During my PhD I’ve explored the integration between palliative care and hematologic cancer patient. Early palliative care together with standard haematologic care for advanced patients is needed worldwide but little is known about its effect. I first performed a systematic literature review to synthesize the evidence on the impact of early palliative care on haematologic cancer patients’ quality of life and resource use. The search terms were early palliative care or simultaneous or integrated or concurrent care and haematologic or onco-haematologic patients. The following databases were searched: PubMed, Embase, Cochrane, CINHAL, and Scopus. Additional studies were identified through cross-checking the reference articles. Studies were in the English language, with no restriction for years. Two researchers independently reviewed the titles and abstracts, and one author assessed full articles for eligibility. A total of 296 studies titles were reviewed. Eight articles were included in the synthesis of the results, two controlled studies provided data on the comparative efficacy of PC interventions, and six one-arm studies were included. Since data pooling and meta-analysis were not possible, only a narrative synthesis of the study results was performed. The quality of the two included comparative studies was low overall. The quality of the 6 non-comparative studies was high overall, without the possibility of linking the observed results to the implemented interventions. Studies on early palliative care and cancer patients are scarce and have not been prospectively designed. More research on the specific population target, type and timing of palliative care intervention and standardization of collected outcomes is required. The systematic review was registered on PROSPERO and published in October 2020 (Tanzi Silvia, Venturelli Francesco, Luminari Stefano, Merlo Franco Domenico, Braglia Luca, Bassi Chiara, Costantini Massimo. Early palliative care in haematological patients: a systematic literature review. BMJ Support Palliat Care) I consequently wrote a research protocol for an RCT on Early Palliative Care and Haematologic Cancer Patients: we developed a palliative care intervention (PCI) integrated with standard hematological care. The aim of the protocol was focused on exploring the feasibility of the intervention by patients, professionals, and caregivers and on assessing its preliminary efficacy. It was a mixed-methods phase 2 trial. The Specialist Palliative Care Team (SPCT) follow each patient on a monthly basis in the outpatient clinic or will provide consultations during any hospital admission. SPCT and hematologists discuss active patient issues to assure a team approach to the patient’s care. This quantitative study is a monocentric parallel-group superiority trial with balanced randomization comparing the experimental PCI plus hematological standard care versus hematological standard care alone. The primary endpoint will calculate on adherence to the planned PCI, measured as the percentage of patients randomized to the experimental arm who attend all the planned palliative care visits in the 24 weeks after randomization. The qualitative study follows the methodological indications of concurrent nested design and was aimed at exploring the acceptability of the PCI from the point of view of patients, caregivers, and physicians. The trial was registered on ClinicalTrials.gov: NCT03743480 and Published in 2020 (Tanzi Silvia, Luminari Stefano, Cavuto Silvio, Turola Elena, Ghirotto Luca, Costantini Massimo. Early palliative care versus standard care in hematologic cancer patients at their last active treatment: study protocol of a feasibility trial.BMC Palliat Care. 2020;19(1):53) We started the RCT in November 2018: in this trial, we will test the feasibility of an integrated palliative care approach starting when the hematologists to propose the last active treatment

Le cure palliative precoci insieme alle cure ematologiche standard per questo tipo di pazienti sono ritenute necessarie in tutto il mondo, ma poco si sa circa l’efficacia della loro integrazione. È stata eseguita una revisione sistematica della letteratura per sintetizzare le prove di efficacia sull'impatto delle cure palliative precoci sulla qualità della vita e sull'uso delle risorse dei malati di cancro ematologico. I termini di ricerca erano cure palliative precoci o cure simultanee o integrate o concomitanti e pazienti ematologici o oncoematologici. Sono stati esaminati un totale di 296 studi. Otto articoli sono stati inclusi nella sintesi dei risultati, due studi controllati hanno fornito dati sull'efficacia degli interventi di cure palliative e 6 studi non comparativi sono stati inclusi. Poiché non è stato possibile realizzare una meta analisi, è stata eseguita una sintesi narrativa dei risultati dello studio. Gli studi sulle cure palliative precoci e sui pazienti con cancro ematologico sono scarsi e non sono stati realizzati in modo prospettico. La revisione sistematica è stata registrata su PROSPERO e pubblicata in Ottobre 2020 A seguire abbiamo scritto un protocollo di ricerca per uno studio randomizzato sulle cure palliative precoci e i malati di cancro ematologico: abbiamo sviluppato un intervento di cure palliative integrato con le cure ematologiche standard. L'obiettivo del protocollo è l'esplorazione della fattibilità dell'intervento integrato dal punto di vista dei pazienti, dei professionisti e dei caregiver e sulla valutazione preliminare della sua efficacia.Lo studio prevede che un servizio specialistico di cure palliative segua mensilmente ogni paziente ambulatoriale o in regime consulenziale durante qualsiasi ricovero ospedaliero. I palliativisti e gli ematologi discutono dei problemi dei pazienti per assicurare un approccio integrato alla cura del paziente. La parte quantitativa dello studio è monocentrico di superiorità a gruppi paralleli con randomizzazione bilanciata che confronta l’intervento di cure palliative sperimentale più la cura standard ematologica rispetto alla sola cura standard ematologica. L'end-point primario verrà calcolato sull'aderenza all’intervento di cure palliative cosí come pianificato, misurato come la percentuale di pazienti randomizzati al braccio sperimentale che partecipano a tutte le visite di cure palliative pianificate nelle 24 settimane successive alla randomizzazione. Il protocollo del trial è stato registrato su ClinicalTrials.gov: NCT03743480 e pubblicato nel 2020 Abbiamo avviato il trial nel novembre 2018, tuttavia l'arruolamento a questo protocollo si è dimostrato lento e difficile; da quando è iniziato sono stati arruolati 13 pazienti coi loro caregiver. Abbiamo quindi deciso di approfondire questa difficoltà insieme ad altri Specialisti internazionali del settore realizzando una intervista/survey. Lo scopo dell'indagine sarà quello di fornire una panoramica delle difficoltà nell'arruolamento dei pazienti in cure palliative specificamente indirizzate alle neoplasie ematologiche esplorando l’opinione degli esperti ed elaborare cosí una teoria dell'arruolamento di ispirazione realista, raccogliendo dati dalla nostra indagine e dalla letteratura rivista. I risultati di questo studio verranno mostrati durante la discussione della tesi

Cure Palliative Precoci nei pazienti onco ematologici / Silvia Tanzi , 2021 May 31. 33. ciclo, Anno Accademico 2019/2020.

Cure Palliative Precoci nei pazienti onco ematologici

TANZI, Silvia
2021

Abstract

During my PhD I’ve explored the integration between palliative care and hematologic cancer patient. Early palliative care together with standard haematologic care for advanced patients is needed worldwide but little is known about its effect. I first performed a systematic literature review to synthesize the evidence on the impact of early palliative care on haematologic cancer patients’ quality of life and resource use. The search terms were early palliative care or simultaneous or integrated or concurrent care and haematologic or onco-haematologic patients. The following databases were searched: PubMed, Embase, Cochrane, CINHAL, and Scopus. Additional studies were identified through cross-checking the reference articles. Studies were in the English language, with no restriction for years. Two researchers independently reviewed the titles and abstracts, and one author assessed full articles for eligibility. A total of 296 studies titles were reviewed. Eight articles were included in the synthesis of the results, two controlled studies provided data on the comparative efficacy of PC interventions, and six one-arm studies were included. Since data pooling and meta-analysis were not possible, only a narrative synthesis of the study results was performed. The quality of the two included comparative studies was low overall. The quality of the 6 non-comparative studies was high overall, without the possibility of linking the observed results to the implemented interventions. Studies on early palliative care and cancer patients are scarce and have not been prospectively designed. More research on the specific population target, type and timing of palliative care intervention and standardization of collected outcomes is required. The systematic review was registered on PROSPERO and published in October 2020 (Tanzi Silvia, Venturelli Francesco, Luminari Stefano, Merlo Franco Domenico, Braglia Luca, Bassi Chiara, Costantini Massimo. Early palliative care in haematological patients: a systematic literature review. BMJ Support Palliat Care) I consequently wrote a research protocol for an RCT on Early Palliative Care and Haematologic Cancer Patients: we developed a palliative care intervention (PCI) integrated with standard hematological care. The aim of the protocol was focused on exploring the feasibility of the intervention by patients, professionals, and caregivers and on assessing its preliminary efficacy. It was a mixed-methods phase 2 trial. The Specialist Palliative Care Team (SPCT) follow each patient on a monthly basis in the outpatient clinic or will provide consultations during any hospital admission. SPCT and hematologists discuss active patient issues to assure a team approach to the patient’s care. This quantitative study is a monocentric parallel-group superiority trial with balanced randomization comparing the experimental PCI plus hematological standard care versus hematological standard care alone. The primary endpoint will calculate on adherence to the planned PCI, measured as the percentage of patients randomized to the experimental arm who attend all the planned palliative care visits in the 24 weeks after randomization. The qualitative study follows the methodological indications of concurrent nested design and was aimed at exploring the acceptability of the PCI from the point of view of patients, caregivers, and physicians. The trial was registered on ClinicalTrials.gov: NCT03743480 and Published in 2020 (Tanzi Silvia, Luminari Stefano, Cavuto Silvio, Turola Elena, Ghirotto Luca, Costantini Massimo. Early palliative care versus standard care in hematologic cancer patients at their last active treatment: study protocol of a feasibility trial.BMC Palliat Care. 2020;19(1):53) We started the RCT in November 2018: in this trial, we will test the feasibility of an integrated palliative care approach starting when the hematologists to propose the last active treatment
EARLY PALLIATIVE CARE IN HEMATOLOGIC CANCER PATIENTS
31-mag-2021
LUMINARI, Stefano
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1246164
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