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Supportive and Palliative Care in Oncology

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: closed (10 July 2021) | Viewed by 42728

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Prof. Mari Lloyd-Williams

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Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
Interests: depression; non-pharmacological interventions; trials; multi-morbidity; sarcoma

Special Issue Information

Dear Colleagues,

Timely palliative and supportive care can not only make a difference to quality of life, but excellent symptom management can prolong life and symptom management can also allow patients to access trials and further palliative therapies if indicated and if it is the patient’s choice. Palliative care is not just about attention to physical symptoms but also to the many psychological symptoms that our patients experience, including depression, which not only impairs quality of life but also reduces survival. As patients are living longer with life-limiting illness, the close integration of oncology and palliative and supportive care is more important than ever. An ever ageing population, many of whom have co-existing multiple morbidities along with a cancer diagnosis, can also make difficult treatment decisions even more challenging.

This Special Issue will inform clinicians, academics and commissioners of the key developments in supportive and palliative care in oncology and will address issues of communication, symptom control, trials and emerging therapies along with systematic reviews.

Prof. Mari Lloyd-Williams
Guest Editor

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Keywords

palliative care
supportive care
trials
qualitative research
symptom control
psychosocial care
multi-morbidity

Published Papers (13 papers)

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Research

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11 pages, 562 KiB

Open AccessArticle

From Distress Screening to Uptake: An Italian Multicenter Study of Cancer Patients

by Elena Meggiolaro, Silvia De Padova, Federica Ruffilli, Tatiana Bertelli, Marina Bragagni, Sabrina Prati, Lidia Pisotti, Ilaria Massa, Flavia Foca, Stefano Tamberi, Ugo De Giorgi, Luigi Zerbinati, Elisa Tiberto and Luigi Grassi

Cancers 2021, 13(15), 3761; https://doi.org/10.3390/cancers13153761 - 27 Jul 2021

Cited by 9 | Viewed by 1931

Abstract

Introduction: Little consideration is given to the referral and uptake of available supportive services after distress screening. However, identifying the reasons for accepting or refusing help is mandatory for implementing a screening policy. The present study explored the practical usefulness of and potential barriers to the application of distress management. Methods: 406 cancer patients were consecutively selected and asked to complete the Distress Thermometer (DT) and Problem Check List (PL). All patients with a DT score ≥6 were invited for a post-DT telephone interview with a trained psychologist. Results: The 112 patients who refused to take part were more often older, retired, at a more advanced stage of illness, and with no previous experience of psychological intervention with respect to those who accepted. Of the 78 patients with a score ≥6 who were referred to the Psycho-Oncology Service, 65.4% accepted the telephone interview. Twenty-two patients rejected the initial invitation immediately for various reasons including logistic difficulties, physical problems, and feeling embarrassed about opening up to a psychologist. Conclusions: Our study confirms that screening per sé is insufficient to deal with the problem of distress and that more emphasis should be placed on implementing referral and treatment. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

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13 pages, 865 KiB

Open AccessArticle

Cannabis Use among Cancer Survivors amid the COVID-19 Pandemic: Results from the COVID-19 Cannabis Health Study

by Marlene Camacho-Rivera, Jessica Y. Islam, Diane L. Rodriguez and Denise C. Vidot

Cancers 2021, 13(14), 3495; https://doi.org/10.3390/cancers13143495 - 13 Jul 2021

Cited by 9 | Viewed by 4760

Abstract

Clinical indications for medicinal cannabis use include those with cancer, a subgroup advised to avoid exposure to COVID-19. This study aims to identify changes to cannabis use, methods of cannabis delivery, and coping strategies among cancer survivors since the pandemic by cancer status. Chi-squared tests were used for univariate comparisons of demographic characteristics, cannabis use patterns, COVID-19 symptoms, and coping behaviors by cancer survivor status. Data included 158 responses between 21 March 2020 and 23 March 2021, from medicinal cannabis users, categorized as cancer survivors (n = 79) along with age-matched medicinal cannabis users without a history of cancer (n = 79). Compared to adults without a history of cancer, cancer survivors were more likely to report use of cannabis as a way of managing nausea/vomiting (40.5% versus 20.3%, p = 0.006), headaches or migraines (35.4% versus 19.0%, p = 0.020), seizures (8.9% versus 1.3%, p = 0.029), and sleep problems (70.9% versus 54.4%, p = 0.033), or as an appetite stimulant (39.2% versus 17.7%, p = 0.003). Nearly 23% of cancer survivors reported an advanced cannabis supply of more than 3 months compared to 14.3% of adults without a history of cancer (p = 0.002); though the majority of cancer survivors reported less than a one-month supply. No statistically significant differences were observed by cancer survivor status by cannabis dose, delivery, or sharing of electronic vaping devices, joints, or blunts. Cancer survivors were more likely to report a fear of being diagnosed with COVID-19 compared to adults without a history of cancer (58.2% versus 40.5%, p = 0.026). Given the frequency of mental and physical health symptoms reported among cancer survivors, clinicians should consider conversations about cannabis use with their patients, in particular among cancer survivors. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

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13 pages, 1160 KiB

Open AccessArticle

A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Study to Evaluate the Efficacy of Aqualief^TM Mucoadhesive Tablets in Head and Neck Cancer Patients Who Developed Radiation-Induced Xerostomia

by Nicola Alessandro Iacovelli, Rossana Ingargiola, Nadia Facchinetti, Marzia Franceschini, Domenico Attilio Romanello, Paolo Bossi, Cristiana Bergamini, Salvatore Alfieri, Stefano Cavalieri, Giovanna Baron, Giancarlo Aldini, Laura Locati and Ester Orlandi

Cancers 2021, 13(14), 3456; https://doi.org/10.3390/cancers13143456 - 10 Jul 2021

Cited by 3 | Viewed by 2594

Abstract

Xerostomia, the subjective complaint of dry mouth, is caused by therapeutic interventions or diseases. Nowadays, radiotherapy (RT) in patients with head and neck cancer (HNC) stands out as one of the most important causes of xerostomia. Currently available therapies for the treatment of xerostomia are still less than optimal and xerostomia still represents an unmet clinical need. In this article, we present the results of a prospective clinical study with a new product, Aqualief^TM, in patients treated with curative RT with or without chemotherapy for HNC. Aqualief^TM is based on two main ingredients, carnosine and karkadé, which have acid buffering and antioxidant properties. The study was performed on 30 patients, with 4 of the patients being lost during the study period. Each patient received randomly one of the two treatments, Aqualief^TM or placebo, for 8 days. After a 10-day wash-out period, each patient received the other treatment for a further 8 days. The results show that Aqualief^TM stimulated salivation in these patients and reduced the pH drop that was observed in an equivalent placebo-treated population of patients. Moreover, no serious, treatment-related adverse events were observed. Aqualief^TM has shown positive results, although with limitations due to unsuccessful trial accrual. Therefore, it may be further investigated as a tool for the treatment of RT-related xerostomia. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

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12 pages, 316 KiB

Open AccessArticle

Socio-Economic Deprivation and Symptom Burden in UK Hospice Patients with Advanced Cancer—Findings from a Longitudinal Study

by Mari Lloyd-Williams, Christopher Shiels, Christopher Dowrick and David Kissane

Cancers 2021, 13(11), 2537; https://doi.org/10.3390/cancers13112537 - 21 May 2021

Cited by 11 | Viewed by 2618

Abstract

Socio-economic deprivation is known to impact on cancer diagnosis, treatment and access to services, but little is known of the impact of socio-economic deprivation on symptom burden in patients with advanced cancer. Patients with advanced cancer attending hospice day services were recruited into a 24 week longitudinal study. An area-based index of social deprivation was collected along with depression and symptom burden at baseline, 8, 16 and 24 weeks. Of the 595 patients included, with an age range of 33–89 years and a mean age of 68 years, 67% were female, and 37% were diagnosed with cancer in the last 12 months. Twenty nine percent lived in one of the most deprived 20% of neighbourhoods. Patients living in the most socio-economically deprived areas were significantly likely to report receiving insufficient information regarding their cancer at diagnosis (p = 0.007), greater pain (p = 0.02), moderate to severe depression (p = 0.04) and higher global symptom burden (p = 0.04). This study is the first to report that patients with advanced cancer attending hospice services, living in the most deprived neighbourhoods experience significantly greater symptom burden, notably depression and pain. We recommend using patient outcome measures in order to provide targeted support and thereby reduce the increased symptom burden that socio-economically disadvantaged patients experience at the end of life. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

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16 pages, 1136 KiB

Open AccessArticle

Using Process Indicators to Monitor Documentation of Patient-Centred Variables in an Integrated Oncology and Palliative Care Pathway—Results from a Cluster Randomized Trial

by Marianne Jensen Hjermstad, Julian Hamfjord, Nina Aass, Olav Dajani, Tonje Lundeby, Torunn Wester and Stein Kaasa

Cancers 2021, 13(9), 2194; https://doi.org/10.3390/cancers13092194 - 03 May 2021

Cited by 3 | Viewed by 2129

Abstract

Background. Despite robust evidence from randomized controlled trials (RCTs) demonstrating clinical and patient-reported benefits of integrated oncology and palliative care, the tumour-centred focus is predominant. This single–centre process evaluation monitors documentation of required patient-centred variables during an RCT. Methods. Performance status, patient self-reported symptoms, weight and summaries to general practitioners were assessed from June 2017 to July 2020 in three consultation types: first oncological after study inclusion and palliative and oncological consultations during chemotherapy. Descriptive statistics were used to monitor if the pre-defined program fulfilment of ≥85% documentation was reached. Results. 435 consultations were monitored in 76 patients; 60.5% males, 86.8% with GI cancers; 76 (17.5%) were from the first oncological consultations, 87 (20.0%) and 272 (62.5%) from palliative or subsequent oncological consultations. Program fulfilment differed across consultation types with 94.8% in the palliative consultations (83.3–100%), relative to 65.8% (62.5–75.0%) and 69.2% (57.0–84.3%) for first and subsequent oncological consultations over time, respectively. Use of self-reported symptoms was consistently lower in the oncological consultations. Conclusions. The documentation level of required core variables was not satisfactory, notwithstanding their high clinical relevance and continuous reminders during study. Pre-trial optimization strategies are paramount to promote integration and reduce professional and personal barriers towards a more patient-centred focus. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

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11 pages, 256 KiB

Open AccessArticle

The Role of Advance Care Planning in Cancer Patient and Caregiver Grief Resolution: Helpful or Harmful?

by Francesca Falzarano, Holly G. Prigerson and Paul K. Maciejewski

Cancers 2021, 13(8), 1977; https://doi.org/10.3390/cancers13081977 - 20 Apr 2021

Cited by 7 | Viewed by 3446

Abstract

Cancer patients and their family caregivers experience various losses when patients become terminally ill, yet little is known about the grief experienced by patients and caregivers and factors that influence grief as patients approach death. Additionally, few, if any, studies have explored associations between advance care planning (ACP) and grief resolution among cancer patients and caregivers. To fill this knowledge gap, the current study examined changes in grief over time in patients and their family caregivers and whether changes in patient grief are associated with changes in caregiver grief. We also sought to determine how grief changed following the completion of advance directives. The sample included advanced cancer patients and caregivers (n = 98 dyads) from Coping with Cancer III, a federally funded, multi-site prospective longitudinal study of end-stage cancer care. Participants were interviewed at baseline and at follow-up roughly 2 months later. Results suggest synchrony, whereby changes in patient grief were associated with changes in caregiver grief. We also found that patients who completed a living will (LW) experienced increases in grief, while caregivers of patients who completed a do-not-resuscitate (DNR) order experienced reductions in grief, suggesting that ACP may prompt “grief work” in patients while promoting grief resolution in caregivers. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

9 pages, 850 KiB

Open AccessArticle

Triggers for Palliative Care Referral in Pediatric Oncology

by Andrea Cuviello, Catherine Yip, Haven Battles, Lori Wiener and Renee Boss

Cancers 2021, 13(6), 1419; https://doi.org/10.3390/cancers13061419 - 19 Mar 2021

Cited by 13 | Viewed by 2550

Abstract

Palliative care (PC) integration into the care of pediatric oncology patients is growing in acceptance and has been shown to improve the quality of life of children with cancer. Yet timing for referrals and referral practices remain inconsistent, and PC remains underutilized. We conducted a retrospective chart review of pediatric oncology patients treated at an academic institution between January 2015 to November 2018. Data collected included demographics, disease and therapy characteristics, and consultation notes, specifically documenting existence of predetermined “high yield triggers” for PC consultation. Among 931 eligible patients the prevalence of PC consultation was 5.6% while approximately 94% of patients had at least 1 trigger for PC consultation. The triggers that more often resulted in PC consultation included: symptom management needs (98%; n = 51) high-risk disease (86%; n = 45), poor prognosis (83%; n = 43), multiple lines of therapy (79%; n = 41) and a documented ICU admission (67%; n = 35). Our findings suggest that the high yield triggers for palliative care consultation that pediatric oncologists identify as important are not translating into practice; incorporating these triggers into a screening tool may be the next step to improve early PC integration. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

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8 pages, 245 KiB

Open AccessArticle

The Prevalence and Characteristics of Breakthrough Cancer Pain in Patients Receiving Low Doses of Opioids for Background Pain

by Sebastiano Mercadante, Marco Maltoni, Domenico Russo, Claudio Adile, Patrizia Ferrera, Romina Rossi, Marta Rosati and Alessandra Casuccio

Cancers 2021, 13(5), 1058; https://doi.org/10.3390/cancers13051058 - 02 Mar 2021

Cited by 8 | Viewed by 1939

Abstract

The aim of this study was to assess the prevalence and characteristics of breakthrough cancer pain (BTcP) in patients receiving low doses of opioids for background pain. A consecutive sample of advanced cancer patients receiving less than 60 mg/day of oral morphine equivalent (OME) was selected. Epidemiological data, background pain intensity, and current analgesic therapy were recorded. The presence of BTcP was diagnosed according to a standard algorithm. The number of BTcP episodes, intensity of BTcP, its predictability and triggers, onset duration, interference with daily activities, BTcP medications, satisfaction with BTcP medication, and time to meaningful pain relief were collected. A total of 126 patients were screened. The mean intensity of background pain was 2.71 (1.57), and the mean OME was 28.5 mg/day (SD15.8). BTP episodes were recorded in 88 patients (69.8%). The mean number/day of BTP episodes was 4.1 (SD 7.1, range 1–30). In a significant percentage of patients, BTcP was both predictable and unpredictable (23%). The BTcP onset was less than 20 min in the majority of patients. The mean duration of untreated episodes was 47.5 (SD 47.6) minutes. The mean time to meaningful pain relief after taking a BTcP medication was >20 min in 44.5% of patients. The efficacy of BTcP medication was not considered good in more than 63% of patients. Gender (females) (OR = 4.16) and lower Karnofsky (OR = 0.92) were independently associated with BTcP. A higher number of BTcP episodes/day was associated with gender (females) (p = 0.036), short duration of BTcP (p = 0.005), poorer efficacy of BTcP medication (none or mild) (p = 0.001), and late meaningful pain relief (p = 0.024). The poor efficacy of BTcP medication was independently associated with a higher number of episodes/day (OR = 0.22). In patients who were receiving low doses of opioids, BTcP prevalence was 69.8%. Many patients did not achieve a sufficient level of satisfaction with BTcP medications, particularly with oral morphine. Data also suggest that better optimization of background analgesia, though apparently acceptable, may limit the number of BTcP episodes. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

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15 pages, 1265 KiB

Open AccessArticle

Emulation of a Target Trial to Evaluate the Causal Effect of Palliative Care Consultation on the Survival Time of Patients with Hepatocellular Carcinoma

by Tassaya Buranupakorn, Phaviga Thangsuk, Jayanton Patumanond and Phichayut Phinyo

Cancers 2021, 13(5), 992; https://doi.org/10.3390/cancers13050992 - 27 Feb 2021

Cited by 4 | Viewed by 3721

Abstract

Palliative care has the potential to improve the quality of life of patients with incurable diseases or cancer, such as hepatocellular carcinoma (HCC). A common misconception of palliative care with respect to the patient’s survival remains a significant barrier to the discipline. This study aimed to provide causal evidence for the effect of palliative care consultation on the survival time after diagnosis among HCC patients. An emulation of a target trial was conducted on a retrospective cohort of HCC patients from January 2017 to August 2019. The primary endpoint was the restricted mean survival time (RMST) at 12 months after HCC diagnosis. We used the clone–censor–weight approach to account for potential immortal time bias. In this study, 86 patients with palliative care consultation and 71 patients without palliative care consultation were included. The adjusted RMST difference was −29.7 (95% confidence interval (CI): −81.7, 22.3; p-value = 0.263) days in favor of no palliative care consultation. However, palliative care consultation was associated with an increase in the prescription of symptom control medications, as well as a reduction in life-sustaining interventions and healthcare costs. Our findings suggest that palliative care consultation was associated with neither additional survival benefit nor harm in HCC patients. The misconception that it significantly accelerates the dying process should be disregarded. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

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16 pages, 996 KiB

Open AccessArticle

Effects of In-Hospital Exercise on Frailty in Patients with Hepatocellular Carcinoma

by Jin Tsuchihashi, Shunji Koya, Keisuke Hirota, Noboru Koga, Hayato Narao, Manabu Tomita, Takumi Kawaguchi, Ryuki Hashida, Dan Nakano, Tsubasa Tsutsumi, Sachiyo Yoshio, Hiroo Matsuse, Taku Sanada, Kazuo Notsumata and Takuji Torimura

Cancers 2021, 13(2), 194; https://doi.org/10.3390/cancers13020194 - 07 Jan 2021

Cited by 16 | Viewed by 2768

Abstract

Frailty including physical inactivity is associated with the survival of patients with hepatocellular carcinoma (HCC). We aimed to investigate the effects of in-hospital exercise on frailty in patients with HCC. This was a multi-center observational study. Patients with HCC were classified into exercise (n = 114) and non-exercise (n = 67) groups. The exercise group was treated with a mixture of aerobic and resistance exercises (20–40 min/day, median four days). Frailty was assessed using the liver frailty index (LFI). Factors for changes in LFI were examined by multivariate and decision-tree analyses. The factors were also examined after propensity score matching. During hospitalization, LFI was significantly improved in the exercise group compared to the non-exercise group (ΔLFI −0.17 vs. −0.02, p = 0.0119). In multivariate analysis, exercise (odds ratio (OR) 2.38, 95% confidence interval (CI) 1.240–4.570, p = 0.0091) and females (OR 2.09; 95%CI, 1.062–4.109; p = 0.0328) were identified as independent factors for the improvement of LFI. In the decision-tree analysis, exercise was identified as an initial classifier associated with the improvement of LFI. Similar findings were also seen in the propensity score matching analyses. We demonstrated that in-hospital exercise improved frailty in patients with HCC. Thus, in-hospital exercise may be beneficial for improving physical function in patients with HCC. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

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Review

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11 pages, 215 KiB

Open AccessReview

Burden and Needs of Patients with Severe GvHD from the Supportive and Palliative Care Perspective—A Literature Review

by Freya Wenzel, Anne Pralong, Udo Holtick, Christoph Scheid, Marco Herling and Steffen T Simon

Cancers 2021, 13(11), 2697; https://doi.org/10.3390/cancers13112697 - 30 May 2021

Cited by 7 | Viewed by 2598

Abstract

Graft-versus-host disease (GvHD) is a frequent, and often life-threatening, complication after an allogeneic, hematopoietic stem cell transplantation (allo-SCT). It can appear in an acute or a chronic form and presents different grades of severity. Particularly, the severe forms of GvHD are often responsible for a change of the curative intent for allo-SCT into a palliative goal of care. For this non-systematic review, we conducted a focused literature search in the MEDLINE database via PubMed to examine whether patients with severe forms of GvHD might have special needs and burdens from a supportive and palliative care perspective. To draw a comprehensive picture of this patient group, we included findings on quality of life (QoL) and physical symptoms and function as well as psychological and spiritual well-being. In most domains, patients with severe forms of GvHD showed greater impairment and a higher symptom burden compared to patients with milder forms of GvHD. However, we could not identify any studies that specifically investigated patients with severe forms of GvHD. Further research in this field is necessary to guarantee the highest standard of care for this very special patient group. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

17 pages, 482 KiB

Open AccessReview

Home-Based Aerobic and Resistance Exercise Interventions in Cancer Patients and Survivors: A Systematic Review

by Ladislav Batalik, Petr Winnige, Filip Dosbaba, Daniela Vlazna and Andrea Janikova

Cancers 2021, 13(8), 1915; https://doi.org/10.3390/cancers13081915 - 15 Apr 2021

Cited by 34 | Viewed by 4490

Abstract

Cancer is a chronic disease requiring long-term treatment. Exercise interventions are increasingly being recognized as an important part of treatment and supportive cancer care for patients and survivors. Previous reviews have evaluated the benefits of exercise interventions in populations of patients under supervision at a center, but none have explored the possibilities of a home-based (HB) approach in exercise during cancer rehabilitation and the period immediately following the end of cancer treatment. The aim of this descriptive systematic review was to identify the literature focusing on the health effects of HB exercise interventions in cancer survivors and to evaluate the methodological quality of the examined studies. Relevant studies were identified by a systematic search of PubMed and the Web of Science until January 2021. Nine randomized controlled trials were included. Most studies were on aerobic and resistance exercises, and the frequency, duration, intensity, and modality varied across the different interventions. Improvements in cardiorespiratory fitness (CRF), physical activity (PA) levels, fatigue, health-related quality of life (HRQOL), and body composition have been reported. However, all the studies were limited in methodology and the reporting of results. Nevertheless, the evidence in this new area, despite the methodological limitations of the studies, suggests that HB exercise interventions are feasible, and may provide physiological and psychological benefits for cancer survivors during the rehabilitation period. A methodologically rigorous design for future research is essential for making progress in this field of study. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

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17 pages, 882 KiB

Open AccessReview

Fatigue in Cancer Patients in Palliative Care—A Review on Pharmacological Interventions

by Caritha Klasson, Maria Helde Frankling, Carina Lundh Hagelin and Linda Björkhem-Bergman

Cancers 2021, 13(5), 985; https://doi.org/10.3390/cancers13050985 - 26 Feb 2021

Cited by 20 | Viewed by 5530

Abstract

Fatigue is one of the most distressing symptoms experienced by cancer patients. The suggested biological mechanism for cancer related fatigue (CRF) includes immune activation triggered by tumor tissue or by anticancer treatment but other mechanisms have also been proposed. Previous large meta-analysis of interventions on fatigue focuses mostly on patients early in the disease trajectory, with only one tenth of included studies performed in palliative cohorts. The aim of this narrative review is therefore to present a background on CRF with focus on the palliative setting. A summary of recent randomized, controlled trials on pharmacological interventions on CRF in palliative care is presented, including studies on psychostimulants, corticosteroids, testosterone and melatonin. Interestingly, in several of these studies there was a positive and similar effect on fatigue in both the intervention and the placebo arm—indicating an important placebo effect for any pharmacological treatment. In addition, studies on dietary supplements and on pharmacological complementary medicines are discussed. To conclude, the evidence is still weak for using pharmacological treatments on CRF in palliative care patients—although methylphenidate and corticosteroids might be considered. Full article

(This article belongs to the Special Issue Supportive and Palliative Care in Oncology)

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