Palliative and Supportive Care

Research line palliative and supportive care

Research focuses on the care for the dying and the management of symptoms, in particular pain and fatigue. The research on palliative care is embedded in the Center of Expertise in Palliative Care of the Erasmus MC. Several departments, Medical Oncology, Public Health, Medical Psychology and Psychotherapy, Pediatric Oncology and the Pain Treatment and Expertise Centers collaborate in the Center of Expertise in Palliative Care, thereby stimulating partnerships in several research projects.

Research topics:

1. Care for the dying

How we live and die has changed dramatically in the past century. Hundred years ago, illness was common at every age. Nowadays, most people live in good health into old age; the average life expectancy has increased to about 80 years. Many of the formerly acute causes of death can be prevented or treated and death is now for most of us the result of chronic disease at a high age. The last phase of life often involves a period of deterioration with comorbidities and functional decline. 

Adequate end-of-life care can have a major impact on the quality of the last phase of life. Our aging population as well as the increasing prevalence of chronic disease at the end of life, advances in medicine, costs of end-of-life care, and empowerment of patients, all make sensitive, patient-centered management of death and dying one of the main challenges of modern health care

Most health professionals believe that patients with advanced disease and their families should be told the truth about prognosis, but many avoid discussing the topic. This is due to uncertainty and a lack of tools, skills and time to adequately discuss sensitive issues around death and dying. Our research program is aimed at developing knowledge about death and dying in the 21st century and at finding clues for high quality end-of-life care.

2. Symptom management

Palliative and supportive care aims to improve the quality of life of patients and their relatives. Palliative care is understood to include the prevention and alleviation of symptoms and suffering of patients with life-threatening diseases and their relatives. It addresses physical, functional, psychosocial, as well as existential problems. When the underlying disease is still responsive to specific therapy, supportive care will be given to enhance the patient’s quality of life by (symptomatic) treatment of concurrent disease- or therapy-induced complications.

Palliative and supportive care is complex, because, in general, patients experience several physical and psychosocial problems simultaneously, pain and fatigue occurring most frequently. Available treatment strategies often have disappointing clinical effects or scientific evaluations of the effects are lacking. Research to develop evidence-based strategies in palliative care therefore is rather needed.

Products closed studies

1. Wandelen (Mijnwensenbijkanker.nl)

2. Prediction model SURPRISE: 

• For COPD
• For cancer

• SILENCE 
  In this study, the prophylactic effect of scopolamine butyl was investigated on death rattle in a double blind placebo-controlled randomized study
  

• SURPRISE 
  In this study, clinical models were developed to predict 1-year mortality for patients with advanced cancer and patients with chronic obstructive pulmonary disease.

• OnVaCT 
  We developed and evaluated an Online Value Clarification Tool (OnVaCT) to assist patients in clarifying their values around the decision to participate in early phase clinical trials (or not).

van Esch HJ, van Zuylen L, Geijteman ECT, Oomen-de Hoop E, Huisman BAA, Noordzij-Nooteboom HS, Boogaard R, van der Heide A, van der Rijt CCD. Effect of Prophylactic Subcutaneous Scopolamine Butylbromide on Death Rattle in Patients at the End of Life: The SILENCE Randomized Clinical Trial.
JAMA. 2021 Oct 5;326(13):1268-1276. doi: 10.1001/jama.2021.14785

Geijteman ECT, Kuip EJM, Oskam J, Lees D, Bruera E. Illness trajectories of incurable solid cancers. BMJ. 2024 Mar 1;384:e076625. doi: 10.1136/bmj-2023-076625

van Lent LGG, van der Ham M, de Jonge MJA, Gort EH, van Mil M, Hasselaar J, van der Rijt CCD, van Gurp J, van Weert JCM. Patient values in patient-provider communication about participation in early phase clinical cancer trials: a qualitative analysis before and after implementation of an online value clarification tool intervention. BMC Med Inform Decis Mak. 2024 Feb 2;24(1):32. doi: 10.1186/s12911-024-02434-1

Recent publications

Owusuaa C, van der Padt-Pruijsten A, Drooger JC, Heijns JB, Dietvorst AM, Janssens-van Vliet ECJ, Nieboer D, Aerts JGJV, van der Heide A, van der Rijt CCD. Development of a Clinical Prediction Model for 1-Year Mortality in Patients With Advanced Cancer. JAMA Netw Open. 2022 Nov 1;5(11):e2244350. doi: 10.1001/jamanetworkopen.2022.44350.

Agema BC, Vrielink K, Hoop EO, van Tienen F, Geijteman E, Van der Rijt CCD, Koch BCP, Koolen SLW, Oosten AW, Mathijssen RHJ. Optimizing the dosing regimen during rotation from subcutaneous to transdermal administration of fentanyl. J Pain Symptom Manage. 2024 Aug 28:S0885-3924(24)00989-8. doi: 10.1016/j.jpainsymman.2024.08.031.

Elsten EECM, Pot IE, Geijteman ECT, Hedman C, van der Heide A, van der Kuy PHM, Fürst CJ, Eychmüller S, van Zuylen L, van der Rijt CCD. Recommendations for Deprescribing of Medication in the Last Phase of Life: An International Delphi Study. J Pain Symptom Manage. 2024 Aug 2:S0885-3924(24)00909-6. doi: 10.1016/j.jpainsymman.2024.07.029.

van Hylckama Vlieg MAM, Pot IE, Visser HPJ, Jong MAC, van der Vorst MJDL, van Mastrigt BJ, Kiers JNA, van den Homberg PPPH, Thijs-Visser MF, Oomen-de Hoop E, van der Heide A, van der Kuy PHM, van der Rijt CCD, Geijteman ECT. Appropriate medication use in Dutch terminal care: study protocol of a multicentre stepped-wedge cluster randomized controlled trial (the AMUSE study). BMC Palliat Care. 2024 Jan 3;23(1):6. doi: 10.1186/s12904-023-01334-x.

Center of Expertise in Palliative Care of the Erasmus MC:

• Public Health, Research group: Medical decisions in end-of-life care
• Medical Psychology and Psychotherapy
• Pediatric Oncology
• Center of Pain Medicine
• Neurology

Collaboration outside of Erasmus MC:

- Netherlands Comprehensive Cancer Organisation

Our research is partly funded by the following organizations:

• KWF
• ZonMW
• Erasmus MC MRACE
• Erasmus MC Health Care Research

• Carin van der Rijt, Professor - Principal investigator
• Wendy Oldenmenger, RN PhD
• Astrid Oosten, MD PhD
• Eric Geijteman, MD PhD
• Jet van Esch, MD PhD
• Marte van Hylckama-Vlieg, MD PhD-student
• Iris Pot, PhD-student
• Joica Benschop, RN PhD-student
• Chantal Bakker, nurse practitioner palliative care
• Namke Groenveld, nurse practitioner palliative care (in training)
• Brenda Roggeveen, nurse consultant palliative care

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