Patients with Advanced Cancer: A Survey of the Understanding of Their Illness and Expectations from Palliative Radiotherapy for Symptomatic Metastases

Chow, Edward; Andersson, L.; Wong, Rebecca; Vachon, Mary L. S.; Hruby, George; Franssen, Edmée; Fung, Kin Wah; Harth, Tamara; Pach, Beata; Pope, Joan; Connolly, R. C.; Schueller, Trudi; Stefaniuk, Kim; Szumacher, Ewa; Hayter, Charles; Finkelstein, Joel; Danjoux, Cyril

doi:10.1053/clon.2001.9255

Cited by 42 publications

(36 citation statements)

References 23 publications

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“…In addition MASCC calculation depends on the burden of the onco-haematological disorder. However, it is usually accepted that patients with advanced cancer under-estimate the severity of the disorder [34,35]. As emergency physicians usually obtain past medical history from patients' interviews, they may misclassify severity of febrile neutropenia when assessed by MASCC level.…”

Section: Discussionmentioning

confidence: 99%

Febrile neutropenia in French emergency departments: results of a prospective multicentre survey

et al. 2010

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IntroductionFebrile neutropenia (FN) is common in cancer patients receiving myelotoxic therapy. The procedures to treat FN are well established in oncology, but it is unclear whether management is adequate in the emergency department (ED).MethodsThis prospective, multicentre, observational study was carried out in 47 French EDs for 6 months. Patients were adults presenting at the ED with FN after myelotoxic treatment for cancer. Severity of infection was defined according to Bone criteria for severe sepsis and septic shock (SS/SSh) and risk was determined according to Multinational Association of Supportive Care in Cancer (MASCC) criteria. The end point was the implementation of guidelines. Management of patients with SS/SSh required: (i) adequate intravenous (IV) antimicrobial therapy for the first 90 min (broad-spectrum beta-lactam with or without an aminoglycoside); (ii) fluid challenge (500 mL); (iii) lactate measurement; (iv) at least one blood culture; and (v) hospitalization. Management of patients without SS/SSh required: (1) no initiation of granulocyte - cell stimulating factor (G-CSF); (2) adequate IV antimicrobial therapy (broad-spectrum beta-lactam) and hospitalization if the patient was high-risk according to MASCC criteria; (3) adequate oral antimicrobial therapy (quinolone or amoxicillin/clavulanate or cephalosporin) and hospital discharge if the patient was low-risk.Results198 patients were enrolled; 89 patients had SS/SSh, of whom 19 received adequate antimicrobial therapy within 90 min and 42 received appropriate fluid challenge. Blood cultures were obtained from 87 and lactate concentration was measured in 29. Overall, only 6 (7%) patients with SS/SSh received adequate management. Among 108 patients without SS/SSh, 38 (35%) were high-risk and 70 (65%) low-risk. In the high-risk group, adequate antimicrobial therapy was given to 31 patients, G-CSF was initiated in 4 and 35 were hospitalized. In the low-risk group, 4 patients received adequate oral antimicrobial therapy, IV antimicrobial therapy was prescribed in 59, G-CSF was initiated in 12 and six patients were discharged. Adequate management was given to 26/38 (68%) high-risk and 1/70 low-risk patients. Factors associated with adequate management were absence of SS/SSh (P = 0.0009) and high-risk according to MASCC criteria (P < 0.0001).ConclusionsIn this French sample of cancer patients presenting to the ED with FN, management was often inadequate and severity was under-evaluated in the critically ill.

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Section: Discussionmentioning

confidence: 99%

Febrile neutropenia in French emergency departments: results of a prospective multicentre survey

et al. 2010

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“…1 Unfortunately multiple studies have shown that patients with advanced cancer often have limited understanding of the incurability of their disease, 10–14 life expectancy and survival, 10,11,15 the impact of different treatments on cure 16 and quality of life, 11,13 and alternatives to treatment. 17,18 In contrast, EoL discussions have been shown to facilitate both receipt of care that is consistent with patient preferences, 6 and EoL care that is less aggressive 5 and costly.…”

Section: Introductionmentioning

confidence: 99%

Male‐female patient differences in the association between end‐of‐life discussions and receipt of intensive care near death

Sharma

Prigerson

Penedo

et al. 2015

Cancer

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Background Patient gender plays a significant role in patient-physician communication, patient illness understanding and aggressiveness of end of life (EoL) care. However, little is known about the extent to which gender differences in the effects of EoL discussions on EoL care contribute to gender differences in EoL care. The present study aims to determine if gender differences exist in receipt of intensive care unit (ICU) care near death and in the association between EoL discussions and receipt of ICU EoL care. Methods Multi-site, prospective, cohort study of patients (N=353) with metastatic cancers, identified as terminally ill at study enrollment and interviewed a median of 4.1 months before their deaths. Postmortem chart reviews and caregiver interviews documented ICU stays in the last week of life. Results Patients who received ICU care at the EoL were more likely to be male than those who did not (73% male vs. 52% male, p=0.02). Adjusting for potential confounds, male patients reporting an EoL discussion were less likely to have an ICU stay in the last week of life than male patients with no EoL discussion (AOR=0.26, 95% CI 0.07–0.91; p=0.04). There was no association between EoL discussions and ICU stays near death among female patients. Conclusions Men with advanced cancers are more likely than women to receive aggressive, non-beneficial, ICU care near death. Gender differences in effects of EoL discussions on EoL care likely contribute to, and may even explain, gender differences in receipt of ICU care in the last week of life.

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“…This leads to misunderstandings and to unrealistic expectations with regard to therapy and prognosis [31,32,33,34,35]. In a discussion with the patient, the physician is able to verify understanding and to add information as needed.…”

Section: Resultsmentioning

confidence: 99%

Online Information on Complementary and Alternative Medicine for Cancer Patients: Evidence-Based Recommendations

Huebner

Senf²,

Micke³

et al. 2013

Oncol Res Treat

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Background: Many cancer patients use complementary and alternative medicine (CAM). Most websites offering online information on CAM are not helpful for them. Methods: We extracted decisive elements for online information on CAM by analyzing the literature on the information needs of cancer patients and on counseling cancer patients on CAM. Results: Key issues for online information on CAM are the qualification of the authors, transparency and accountability of the information, description of the aims, a scientific approach, description of treatment alternatives, support for the patient-physician relationship, individualized information, a summary of the information, disclosure of funding, and the privacy policy. Conclusions: The communicative challenge will be to convey information without destroying hope and motivation. We suggest that CAM topics should be integrated into broader information provided on cancer (etiology, conventional treatment). By also providing information for physicians, such a website could promote shared decision-making. Online information will gain the status of independent expert knowledge if provided by a well-known scientific organization as, e.g., a national cancer society.

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Patients with Advanced Cancer: A Survey of the Understanding of Their Illness and Expectations from Palliative Radiotherapy for Symptomatic Metastases

Cited by 42 publications

References 23 publications

Febrile neutropenia in French emergency departments: results of a prospective multicentre survey

Febrile neutropenia in French emergency departments: results of a prospective multicentre survey

Male‐female patient differences in the association between end‐of‐life discussions and receipt of intensive care near death

Online Information on Complementary and Alternative Medicine for Cancer Patients: Evidence-Based Recommendations

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