Annals of palliative medicine最新文献

{"title":"Palliative care in oncology at a time of extreme global health inequalities and over-stretched resources: contextualizing the ASCO Palliative Care for Patients with Cancer Guideline Update.","authors":"Maria Vassiliou, Agata Rembielak, Shing Fung Lee, Charles B Simone Ii, Henry Wong, Muna Al-Khaifi, Yvette Van de Linden, Primus Ochieng, Jeffrey Smith, Warren Bacorro, Adrian Chan, Seamus Coyle, Ann Griffiths, Edward Chow, Eva Oldenburger","doi":"10.21037/apm-24-165","DOIUrl":"https://doi.org/10.21037/apm-24-165","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregiver needs in end-of-life care are diverse, yet invisible: a narrative review.","authors":"Alice Koo, Michelle Low, Zhi-Zheng Yeo, Jonathan Ee, Poh-Heng Chong","doi":"10.21037/apm-24-151","DOIUrl":"10.21037/apm-24-151","url":null,"abstract":"<p><strong>Background and objective: </strong>Informal caregivers are essential to home-based end-of-life (EOL) care. However, their needs are often not well-understood and described in relation to caregiving, rather than with a 'caregiver-centric' perspective. This review aimed to provide an overview of research on EOL caregiver needs, discussing the types of needs, factors that influence them, and gaps in supporting caregivers.</p><p><strong>Methods: </strong>An unsystematic narrative review was performed to provide a broad overview of caregiver needs research. A targeted search was done on PubMed. Search terms included \"caregiver needs\", \"concerns\", \"experiences\", \"palliative\", \"hospice\", and \"end-of-life\". Qualitative and quantitative studies, reviews between January 2019 and November 2024. Selected papers were analysed to distil themes on the types of caregiver needs, as well as contextual factors and barriers that impact them. Assessment tools and processes were also included.</p><p><strong>Key content and findings: </strong>A total of 63 papers were included. Major findings showed that caregivers often prioritize 'care-enabling needs'-such as information access and logistic support-over their personal 'direct support' needs-which encompasses the need for validation, recognition of their autonomy, and relational needs. While caregiver needs are increasingly appreciated, there remained substantial gaps in addressing them, the extent of which also varying due to contextual factors, such as patient's condition, availability of resources, and cultural norms. Barriers identified included ongoing prioritization of patient needs above self, suboptimal cultural sensitivity among providers, and general lack of needs assessment tools.</p><p><strong>Conclusions: </strong>In EOL care, it is critical that providers acknowledge that caregivers are essential partners and a co-client to the patient. There is a need to recognize caregivers' direct support alongside care-enabling needs to ensure caregivers' well-being are also looked after. More attention can be given to increasing the visibility of caregiver needs by developing sensitivity to contextual factors and implementing assessment processes.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"160-171"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of recent clinical trials on meta-analysis of stereotactic body radiation therapy for spine metastases and urgent call for consistent study endpoints.","authors":"Henry C Y Wong, Shing Fung Lee, Samuel Ryu, Adrian Wai Chan, Saverio Caini, Peter Johnstone, Yvette van der Linden, Joanne M van der Velden, Emily Martin, Sara Alcorn, Candice Johnstone, J Isabelle Choi, Gustavo Nader Marta, Eva Oldenburger, Srinivas Raman, Agata Rembielak, Vassilios Vassiliou, Pierluigi Bonomo, Quynh-Nhu Nguyen, Shirley Tse, Peter J Hoskin, Charles B Simone","doi":"10.21037/apm-24-145","DOIUrl":"https://doi.org/10.21037/apm-24-145","url":null,"abstract":"<p><p>Pain from spinal metastases can result in significant impact to patients' quality of life. Conventional external beam radiation therapy (cEBRT) has long been shown to be effective in the pain control of patients with spinal metastases. With the advancement in radiation therapy, stereotactic body radiation therapy (SBRT) has been increasingly adopted for the treatment of spinal metastases. Multiple randomised controlled trials (RCT) have been performed to evaluate whether SBRT provides better pain relief compared to cEBRT. Previous meta-analyses showed that SBRT have significantly better complete pain response at 3 months compared to cEBRT. This report updates meta-analyses by incorporating the complete pain response data obtained from personal communication with the NRG Oncology Radiation Therapy Oncology Group (RTOG) 0631 principal investigator and the recently published RCT by Guckenberger et al. The results demonstrate that the results for complete pain response at 3 months have now changed and no longer favour SBRT. It is postulated that inconsistent definitions and reporting of study endpoints, specifically regarding vertebral compression fractures induced by radiation therapy, could be possible reasons for the difference in meta-analyses results. A consensus for standardizing study endpoints for future clinical trials in SBRT for painful bone metastases is needed to allow for better interpretation of study results.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 2","pages":"155-159"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The approach of internal medicine healthcare personnel to palliative care.","authors":"Igal Lifshits, Hanan Agbaria, Anwar Zoabi Sawaed, Ami Neuberger, Said Darawshi","doi":"10.21037/apm-24-152","DOIUrl":"https://doi.org/10.21037/apm-24-152","url":null,"abstract":"<p><strong>Background: </strong>Healthcare workers in internal medicine wards often encounter challenges while providing palliative care due to a lack of training, emotional support, and organizational resources. Existing studies have explored attitudes toward palliative care in specialized teams, but less is known about internal medicine workers' perspectives. This study aims to address this gap by investigating the attitudes of internal medicine staff, analyzing demographic and professional factors, and assessing specific features, including knowledge of the legal aspects of palliative care.</p><p><strong>Methods: </strong>A novel, 20-item questionnaire was distributed to 106 healthcare workers from six internal medicine departments at a tertiary care hospital in Israel. The questionnaire assessed participants' demographic and professional data, attitudes toward palliative care, self-perceived knowledge, emotional support needs, and organizational support. Responses were scored on a 0-10 Likert scale, with higher scores indicating stronger agreement. Data analysis included one-way analyses of variance (ANOVA), chi-square tests, and descriptive statistics.</p><p><strong>Results: </strong>Participants included nurses (61%), medical doctors (32.4%), and other healthcare personnel (6.7%). Perceived knowledge and training were rated as moderately adequate (6.0/10 and 5.6/10, respectively), while organizational support was rated similarly (6.0/10). Emotional support from family and friends (6.5/10) was deemed higher than from institutions (4.8/10). Nurses and medical doctors reported insufficient time for palliative conversations (4.8/10 and 4.18/10). Healthcare workers disagreed that palliative care should be restricted to terminally ill patients (2.89/10). Statistically significant differences were observed in attitudes toward palliative care across professions, marital status, and years of experience. Ethnic and religious affiliations did not influence attitudes towards palliative care.</p><p><strong>Conclusions: </strong>The findings highlight the need for targeted training, enhanced organizational support, and mentorship programs to address gaps in palliative care delivery within internal medicine departments. Addressing these needs can improve healthcare workers' preparedness and ultimately raise the quality of care for terminally ill patients.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 2","pages":"128-135"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjustment of pharmacotherapy during the final days of life in home hospice care: a pilot retrospective study.","authors":"Martina Novosadová, Stanislav Filip, Veronika Molnárová, Anna Michlová, Jana Hrubešová, Jakub Novosad","doi":"10.21037/apm-24-146","DOIUrl":"https://doi.org/10.21037/apm-24-146","url":null,"abstract":"<p><strong>Background: </strong>Effective end-of-life care requires transitioning pharmacotherapy from chronic disease management to symptom relief. Patients in pre-terminal and terminal palliative care may be at risk of receiving potentially inappropriate drugs regarding indication, dosage, route of administration, and polypharmacy, which can increase the risk of deteriorating quality of life. However, data on this process in Home Hospice Care (HHC) is limited. This pilot retrospective study evaluated the pharmacotherapy of 50 patients during their final days under HHC, focusing on changes in treatment and preferred administration routes to optimize symptomatic care.</p><p><strong>Methods: </strong>Anonymised medical records data were analysed retrospectively to assess the shift from chronic disease pharmacotherapy to symptom and quality-of-life-focused treatment. Statistical methods were applied to identify trends in drug utilisation and administration routes.</p><p><strong>Results: </strong>The study group qualified the most common drugs associated with potential drug-related problems: antidepressants (26%), sedatives/hypnotics (32%), gastroprotection (34%), antihypertensives (46%), coanalgesics (50%), and analgesics (84%). On the final day, the mean was 2.64 systemic medication (standard deviation 1.27), with a minimum number of drugs and a maximum of 6. The most common symptom addressed was pain, which occurred in 28 patients in the group (56%). Therefore, terminal analgosedation was mapped in more detail when, at the end of life, 26 patients (52%) were terminally transferred to continuous medication administered subcutaneously. Continuous subcutaneous linear driver for analgosedation containing two components was used in 12 patients (46.2%) or three components in 14 patients (53.8%).</p><p><strong>Conclusions: </strong>This retrospective study highlights the importance of targeted pharmacotherapy adjustments in terminal care, including multidisciplinary HHC teams. Pharmacotherapy is simplified and targeted to prevalent symptoms, using the widely used subcutaneous drug administration.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 2","pages":"136-145"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simplifying post-operative radiotherapy for bone metastases.","authors":"Emily Keit, Daniel E Oliver, Hsiang-Hsuan M Yu, Peter A S Johnstone","doi":"10.21037/apm-24-168","DOIUrl":"https://doi.org/10.21037/apm-24-168","url":null,"abstract":"<p><p>The delivery of post-operative radiotherapy (PORT) for solid tumor bone metastases is a well-established practice that aims to enhance patient outcomes following surgical intervention. Surgery for osseous metastases serves to stabilize bone, alleviate pain, reduce tumor volume, and relieve pressure on critical neurological components. Radiotherapy complements surgery by addressing residual malignant disease and cancer-induced pain. Together, they serve to improve local control, maximize functional outcomes, control pain, and improve patients' overall quality of life. Despite the prevalence of non-spine bone metastases (NSBMs) necessitating operative intervention, structured guidelines for palliative PORT are limited. This is, in part, due to a paucity of research specific to this topic. As such, a wide array of doses are deemed acceptable, leading to varied practice patterns. Conversely, there is more extensive literature available, including prospective trials, for the management of post-operative spine bone metastases (SBMs). This includes advances such as stereotactic body radiotherapy (SBRT), separation surgery, and the utilization of simultaneous integrated boosts that enable evidence driven, safe dose escalation. This mini-review aims to provide a summary of the existing literature on palliative postoperative radiotherapy for both NSBMs and SBMs. By offering historical context and summarizing current evidence, this article seeks to aid clinical decision-making and highlight areas for future research to enhance treatment standardization and patient care.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 2","pages":"189-195"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Society for Palliative Radiation Oncology: Report from the Eleventh Annual Meeting (2024).","authors":"Emily J Martin, Sara Alcorn, Candice Johnstone, Jared R Robbins, Eric M Chang, Andrew R Bruggeman, Malcolm D Mattes, Charles B Simone","doi":"10.21037/apm-25-17","DOIUrl":"https://doi.org/10.21037/apm-25-17","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 2","pages":"225-227"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic chemotherapy-induced peripheral neuropathy: living with neuropathy during and after cancer treatments.","authors":"Nur Rahman, Jasmine Sukumar, Maryam B Lustberg","doi":"10.21037/apm-24-154","DOIUrl":"https://doi.org/10.21037/apm-24-154","url":null,"abstract":"<p><p>Chemotherapy-induced peripheral neuropathy (CIPN) is a prevalent and often debilitating side effect faced by many patients undergoing chemotherapy, significantly impacting their quality of life and functional status. Psychological impact in patients with CIPN remains widely understudied and can range from symptoms of sadness, fear, depression, and anxiety, substantially impacting quality of life and daily functioning in cancer survivors. CIPN is characterized by peripheral nerve damage due to neurotoxic effects of chemotherapeutic agents. However, the pathophysiology and exact mechanism is not fully understood. Patients experience symptoms ranging from numbness, tingling, pain, and motor dysfunction. Various clinical factors [e.g., the specific chemotherapeutic agents and dosing, patient characteristics such as body mass index (BMI), age, race, genetics and co-morbid conditions] have been associated with risk of developing CIPN. The prevalence of CIPN continues to increase; however, effective preventive and treatment strategies for CIPN remain limited. Current treatment strategies are limited to dose adjustments and symptomatic relief, highlighting the need to identify evidenced-based preventive strategies and well beneficial therapeutics. Further research in CIPN is essential for improving outcomes and quality of life in patients experiencing this debilitating condition. In this review, we examine the clinical presentation, incidence and prevalence, risk factors, diagnostic evaluation, and current preventive/treatment strategies with a focus on the impact of CIPN on quality of life, patient experience and functional status.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 2","pages":"196-216"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussing end-of-life care for persons experiencing severe and persistent mental illness: a qualitative study among stakeholders in Flanders.","authors":"Loïc Moureau, Monica Verhofstadt, Caressa Van Hoe, Joris Vandenberghe, Chantal Van Audenhove, Axel Liégeois","doi":"10.21037/apm-24-157","DOIUrl":"https://doi.org/10.21037/apm-24-157","url":null,"abstract":"<p><strong>Background: </strong>End-of-life care for persons experiencing severe and persistent mental illness (SPMI) is a complex topic that deserves more attention. Despite growing awareness within international scientific research, topics such as palliative psychiatry, the provision of palliative care, and ethical dilemmas, including medical assistance in dying, remain under-researched. The aim of this study is therefore to qualitatively explore the views of different stakeholders on these issues to inform care providers about current challenges and opportunities in care.</p><p><strong>Methods: </strong>A qualitative study in Flanders, Belgium, involving 73 participants-including care users, caregivers, managers, and experts-explored experiences, needs, challenges and dilemmas regarding end-of-life care for persons experiencing SPMI. Semi-structured interviews were conducted, transcribed, and thematically analyzed.</p><p><strong>Results: </strong>Explored themes included advance care planning, suicide risk and prevention, euthanasia, the provision of palliative care, bereavement care, and the use of a palliative care approach. Challenges in standardizing advance care planning were noted. Euthanasia requests were rare but ethically complex. The provision of palliative care within familiar settings was favored but posed challenges related to expertise and staffing. Farewell rituals emphasized strong bonds between caregivers and care users. The study highlights the importance of advance care planning, the relative absence of discussions about suicide and euthanasia, and the challenges in providing palliative care. It underscores the need for education, ethical support, and collaboration with palliative care networks.</p><p><strong>Conclusions: </strong>End-of-life care for persons experiencing SPMI demands a comprehensive approach that addresses ethical considerations, advance care planning, suicide risk, and the provision of palliative care. Policy recommendations include investing in education, establishing ethical support mechanisms, and fostering collaboration with palliative care networks to ensure dignified and compassionate care for this vulnerable population.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 2","pages":"114-127"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The curative potential of stereotactic radiotherapy in oligometastatic colorectal cancer: a narrative review.","authors":"Hasan Al-Sattar, Esele Okondo, Jakob Hassan-Dinif, Amir Mashia Jaafari, Anojan Augustine, Joao R Galante, Mohamed Metawe, Christos Mikropoulos, Sola Adeleke","doi":"10.21037/apm-24-170","DOIUrl":"https://doi.org/10.21037/apm-24-170","url":null,"abstract":"<p><strong>Background and objective: </strong>Oligometastatic colorectal cancer (CRC), characterised by limited metastatic disease, has traditionally been managed with surgery and chemotherapy. However, advances in stereotactic ablative radiotherapy (SABR), also known as stereotactic body radiotherapy (SBRT), have introduced the possibility of curative outcomes for selected patients with limited metastatic disease. SABR delivers high-dose, highly precise radiation with minimal toxicity, making it an attractive alternative or complement to surgery and systemic therapy. This narrative review evaluates the role of SABR in the management of oligometastatic CRC, and its application in both palliative and curative settings.</p><p><strong>Methods: </strong>A systematic search of PubMed and Scopus databases (2014-2024) was conducted using search terms including \"colorectal cancer\", \"oligometastatic\", \"SABR\", \"SBRT\", \"palliative\", and \"radical\". Relevant meta-analyses, systematic reviews, and single- and double-arm studies were included.</p><p><strong>Key content and findings: </strong>SABR demonstrates promising outcomes in both palliative and curative settings for oligometastatic CRC. Trials like SABR-COMET report significant improvements in overall survival (OS) and progression-free survival (PFS) with SABR, achieving a median OS of 50 months compared to 28 months with standard care. SABR is particularly effective for pulmonary metastases, achieving higher local control (LC) rates than hepatic lesions, likely due to differences in tissue radiosensitivity. Palliative SABR has been shown to delay systemic therapy and improve symptom management, with low toxicity rates, while radical SABR offers durable disease control and potential curative outcomes. Despite these benefits, evidence is limited by small cohort sizes, variable dosing regimens, and a lack of CRC-specific randomised trials.</p><p><strong>Conclusions: </strong>SABR has emerged as a transformative treatment for oligometastatic CRC, providing significant benefits in both palliative and curative settings, although not yet outperforming traditional treatment modalities such as surgery. Future research, including ongoing phase III trials, aims to refine patient selection, optimise dosing protocols, and integrate SABR with systemic treatments to enhance outcomes. With further validation, SABR has the potential to redefine the therapeutic landscape for oligometastatic CRC, offering hope for improved survival and quality of life.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 2","pages":"172-188"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}