihrer Angehörigen sind häufig komplex, so dass die Einbeziehung eines multidisziplinären palliativen Teams hilfreich sein kann. Die vorliegende Studie untersucht, ob ein solcher Ansatz routinemäßig kurz nach der Diagnose oder erst später erwogen werden sollte [1]. Material und Methode Die randomisierte US-amerikanische Studie rekrutierte von 2010 bis 2013 Patienten aus einem ...

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Palliative radiotherapy with or without additional care by a multidisciplinary palliative care team in patients with newly diagnosed cancer: a retrospective matched pairs comparison

Cited by 13 publications

References 16 publications

Profile of patients undergoing palliative radiotherapy: A single-institute study from a tertiary care oncology center

Profile of patients undergoing palliative radiotherapy: A single-institute study from a tertiary care oncology center

Frequency and Prognostic Impact of Consistently Low Edmonton Symptom Assessment System Score in the Patients Treated with Palliative Radiotherapy

Frühe oder verzögerte Einleitung einer Palliativbetreuung

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