Access to palliative care for patients with advanced cancer: A longitudinal population analysis

Background The UK National Health Service is striving to improve access to palliative care for patients with advanced cancer however limited information exists on the level of palliative care support currently provided in the UK. We aimed to establish the duration and intensity of palliative care received by patients with advanced cancer and identify which cancer patients are missing out. Methods Retrospective cancer registry, primary care and secondary care data were obtained and linked for 2474 patients who died of cancer between 2010 and 2012 within a large metropolitan UK city. Associations between the type, duration, and amount of palliative care by demographic characteristics, cancer type, and therapies received were assessed using Chi-squared, Mann-Whitney or Kruskal-Wallis tests. Multinomial multivariate logistic regression was used to assess the odds of receiving community and/or hospital palliative care compared to no palliative care by demographic characteristics, cancer type, and therapies received. Results Overall 64.6% of patients received palliative care. The average palliative care input was two contacts over six weeks. Community palliative care was associated with more palliative care events (p<0.001) for a longer duration (p<0.001). Patients were less likely to receive palliative care if they were: male (p = 0.002), aged 80 years or over (p<0.05), diagnosed with lung cancer (p<0.05), had not received an opioid prescription (p<0.001), or had not received chemotherapy (p<0.001). Patients given radiotherapy were more likely to receive community only palliative care compared to no palliative care (Odds Ratio = 1.49, 95% Confidence Interval = 1.16–1.90). Conclusion Timely supportive care for cancer patients is advocated but these results suggest that older patients and those who do not receive anti-cancer treatment or opioid analgesics miss out. These patients should be targeted for assessment to identify unmet needs which could benefit from palliative care input

Burden on family caregivers of the elderly in oncologic palliative care

Objective: To identify the perception of burden of caregivers of elderly patients in oncologic palliative care. Methods: A cross-sectional survey with an exploratory non-probabilistic, quantitative methodology conducted on a sample of 100 subjects stratified according to the score obtained by applying the Karnofsky Performance Scale (KPS) to the elderly in oncologic palliative care. Group 1 - 25 family caregivers of elderly subjects with a KPS score below 40%; Group 2 - 25 caregivers of elderly subjects in oncologic palliative care with KPS scores of 70%, 60% or 50%; Control Group - 50 family caregivers of elderly subjects in oncologic palliative care with a KPS score of 80% or more. A clinical and sociodemographic questionnaire and the following protocols were applied: Brazil Economic Classification Criteria and the Caregiver Burden Scale. For data analysis, descriptive statistics and group comparisons by Fisher's exact test and a Regression Quantiles Model were used. Data were analyzed using the SAS 9.0 and Stata version 13 software. Results: Family caregivers are mostly middle-aged to older women, daughters or wives predominantly in the 56-71 age group, poorly educated, belonging to social class C and performing no remunerated activity. The largest burden rates were seen in female caregivers and caregivers of seniors who have lower functional capacity scores. Conclusions: The aggravation of the disease, the functional decline of the elderly and the possibility of death increase the burden, indicating the need to offer support services to this population as early as possible.Acknowledgements The authors received financial support from Coordination for the Improvement of Higher Education Personnel (CAPES) – Brazil

Grau de complexidade dos cuidados de enfermagem: readmissões hospitalares de pessoas com câncer de mama

Resumo OBJETIVO Avaliar o grau de complexidade dos cuidados de enfermagem de pacientes com câncer de mama readmitidas na oncologia clínica. MÉTODOS Estudo transversal com 108 pessoas com câncer de mama readmitidas na oncologia clínica num centro de alta complexidade de oncologia do Rio de Janeiro durante 2015. Realizada análise documental sendo dados analisados estatisticamente. RESULTADOS Os graus de complexidade de cuidados de enfermagem predominantes foram semi-intensivos (36,1%) e cuidados intensivos (36,1%). Na análise multivariada, apenas a performance status (p<0,001) e a hipertensão arterial (p=0,024) permaneceram associados ao grau de complexidade. CONCLUSÕES O grau de complexidade dos pacientes readmitidos foi predominantemente semi-intensivo e intensivo. Essa avaliação implica no gerenciando do cuidado por meio do conhecimento do perfil dos pacientes com câncer de mama em readmissão hospitalar e da detecção das características associadas ao grau de complexidade

The evidence of early specialist palliative care on patient and caregiver outcomes

Although there are many differences regarding what palliative care is and to whom it should be delivered, its delivery and integration earlier in the disease trajectory have been advocated since 1990. More recently, there has been a heightened interest in early access to specialist palliative care through its provision earlier in the disease trajectory to improve patient and caregiver outcomes. This article explores the challenges in understanding and defining ‘early’ specialist palliative care. It also examines the available evidence on early specialist palliative care interventions and their association with patient and caregiver outcomes. Finally, recommendations for future direction of research and practice are discussed