Journal of pain and symptom management最新文献

{"title":"The Distress and Benefits of the Bereaved Family Survey: A Mortality Follow-Back Survey.","authors":"Mai Hosokawa, Yoko Nakazawa, Mitsunori Miyashita, Kento Masukawa, Momoka Sato, Tatsuya Morita, Yasuyiki Okumura, Yoshiyuki Kizawa, Shohei Kawagoe, Hiroshi Yamamoto, Emi Takeuchi, Risa Yamazaki, Asao Ogawa","doi":"10.1016/j.jpainsymman.2024.10.029","DOIUrl":"10.1016/j.jpainsymman.2024.10.029","url":null,"abstract":"<p><strong>Context: </strong>The Bereaved Family Survey is an important method for evaluating the quality of palliative care.</p><p><strong>Objectives: </strong>To examine the distress and benefits of bereaved families of patients with or without cancer, who participated in a Bereaved Family Survey, and identify factors associated with distress and benefits.</p><p><strong>Methods: </strong>We conducted a nationwide cross-sectional, self-reported questionnaire mail survey among the bereaved families of patients who died of cancer, heart disease, cerebrovascular disease, pneumonia, or kidney failure. Participants answered questions on a four-point Likert scale measuring the distress and benefit associated with participating in the Bereaved Family Survey. We conducted a qualitative analysis of responses to open-ended questions about the distress and benefits of participating in the survey to comprehensively examine the distress and benefits of participating in the survey.</p><p><strong>Results: </strong>Questionnaires were distributed to 115,816 eligible bereaved family members between February 2019 and February 2020; 62,576 (54.0%) family members returned valid responses. Distress and benefits accounted for 51.4% and 49.3%, respectively. The results of the binomial logistic analysis for distress were significantly higher among cancer patients (P < 0.001-0.003), 20-39-year-old patients (P < 0.001), female bereaved family members (P < 0.001), and bereaved family members with poor mental health statuses (P < 0.001). Factors related to \"benefit\" were significantly higher among over-80-year-old bereaved family members (P < 0.001), higher care evaluation scale (CES) scores (P < 0.001), and higher good death inventory (GDI) scores (P < 0.001).</p><p><strong>Conclusion: </strong>Bereaved family members experience both distress and benefits. There is need to devise ways to reduce distress and increase its benefits to continue assessing the quality of palliative care.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"152-164"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sights and Sounds of Respiratory Changes During Hospice Death Vigils: Hospice Caregivers Experience.","authors":"Debra Parker Oliver, Masako Mayahara, Allison Donehower, Jacquelyn J Benson, Daniel Paget, Keisha White Makinde, Justin Daniels, Patrick White","doi":"10.1016/j.jpainsymman.2024.10.035","DOIUrl":"10.1016/j.jpainsymman.2024.10.035","url":null,"abstract":"<p><strong>Context: </strong>Research has documented common respiratory changes at the end of life for hospice patients. Some studies have noted these symptoms as distressing and challenging for families, and as a potential reason for emergency room visits and hospice benefit revocation. However, the experiences and emotions of family members regarding these respiratory changes in the final days, particularly when they are alone in a home setting, are not well documented. A recent study found 51% caregivers identified abnormal breathing as a challenge during their vigil experience.</p><p><strong>Objectives: </strong>The study aimed to answer three research questions: 1) How do family members describe the sights and sounds of the respiratory changes experienced during the final days of life? 2) What are the emotions caregivers experience as a result of witnessing the sights and sounds of respiratory changes? 3) What interventions are caregivers using to manage respiratory changes?</p><p><strong>Methods: </strong>A secondary analysis of 22 hospice caregiver interviews from a larger study of family interviews focused analyzing in depth narratives related to respiratory changes during the vigil period.</p><p><strong>Results: </strong>Caregiver narratives distressful sights and sounds related to respiratory symptoms during the final days were described by 27% and 77% of family narratives, respectively. Negative emotional reactions were reported by more than a third of those interviewed. Caregivers expressed frustration at not understanding the reasons behind respiratory changes, with 27% noting they wished for more information on what to expect and how to intervene. There were inconsistencies in the interventions provided by hospice teams in managing respiratory symptoms.</p><p><strong>Conclusions: </strong>Opportunities exist for hospice agencies to better address the caregiver distress caused by witnessing noisy breathing (death rattle), Cheyne-Stokes breathing, and agonal breathing. Further research is needed to identify standard definitions for these respiratory changes, their prevalence in the home hospice setting, and to develop practice standards and effective interventions to relieve caregiver distress.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"190-195"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-pharmacological Therapies for Depression in Women With Breast Cancer at Different Treatment Phases: A Systematic Review and Network Meta-Analysis.","authors":"Deqi Zhang, Wenxin Zhao, Lin Yuan, Qiling Xu, Hongyan Bi","doi":"10.1016/j.jpainsymman.2024.10.022","DOIUrl":"10.1016/j.jpainsymman.2024.10.022","url":null,"abstract":"<p><strong>Context: </strong>Various non-pharmacological therapies (NPTs) have been found to be helpful for depression in women with breast cancer (BC). However, the relative efficacy of different NPTs in women with BC during different treatment phases is unclear.</p><p><strong>Objectives: </strong>To conduct a systematic review and network meta-analysis (NMA) to compare the relative efficacy of various NPTs for improving depression in women with BC during the inter-/post-treatment periods.</p><p><strong>Methods: </strong>We searched eight databases (Embase, PubMed, PsycINFO, The Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and WanFang Database) to identify relevant randomized controlled trials published in English and Chinese from their inception to 31 January 2024. We assessed the methodological quality of the included studies using the Cochrane Collaboration Risk of Bias Tool. NMA was conducted using a frequentist approach. The surface under the cumulative ranking (SUCRA) probabilities were used to rank the NPTs.</p><p><strong>Results: </strong>A total of 41 articles involving 5408 participants studied 18 NPTs. Based on NMA, in the intertreatment phase, mindfulness-based cognitive therapy (MBCT), psychological education, virtual reality (VR) and yoga significantly improved depression in women with BC. MBCT, psychological education, and VR were the three most effective NPTs in this period. In the post-treatment phase, mindfulness-based stress reduction significantly improved depression in women with BC, which was the most effective NPTs in this period. Based on the GRADE framework, most results were rated as \"high\" to \"very low\" for the confidence of evidence.</p><p><strong>Conclusions: </strong>Our study confirmed the efficacy of several NPTs for depression in women with BC during inter-/post-treatment phases. These results should inform future clinical decisions and guidelines for depression in women with BC.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"e113-e130"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electronic Health Record Serious Illness Conversation Dashboards: An Implementation Case Series.","authors":"Yasmina Hachem, Joshua Lakin, Winifred Teuteberg, Amelia Cullinan, Matthew J Gonzales, Charlotta Lindvall, Pallavi Kumar, Laura Dingfield, Laurel Kilpatrick, Jeff Greenwald, Angela Miller, Tamra Keeney, Erik K Fromme, Joanna Paladino","doi":"10.1016/j.jpainsymman.2024.10.032","DOIUrl":"10.1016/j.jpainsymman.2024.10.032","url":null,"abstract":"<p><strong>Introduction: </strong>Dashboards are used to track and visualize quality indicators within health systems to improve clinical performance. Structured serious illness conversation (SIC) documentation templates within electronic health records (EHR) have enabled the development of SIC dashboards for quality improvement. Little is known about the successes and challenges of SIC dashboards.</p><p><strong>Methods: </strong>This implementation case series describes findings from semi-structured interviews and surveys with nine palliative care leaders in eight health systems that implemented SIC dashboards. Interviews and case information were analyzed to identify themes.</p><p><strong>Results: </strong>Five themes were identified. First, dashboards focus on process metrics. By creating transparent and efficient access to data on EHR-documented SICs, dashboards facilitated monitoring of the results of clinician training and quality improvement efforts. Second, palliative care leaders used dashboard data on documented SICs to implement clinician practice change strategies (e.g. data feedback; quality incentives), but clinicians had mixed reactions to data. Third, dashboards facilitated leadership investment in SIC efforts and required financial and technical resources to build and maintain. Fourth, while dashboards streamlined data collection for implementation teams, participants noted challenges with data reliability, including inadequate clinician use of structured SIC documentation templates (which most dashboards rely on for measurement). Fifth, needs and tensions arose with integrating patient-centered outcome measures as part of dashboards.</p><p><strong>Conclusion: </strong>Dashboards can be powerful tools for identifying gaps in SIC and driving interventions for clinician practice change. However, challenges related to clinician adoption of structured templates for SIC documentation and mixed clinician receptivity to data feedback may limit their reliability and use.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"e139-e146"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic Study in Opioid-Treated Cancer Patients Identifies Variants Associated With Nausea-Vomiting.","authors":"Francesca Minnai, Morena Shkodra, Sara Noci, Cinzia Brunelli, Alessandra Pigni, Ernesto Zecca, Frank Skorpen, Pål Klepstad, Stein Kaasa, Oscar Corli, Maria Caterina Pallotti, Marco Cesare Maltoni, Augusto Tommaso Caraceni, Francesca Colombo","doi":"10.1016/j.jpainsymman.2024.10.033","DOIUrl":"10.1016/j.jpainsymman.2024.10.033","url":null,"abstract":"<p><strong>Context: </strong>Opioids are the mainstay therapy for patients affected by cancer pain. However, about 10%-20% of patients do not benefit from the received analgesic treatment or experience side effects. Genetic variability might account for the variation in individual responses to opioids, both in terms of efficacy and toxicity.</p><p><strong>Objectives: </strong>The aim of this genome-wide association study (GWAS) was to identify genetic markers of opioid toxicity, in terms of nausea-vomiting.</p><p><strong>Methods: </strong>Cancer patients receiving morphine, oxycodone, buprenorphine, and fentanyl were recruited from different European countries. Data about toxicity (nausea-vomiting score, NVS) and other relevant clinical information were collected, as well as genotyping data. Regression analysis between genotypes of 2052 patients and NVS was performed, using appropriate covariates, with REGENIE software.</p><p><strong>Results: </strong>We found 65 variants associated with NVS (P-value < 1.0×10^-5). Of note, 14 intronic variants on chromosome 2 were in NPAS2 gene, encoding a circadian transcription factor reported to play a role in another opioid side effect, the alteration of sleep. Some of these variants were previously identified as splicing quantitative trait loci of the NPAS2 gene.</p><p><strong>Conclusions: </strong>This is the first GWAS, performed in more than two thousand individually genotyped patients treated with opioids for cancer pain, that investigated the genetic bases of opioid-induced nausea-vomiting. Although further studies are needed to confirm our findings and to characterize the functional role of the identified variants, our results emphasize the importance of performing large pharmacogenomic studies to identify germline variants associated with opioid response, with the ultimate goal of tailoring cancer pain therapies.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"175-182.e5"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Muscle and Fat Loss Predictive of Clinical Events in Pancreatic Cancer? The Importance of Precision Metrics.","authors":"Mellar P Davis, Nada Bader, James Basting, Erin Vanenkevort, Nicole Koppenhaver, Aalpen Patel, Mudit Gupta, Braxton Lagerman, Mark Wojtowicz","doi":"10.1016/j.jpainsymman.2024.10.004","DOIUrl":"10.1016/j.jpainsymman.2024.10.004","url":null,"abstract":"<p><strong>Context: </strong>Muscle and fat loss from cancer may have prognostic significance. Skeletal muscle and fat areas measured at L3 on a CT scan correlate with body muscle and fat mass. We wished to know if reduced skeletal muscle area or fat on diagnostic CT scans or changes from initial CT scans in patients with pancreatic cancer who died in 2018 and 2019 predicted mortality.</p><p><strong>Method: </strong>Electronic records of 112 patients with locally advanced or metastatic pancreatic cancer were used to extract stage, age, gender, comorbidities, weight, and height at the time of the first CT scan. Survival (in days) was defined from the first CT scan to the death date. Patients had at least one CT scan of the abdomen. I. Two trained medical students read scans independently using TeraRecon software (Durham, NC). Results were averaged, and the differences determined precision. Interclass correlation coefficient (ICC), coefficient of variation, and least significant change determined the precision between readers. Independent prognostic modeling included age and BMI.</p><p><strong>Results: </strong>An evaluable sample of 104 with an average age of 67, 56 were male. Nearly half had a TNM Stage of IV (45%). The average Charlson Comorbidity index is 7.2. In those undergoing repeat scans, most were in the timeframe of 60-120 days. Changes in visceral fat in men in the unadjusted Cox proportional hazard model and reduced skeletal muscle area in the age-adjusted model of men predicted mortality. In contrast, myosteatosis in women marginally predicted improved survival. ICC's precision between readers was adequate but by least significant change would have missed subtle, clinically important changes.</p><p><strong>Discussion: </strong>Muscle loss during chemotherapy in men predicted mortality in men but not women. Precision is an important metric when measuring body composition.</p><p><strong>Conclusion: </strong>Muscle loss in men during chemotherapy of pancreatic cancer predicts mortality.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"141-151"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and Evaluation of a Pediatric Palliative Care Curriculum for Adult-Track HPM Fellows.","authors":"Emilee Flynn, Camille Murray, Cynthia B Sinha, Ulemu Luhanga","doi":"10.1016/j.jpainsymman.2024.10.027","DOIUrl":"10.1016/j.jpainsymman.2024.10.027","url":null,"abstract":"<p><strong>Introduction: </strong>Hospice and Palliative Medicine (HPM) fellowship training provides education on caring for patients from early childhood through adulthood. Yet, there are few guidelines about how to teach these key components, and more specifically the components of Pediatric Palliative Care (PPC), to fellows who have a variety of backgrounds prior to entering HPM fellowship.</p><p><strong>Methods: </strong>We created a curriculum in PPC that could be used with adult-track HPM fellows. We developed an outline for material to cover during each of the three weeks of PPC clinical rotations. We also created a longitudinal lecture series encompassing several foundational topics and concepts in PPC. We conducted \"Just-in-Time\" evaluation of the clinical rotation curriculum utilizing a critical reflection model as well as focus groups with fellows and faculty members to further explore the knowledge, attitudes, and perceptions of the entire PPC curriculum. Transcripts were coded Nvivo and template analysis was used to understand code distribution between and within focus groups.</p><p><strong>Results: </strong>Eight overarching codes emerged from the focus groups: \"Staffing Issues,\" \"Learning Structure,\" \"Useful Material,\" \"Topics Attending Contingent,\" \"Time Management,\" \"Teachable Moment,\" \"Not Useful Material,\" and \"Adherence to Teaching Materials.\"</p><p><strong>Conclusion: </strong>The study revealed some limitations in the current curriculum design, such as its lack of consistency. However, it also highlighted several strengths, including the importance of flexibility and personal responsibility for learning. The results provide valuable insights into the experiences among fellows and educators at a single institution with a PPC Curriculum for adult-track HPM fellows.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":"e150-e177"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arts in Medicine for the Reduction of Pain and Stress in Cancer Patients During Chemotherapy.","authors":"Valerie J Kelley, Haley G Galvis, Miranda D Proctor, B J Broome","doi":"10.1016/j.jpainsymman.2025.01.009","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.01.009","url":null,"abstract":"<p><strong>Context: </strong>Rates of pain and stress are found in greater numbers in cancer patients than in the general population. Cancer patients often are concerned about unwanted side effects that can arise from taking medications to lower their pain and stress. As doctors are reaching for evidence-based, non-pharmaceutical, adjunct modalities, previous research indicates that visual art-making shows promise to help improve perceptions of pain and stress caused by a cancer diagnosis and treatment.</p><p><strong>Objectives: </strong>This mixed-methods pilot study was conducted at the Orlando Health Cancer Institute and included 54 participants to determine whether a 90-minute watercolor visual arts intervention was a viable option to reduce perceptions of pain and stress in adult cancer patients with mild to moderate pain and stress during outpatient chemotherapy sessions.</p><p><strong>Methods: </strong>Paired T-Tests were conducted to determine the effect of the bedside visual arts intervention by comparing differences between pre- and post-ratings of self-reported pain and stress.</p><p><strong>Results: </strong>The results indicated a significant decrease from pre- to post- ratings for both perceived pain and stress that corresponded with large effect sizes.</p><p><strong>Conclusion: </strong>This suggests that a watercolor visual arts intervention is a viable and feasible non-pharmaceutical complementary alternative to opioid prescriptions for pain management.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143039547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Pediatric Palliative Care on Goal Concordant Care in the Neonatal Intensive Care Unit.","authors":"Matthew Lin, Sadaf Kazmi, Olivia Bosworth, Taylor Kiernan, Clara Horner, Jordan Nelson, Kristyn Pierce, Deborah Dore, Daniel Eison, Christine Zawistoswki","doi":"10.1016/j.jpainsymman.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.jpainsymman.2025.01.008","url":null,"abstract":"<p><strong>Context: </strong>Little is known about the prevalence of goal-concordant care (GCC) in the NICU and whether it can be measured from chart data.</p><p><strong>Objectives: </strong>To determine if GCC can be evaluated using chart data, to identify factors associated with GCC, and to evaluate the impact of pediatric palliative care (PPC) consultation on GCC.</p><p><strong>Methods: </strong>Retrospective review of infants who died in a level IV NICU over a 10-year period (2014-2024). A structured questionnaire was used to guide independent chart abstraction for GCC outcomes between two reviewers. Cohen's kappa was used to measure reviewer agreement. Mann-Whitney U and Chi-square or Fisher's exact tests were used to evaluate differences between infants with GCC vs. no GCC. Logistic regression was used to evaluate the impact of PPC on aspects of GCC.</p><p><strong>Results: </strong>78% (99/127) of patients received GCC. Reviewer agreement for determining aspects of GCC was low, however, consensus was reached for all GCC outcomes. GCC was significantly associated with religious tradition, insurance status, limitations of resuscitation, mode of death, PPC consult, any family meeting or advance care planning discussion, and more social work visits. In logistic regression, PPC consultation was not a significant predictor of GCC after adjusting for religion, insurance, time since death, length of stay, and family meetings.</p><p><strong>Conclusion: </strong>Most infants received GCC, which was able to be determined from chart data. GCC was associated with several demographic and hospitalization factors such as PPC consultation and psychosocial supports. After adjusting for confounding, PPC was not a significant predictor of GCC.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant Hematologic Oncology Referrals to an Outpatient Palliative Care Clinic at a Tertiary Cancer Center.","authors":"Helen Alemu, Ashley Pope, Samantha Lo, Nicolas Chin-Yee, Katayoun Khorramak, Criselda Isabel Cenizal, Lisa W Le, Dior Caruso, Christine Chen, John Kuruvilla, Camilla Zimmermann, Breffni Hannon","doi":"10.1016/j.jpainsymman.2025.01.005","DOIUrl":"10.1016/j.jpainsymman.2025.01.005","url":null,"abstract":"<p><strong>Context: </strong>Hematological malignancies represent a heterogeneous group of diseases with variable and often unpredictable illness trajectories. Comparisons between hematological and solid tumor malignancy referrals to an outpatient palliative care clinic have not been explored.</p><p><strong>Objectives: </strong>This study compared characteristics, referral trends, and time from first palliative care clinic visit to death between patients with hematological and solid tumor malignancies.</p><p><strong>Methods: </strong>A retrospective review of palliative care clinic referrals at a tertiary cancer center from January 1st, 2018 to December 31st, 2022 was conducted. Clinical and demographic data, symptom burden, performance status, and time from first palliative care clinic visit to death were compared.</p><p><strong>Results: </strong>Of 5230 outpatients, 283 (5.4%) had a hematological malignancy (107 [38%] leukemia, 98 [35%] lymphoma, and 78 [28%] multiple myeloma). Patients with leukemia and lymphoma had similar symptom burden to solid tumor malignancies; patients with multiple myeloma had significantly more pain (P < 0.0001) and constipation (P = 0.005). Patients with hematological malignancies had worse performance status compared with solid tumor malignancies (ECOG ≥3 for 37.9% leukemia, 35.0% lymphoma, and 31.6% multiple myeloma vs. 19.6% solid tumor malignancies, P < 0.0001). At 12-months from first palliative care clinic visit, survival probabilities were 27.6% for leukemia, 42.2% lymphoma, and 69.5% multiple myeloma vs. 39.5% solid tumor malignancies.</p><p><strong>Conclusion: </strong>Patients with hematological malignancies experience at least similar symptom burden to those with solid tumor malignancies referred to a palliative care clinic, and worse performance status, factors that should be considered when designing palliative care clinic interventions for patients with hematological malignancies.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}