Projected referral to other healthcare services in an outpatient palliative radiotherapy clinic

Nguyen, Janet; Giovanni, Julia Di; Zhang, Liying; Popović, Marko; Zeng, Liang; Jamani, Rehana; Cramarossa, Gemma; Culleton, Shaelyn; Jon, Florence; Chow, Edward

doi:10.1586/erp.12.4

Cited by 7 publications

(7 citation statements)

References 38 publications

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“…(117) The American College of Surgeons Commission on Cancer mandates distress screening as a criterion for accreditation. (118) ESAS has been proposed as tool for such purpose.…”

Section: Future Developmentsmentioning

confidence: 99%

“…(129, 130) Importantly, any automatic referral should complement rather than override clinician judgement. Future studies should determine what proportion of patients fulfill these criteria,(117) how patients, families and clinicians perceive the use of ESAS to trigger a referral, and whether it would improve healthcare outcomes compared to clinician-based referral alone. (131)…”

Section: Future Developmentsmentioning

confidence: 99%

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The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

Hui

Bruera

2017

Journal of Pain and Symptom Management

559

428

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Context Routine symptom assessment represents the cornerstone of symptom management. ESAS is one of the first quantitative symptom assessment batteries that allows for simple and rapid documentation of multiple patient-reported symptoms at the same time. Objective To discuss the historical development of ESAS, its current uses in different settings, and future developments. Methods Narrative review Results Since its development in 1991, ESAS has been psychometrically validated and translated into over 20 languages. We will discuss the variations, advantages and limitations with ESAS. From the clinical perspective, ESAS is now commonly used for symptom screening and longitudinal monitoring in patients seen by palliative care, oncology, nephrology, and other disciplines in both inpatient and outpatient settings. From the research perspective, ESAS has offered important insights into the nature of symptom trajectory, symptom clusters and symptom modulators. Furthermore, multiple clinical studies have incorporated ESAS as a study outcome and documented the impact of various interventions on symptom burden. On the horizon, multiple groups are actively investigating further refinements to ESAS, such as incorporating it in electronic health records, employing ESAS as a trigger for palliative care referral, and coupling ESAS with personalized symptom goals to optimize symptom response assessment. Conclusion ESAS has evolved over the past 25 years to become an important symptom assessment instrument in both clinical practice and research. Future efforts are needed to standardize this tool and explore its full potential to support symptom management.

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“…(117) The American College of Surgeons Commission on Cancer mandates distress screening as a criterion for accreditation. (118) ESAS has been proposed as tool for such purpose.…”

Section: Future Developmentsmentioning

confidence: 99%

Section: Future Developmentsmentioning

confidence: 99%

The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

Hui

Bruera

2017

Journal of Pain and Symptom Management

559

428

View full text Add to dashboard Cite

show abstract

“…As APC is a lethal disease, with a high symptom burden, it is critical to explore how QOL can be improved for this group of patients. Early interventions, such as pain and symptom management or automatic palliative care referral, could be considered [9,[53][54][55][56]. Using baseline symptoms and symptom trajectory as opportunities for intervention may result in optimization of patient-centered care in the outpatient setting.…”

Section: Discussionmentioning

confidence: 99%

Symptom Burden of Patients with Advanced Pancreas Cancer (APC): A Provincial Cancer Institute Observational Study

et al. 2021

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Patients with advanced pancreatic cancer (APC) experience many disease-related symptoms. ESAS-r measures the severity of 9 symptom domains and has been validated for use in the ambulatory oncology setting. We aimed to describe symptom burden at baseline for patients with APC treated with modern chemotherapy (CT), and to determine whether symptom burden at baseline is prognostic. Patients diagnosed with APC between 2012–2016, treated with ≥1 cycle of CT, who completed ≥1 ESAS-r were identified. Descriptive statistics were used to report symptom burden and common moderate-to-severe symptoms. A joint model was used to describe the trajectory of ESAS-r during follow-up while controlling for death. Multivariable Cox regression was used to identify independent predictors of death. Of 123 patients identified, the median age was 65 and 61% had metastatic disease. The median baseline ESAS-r total symptom distress score (TSDS) was 24. A total of 86% of patients had at least one symptom score of ≥4 at baseline, with the most common being: fatigue, nausea, anxiety, and shortness of breath. Median overall survival was 10.2 months. Baseline TSDS was not predictive for worse survival in the era of modern CT. Patients with APC have a high burden of cancer-associated symptoms and a high prevalence of moderate-to-severe symptoms. Early intervention has the potential to improve quality of life in this group of patients and should be investigated.

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“…The question was therefore raised as to whether some of these tasks could be completed by the PRT and NP, working in collaboration with ROs. With support from the [Alberta] Cancer Foundation's Dr. Solomon Levin Memorial Award [22], the PRT and NP undertook site visits to the PRO clinics at the Princess Margaret Cancer Centre [3] and the Odette Cancer Centre [2] to investigate this approach. Their observations formed the basis of the new ''navigator'' position shared by the PRT and NP, starting in November 2012.…”

Section: Initiation: Brain Metastasesmentioning

confidence: 99%

“…The evolution of the palliative radiation therapist (PRT) role in radiation oncology clinics at larger Canadian cancer centers began in approximately 1996 with the Rapid Response Radiotherapy Program at the Odette Cancer Centre [2] followed by the Palliative Radiation Oncology Program (PROP) at the Princess Margaret Cancer Centre in 1997 [3]. Both utilize one or more radiation therapists (RTTs) as team members and/or central facilitators.…”

Section: Introductionmentioning

confidence: 99%

Evolution of the Radiation Therapist Role in a Multidisciplinary Palliative Radiation Oncology Clinic

LeGuerrier¹,

Huang²,

Spence³

et al. 2019

Journal of Medical Imaging and Radiation Sciences

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Background: Palliative radiation therapists (PRTs) have been integrated in varying capacities into outpatient palliative radiation therapy (RT) services across Canada for over 2 decades. At our institution, PRTs have developed an essential role over 11 years within a palliative radiation oncology (PRO) clinic that focuses on integrating symptom management with radiation oncology assessment for palliative RT. PRTs have had direct clinical, technical, research, and administrative involvement as the clinic evolved from a pilot in 2007 supporting one half-day per week to the current model of five full clinical days.Methods: Using collaborative reflection, we explored the PRTs' experience and insight. Twelve PRTs who contributed to the PRO clinic for varying lengths of time from 2007 through to 2016 were invited to participate in the development of a collective expression of the PRT experience. Seven PRTs consented to completing an electronic survey consisting of fifteen open-ended questions regarding individual roles and perspectives relating to our PRO clinic. Survey answers were enhanced by semistructured interviews when needed for clarification. Responses were contextualized within the operational changes to our multidisciplinary clinical model, from pilot to integrated service.Results/Discussion: Five respondents answered all of the questions. From the narratives, PRT roles and responsibilities were outlined and their insights and reflections included to contextualize clinical changes. Four phases of the clinic were identified and elucidated. Beginning in January 2007, three PRTs staffed a multidisciplinary clinical pilot one half-day per week for single-fraction, symptomatic bone metastases. The clinic has now evolved through various iterations to the current model with four PRTs sharing a ''navigator'' role with two registered nurses five full clinic days per week. The range of PRT experiences, responsibilities, and challenges encountered reflected specific clinical and operational conditions.

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Projected referral to other healthcare services in an outpatient palliative radiotherapy clinic

Abstract: Cancer symptoms are complex, and a multidisciplinary and collaborative approach should be taken to provide timely management and maintain patients' quality of life.

Cited by 7 publications

References 38 publications

The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

Symptom Burden of Patients with Advanced Pancreas Cancer (APC): A Provincial Cancer Institute Observational Study

Evolution of the Radiation Therapist Role in a Multidisciplinary Palliative Radiation Oncology Clinic

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