"She Would Be Flailing Around Distressed": The Critical Role of Home-Based Palliative Care for Patients with Advanced Cancer.

BACKGROUND: Patients with advanced cancer experience significant symptoms, ineffective treatments, and hospice underutilization. Home-based palliative care (HBPC) may fill a service gap for patients who require intensive home management, but are not enrolled in hospice. Even as data emerge on the utilization impacts of HBPC, other impacts are not as well known. METHODS: We describe findings of a pilot project in HBPC, Community Bridges (CB), for patients with advanced cancer. We assessed baseline symptom severity, caregiver burden, patient and caregiver program satisfaction, and CB team experience. RESULTS: Seventeen patients were seen. Baseline patient symptom burden and caregiver burden were high. Half of patients died within six months of enrollment. Patients and caregivers reported high program satisfaction and that CBs filled a gap in care. CB providers often served in the role as crisis managers and as trusted reporters for treating oncologists. CONCLUSIONS: CBs filled an unmet need for patients with advanced, metastatic cancer who desired ongoing cancer treatment, but were also in need of intensive end-of-life home services.

Concurrent urologic and palliative care after cystectomy for treatment of muscle-invasive bladder cancer.

PURPOSE: To characterize the effect of palliative care provided concurrently with usual urologic care for patients with bladder cancer undergoing cystectomy. MATERIALS AND METHODS: Prospective, 6-month, serial cohort study comparing 33 participants receiving usual care with cystectomy for muscle-invasive bladder cancer, with 30 participants also receiving concurrent palliative care. Patients and family caregivers completed validated symptom assessment and satisfaction surveys preoperatively and at 2, 4, and 6 months postoperatively. RESULTS: The intervention group saw improvements in most symptom measures over the 6 months following cystectomy compared with the control group. Depression and anxiety decreased over the 6-month period for the intervention group patients but increased over this time among the controls (P = 0.01). Fatigue decreased to a minimum for the intervention group participants at 4 months, whereas it peaked at this time for control participants (0.002). Quality-of-life and posttraumatic growth scores followed a similar pattern, with scores peaking at 4 months for the intervention group whereas controls reported their lowest scores at this time (P = 0.01 and P = 0.03, respectively). Changes in pain scores did not reach statistical significance. Neither family caregiver burden nor patient satisfaction showed statistically significant changes over time. CONCLUSIONS: Patients who received concurrent palliative care in addition to usual urologic care following radical cystectomy for muscle-invasive bladder cancer had better outcomes, including improved fatigue, depression, quality of life, and posttraumatic growth. Although further research on this topic is needed, our results suggest that providing palliative care services in addition to usual urologic care for patients with bladder cancer may significantly reduce postoperative symptoms.

The natural history of symptoms and distress in patients and families following cystectomy for treatment of muscle invasive bladder cancer.

PURPOSE: We characterized the natural history of symptoms with time in patients with bladder cancer undergoing cystectomy. MATERIALS AND METHODS: For 6 months we followed 33 participants treated with muscle invasive bladder cancer treatment with cystectomy in this prospective cohort study. Patients and family caregivers completed validated symptom assessment and satisfaction surveys at baseline, and 2, 4 and 6 months later. Primary outcomes were the change from baseline in pain, fatigue, depression, anxiety, quality of life and spiritual well-being. Secondary outcomes included posttraumatic growth, patient satisfaction and family caregiver burden. RESULTS: Pain increased after radical cystectomy and remained increased 6 months postoperatively based on Brief Pain Inventory scores (baseline and 6-month scores 4.0, 95% CI 0-8.0 and 9.8, 95% CI 1.9-17.6, respectively, p = 0.03). Posttraumatic growth showed a trend toward an increase at 2 months (p = 0.06). Fatigue peaked at 4 months but did not change significantly with time (p = 0.12). There was similarly no significant change with time in depression, anxiety, quality of life, spiritual well-being or satisfaction. Neither family caregiver burden nor satisfaction showed a statistically significant change with time postoperatively. CONCLUSIONS: Pain increased after radical cystectomy and remained increased 6 months postoperatively. There was a trend toward increased posttraumatic growth at 2 months. Otherwise, by 6 months cystectomy was associated with no improvement in preoperative symptoms of fatigue, quality of life, spiritual well-being, depression or anxiety. After cystectomy pain should be assessed and treated more aggressively in patients with bladder cancer and efforts should be made to improve postoperative symptoms.

Putting evidence into practice: evidence-based interventions to prevent and manage anorexia.

Anorexia is defined as an involuntary loss of appetite.Approximately 50% of newly diagnosed patients with cancer experience the symptom, which often is accompanied by weight loss and most typically associated with advanced disease.Anorexia significantly affects the clinical course of cancer; it can lead to the development or exacerbation of disease- or treatment-related symptoms, decreased functional status, and diminished quality of life.As part of the Oncology Nursing Society's Putting Evidence Into Practice initiative, a team of oncology nurses examined and evaluated published research literature for the purpose of developing an evidence-based practice resource focused on the management of cancer-related anorexia.Even though anorexia is common among newly diagnosed patients and those with advanced disease, interventions to prevent, treat, and manage the symptom are limited.The evidence revealed that only two pharmacologic interventions, corticosteroids and progestins, can be recommended for use in clinical practice, and dietary counseling was identified as likely to be effective.This article summarizes selected empirical literature on interventions used to prevent and manage anorexia in patients with cancer.Familiarity with the literature will assist oncology nurses in proactively identifying and effectively managing patients experiencing this distressing symptom.