Literature Review

Too Much, Too Little, Just Right: Optimizing cancer care for older adults The ASCO Post, American Society of Clinical Oncology; by Ramy Sedhom, MD; Bobby Green, MD; and Julia  Frydman, MD, MS; 9/10/24 Imagine walking into a fancy restaurant only to find a menu consisting mostly of kids’ dishes. It would make no sense. Just 25% of restaurant diners are younger than age 12, and they rarely write Yelp reviews. But when it comes to cancer treatment, this is not very far from what we do. The median age for a new cancer diagnosis is 67, and among those who die of cancer each year, 73% are older adults. Yet just one in four clinical trial participants is aged 70 or older. Consequently, guidelines for most new cancer therapies are based on a median age that is significantly younger than the patient population who actually receives these therapies. That’s quite a conundrum. More than half of patients older than age 65 experience toxicity of grade 3 or worse while undergoing standard chemotherapy. ... Palliative Care—For a 40-year-old mother of two young children, the goal of cancer treatment is usually clear: complete remission and long-term survival. But when you ask older patients with cancer about their priorities, a majority regard symptom control, emotional coping, and other quality-of-life measures at least as much as longevity and sometimes more.

CHCF unveils palliative care mural California Department of Corrections and Rehabilitation (CHCF); by Lt. M. Orozco; 9/9/24 California Health Care Facility (CHCF) staff joined the incarcerated population and outside stakeholders to unveil the palliative care mural Aug. 23. Warden Gena Jones had a vision to normalize CHCF’s environment, making it more appealing for the incarcerated population and staff to enjoy while working. The vision consists of murals being painted throughout the institution with this mural setting the path for many more to come. In April 2024, incarcerated artists Issac Sinsun, Antiono Garcia, Loreto Arizpe, and Francsico Olivares started the palliative care mural. Little did they know it was the start to a new beginning. With the combined efforts of the four artists, the mural took 81 days and about 2,268 hours to complete. The ideas for the artwork were a combined effort from custody and medical staff as well incarcerated population within the housing unit. [Click on the title's link to see photos.]

Blue Ridge Hospice expanding mission to serve people better, sooner The Winchester Star, Winchester, VA; by Brian Brehm; 9/9/24 “We’re calling this a year of transformation,” said Jason Parsons, who was named CEO of the Winchester-based nonprofit in December. “Blue Ridge has been around for 43 years and this year, 2024, we’re transforming ourselves into Blue Ridge Care, which includes Blue Ridge Hospice, Blue Ridge Independence at Home — which is our PACE (Program of All-Inclusive Care for the Elderly) program — Blue Ridge Palliative Care Services and our eight thrift shops.” It’s a sweeping change for an organization that most people only associate with end-of-life care. Parsons ... said Blue Ridge Care will continue to provide graceful exits for patients in the final chapter of their lives, but it will also expand its focus to improve the quality of life for seniors who still have a lot of stories to tell.

Palliative care for dialysis-dependent pediatric patients: A survey of providers, nurses, and caregiversKidney360; Joshua Lipsitz, Mark Stockton Beveridge, Katherine Maddox; 8/24Dialysis-dependent pediatric patients and their families face significant biopsychosocial burdens and low health-related quality of life. Palliative care consultations can alleviate some degree of suffering for patients and families but remain underutilized within pediatric nephrology. 90% of providers and all nurses desired more palliative care education. Of the 22% of caregivers whose child had already received palliative care services, all found the consultation to be helpful. These data support further palliative care education for pediatric nephrology providers and nurses and more robust and systematic involvement of subspecialty palliative care for dialysis-dependent pediatric patients.

American Heart Association affirms importance of palliative care in treating cardiac conditions Hospice News; by Jim Parker; 9/4/24 Multidisciplinary palliative care offers clear benefits to patients with cardiovascular disease, particularly when it comes to medication management and goals-of-care conversations. Palliative care with effective medication management, shared decision making and symptom management can help improve quality of life for heart disease patients, according to a scientific statement from the American Heart Association (AHA) — “Palliative Pharmacotherapy for Cardiovascular Disease.” The statement offers guidance for health care providers to integrate palliative methods as part of holistic medication management at all stages of a patient’s illness, the AHA indicated. This underscores the importance of collaboration between palliative care professionals and other clinical specialties, according to Dr. Andrew Esch, director of palliative care program development at the Center to Advance Palliative Care (CAPC). 

“What I wish I knew about hospice”: A Cleveland Clinic palliative care physician’s insights The Healthy; by Dr. Patricia Varacall, DO; 9/3/24 End-of-life care is deeply personal and incredibly complex. An expert MD shares essential insights on hospice: "At its core, is about human connection." … Laura Hoeksema, MD, MPH, FAAHPM, medical director of Cleveland Clinic Hospice and staff physician in the department of palliative and supportive care, explains the importance of hospice: “Death is a part of life just as much as birth is. When time becomes limited, patients need to be able to spend time in a way that’s meaningful to them.” ... Dr. Hoeksema emphasizes that choosing hospice care is exactly that—a choice. The team offers additional support, guiding patients and their families through the last months of life. ... “When a patient has a serious illness, it’s common for their illness to become the primary focus,” reflects Dr. Hoeksema. The constant anticipation of how the disease might progress can create overwhelming anxiety. With hospice, the illness recedes into the background, allowing the emphasis to be on caring for the person as a whole. ... “The most profound healing I’ve witnessed as a physician has been in patients receiving hospice care,” Dr. Hoeksema adds. She recalls seeing families reconcile after years of tension and others coming together after long periods of distance. The joy on a patient’s face when surrounded by loved ones, laughing and reminiscing, is what it’s all about. “Hospice care, at its core, is about human connection.”

CareXM and Enhabit increase clinician capacity by 250% using virtual visits amid staffing shortages GlobeNewswire; by CareXM; 8/27/24 CareXM ... is proud to announce  some of the exciting results with Enhabit in their quick connect Virtual Visits platform. ... “We saw an increase in clinician capacity, allowing us to do more with less,” says Vice President of Care Management Shelley Baker of Enhabit, which provides care annually to 228,000 patients. “Completing visits virtually, when appropriate, has freed up our clinicians to better manage their schedules so they can be with patients who need hands-on care.” "While virtual visits do not replace the need for in-home visits, they do offer the ability to connect with patients more frequently, supplementing the visits that do need to be in-person,” said Si Luo, CEO at CareXM, “We see a growing need not just for visit utilization but for visit prioritization- let’s save our field nurses for those visits that truly do need to be in-person. ..."

The surprising truth about who opts for palliative care Psychology Today; by Jer Clifton, PhD; 8/23/24 A study of 407 cancer patients says palliative care is a final act of hope. Key points:

Improving post-hospital care of older cancer patients Cancer Health; by University of Colorado Cancer Center and Greg Glasgow; 8/26/24 A few years ago, University of Colorado Cancer Center member and hospitalist Sarguni Singh, MD, began to notice a troubling trend: Older adults with cancer who were leaving the hospital for skilled nursing facilities after treatment were being readmitted to the hospital or having worse outcomes while in rehabilitation. ... Singh knew of an intervention called Assessing and Listening to Individual Goals and Needs (ALIGN) — a palliative care social worker-led protocol aimed at improving quality of life, aligning goals of care, and providing support to patients and caregivers — and she began using it for cancer care. ... The results were overwhelmingly positive, and patients and caregivers told us, ‘This was so helpful,’” says Singh, associate professor of hospital medicine in the CU School of Medicine.

[Ireland] Does a palliative medicine service reduce hospital length of stay and costs in adults with a life-limiting illness?-a difference-in-differences evaluation of service expansion in IrelandAnnals of Palliative Medicine; by Soraya Matthews, Eimir Hurley, Bridget M Johnston, Pauline Kane, Karen Ryan, Eoin Tiernan, Charles Normand, Peter May; 7/24People approaching end of life account disproportionately for health care costs, and the majority of these costs accrue in hospitals. The economic evidence base to improve value of care to this population is thin. Our primary analytic sample included 4,314 observations, of whom 608 (14%) received timely palliative care. We estimated that the intervention reduced LOS [length of stay] by nearly two days, with an estimated associated saving per admission of €1,820.

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. 

Bridgeway Hospice’s new nonprofit ensures access to care Hays Free Press, Buda, TX; by Megan Navarro; 8/21/24 To ensure that members of the community have ease of access to the care that they need, a new nonprofit has been established out of a local hospice service in Buda: Bridgeway To Care Foundation. “We’ve had the hospice for three years — Bridgeway Hospice — and then we have our home health, which is Be Healthy At Home; we established that in 2008. We just saw a certain number of clients that are going without care or kind of falling in between either Medicare age or not being able to utilize their hospice benefit, whether because they’re [younger] than 65 or they’re continuing to seek treatment, such as chemotherapy,” said Brandis Wilmore, president of Bridgeway Hospice. 

Bereaved parent preferences on quality end-of-life care for children with cancer in the South Cancer - American Cancer Society; by Isaac Martinez BA, Erin Currie PhD, RN, Elizabeth S. Davis MS, Rohail Kumar MD, Valerie Lawhon MS, ALC, NCC, Jennifer M. Snaman MD, Raba B. Tefera BA, Smita Bhatia MD, MPH, Abby R. Rosenberg MD, MS, MA, Emily E. Johnston MD, MS; 8/18/24 The authors sought to understand bereaved family preferences for end-of-life (EOL) care, particularly among Black families and those in the South. ... Family decision-making involved maintaining hope, not causing harm, doing what was best for their child and themselves, and religious beliefs. There was no clear preference for home versus hospital death (3.0 [1.8–4.0]). Instead, parents considered their child’s desires and/or medical needs, siblings, and prior experiences with death. To have a comfortable death, parents highlighted the need for comprehensive education about their child’s EOL, a caring and comfortable environment, and 24/7 access to their care team. Families expressed a dual preference for comfort care ... and chemotherapy ... at EOL.