Maintaining physical independence is important to terminally ill patients; rehabilitation can improve both functional status and quality of life (QOL) during palliative care. In this prospective pilot study, we evaluated changes in physical function, symptoms, and QOL among 19 hospitalized patients receiving palliative or terminal care for cancer (7 men and 12 women; mean age, 66.8 years, range, 44–84 years). Assessments were performed at admission and after 2 weeks, primarily using the Functional Independence Measure (FIM) and the McGill Quality of Life Questionnaire (MQOL), and a follow-up evaluation was performed 4 weeks after admission if possible. The study was from April to September 2013. In 19 patients, FIM responses were obtained from 17 and 7 patients at 2 and 4 weeks, respectively. MQOL responses were obtained from 11 and 5 patients at 2 and 4 weeks, respectively. A comparison of FIM scores at admission and 2 weeks revealed nonsignificant reductions in the total, motor, and cognitive elements (P = 0.46, 0.70, and 0.20, respectively), which remained nonsignificant at 4 weeks (P = 0.51, 0.65, and 0.27, respectively). There was no significant decline in the total MQOL between admission and 2 and 4 weeks. Although QOL was correlated with physical symptoms, it was not correlated with function. In conclusion, we showed that patient function did not significantly decline and that self-efficacy was maintained with our intervention. A multidisciplinary palliative care approach may reduce symptoms, thereby improving patient QOL. Achieving symptom control is still the mainstay of palliative care.
BACKGROUND: Dyspnea is common in interstitial lung disease (ILD) patients and often refractory to conventional treatment. Little is known regarding the safety of systemic morphine in ILD patients.
OBJECTIVE: The objective of this study is to evaluate the safety of a single subcutaneous morphine injection and to determine the recommended dose of morphine for alleviating dyspnea in ILD patients.
DESIGN: We conducted a dose-escalation Phase I study for investigating the recommended dose of a single subcutaneous morphine injection to alleviate dyspnea in ILD patients.
SETTING/SUBJECTS: Eligible subjects were ILD inpatients with dyspnea at rest who were refractory to conventional dyspnea treatment. The morphine doses used were 1 mg and 2 mg in cohort 1 and cohort 2, respectively. The primary endpoint was dose-limiting toxicity, which was defined as (1) respiratory depression, that is, 30% reduction of respiratory rate and 10 Torr increase of PaCO2 compared with baseline; (2) hypotension, that is, 20% reduction of systemic blood pressure compared with baseline and presentation of hypotension-related symptoms; or (3) grade 3, 4, or 5 treatment-emergent adverse events graded by Common Terminology Criteria for Adverse Events (version 4).
RESULTS: A total of six patients were enrolled, with three patients each in cohorts 1 and 2. No dose-limiting toxicities were observed; three patients experienced worsened somnolence, but no patients experienced sedation.
CONCLUSION: We conclude that 2 mg of morphine has a tolerable safety profile in ILD patients with dyspnea, and can be tested in further clinical trials.
BACKGROUND: Emergency admissions and emergency department visits (EAs/EDVs) have been used as quality indicators of home care in terminally ill cancer patients. We established a cancer transitional care (CTC) program to monitor and manage terminally ill cancer patients receiving care at home. The purpose of this study was to evaluate the effectiveness of CTC by the frequency of EAs/EDVs.
METHODS: In a retrospective chart review, we identified 133 patients with cancer admitted to our department, of whom 56 met study eligibility criteria. The CTC consisted of at least 1 or more following components: (1) a 24-hour hotline for general physicians or home care nurses to reach hospital-based physicians, (2) periodic phone calls from an expert hospital-based oncology nurse to home care medical staff, and (3) reports sent to our department from home care medical staff. The primary outcome variable was the frequency of EAs/EDVs.
RESULTS: There were 32 EAs/EDVs and 69 planned admissions during the observation period. In the last 30 days of life, 16 patients (28.6%) had 1 EA/EDV and none had multiple EAs/EDVs. Compared with previous studies, our study found a similar or lower frequency of EAs/EDVs.
CONCLUSION: Our findings suggest that the implementation of CTC reduces the number of EAs/EDVs by replacing them with planned admissions. Further prospective studies to evaluate CTC are warranted.