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1
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Wang C, Wang W, Wang M, Deng J, Sun C, Hu Y, Luo S. Different evasion strategies in multiple myeloma. Front Immunol 2024; 15:1346211. [PMID: 38464531 PMCID: PMC10920326 DOI: 10.3389/fimmu.2024.1346211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
Multiple myeloma is the second most common malignant hematologic malignancy which evolved different strategies for immune escape from the host immune surveillance and drug resistance, including uncontrolled proliferation of malignant plasma cells in the bone marrow, genetic mutations, or deletion of tumor antigens to escape from special targets and so. Therefore, it is a big challenge to efficiently treat multiple myeloma patients. Despite recent applications of immunomodulatory drugs (IMiDS), protease inhibitors (PI), targeted monoclonal antibodies (mAb), and even hematopoietic stem cell transplantation (HSCT), it remains hardly curable. Summarizing the possible evasion strategies can help design specific drugs for multiple myeloma treatment. This review aims to provide an integrative overview of the intrinsic and extrinsic evasion mechanisms as well as recently discovered microbiota utilized by multiple myeloma for immune evasion and drug resistance, hopefully providing a theoretical basis for the rational design of specific immunotherapies or drug combinations to prevent the uncontrolled proliferation of MM, overcome drug resistance and improve patient survival.
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Affiliation(s)
| | | | | | | | | | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanshan Luo
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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2
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Malakian A, Rodin G, Widger K, Ali R, Mahendiran AE, Mayo SJ. Experience of Care Among Adults With Acute Leukemia Near the End of Life: A Scoping Review. J Palliat Med 2024; 27:255-264. [PMID: 37738328 DOI: 10.1089/jpm.2023.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
Background: Acute leukemia is a cancer of the blood and bone marrow with a high symptom burden and a high mortality rate in adults. The quality of end-of-life care among this patient population is deemed to be low based on health care administrative data, though the patient experience is not included in this evaluation. Objective: This scoping review aims at exploring and mapping the current research literature on the experience of care among adults with incurable acute leukemia near the end of life. Design: The JBI framework guided our scoping review, and the protocol was prospectively registered in the Open Science Forum. Results: A total of 5661 unique articles were screened for title and abstract, and 44 were selected for full text. After a manual search, five studies published in seven articles were selected for data extraction, including three qualitative and two quantitative studies. Two studies used family caregivers as patient proxies, two studies engaged patients directly, whereas one study obtained data from patients and family caregivers. Patient care in acute settings was reported in all studies, with most patients dying in acute care settings. Patients and family caregivers often valued an open and honest approach, with sufficient time for dialogue with their providers. Discussions about prognosis, palliative care, and hospice care were often late or incomplete. The medicalization of end-of-life care, including intensive care unit admissions and invasive medical procedures, were viewed as the norm by some providers, though perceived as distressing for both patients and their loved ones. Conclusions: Adults with acute leukemia face significant challenges in accessing high-quality end-of-life care brought about by the complex nature of their disease and its treatment. A systematic exploration of the end-of-life experience among these patients through direct patient engagement or by way of patient reporting proxies is needed.
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Affiliation(s)
- Argin Malakian
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | - Gary Rodin
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, University Health Network (UHN), Toronto, Ontario, Canada
| | - Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Lifespan Program, ICES, Toronto, Ontario, Canada
| | - Ridwaanah Ali
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angela E Mahendiran
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | - Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
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3
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Button E, Cardona M, Huntley K, Gavin NC, LeBlanc TW, Olsen A, Smith M, Yates P. Clinicians' Understanding of Preferences and Values of People with Hematological Malignancies at the End of Life: Concurrent Surveys. J Palliat Med 2022; 25:1386-1397. [PMID: 35443803 DOI: 10.1089/jpm.2021.0490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: People with hematological malignancies can deteriorate rapidly to a terminal event and have variable levels of engagement when transitioning to palliative and end-of-life care. Objectives: To describe end-of-life care values and preferences of people with hematological malignancies and explore whether these align with hematology clinicians' perceptions. Design: Two matched anonymous quantitative cross-sectional surveys explored: (1) patients' values and preferences around manner and timing of discussions regarding life expectancy and prognosis, involvement in decision making, and concurrent integration of palliative care with active treatment; and (2) clinicians' perceptions of their patients' values and preferences in relation to prognostic information. Settings/Participants: Concurrent online national surveys of people with hematological malignancies known to the Leukemia Foundation of Australia, and clinicians in Australia with membership to the Hematology Society of Australia and New Zealand. Results: Five hundred nine (38% response rate) patients (median age 64 [min 20, max 89, interquartile range 56-70]) and 272 clinicians (21% response rate) responded to the survey. If their health was deteriorating, most patients wanted honest prognostic and life expectancy information (87%); welcomed involvement in decision making (94%); felt they would be comfortable talking to the treating team about the possibility of death (86%); and would be comfortable seeing someone from a specialist palliative care team (74%). Clinicians generally underestimated most of these responses. Conclusion: Although our findings indicate that most people believe they would be comfortable discussing prognosis, life expectancy, and wishes at the end of life, clinicians were largely unaware of their preferences. This highlights the need to embed values clarification in routine care for each patient and family.
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Affiliation(s)
- Elise Button
- Cancer and Palliative Outcomes Center, Center for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Kathryn Huntley
- Leukemia Foundation of Australia, Windsor, Queensland, Australia
| | - Nicole C Gavin
- Cancer and Palliative Outcomes Center, Center for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Thomas W LeBlanc
- Division of Hematological Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, North Carolina, USA
| | - Avalon Olsen
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Michael Smith
- Cancer and Palliative Outcomes Center, Center for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Patsy Yates
- Cancer and Palliative Outcomes Center, Center for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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4
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Salazar MM, DeCook LJ, Butterfield RJ, Zhang N, Sen A, Wu KL, Vanness DJ, Khera N. End-of-Life Care in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation. J Palliat Med 2021; 25:97-105. [PMID: 34705545 DOI: 10.1089/jpm.2021.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients receiving allogeneic hematopoietic cell transplantation (HCT) have high morbidity and mortality risk, but literature is limited on factors associated with end-of-life (EOL) care intensity. Objectives: Describe EOL care in patients after allogeneic HCT and examine association of patient and clinical characteristics with intense EOL care. Design: Retrospective chart review. Setting/Subjects: A total of 113 patients who received allogeneic HCT at Mayo Clinic Arizona between 2013 and 2017 and died before November 2019. Measurements: A composite EOL care intensity measure included five markers: (1) no hospice enrollment, (2) intensive care unit (ICU) stay in the last month, (3) hospitalization >14 days in last month, (4) chemotherapy use in the last two weeks, and (5) cardiopulmonary resuscitation, hemodialysis, or mechanical ventilation in the last week of life. Multivariable logistic regression modeling assessed associations of having ≥1 intensity marker with sociodemographic and disease characteristics, palliative care consultation, and advance directive documentation. Results: Seventy-six percent of patients in our cohort had ≥1 intensity marker, with 43% receiving ICU care in the last month of life. Median hospital stay in the last month of life was 15 days. Sixty-five percent of patients died in hospice; median enrollment was 4 days. Patients with higher education were less likely to have ≥1 intensity marker (odds ratio 0.28, p = 0.02). Patients who died >100 days after HCT were less likely to have ≥1 intensity marker than patients who died ≤100 days of HCT (p = 0.04). Conclusions: Death within 100 days of HCT and lower educational attainment were associated with higher likelihood of intense EOL care.
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Affiliation(s)
- Marisa M Salazar
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Science and Medicine, Scottsdale, Arizona, USA
| | - Lori J DeCook
- Division of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Nan Zhang
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ayan Sen
- Department of Critical Care Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Kelly L Wu
- Division of General Internal Medicine, Center for Palliative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - David J Vanness
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Nandita Khera
- Division of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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5
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Wu J, Li P. Detection of short stature homeobox 2 and RAS-associated domain family 1 subtype A DNA methylation in interventional pulmonology. World J Clin Cases 2021; 9:5391-5397. [PMID: 34307592 PMCID: PMC8281403 DOI: 10.12998/wjcc.v9.i20.5391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/07/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
One of the most important aspects of interventional pulmonology is to obtain tissue or liquid samples of the chest to diagnose a respiratory disease; however, it is still possible to obtain insufficient tissue or cytologic specimens. Indeed, methylation detection is an effective method by which to establish a diagnosis. This review focuses on the clinical application of short stature homeobox 2 and RAS-associated domain family 1 subtype A DNA methylation detection in interventional pulmonology, including bronchoscopic fluid biopsy, transbronchial needle aspiration, and pleural effusion.
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Affiliation(s)
- Jian Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Peng Li
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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6
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Sun G, Dong Y, Sun C, Yao H, Lin Z. Vital Role of Glutamate Dehydrogenase Gene in Ammonia Detoxification and the Association Between its SNPs and Ammonia Tolerance in Sinonovacula constricta. Front Physiol 2021; 12:664804. [PMID: 34025453 PMCID: PMC8131826 DOI: 10.3389/fphys.2021.664804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
Increasing evidence has revealed accumulated ammonia will cause adverse effects on the growth, reproduction, and survival of aquatic animals. As a marine benthic mollusk, the razor clam Sinonovacula constricta shows better growth and survival under high ammonia nitrogen environment. However, little is known about its adaptation mechanisms to high ammonia stress in an integrated mariculture system. In this study, we analyzed the association between the polymorphism of glutamate dehydrogenase gene (GDH), a key gene involved in ammonia nitrogen detoxification, and ammonia tolerance. The results showed that 26 and 22 single-nucleotide polymorphisms (SNPs) of GDH in S. constricta (denoted as Sc-GDH) were identified from two geographical populations, respectively. Among them, two SNPs (c.323T > C and c.620C > T) exhibited a significant and strong association with ammonia tolerance, suggesting that Sc-GDH gene could serve as a potential genetic marker for molecular marker–assisted selection to increase survival rate and production of S. constricta. To observe the histological morphology and explore the histocellular localization of Sc-GDH, by paraffin section and hematoxylin–eosin staining, the gills were divided into gill filament (contains columnar and flattened cells) and gill cilia, whereas hepatopancreas was made up of individual hepatocytes. The results of immunohistochemistry indicated that the columnar cells of gill filaments and the endothelial cells of hepatocytes were the major sites for Sc-GDH secretion. Under ammonia stress (180 mg/L), the expression levels of Sc-GDH were extremely significantly downregulated at 24, 48, 72, and 96 h (P < 0.01) after RNA interference. Thus, we can speculate that Sc-GDH gene may play an important role in the defense process against ammonia stress. Overall, these findings laid a foundation for further research on the adaptive mechanisms to ammonia–nitrogen tolerance for S. constricta.
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Affiliation(s)
- Gaigai Sun
- College of Fisheries, Henan Normal University, Xinxiang, China
| | - Yinghui Dong
- Ninghai Institute of Mariculture Breeding and Seed Industry, Zhejiang Wanli University, Ninghai, China.,Key Laboratory of Aquatic Germplasm Resources of Zhejiang, College of Biological and Environmental Sciences, Zhejiang Wanli University, Ningbo, China
| | - Changsen Sun
- Ninghai Institute of Mariculture Breeding and Seed Industry, Zhejiang Wanli University, Ninghai, China
| | - Hanhan Yao
- Key Laboratory of Aquatic Germplasm Resources of Zhejiang, College of Biological and Environmental Sciences, Zhejiang Wanli University, Ningbo, China
| | - Zhihua Lin
- Ninghai Institute of Mariculture Breeding and Seed Industry, Zhejiang Wanli University, Ninghai, China.,Key Laboratory of Aquatic Germplasm Resources of Zhejiang, College of Biological and Environmental Sciences, Zhejiang Wanli University, Ningbo, China
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7
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Moreno-Alonso D, Porta-Sales J, Monforte-Royo C, Trelis-Navarro J, Sureda-Balarí A, Fernández De Sevilla-Ribosa A. Palliative care in patients with haematological neoplasms: An integrative systematic review. Palliat Med 2018; 32:79-105. [PMID: 29130387 DOI: 10.1177/0269216317735246] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative care was originally intended for patients with non-haematological neoplasms and relatively few studies have assessed palliative care in patients with haematological malignancies. AIM To assess palliative care interventions in managing haematological malignancies patients treated by onco-haematology departments. DESIGN Integrative systematic review with data extraction and narrative synthesis (PROSPERO #: CRD42016036240). DATA SOURCES PubMed, CINAHL, Cochrane, Scopus and Web-of-Science were searched for articles published through 30 June 2015. Study inclusion criteria were as follows: (1) published in English or Spanish and (2) containing data on palliative care interventions in adults with haematological malignancies. RESULTS The search yielded 418 articles; 99 met the inclusion criteria. Six themes were identified: (1) end-of-life care, (2) the relationship between onco-haematology and palliative care departments and referral characteristics, (3) clinical characteristics, (4) experience of patients/families, (5) home care and (6) other themes grouped together as 'miscellany'. Our findings indicate that palliative care is often limited to the end-of-life phase, with late referral to palliative care. The symptom burden in haematological malignancies patients is more than the burden in non-haematological neoplasms patients. Patients and families are generally satisfied with palliative care. Home care is seldom used. Tools to predict survival in this patient population are lacking. CONCLUSION Despite a growing interest in palliative care for haematological malignancies patients, the evidence base needs to be strengthened to expand our knowledge about palliative care in this patient group. The results of this review support the need to develop closer cooperation and communication between the palliative care and onco-haematology departments to improve patient care.
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Affiliation(s)
- Deborah Moreno-Alonso
- 1 Palliative Care Service, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Porta-Sales
- 1 Palliative Care Service, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Monforte-Royo
- 2 Nursing, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Jordi Trelis-Navarro
- 1 Palliative Care Service, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Sureda-Balarí
- 3 Clinical Haematology Service, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
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8
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Virdun C, Luckett T, Lorenz K, Davidson PM, Phillips J. Dying in the hospital setting: A meta-synthesis identifying the elements of end-of-life care that patients and their families describe as being important. Palliat Med 2017; 31:587-601. [PMID: 27932631 DOI: 10.1177/0269216316673547] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite most expected deaths occurring in hospital, optimal end-of-life care is not available for all in this setting. AIM To gain a richer and deeper understanding of elements of end-of-life care that consumers consider most important within the hospital setting. DESIGN A meta-synthesis. DATA SOURCES A systematic search of Academic Search Complete, AMED, CINAHL, MEDLINE, EMBASE, PsycINFO, PubMed, Google, Google Scholar and CareSearch for qualitative studies published between 1990 and April 2015 reporting statements by consumers regarding important elements of end-of-life hospital care. Study quality was appraised by two independent researchers using an established checklist. A three-stage synthesis approach focusing on consumer quotes, rather than primary author themes, was adopted for this review. RESULTS Of 1922 articles, 16 met the inclusion criteria providing patient and family data for analysis. Synthesis yielded 7 patient and 10 family themes including 6 common themes: (1) expert care, (2) effective communication and shared decision-making, (3) respectful and compassionate care, (4) adequate environment for care, (5) family involvement and (6) financial affairs. Maintenance of sense of self was the additional patient theme, while the four additional family themes were as follows: (1) maintenance of patient safety, (2) preparation for death, (3) care extending to the family after patient death and (4) enabling patient choice at the end of life. CONCLUSION Consumer narratives help to provide a clearer direction as to what is important for hospital end-of-life care. Systems are needed to enable optimal end-of-life care, in accordance with consumer priorities, and embedded into routine hospital care.
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Affiliation(s)
- Claudia Virdun
- 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
| | - Tim Luckett
- 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
| | - Karl Lorenz
- 2 Center for Innovation to Implementation, VA Palo Alto Health Care System, USA
- 3 The RAND Corporation, USA
- 8 Stanford School of Medicine, USA
| | - Patricia M Davidson
- 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
- 4 School of Nursing, Johns Hopkins University (JHU), Baltimore, MD, USA
- 5 St. Vincent's Hospital, Sydney, NSW, Australia
| | - Jane Phillips
- 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
- 2 Center for Innovation to Implementation, VA Palo Alto Health Care System, USA
- 6 School of Nursing, Sydney, The University of Notre Dame Australia, Sydney, NSW, Australia
- 7 Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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9
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Hall A, Lynagh M, Carey M, Sanson-Fisher R, Mansfield E. Who are the support persons of haematological cancer survivors and how is their performance perceived? Psychooncology 2017; 26:2201-2207. [DOI: 10.1002/pon.4449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 04/10/2017] [Accepted: 04/27/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Alix Hall
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; New Lambton Heights NSW Australia
| | - Marita Lynagh
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; New Lambton Heights NSW Australia
| | - Mariko Carey
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; New Lambton Heights NSW Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; New Lambton Heights NSW Australia
| | - Elise Mansfield
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; New Lambton Heights NSW Australia
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10
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LeBlanc TW, Fish LJ, Bloom CT, El-Jawahri A, Davis DM, Locke SC, Steinhauser KE, Pollak KI. Patient experiences of acute myeloid leukemia: A qualitative study about diagnosis, illness understanding, and treatment decision-making. Psychooncology 2016; 26:2063-2068. [DOI: 10.1002/pon.4309] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/24/2016] [Accepted: 11/11/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas W. LeBlanc
- Duke Cancer Institute; Durham NC USA
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine; Duke University School of Medicine; Durham NC USA
| | | | | | | | | | | | - Karen E. Steinhauser
- Division of General Internal Medicine, Department of Medicine; Duke University School of Medicine; Durham NC USA
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11
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Evaluation of care for leukemia and lymphoma patients during their last hospitalization from the perspective of the bereaved family. Leuk Res 2016; 47:93-9. [DOI: 10.1016/j.leukres.2016.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/03/2016] [Accepted: 05/21/2016] [Indexed: 11/17/2022]
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12
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Hung YT, Huang CY, Chang CM, Lee CC. The Association of Hematological Malignancy and End-of-Life Expenditure in Cancer Decedents: A Population-Based Study in an Asian Country. Medicine (Baltimore) 2015; 94:e1036. [PMID: 26131810 PMCID: PMC4504639 DOI: 10.1097/md.0000000000001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Within the overall National Health Insurance (NHI) budget in Taiwan, there has been a remarkable increase in expenditure for cancer patients. This study was designed to explore whether hematological malignancy is associated with higher end-of-life (EOL) medical expenditure in their last 6 months of life.We used data from the Taiwan NHI Research Database to do a retrospective cohort and population-based study. There were 42,754 cancer patients enrolled in order to study the determinants of medical expenditure for EOL care from 2009 to 2011.The mean medical expenditure for EOL care for cancer patients in the last 6 months of life was $12,965 ± 10,959 (mean ± standard deviation ) (all costs are given in US dollars). Patients with acute leukemia and lymphoma had an additional cost of $16,934 and $7840 than those with nonhematological malignancy (P < 0.001). Medical expenditures for cancer patients with a hematological malignancy and postdiagnosis survival of >6 months, between 6 and 12 months, and >12 months all showed that acute leukemia and lymphoma accounted for more medical expenditure than did others (P < 0.001). The primary physician's specialty between acute leukemia, lymphoma, and nonhematological malignancy patients had statistically difference.The medical expenditure of cancer patients in acute leukemia and lymphoma was more than nonhematological malignancy. Treatment strategies for acute leukemia should be studied further in order to save the health care budget.
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Affiliation(s)
- Yeh-Ting Hung
- From the Department of Pediatrics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan (Y-TH); Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan (C-YH); Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan (C-CL); Center for Clinical Epidemiology and Biostatistics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan (C-CL); School of Medicine, Tzu Chi University, Hualian, Taiwan (Y-TH, C-MC, C-CL); Community Medicine Research Center and the Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (C-CL); and Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan (C-MC)
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13
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Uceda-Torres ME, Rodríguez-Rodríguez JN, Alvarado-Gómez F, Sánchez-Ramos JL, McGrath P. Informal Caregivers of Palliative Oncohematologic Patients. Am J Hosp Palliat Care 2015; 33:691-702. [DOI: 10.1177/1049909115582007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Informal caregivers are crucial members of the teams that care for palliative patients with cancer, including those with oncohematological malignancies. Publications concerning specific aspects of this latter group of carers are limited. This literature review indicates that palliative oncohematologic patients’ caregivers do not differ from those of patients with solid tumors in ethical and related problems. However, there are specific problems for the former group with regard to negotiating the curative system, which are experienced as distressing, often without support from the health system and without offers of the possibility of being referred to palliative teams that they would have valued as very positive. Although this tendency seems to be changing, there is still considerable work to be done to improve the role of these carers.
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Affiliation(s)
| | | | | | | | - Pam McGrath
- Centre for Community Science, Population & Social Health Program, Griffith Health Institute, Griffith University, Queensland, Australia
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14
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Manitta VJ, Philip JA, Cole-Sinclair MF. Palliative Care and the Hemato-Oncological Patient: Can We Live Together? A Review of the Literature. J Palliat Med 2010; 13:1021-5. [DOI: 10.1089/jpm.2009.0267] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vanessa J. Manitta
- Palliative Care Service, St Vincent's Hospital, Melbourne, Victoria, Australia
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15
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Patients' and Families' Experience of Their Relationship With Professional Healthcare Providers in Hospital End-of-Life Care. J Hosp Palliat Nurs 2010. [DOI: 10.1097/njh.0b013e3181d4c20b] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sands R, Manning JC, Vyas H, Rashid A. Characteristics of deaths in paediatric intensive care: a 10-year study. Nurs Crit Care 2009; 14:235-40. [PMID: 19706074 DOI: 10.1111/j.1478-5153.2009.00348.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the patient mortality over a 10-year period in a paediatric intensive care unit (PICU) including patient demographics, length of stay, cause and mode of death and to compare these findings with pre-existing literature from the western world. DESIGN A retrospective chart review. SETTING A UK tertiary PICU. PATIENTS All children who died in the PICU over a 10-year period between 1 November 1997 and 31 October 2007 (n = 204). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data recorded for each patient included patient demographics, length of stay and cause of death according to the International Classification of Disease-10 classification, and mode of death. Mode of death was assigned for each patient by placement in one of four categories: (i) brain death (BD), (ii) managed withdrawal of life-sustaining medical therapy (MWLSMT), (iii) failed cardiopulmonary resuscitation (CPR) and (iv) limitation of treatment (LT). Over the study period, findings showed a median length of stay of 2 days (IQR 0-5 days), with a mortality rate of 5%. The most common mode of death was MWLSMT (n = 112, 54.9%) and this was consistent across the 10-year period. Linear regression analysis demonstrated no significant change in trend over the 10 years in each of the modes of death; BD (p = 0.84), MWLSMT (p = 0.88), CPR (p = 0.35) and LT (p = 0.67). CONCLUSION End-of-life care is an important facet of paediatric intensive nursing/medicine. Ten years on from the Royal College of Paediatrics and Child Health publication 'Withholding or withdrawing life sustaining treatment in children: A framework for practice', this study found managed withdrawal of MWLSMT to be the most commonly practised mode of death in a tertiary PICU, and this was consistent over the study period.
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Affiliation(s)
- Rebecca Sands
- MRCPCH, Paediatric Specialist Registrar, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Derby Road, Nottingham, UK
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Grundy M, Ghazi F. Research priorities in haemato-oncology nursing: Results of a literature review and a Delphi study. Eur J Oncol Nurs 2009; 13:235-49. [DOI: 10.1016/j.ejon.2009.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 03/05/2009] [Accepted: 03/11/2009] [Indexed: 11/24/2022]
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18
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Cooke L, Gemmill R, Kravits K, Grant M. Psychological issues of stem cell transplant. Semin Oncol Nurs 2009; 25:139-50. [PMID: 19411017 DOI: 10.1016/j.soncn.2009.03.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To address the psychological impact of transplant on quality of life, including physical, psychological, social, and spiritual, for the patient and caregiver, and to discuss the nurse's "emotional labor of caring" and "compassion fatigue" for such an intense vulnerable population. DATA SOURCES Psychological transplant studies, peer review journals, and textbooks. CONCLUSION The psychological impact after the experience of transplant can leave an indelible impression on the patient, caregiver, and nurse. IMPLICATIONS FOR NURSING PRACTICE Suggestions are made for assessment and management of various potential psychological issues for the three mentioned populations. With these issues being better understood, nurses can actively lessen psychological morbidity.
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Affiliation(s)
- Liz Cooke
- Department of Nursing Research, City of Hope Medical Center, Duarte, CA 91010, USA.
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19
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Spichiger E. Family experiences of hospital end-of-life care in Switzerland: An interpretive phenomenological study. Int J Palliat Nurs 2009; 15:332-7. [DOI: 10.12968/ijpn.2009.15.7.43423] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elisabeth Spichiger
- Institute of Nursing Science, University of Basel, Switzerland
- Inselspital Bern University Hospital, Bern, Switzerland
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20
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Delgado-Guay MO, Parsons HA, Li Z, Palmer LJ, Bruera E. Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team. Cancer 2008; 115:437-45. [DOI: 10.1002/cncr.24017] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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21
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Allen S, Chapman Y, O'Connor M, Francis K. Discourses associated with nursing aged people who are dying in the Australian context: a review of the literature. Int Nurs Rev 2008; 55:349-54. [DOI: 10.1111/j.1466-7657.2008.00628.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Spichiger E. Living with terminal illness: patient and family experiences of hospital end-of-life care. Int J Palliat Nurs 2008; 14:220-8. [DOI: 10.12968/ijpn.2008.14.5.29489] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elisabeth Spichiger
- Institute of Nursing Science, University Basel, Switzerland and Scientific Collaborator in Nursing, Head Office of Nursing and Allied Health Professionals, Inselspital University Hospital, Bern, Switzerland
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23
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24
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Fadul N, Elsayem A, Palmer JL, Zhang T, Braiteh F, Bruera E. Predictors of Access to Palliative Care Services among Patients Who Died at a Comprehensive Cancer Center. J Palliat Med 2007; 10:1146-52. [DOI: 10.1089/jpm.2006.0259] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Nada Fadul
- Department of Palliative Care and Rehabilitation Medicine, Section of Symptom Control and Palliative Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Ahmed Elsayem
- Department of Palliative Care and Rehabilitation Medicine, Section of Symptom Control and Palliative Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - J. Lynn Palmer
- Department of Palliative Care and Rehabilitation Medicine, Section of Symptom Control and Palliative Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Tao Zhang
- Department of Palliative Care and Rehabilitation Medicine, Section of Symptom Control and Palliative Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Fadi Braiteh
- Department of Palliative Care and Rehabilitation Medicine, Section of Symptom Control and Palliative Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, Section of Symptom Control and Palliative Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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25
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McGrath PD, Holewa HA. Description of an Australian model for end-of-life care in patients with hematologic malignancies. Oncol Nurs Forum 2007; 34:79-85. [PMID: 17562635 DOI: 10.1188/07.onf.79-85] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To present a model for end-of-life care in adult hematology that has been developed from nursing insights. DATA SOURCES Insights obtained from 25 nursing interviews during a two-year, qualitative, Australian National Health and Medical Research Council research study. DATA SYNTHESIS The nursing insights indicate that an understanding of end-of-life care in hematology needs to be set in a trilogy of overlapping models (labeled functional, evolving, and refractory) that address the complexity of issues associated with professional and hospital culture. CONCLUSIONS The authors have used the findings of their national research study to develop a useful, working model to assist with the integration of palliative care into adult hematology. IMPLICATIONS FOR NURSING The model develops a new language for understanding and fostering the integration of palliative care and hematology.
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Affiliation(s)
- Pam D McGrath
- School of Nursing and Health, Central Queensland University, Brisbane, Australia.
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26
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McGrath P, Holewa H. Special considerations for haematology patients in relation to end-of-life care: Australian findings. Eur J Cancer Care (Engl) 2007; 16:164-71. [PMID: 17371426 DOI: 10.1111/j.1365-2354.2006.00745.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recent hematology clinical guidelines recommend that palliative care specialists should have central roles in hemato-oncology teams. However, the available research evidence indicates there are presently significant obstacles to the integration of palliative care in hematology. The following discussion presents findings from an Australian study designed to address the problems associated with lack of referral of hematology patients to the palliative system through the development of a best-practice model for end-of-life care for these diagnostic groups. The preliminary step in the development of such a model is to document the factors that denote the special characteristics of the end-of-life stage of hematological conditions and their treatments. This article presents the list of special considerations from a nursing perspective, including issues associated with the high-tech nature of treatments, the speed of change to a terminal event, the need for blood products and possibility of catastrophic bleeds, the therapeutic optimism based on a myriad of treatment options and the clinical indices of the terminal trajectory. The nursing insights provide an important foundation for building a practical, patient-centred model for terminal care in hematology.
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Affiliation(s)
- P McGrath
- Central Queensland University - International Program for Psycho-Social Health Research, Brisbane, Queensland, Australia.
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27
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McGrath P, Holewa H. Missed opportunities: nursing insights on end-of-life care for haematology patients. Int J Nurs Pract 2006; 12:295-301. [PMID: 16942518 DOI: 10.1111/j.1440-172x.2006.00585.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is now extensive consumer research to indicate that patients with haematological malignancies are not receiving appropriate or timely referrals to the palliative system. This paper begins to explore the issue from the professional perspective by presenting findings from haematology nurses on their experience with terminal care. The nursing insights have been gathered through open-ended interviews with a national sample of nurses with extensive experience in haematology in both public and private hospitals throughout Australia. The findings resonate with the previous consumer research in that all the acute care nurses affirmed that it is their belief, based on their professional experience, that patients from these diagnostic groups typically die in the acute ward dealing with escalating technology and invasive treatments. For some, the statements could be qualified by the satisfaction that they worked in a haematology unit, aware of the death-denying issues, trying to address the problem. Others, caught in a 'refractory' subculture (i.e. a subculture with a negative perception of palliative care), outlined the factors driving the lack of integration for their specific hospital. The focus of the discussion of findings is on the latter.
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Affiliation(s)
- Pam McGrath
- NH&MRC Senior Research Fellow, International Program for Psycho-Social Health Research, Central Queensland University, Brisbane, Queensland, Australia.
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28
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Andershed B. Relatives in end-of-life care--part 1: a systematic review of the literature the five last years, January 1999-February 2004. J Clin Nurs 2006; 15:1158-69. [PMID: 16911057 DOI: 10.1111/j.1365-2702.2006.01473.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To review systematically research conducted during the past five years focusing on the relatives' situation and needs in end-of-life care. BACKGROUND AND AIM That relatives make a large contribution in the care of the dying is well-known. In this situation, relatives often have to solve many new practical problems in the care as well as dealing with the sorrow of both themselves and the dying person. In recent years, palliative care has been developed in many countries and many new studies have been carried out. METHODS A systematic search of the literature was performed in the CINAHL and Medline databases. Of the 94 papers analysed, there were 59 qualitative and 35 quantitative studies with differing designs. The studies were carried out in 11 countries and were published in 34 different journals. RESULTS The results were categorized in two main themes with several subthemes: (1) being a close relative--the situation: (i) exposed position--new responsibility, (ii) balance between burden and capacity and (iii) positive values; (2) being a close relative--needs: (i) good patient care, (ii) being present, (iii) knowing and communicating and (iv) support from and trusting relationship with the professional. The relative's feelings of security and trust in the professional were found to be of great importance. CONCLUSION More than twice as many studies had a descriptive/explorative design, which is of importance in the assessment of evidence. However, different studies complement one another and in summary, it can be said that analytic evidence is unequivocal: good patient care, communication, information and the attitude of the professional are of decisive importance regarding relatives' situation. These results are also in accord with earlier review studies. RELEVANCE TO CLINICAL PRACTICE Staff members have a great deal of responsibility for assuring that the patient feels as good as possible, facilitating relatives' involvement based on the family's wishes and limiting the stress and difficulties experienced by the family. The results showed that the relative's satisfaction could depend on the attitude of the professional as well as on good communication, good listening and good information. This can also be viewed as a prerequisite for the professional to get to know the family and to provide 'care in the light'.
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Affiliation(s)
- Birgitta Andershed
- Department of Caring Sciences, Orebro University, Orebro and Ersta Sköndal University College, Stockholm, Sweden.
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29
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Abstract
It will be shown, through the presentation of recent research findings, that haematology is a neglected area in terms of sensitive care of the dying. The Australian evidence indicates that scant progress has been made in relation to even the most basic palliative care practices such as sensitive, honest information giving or appropriate referral to the palliative system. Rather, the data show that during terminal trajectory, patients from these diagnostic groups and their families remain trapped in processes within the high-tech, curative system that are not responsive to the needs of the dying.
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Affiliation(s)
- Pam McGrath
- School of History, Philosophy, Religion and Classics, University of Queensland, St. Lucia Q 4072, Australia.
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Knuti KA, Amrein PC, Chabner BA, Lynch TJ, Penson RT. Faith, identity, and leukemia: when blood products are not an option. Oncologist 2002; 7:371-80. [PMID: 12185299 DOI: 10.1634/theoncologist.7-4-371] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital, founded the Kenneth B. Schwartz Center. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and sustenance to the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers and gain insight and support from fellow staff members. When a competent adult patient refuses lifesaving treatment for religious or personal reasons, caregivers have a legal obligation to respect this decision. A patient's refusal of treatment adds particular challenges to the delivery of compassionate care. The case of a 50-year-old Jehovah's Witness with acute myelocytic leukemia who declined blood product support is presented. Respecting her religious beliefs during chemotherapy required balancing risk and benefit, watching her suffer while unable to intervene with what the staff saw as simple treatment, and eventually undertaking a complicated grief process. Jehovah's Witness beliefs regarding blood products are reviewed. Caregiver roles and responsibilities are discussed in the context of psychosocial, legal, familial, and ethical issues.
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Affiliation(s)
- Kristine A Knuti
- Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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