Symptom Assessment and Early Access to Supportive and Palliative Care for Patients With Advanced Solid Tumors in Mexico

Abstract

Background: Early specialized palliative care improves quality of life of patients with advanced cancer, and guidelines encourage its integration into standard oncology care. However, many patients fail to obtain timely palliative/supportive care evaluations, particularly in limited-resource settings. We aimed to determine the proportion of patients with advanced cancer who received an assessment of symptoms and were referred to supportive and palliative care services during the first year after diagnosis in a Mexican hospital. Methods: Individuals with newly diagnosed advanced solid tumors and 1 year of follow-up at the oncology clinics in the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City from October 2015 to April 2016 were included in this retrospective study. Results: Seventy-seven patients were included. Forty-two (54.5%) were referred to the various supportive care services during the first year after diagnosis, and 23 (29.8%) were referred to the palliative care clinic. The most commonly assessed symptoms by oncologists were pain (77.9%), anorexia (74.0%), fatigue (68.8%), and nausea (55.8%), while depression/anxiety were evaluated in 10 (12.9%) patients. The oncologist offered to clarify treatment goals in 39 (50.6%) cases and evaluated the understanding of diagnosis/illness and prognosis in 22 (28.5%). Conclusion: Palliative and supportive care services were widely underutilized, which may be related to a lack of standardized symptom assessments and poor end-of-life communication. Novel strategies are needed to improve the implementation of tools for systematic symptom assessment and to optimize the integration of supportive care interventions into oncology care in developing countries.

Patient Navigation to Improve Early Access to Supportive Care for Patients with Advanced Cancer in Resource-Limited Settings: A Randomized Controlled Trial

“…However, most RCT of early palliative care were conducted in cancer centers located in HIC, where patients obtained palliative care from specialized physicians and nurses [23,24]. Unfortunately, this may not always be feasible in resource-limited settings, where palliative care services are not cancer-specific, severely underutilized, or nonexistent [2,7,9,10,25]. Currently, there is little understanding of how to deliver supportive and palliative care interventions effectively in diverse settings and within the wide range of existing health systems and, in order to bridge this gap, the World Health Organization has recommended conducting practical real-world implementation research [26].…”

“…Patients allocated to usual oncological care alone did not meet with the PN and received care from their treating oncologist, who was responsible for assessing symptoms and supportive care needs, and for undertaking necessary referrals. As per the usual care at INCMNSZ, patients are not routinely evaluated by supportive care professionals, the existing palliative care service is only available at demand and not exclusive for patients with cancer, and patients with a limited life expectancy do not routinely complete AD [9]. The treating oncologist was not provided information regarding the multidisciplinary team meeting, the questionnaires, or the personalized intervention plan.…”

“…Unfortunately, this early integration of supportive and palliative care seldom happens in LMIC due to a lack of training and infrastructure, and most palliative care interventions are provided near the end of life [7,8]. In Mexico, as in other LMIC, less than 50% of patients with advanced cancer receive supportive care consultations and have discussions regarding end-of-life care and advance care planning in the first year after diagnosis [9]. This leads to late referrals to palliative care services; with an average time from first palliative care visit to death of approximately 14 days [9].…”

Association between chemotherapy toxicity risk scores and physical symptoms among older Brazilian adults with cancer

“…Physical symptoms have been associated with worse physical, psychosocial and functional well-being [27][28][29]. In our study, older patients with high CARG chemotherapy toxicity risk scores tended to report more symptoms of fatigue, nausea, and pain.…”

Living with Metastatic Cancer: A Roadmap for Future Research

“…Although some metavivors are living longer with their disease, metastatic cancer remains a terminal diagnosis; thus, advance care planning (ACP) including clarifying treatment goals and formal advance directive documentation may be helpful for metavivors and their family caregivers. ACP remains underutilized along with supportive and palliative care services [181]. Providers may hesitate to initiate ACP discussions due to concern about causing distress; however, a large prospective study of patients with advanced cancer and family caregivers found that end-of-life discussions with medical providers were not associated with increased risk of depression or worry [182].…”