The Association of Symptom Severity and Functional Status Among Patients Who Received Palliative Consults (Sch476)

1. Describe the association of functional status and symptom severity for 10 common symptoms among patients who receive palliative care consultation. 2. Consider the interaction of functional status and different symptoms when managing symptoms of patients who receive palliative care consultations. The interaction of functional status and individual symptoms has never been comprehensively investigated in palliative care (PC) populations. Therefore, we studied the relationship between the Karnofsky Performance Status (KPS) and the prevalence and severity of 10 common symptoms among hospitalized patients at the time of PC consult. Weretrospectively analyzed data from a registry of PC consults across five hospitals within the Mount Sinai Health System between January 1, 2020, and December 31, 2021. Demographics and ICD-10 codes were extracted from electronic medical and billing records. During consult, PC clinicians assessed functional status using the KPS at the time of consult (0%-100%) and symptom burden using the 10-item Edmonton Symptom Assessment Scale (ESAS), which rates each symptom as none, mild, moderate, or severe. The association of KPS and ESAS symptom severity was assessed using ordinal logistic regression models, adjusting for age, gender, Elixhauser comorbidity index, and the underlying serious illness (cancer, sepsis, dementia, COVID-19). The study population included 6,065 patients (mean age 70±16 years, 50.9% male). The most frequent underlying serious illnesses were sepsis (36.6%), cancer (32.9%), and dementia (22.8%). In regression analysis, KPS was significantly associated with symptom severity for all ESAS symptoms (p<0.001). However, symptoms separated into two different groups. Drowsiness (β=-0.85), inactivity (β=-0.71), dyspnea (β=-0.21), anorexia (β=-0.19), and agitation (β=-0.06) were negatively associated with KPS (ie, lower functional status was associated with more severe symptoms), whereas nausea (β=0.2), anxiety (β=0.15), physical discomfort (β=0.13), depression (β=0.13), and constipation (β=0.06) were positively associated with KPS (ie, lower functional status was associated with milder symptoms). These associations remained statistically significant after adjusting for baseline characteristics. While some symptoms were more severe, other symptoms were less severe among patients with poor functional status. This observation can inform symptom management and warrants further investigation. [ FROM AUTHOR] Copyright of Journal of Pain & Symptom Management is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

"Building a Presence": Strategies Used to Implement and Expand Palliative Care Services Across Six Diverse Health Systems (Sci205)

1. Label the strategies used in implementing palliative care programs and demonstrate how the various strategies impacted acceptability and adoption. 2. Connect implementation strategies with teaming concepts, both within palliative care teams and between teams (ie, palliative care with oncology, primary care, or other specialty care teams). Implementation strategies are methods or techniques used to improve the adoption of new practices. Team-based health care, or teaming—which is when at least two providers work collaboratively within and across settings to achieve high-quality coordinated patient care—is necessary for successful palliative care. Understanding which strategies are related to teaming and their importance in different settings is essential for achieving desired outcomes in palliative care. Identify and compare implementation strategies related to teaming used by six diverse health systems in expanding palliative care services Sixty-five longitudinal interviews conducted over 2 years with implementers representing academic, large nonprofit, public, and community hospitals. Content analysis using the Expert Recommendations for Implementing Change (ERIC) strategies and strategy domains for categorizing implementation strategies. More than 35 of the 73 ERIC strategies were identified;strategies related to teaming fell primarily into three domains: 1) support clinicians, 2) train and educate stakeholders, and 3) develop stakeholder interrelationships. Creating new clinical teams (support clinicians) where there were previously none was an essential strategy;those unable to fully staff their teams experienced program establishment delays. Ongoing training, specifically in-person group trainings, and educational meetings (train and educate stakeholders) by the palliative care team to promote awareness and competencies within and across teams, were hindered by the COVID-19 pandemic, limiting initial adoption. Developing stakeholder interrelationships, particularly involving executive boards/leadership, was perceived as a necessary ongoing strategy for program establishment, adoption, and sustainability. Strategies related to teaming include creating palliative care teams, training and educating the interdisciplinary team and referring providers, and establishing relationships with providers and leadership, which impact the acceptability and adoption of palliative care services. Strategies promoting within and cross team relationships, education, and clinician support are necessary when expanding palliative care services and should be continuous. [ FROM AUTHOR] Copyright of Journal of Pain & Symptom Management is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Symptom Burden in Patients Treated With Palliative Radiotherapy Before and During the COVID-19 Pandemic.

BACKGROUND/AIM: Oncological care has faced several challenges during the COVID-19 pandemic, e.g. treatment delay and worsening symptoms. Patient-reported anxiety, depression and sleep quality might have changed due to these special circumstances. Therefore, we analyzed the symptom burden of patients treated with palliative radiotherapy at our center. PATIENTS AND METHODS: A retrospective study was performed of 50 consecutive patients and the results were compared to those obtained in a previous pre-COVID study. The Edmonton Symptom Assessment Scale was employed to assess the preradiotherapy symptoms. RESULTS: The highest mean scores were reported for pain in activity (3.2) and dry mouth (3.1). Regarding anxiety, sadness/depression and sleep, the corresponding scores were 1.5, 1.2 and 2.7, respectively. Compared to the previous study, no significant increases were found. Most items had numerically lower mean values, e.g. anxiety (1.5 vs. 2.7). Both study populations had comparable median age (70.5 vs. 70 years), gender distribution and proportion of patients with bone metastases. However, there were two significant imbalances, namely a lower proportion of patients with prostate cancer (12 vs. 30%, p=0.02) and breast cancer (0 vs. 12%, p=0.02). CONCLUSION: In patients who showed up for radiation treatment planning, the suspected increase in anxiety, sadness/depression and sleep disturbance was not demonstrable. It is not known whether or not patients with substantial worries chose to decline referral to palliative radiotherapy. Therefore, comprehensive large-scale studies of patterns of care are needed to fully understand the impact of COVID-19-related measures.

Palliative Radiotherapy During the Last Month of Life: Have COVID-19 Recommendations Led to Reduced Utilization?

BACKGROUND/AIM: The study aimed to evaluate practice changes in the time period of the early wave of the COVID-19 pandemic. PATIENTS AND METHODS: This was a retrospective single institution study. We defined palliative radiotherapy (PRT) initiated before Saturday, March 14th as pre-COVID and PRT initiated later as during-COVID (through June 30th). RESULTS: National COVID-19 recommendations led to a significant decrease in PRT with 10 or more fractions, while re-irradiation and radiotherapy during the final 30 days of life were equally common before and after these recommendations had been issued in March 2020. CONCLUSION: Rapid adoption of modified PRT regimens was feasible. However, the challenge of overtreatment in the final phase of the disease, due to inaccurate survival prediction, persisted.

Radiotherapy in COVID-19 patient affected by multiple myeloma: a case report.

In COVID-19 pandemic, cancer patients may be vulnerable for their immunological status and need of immunosuppressive anti-neoplastic treatments. Choosing the best treatment option in COVID-19 positive cancer patients is still a challenging issue. We report the case of a 62-year-old woman diagnosed with multiple myeloma and affected by COVID-19. After the diagnosis of multiple myeloma in January 2019, the patient underwent first line therapy followed by bone marrow autologous stem cell transplantation, achieving a complete response in September 2019. In March 2020, the patient showed intrathoracic progression of the disease, resulting in a severe dysphagia and concomitant positivity to SARS-CoV-2 swab test, cough, fever, and dyspnea related to the involvement of the lung parenchyma as shown by CT-scan. After her admittance to a COVID-19 dedicated inward, she was administered oral hydroxychloroquine and darunavir-cobicistat for 7 days with stabilization of her general clinical conditions. For the worsening of dysphagia, after multidisciplinary discussion, it was decided to deliver radiotherapy to the mediastinal and paravertebral mass with 8 Gy single fraction. After 5 days, her clinical conditions improved, with reduction of dysphagia. The CT confirmed a partial response with reduction of the mass of about 50%. Viral clearance was confirmed by triple negative search for SARS-CoV-2 on nasopharyngeal swabs, one month after first documentation of positivity. Unfortunately, the patient died three months later due to a pulmonary mycotic infection causing respiratory failure. To our knowledge, this case report describes the first experience of mediastinal radiotherapy in a COVID-19 patient affected by myeloma reported in the literature. In case of clinical indication, even in presence of SARS-CoV-2 infection, radiotherapy can be safely delivered and might be considered a treatment option as shown by our experience in this challenging case of intrathoracic myeloma.