Literature Review

Telehealth palliative care helps people living with advanced cancer Cancer Health; by Liz Highleyman; 9/9/24 Virtual palliative care can be as effective as in-person care, according to a recent study. Oncology palliative care is intended to relieve symptoms and improve quality of life. It is not the same as hospice care, and it can help people at any stage of cancer. National guidelines recommend integrating palliative care from the time of diagnosis for people with advanced cancer, but it is underutilized in part due to a shortage of trained providers. This study included 1,250 adults at 22 U.S. cancer centers who were diagnosed with advanced non-small-cell lung cancer. They had palliative care sessions every four weeks conducted either via video or in person. After six months, quality-of-life scores were equivalent in the two groups. They also did not differ significantly in terms of depression or anxiety, coping skills, understanding treatment goals or perception of their prognosis.

Long-term dementia risk in Parkinson DiseaseNeurology; Julia Gallagher, Caroline Gochanour, Chelsea Caspell-Garcia, Roseanne D Dobkin, Dag Aarsland, Roy N Alcalay, Matthew J Barrett, Lana Chahine, Alice S Chen-Plotkin, Christopher S Coffey, Nabila Dahodwala, Jamie L Eberling, Alberto J Espay, James B Leverenz, Irene Litvan, Eugenia Mamikonyan, James Morley, Irene H Richard, Liana Rosenthal, Andrew D Siderowf, Tatyana Simuni, Michele K York, Allison W Willis, Sharon X Xie, Daniel Weintraub, Parkinson's Progression Markers Initiative; 9/24It is widely cited that dementia occurs in up to 80% of patients with Parkinson disease (PD), but studies reporting such high rates were published over two decades ago, had relatively small samples, and had other limitations. We aimed to determine long-term dementia risk in PD using data from two large, ongoing, prospective, observational studies. Participants from the Parkinson's Progression Markers Initiative (PPMI), a multisite international study, and a long-standing PD research cohort at the University of Pennsylvania (Penn), a single site study at a tertiary movement disorders center, were recruited. Results from two large, prospective studies suggest that dementia in PD occurs less frequently, or later in the disease course, than previous research studies have reported.

Respiratory patients less likely to get palliative care Hospice News; by Jim Parker; 9/3/24 Patients with some respiratory conditions often do not receive outpatient palliative care and have relatively higher rates of intensive care admissions than those with other illnesses. This includes patients with lung cancer, chronic obstructive pulmonary disease (COPD) and a condition called idiopathic pulmonary fibrosis (IPF), according to a recent study published in the pulmonology journal CHEST. These patients tend to have high symptom burden, diminished quality of life and aggressive health care utilization at the end of life, the study found.

New ASCO Guidelines stress importance of early palliative care Hospice News; by Jim Parker; 8/26/24 The 2024 update to the American Society of Clinical Oncology’s (ASCO) clinical practice guidelines place renewed emphasis on palliative care. The guidelines are updated periodically by a multidisciplinary team, including a patient representative and experts in medical and radiation oncology, hematology and palliative care. For the 2024 revisions, this panel reviewed 52 randomized controlled trials that evaluated outcomes among cancer patients who received palliative care, ASCO reported. “This is a pivotal time,” the panel’s co-chair Betty Ferrell of City of Hope Cancer Care told the ASCO Post. “This guideline is a call to action for everyone to think about how they are integrating palliative care for all patients with cancer. There are great advances in cancer care, but none of these will be fully effective unless we fully integrate palliative care.”

Hospice student volunteers gain insight into dementia Ahwatukee Foothills News; by Lin Sue Flood; 8/23/24 Once a week, graduate nursing student Merle Tamondong pauses her busy college life to visit Micheline Schulte. They color together, play Micheline’s favorite songs and chat in French, her native language. “When I come here, the only time I’m on my phone is when I’m playing some music, which Micheline likes when we are coloring,” Merle said. “I feel very lucky.” Merle is part of Hospice of the Valley’s College Partners Program, an innovative collaboration with Maricopa Community Colleges, Arizona State University and other schools to provide socialization to people living with dementia and a much-needed break to family caregivers. Hospice of the Valley’s dementia and volunteer departments spearheaded this intergenerational program to help inspire careers in dementia care. ... To date, 106 students have been trained and paired with 123 patients since College Partners launched in 2021 with a grant from Community Care Corps. 

Palliative care is a viable option for frail elderly patients with neurocognitive disorders admitted for hip fractures BMC Musculoskeletal Disorders; by Justine Boulet, Etienne L Belzile, Norbert Dion, Chantal Morency, Mélanie Bérubé, Alexandra Tremblay, Stéphane Pelet; 8/10/24 Most patients presenting with a hip fracture regardless of their comorbidities are surgically treated. A growing body of research states that a certain type of elderly patient could benefit more from a palliative approach. ... The presence of [a nuerocognitive disorder] NCD and diminished prefracture autonomy strongly support counseling for palliative care. The high rate of complications when surgery is proposed for frail patients with multiple comorbidities suggests that the concept of palliative surgery needs to be revisited. 

Cognitive impairment in the workplace Alzheimer's Association; email 8/14/24, webpage posted 8/8/24 Due to the aging of the U.S. population, rates of cognitive impairment and dementia in the workplace are on the rise. This creates challenges for employers, many of whom may not know how to best support employees who are experiencing symptoms of cognitive impairment. Conversely, employees may be hesitant to share with their employer the challenges that they’re experiencing. ... Recommendations Regarding Dementia in the Workplace ... [Click on the title's link for this excellent HR information.]

Dr. Oswalt on the effects of palliative care timing on end-of-life care in mNSCLC OncLive, Oncology Specialty Group; by Cameron James Oswalt, MD; 8/15/24 Cameron James Oswalt MD, fellow, Hematology-Oncology, assistant professor, medicine, Department of Medicine, Duke University School of Medicine, discusses findings from a study evaluating the timing of palliative care referral and its effect on end-of-life care outcomes in patients with metastatic non–small cell lung cancer (mNSCLC). ...  Investigators found that fewer than half of patients received palliative care during their treatment course, and fewer than one-third of the patients who received palliative care accessed this care within 2 months of diagnosis, ... The low referral rate in this cohort could be attributed to several factors, including patient preferences, preconceived notions, barriers to referral, and overall disease burden, he says. Among patients who died, 59.1% were enrolled in hospice. 

Commentary: Prognostication in Alzheimer's disease and related dementias Journal of the American Geriatrics Society / Early View; by Natalie C. Ernecoff PhD, MPH, Kathryn L. Wessell MPH, Laura C. Hanson MD, MPH; 8/8/24  ... Hospice provides comfort-oriented care, emphasizing patient-tailored elements of quality of life, including time with family, access to nature, and music. In late-stage ADRD, studies show that a majority of families prioritize comfort-oriented treatment, and understanding prognosis may help them align treatments accordingly. Yet, only 15% of people enrolled in hospice with a primary diagnosis of ADRD. This is due to difficulty estimating 6-month prognosis required for hospice eligibility—ADRD carries a prognosis of 12–18 months in the latest stage. While low rates of live discharges from hospice are a regulatory requirement for hospices, people who are increasingly experiencing ADRD progression lose access to those beneficial hospice services. ...

Center for Hospice Care Heartwize Program brings an individualized approach to cardiac care Great News Life; by Lauren Grasham; 8/12/24 To help patients live peacefully and at ease during one of life’s most vulnerable moments, Center for Hospice Care (CHC) welcomes all with open arms to its HeartWize program. Through the program, the CHC staff develops individualized plans with each patient and their loved ones to help them manage heart failure and other heart diseases, allowing patients to receive quality care in the comfort of their own homes without the worry of a hospital visit. “When their symptoms are not managed promptly, it gets to the point that patients can't breathe. When a patient can't breathe, the very first thing they're going to want to do is go to the hospital,” said Director of Nursing Chrissy Madlem. “It's important that we teach them the techniques to manage these end-of-life care symptoms that they're dealing with so they can stay home and be comfortable with their families.”Editor's Note: The Center for Hospice Care is in Mishawaka, IN.

ETC model is failing to boost home dialysis utilization, nephrologists say McKnights Home Care; by Adam Healy; 8/9/24 Nephrologists are worried that the End-Stage Renal Disease Treatment Choices (ETC) model has not made good on its promise to promote home-based kidney care and advance health equity. The Centers for Medicare & Medicaid Services launched the ETC model in 2021, randomly selecting about 30% of providers treating end-stage renal disease for participation. The model uses financial incentives to encourage greater use of home dialysis treatment and increase kidney transplant access. However, these incentives have not been effective in producing their intended results, according to Amit Kapoor, MD, the chief nephrologist at Strive Health. ... A March study published in JAMA found that the ETC model may unintentionally punish providers who serve high-needs, low-income or minority patients. 

Dr. El-Jawahri on the impact of palliative care on end-of-life care for AML and MDS OncLive; by Areej R. El-Jawahri, MD; 8/12/24 Areej El-Jawahri, MD, associate director, Cancer Outcomes Research and Education Program, director, Bone Marrow Transplant Survivorship Program, associate professor, medicine, Massachusetts General Hospital, discusses findings from a multi-site, randomized trial (NCT03310918) investigating a collaborative palliative oncology care model for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) receiving nonintensive therapy at 2 tertiary care academic hospitals. Patients in the study who received the palliative care interventions had a median of 41 days from end-of-life care discussions to death, compared with 1.5 days in the standard care group (P < .001). Additionally, patients who received the palliative care interventions were more likely to articulate their end-of-life care preferences and have these preferences documented in electronic health records, El-Jawahri begins. This documentation correlated with fewer hospitalizations in the final 30 days of life, she notes. Furthermore, palliative care recipients experienced QOL improvements and a trend toward reduced anxiety symptoms vs the patients who received usual care, El-Jawahri says. These findings underscore the necessity of integrating palliative care as a standard of care for patients with AML and high-risk MDS, El-Jawahri emphasizes.

Psychiatric manifestations of neurological diseases: a narrative reviewCureus Journal of Medical Science; Anthony J. Maristany, Brianna C. Sa, Cameron Murray, Ashwin B. Subramaniam, Sean E. Oldak; 7/24Neurological diseases like Alzheimer's, FTD [frontotemporal dementia], Parkinson's, MS [multiple sclerosis], stroke, epilepsy, Huntington's, ALS [amyotrophic lateral sclerosis], TBI [traumatic brain injury], andMSA [multiple system atrophy] are not only characterized by neurological symptoms but also by various psychiatric manifestations, complicating diagnosis and treatment. For instance, Alzheimer's induces cognitive decline and emotionaldistress, Parkinson's leads to motor impairments and mood disorders, and MS intertwines physicalsymptoms with emotional disturbances. Understanding these complex relationships is crucial forcomprehensive care. Collaboration, innovation, and ethical commitment are essential for improvingoutcomes.