Symptoms During Outpatient Cancer Treatment and Options for their Management

Background: Cancer patients account for a large segment of the German healthcare system, with a 5-year prevalence of around 1.7 million persons. Advances in oncological treatment, now frequently performed on an outpatient basis, are granting many of these individuals a longer life span. At the same time, cancer patients often suffer disease-related symptoms and adverse effects from their tumor treatment, which may strongly impair their quality of life despite the improved techniques for management of side effects. Methods: This review is based on a selective literature search of the PubMed and Cochrane Library databases carried out in December 2019 and January 2020. Special attention was paid to guidelines, expert opinions, and recommendations from professional societies. Results: Alongside decreased well-being, cancer patients often suffer from fatigue (70-100%), loss of appetite (6-53%), pain (30-80 %), and dyspnea (10-70%). The prevalence and severity of the symptoms varies depending on the tumor entity and the patients sex. A meta-analysis showed that besides causal treatment, physical activity achieves moderately strong effects in tumor-associated fatigue syndrome (Cohen's d = 0.30 [0.25; 0.36]). The WHO recommends early use of opioids in tumor-associated pain. A meta-analysis of randomized trials described symptom relief by means of opioids also in dyspnea (standardized mean difference: similar to 0.32 [similar to 0.53; similar to 0.10]). Increasingly, guidelines are recommending regular palliative medical symptom screening. Conclusion: Regular documentation of symptoms in outpatients offers the opportunity for targeted management of symptoms during treatment with the involvement of various disciplines such as palliative medicine, exercise therapy. and psychotherapy

A Systematic Review of the Safety, Feasibility and Benefits of Exercise for Patients with Advanced Cancer

Simple Summary Most advanced cancer patients suffer from severe symptoms due to cancer and medical treatment. Common symptoms are physical weakness, mental problems, and tiredness. Research has shown that exercise positively influences cancer-related side effects during and after treatment and longevity in cancer survivorship. However, exercise as a supportive therapy in advanced cancer patients is still not recommended in oncological guidelines. Therefore, the aim of this systematic review was to assess the safety, feasibility, and benefits of exercise for patients with advanced cancer. Based on the results of 14 included exercise intervention studies, we conclude that exercise is safe and feasible, seems to improve physical performance, and may lower symptoms like chronic tiredness. Early integration of exercise for advanced cancer patients should be considered as usual care as a supportive strategy. Exercise therapy is a common supportive strategy in curative cancer treatment with strong evidence regarding its positive effects on, for example, cancer-related fatigue, health- related quality of life, and physical function. In the field of advanced cancer patients, knowledge about exercise as a useful supportive strategy is missing. The aim of this systematic review was to evaluate the feasibility and safety of exercise interventions as well as its effects on lowering the symptom burden. We included randomized controlled trials and nonrandomized controlled trials with advanced cancer patients receiving any type of exercise intervention. After an extensive literature search (in accordance to PRIMSA guidelines) in PubMed, Cochrane Library, and SPORTDiscus, 14 studies including 940 participants with different cancer entities were eligible. The results indicated the safety of exercise. In total, 493 participants received exercise interventions, with nine adverse events and no severe adverse events. The median recruitment rate was 68.33%, and adherence to exercise intervention was 86%. Further research with a high-quality and larger sample size is needed to clarify the potential of exercise with advanced cancer patients. Different advanced cancer entities have distinguished symptoms, and future research should construct entities-specific trial populations to figure out the best supportive exercise interventions

PARPACT – Paramedic Palliative Care Test

Hintergrund: Angesichts der Vielzahl von Palliativpatienten, die vom Rettungsdienst versorgt werden, spielen Aus- und Weiterbildung in palliativmedizinischen Themen eine immer größere Rolle. Zur Verbesserung der Entscheidungsfindung in Rettungssituationen wurde in vielen Städten ein Palliativ- bzw. Notfallausweis eingeführt. Ziel der Arbeit: Um den Erfolg von Bildungsmaßnahmen und den Effekt des Palliativ- bzw. Notfallausweises zu überprüfen, wurde der 'Paramedic Palliative Care Test' (PARPACT), ein Fragebogen zur Ermittlung von palliativem Wissen und palliativer Selbstwirksamkeitserwartung im Rettungsdienst. entwickelt und validiert. Material und Methoden: Die Entwicklung und Inhaltsvalidierung erfolgte mithilfe eines Delphi-Prozesses. Zur Konstruktvalidierung wurde die Faktorenanalyse genutzt. Die Kriteriumsvalidität wurde anhand von 22 speziell in Palliative Care geschulten Pflegekräften überprüft. Die Reliabilität wurde mittels Cronbach's alpha als Maß der internen Konsistenz ermittelt. Ergebnisse: 291 von 750 Rettungsdienstmitarbeitern nahmen an der freiwilligen Befragung teil. Nach Abschluss des Delphi-Prozesses bestand Konsens, dass die wichtigen Themen Schmerz, Dyspnoe, Sedierung, Sterbebegleitung, Sterbehilfe und rechtliche Aspekte im Fragebogen abgedeckt sind. Das Ergebnis der Faktorenanalyse sprach für eine 6-Faktoren-Lösung. Im Rahmen der Kriteriumsvalidierung zeigte sich ein signifikanter Unterschied im palliativen Wissen zwischen den Palliative-Care-Pflegekräften (M (tief)Rang 289,73) und den Rettungsdienstmitarbeitern (M (tief)Rang 146,97, U = 281.000, r = 0,40, p< 0,001). Cronbach's alpha lag für die Wissensfragen bei .70 und für die Subskala der palliativen Selbstwirksamkeitserwartung bei .82. Diskussion: Mit dem Paramedic Palliative Care Test (PARPACT) liegt ein validiertes Messinstrument zur Überprüfung von Bildungsmaßnahmen im Rettungsdienst vor

Palliative Care Teams in the German Comprehensive Cancer Centers

Background A palliative care team is recognized as a quality indicator in the consultation and care of patients with a tumor disease and is used nationally (92 %) in the National Cancer Institutes, model of the German Comprehensive Cancer Center (CCC). This begs the question of how palliative care teams are presently integrated into the CCCs. Method From July to August 2017, a paper-based quantitative survey of 16 locations of the CCCs, supported to that date, gathered information on the existence, personnel situation, use and prospects of a specialized inpatient palliative care service. The survey was addressed to the heads of the palliative medical units of the CCCs. The data were evaluated in SPSS (frequency, median, mean, range). Results Fifteen CCCs took part in the survey (response 94 %). Thirteen of the fifteen CCCs have a service that also treats palliative patients. Twelve of thirteen CCCs of these are attainable during regular working hours (8a. m.-4p. m. on weekdays). All services are staffed by physicians, additional eleven are staffed by nurses. Seven services are besides physicians and nurses joined by other professions. In 2016, 4482 median co-treatments were provided by the services, 80 % of these as additional charges without revenue and without codable OPS. In 2017, five centers plan to charge ZE 2017-133, two centers ZE 60 and three centers both intend to charge ZE 2017-133. Conclusions Services for palliative patients exist generally in the German CCCs, but only half of them satisfy the condition of multi-professionality required for the fulfillment of the german guidelines. The new surcharge introduced in 2017, which can be charged on an hourly basis, could create improvements in this regard and contribute to cost recovery. Thus, contrary to the previous arrangement, essential and reasonable performances with a time of treatment of less than seven days can be charged

Changes in fatigue, barriers, and predictors towards physical activity in advanced cancer patients over a period of 12 months—a comparative study

Purpose!#!Physical activity (PA) is recommended to improve advanced cancer patients' (ACP) physical functioning, fatigue, and quality of life. Yet, little is known about ACPs' attitude towards PA and its influence on fatigue and depressiveness over a longer period. This prospective, non-interventional cohort study examined ACPs' fatigue, depression, motivation, and barriers towards PA before and after 12 months of treatment among ACP METHODS: Outpatients with incurable cancer receiving treatment at a German Comprehensive Cancer Center reporting moderate/severe weakness/tiredness during self-assessment via MIDOS II were enrolled. Fatigue (FACT-F), depression (PHQ-8), cancer-related parameters, self-assessed PA behavior, motivation for and barriers against PA were evaluated (T0). Follow-up data was acquired after 12 months (T1) using the same questionnaire.!##!Results!#!At follow-up, fatigue (p=0.017) and depressiveness (p=0.015) had increased in clinical relevant extent. Physically active ACP did not show significant progress of FACT-F (p=0.836) or PHQ-8 (p=0.799). Patient-reported barriers towards PA remained stable. Logistic regression analyses identified motivation as a positive predictor for PA at both time points (T0, β=2.152, p=0.017; T1, β =2.264, p=0.009). Clinically relevant depression was a negative predictor for PA at T0 and T1 (T0, β=-3.187, p=0.044; T1, β=-3.521, p=0.041).!##!Conclusion!#!Our findings emphasize the importance of psychological conditions in physical activity behavior of ACP. Since psychological conditions seem to worsen over time, early integration of treatment is necessary. By combining therapy approaches of cognitive behavioral therapy and exercise in interdisciplinary care programs, the two treatment options might reinforce each other and sustainably improve ACPs' fatigue, physical functioning, and QoL.!##!Trial registration!#!German Register of Clinical Trials, DRKS00012514, registration date: 30.05.2017