Annals of palliative medicine最新文献

{"title":"How do palliative care rotations impact junior doctors?","authors":"Shomel Gauznabi, Marcus Alexander Henning, Karen Falloon, Mataroria Lyndon","doi":"10.21037/apm-2026-0051","DOIUrl":"https://doi.org/10.21037/apm-2026-0051","url":null,"abstract":"<p><strong>Background: </strong>There is a current inequitable distribution of palliative care services and an increasing need for specialist and generalist palliative care workforce globally. Despite this, there are difficulties in retaining and recruiting palliative care specialists and in developing generalist palliative care skills for all clinicians. This study aims to investigate how palliative care rotations influence junior doctors in their career choices regarding palliative medicine, to explore how junior doctors develop generalist palliative care skills, and to explore possible barriers to providing accessible palliative care.</p><p><strong>Methods: </strong>This qualitative study utilizes semi-structured interviews to explore the views of sixteen doctors from various regions of Aotearoa New Zealand on how their palliative care rotations impacted their vocational choices and clinical practice. Data were analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Four themes were identified from the research data, namely 'Recognized the Importance of Palliative Care', 'Pursue Career in Palliative Care', 'Choice of Alternative Vocation', and 'Improve and Promote Palliative Care'.</p><p><strong>Conclusions: </strong>To meet the growing demands of accessible and equitable palliative care needs, there needs to be greater recruitment and retention of palliative care providers, and all doctors should develop generalist palliative care skills. This study provides doctors' insights into the crucial impacts that palliative care rotations have for junior doctors and how it impacts career choices around palliative medicine.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147428","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":"A rapid systematic review of palliative uses of ketamine for depression and pain in people living with advanced cancer.","authors":"Danielle B Tometich, Christina L Hersh, Matthew A Murphy, Lanie A Simon, Aishwarya Aggarwal, Ardis Hanson, David C Buxton","doi":"10.21037/apm-2026-0032","DOIUrl":"10.21037/apm-2026-0032","url":null,"abstract":"<p><strong>Background: </strong>Given the growing population of patients living with metastatic cancer, palliative care providers need every available tool for symptom management. We conducted a rapid review of the literature on palliative uses of ketamine for pain and depression in people with cancer.</p><p><strong>Methods: </strong>We systematically searched for studies published since 2015 that examined palliative uses of ketamine in adults with cancer using clinical trial, experiment, quasi-experiment, or meta-analytic designs. We excluded studies focused on perioperative or post-operative sedation and/or pain, and studies lacking patient-reported outcomes.</p><p><strong>Results: </strong>There were 13 articles included in the final review. One open-label phase II study reported positive antidepressant effects of intranasal ketamine. Four open-label pilot studies found promising benefits for acute and chronic cancer-related pain in outpatient settings. Seven studies-pilot trials, retrospective chart reviews, and one mechanistic trial-reported improvements in refractory cancer pain near end of life. However, a cost-effectiveness analysis of the only adequately powered randomized controlled trial found no analgesic benefit and greater toxicity for ketamine among inpatients near end of life.</p><p><strong>Conclusions: </strong>Ketamine may alleviate refractory pain, depression, and acute cancer‑related pain, but findings remain inconsistent, particularly considering the negative randomized trial. More rigorous, practice‑aligned research is needed to define ketamine's benefits, potential synergistic effects, and the role of supportive psychotherapy in palliative care. Palliative care clinicians should cautiously consider time-limited, individualized trials of ketamine for cancer patients with high symptom burden.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148962982","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":"Oligometastatic disease and oligoprogression in gastrointestinal cancers.","authors":"Trudy C Wu, Krishan R Jethwa","doi":"10.21037/apm-2026-0034","DOIUrl":"https://doi.org/10.21037/apm-2026-0034","url":null,"abstract":"<p><p>Oligometastatic disease has fundamentally altered how we approach metastatic gastrointestinal (GI) cancers, blurring the boundary between curable and incurable disease. Patients with limited metastatic burden may benefit from metastasis-directed therapy (MDT) aimed at long-term disease control or even cure. In selected settings, randomized studies have demonstrated meaningful improvements in progression-free survival, and contemporary series report 5-year overall survival rates of approximately 30-65% in carefully selected patients undergoing MDT. The concept of oligoprogression-isolated sites of progression despite otherwise stable disease-has become particularly relevant as modern systemic therapies have extended disease control in many patients. Emerging data suggest that timely local consolidation at oligoprogressive sites may allow patients to continue effective systemic regimens and delay treatment switches. Successful application of MDT with either palliative or curative intent depends on careful multidisciplinary assessment. Disease kinetics, molecular and/or genomic features, response to prior treatment, and individual patient characteristics all factor into decision-making. Critically, the strength of evidence varies considerably across GI tumor types, and not all oligometastatic disease is created equal. Radiotherapy also serves an essential palliative function, addressing common symptoms including bleeding, obstruction, and pain. This review examines the current evidence and explores unresolved questions about when and how to deploy local therapy across the spectrum of metastatic GI primary tumors.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"76"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147298","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 most downloaded articles published in Annals of Palliative Medicine from 2025.","authors":"Charles B Simone","doi":"10.21037/apm-20262-05","DOIUrl":"https://doi.org/10.21037/apm-20262-05","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"66"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147145","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":"Spinal cord stimulation for cancer pain: a narrative review of mechanistic rationale, clinical integration, and emerging applications.","authors":"Charles A Odonkor, Muhammad Uzair Siddique, Siri Bohacek, Alaa Abd-Elsayed","doi":"10.21037/apm-2026-0062","DOIUrl":"10.21037/apm-2026-0062","url":null,"abstract":"<p><strong>Background and objective: </strong>Pain remains one of the most prevalent symptoms among patients with advanced cancer, with a substantial subset experiencing persistent pain despite optimized pharmacologic management. Although spinal cord stimulation (SCS) has emerged as a potential neuromodulatory option for refractory cancer-related pain, its role within contemporary multidisciplinary cancer pain management remains incompletely defined. This narrative review examines the mechanistic rationale, clinical applications, guideline positioning, and practical implementation of SCS across cancer pain phenotypes.</p><p><strong>Methods: </strong>A narrative literature search was conducted using PubMed/MEDLINE, Cochrane Library, Embase, ClinicalTrials.gov, and relevant guideline sources from database inception through May 21, 2026. Search terms included combinations of \"spinal cord stimulation\", \"SCS\", \"neuromodulation\", \"cancer pain\", \"cancer-related pain\", \"refractory cancer pain\", \"palliative care\", \"chemotherapy-induced peripheral neuropathy\", \"CIPN\", \"intrathecal drug delivery\", \"dorsal root ganglion stimulation\", and \"peripheral nerve stimulation\". English-language clinical studies (prospective and retrospective), case reports, case series, systematic, scoping, and narrative reviews, guideline statements, and relevant preclinical studies were considered.</p><p><strong>Key content and findings: </strong>Available evidence, consisting predominantly of retrospective cohorts and case-based literature without randomized trials, suggests that SCS may provide clinically meaningful pain relief and opioid-sparing benefit in selected patients with refractory cancer pain. This review contextualizes SCS within contemporary cancer pain management by examining its mechanistic foundations, waveform evolution, patient selection, prognosis-sensitive decision-making, magnetic resonance imaging (MRI) compatibility, and comparative positioning relative to intrathecal drug delivery systems and other interventional therapies. Emerging applications, particularly in chemotherapy-induced neuropathy and survivorship-related pain syndromes, are also discussed.</p><p><strong>Conclusions: </strong>SCS represents a promising yet selectively applicable modality for refractory cancer-related pain, particularly among patients with neuropathic and mixed pain phenotypes inadequately controlled with pharmacotherapy alone. Rather than functioning as a competing alternative to existing cancer pain interventions, SCS should be considered within a broader, multidisciplinary, phenotype-informed framework that includes guideline-directed pharmacologic care, interventional procedures, and neuromodulatory strategies such as intrathecal drug delivery. Future prospective studies are needed not only to clarify efficacy but also to refine patient selection and optimize the integration of SCS into modern cancer pain care.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"75"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147372","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":"Using strengths-based nursing to introduce the Kerala model of palliative care to Australia-a theoretical integrative narrative review.","authors":"Damaris Cheluvappa, Rajkumar Cheluvappa","doi":"10.21037/apm-2026-1-0018","DOIUrl":"https://doi.org/10.21037/apm-2026-1-0018","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objective: &lt;/strong&gt;Palliative care aims to enhance the quality of life for individuals with life-limiting illness through holistic, person-centred, and family-centred support. However, delivering equitable palliative care in rural/remote Australia remains a persistent challenge due to vast geography, limited clinicians, and diverse community needs. This paper proposes adapting the community-driven, cost-effective Kerala model of palliative care (KMPC)-to rural/remote Australian settings through strengths-based nursing (SBN).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The theoretical integrative narrative review methodology was used. Search words included combinations of \"Kerala model\", \"India\", \"Australia\", \"telehealth\", \"end-of-life care\", \"law\", \"legislation\", \"strengths-based nursing\", \"community nursing\", \"palliative care\", \"nursing governance\", \"rural palliative care\", \"nursing\", and \"nurse\". Our sources include reports, guidelines, and publications from Government repositories and research portals like PubMed and Google Scholar. Our searches resulted in about 40 publications and 10 reports, which were match-analyzed and integrated to critically evaluate the applicability of the KMPC using SBN in rural/remote Australia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key content and findings: &lt;/strong&gt;The KMPC, developed in Kerala (India), demonstrates near-universal access to palliative care despite limited resources. Its success is attributable to decentralised governance, community participation, home care units (HCUs), broad-based funding sources, and flexible integration of trained volunteers, social workers, nurses, and family caregivers. SBN complements this model by mobilising local strengths, fostering community capability, and enabling collaborative, holistic care. The paper describes three SBN phases-pre-commitment, pre-adoption, and adoption-and details the legislative, organisational, and workforce requirements for establishing Australian SBN-guided HCUs with community involvement. Evidence from Australian telehealth initiatives, rural palliative care models, and community-integrated care trials demonstrates the feasibility of combining KMPC principles with existing local frameworks, nurse-led coordination, community engagement, accredited training pathways, and telehealth support. Challenges include legislative reform, decentralisation of services, funding constraints, workforce training, and the need to adapt Kerala's sociocultural strengths to the Australian context.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;SBN-enabled adaptation of the KMPC offers a sustainable, culturally responsive, and cost-effective pathway to improving palliative care access and quality in rural/remote Australia. By leveraging community capacity, strengthening interdisciplinary collaboration, and integrating telehealth innovations, this model has the potential to enhance patient comfort, reduce unnecessary hospitalisation, and deliver high-quality end-of-life (EOL) care close","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"74"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147046","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":"Intraoperative methadone for cardiac surgery: is it time to embrace it?","authors":"Ashanpreet Grewal, Khang Lee, Samhati Mondal","doi":"10.21037/apm-2026-0060","DOIUrl":"https://doi.org/10.21037/apm-2026-0060","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"68"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147203","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":"Disparities in surgical palliation for malignant gastrointestinal obstruction: a review.","authors":"Jaewook Shin, Joshua T Cohen, Thomas J Miner","doi":"10.21037/apm-2026-0040","DOIUrl":"https://doi.org/10.21037/apm-2026-0040","url":null,"abstract":"<p><p>Surgical palliation is a critical component of comprehensive care for patients with advanced, unresectable cancer, often measured by symptom relief and improved quality of life (QOL). Malignant gastrointestinal (GI) obstructions-gastric outlet obstruction (GOO), malignant bowel obstruction (MBO), and biliary obstruction-are some of the most common indications for palliative surgery and associated with life-limiting nausea, vomiting, per oral (PO) intolerance, or jaundice. Treatment is inherently multimodal, including percutaneous, endoscopic, and operative approaches, with selection determined by disease burden, patient condition, and prognosis. Despite such advances in modalities, disparities in access to and outcomes of palliative surgical care are poorly characterized. Current evidence suggests racial and ethnic minorities, lower socioeconomic status, and rural settings are associated with reduced access to palliative care, delayed presentations, and poor outcomes. However, data specific to palliative surgery, including malignant GI obstructions, are limited, as most studies prioritize comparing efficacy of treatment modalities as opposed to disparities in palliative surgical care. This review surveys current surgical palliative options for GOO, MBO, and biliary obstruction and examines available evidence on disparities in access, utilization, and outcomes. We also highlight gaps in palliative surgical research that may hamper high-quality disparities research and propose future directions focused on standardized definitions, patient-centered palliative outcomes, and improved methodologies to better identify and address disparities in palliative surgical care.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"78"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147271","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":"What is oligoprogression?-a narrative review.","authors":"Lucas Uhl, Edward Christopher Dee, Nikolaos Dimitriou, Yue Helen Zhang, Narek Shaverdian, Puneeth Iyengar, Matthias Guckenberger, Jonas Willmann","doi":"10.21037/apm-2026-0042","DOIUrl":"10.21037/apm-2026-0042","url":null,"abstract":"<p><strong>Background and objective: </strong>Modern systemic therapies have transformed metastatic cancer management, yet acquired resistance remains a persistent clinical challenge. Frequently, this resistance manifests as oligoprogression, a distinct biological state in which a limited number of metastatic lesions grow or newly develop during active systemic therapy. Driven by branching clonal evolution, these rogue lesions can seed further widespread dissemination. This review examines how oligoprogression is defined and classified, which biological mechanisms underlie it, what clinical evidence supports local ablative therapy (LAT), and which endpoints and selection tools are required to validate the concept.</p><p><strong>Methods: </strong>Relevant English-language literature was identified through a search of PubMed/MEDLINE, supplemented by ClinicalTrials.gov and backward citation screening, covering the period from database inception to June 22, 2026. Prospective and, where available, randomized trials were prioritized, while consensus documents and selected retrospective and translational studies were included according to relevance and informative value.</p><p><strong>Key content and findings: </strong>Historically, focal progression prompted an immediate switch to next-line systemic treatments, which are often more toxic and less effective. However, a paradigm shift is underway: rather than discarding a largely successful regimen, clinicians increasingly utilize metastasis-directed therapy (MDT), such as stereotactic body radiation therapy (SBRT), to locally ablate progressive sites. Continuing effective systemic therapy while ablating resistant sites aims to safely extend its therapeutic window. Recent prospective trials suggest that SBRT may prolong progression-free survival (PFS) in selected settings, with outcomes varying substantially according to tumor histology and disease biology.</p><p><strong>Conclusions: </strong>LAT is a reasonable option in carefully selected patients, but the benefit depends on tumor histology, the systemic treatment context, and the endpoint assessed. Before oligoprogression can be regarded as an established clinical entity, trials should report PFS after subsequent therapy, time to next systemic therapy (TTNST), toxicity, and patient-reported outcomes (PROs) as distinct measures, and should evaluate imaging- and biomarker-based patient selection prospectively.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"73"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147287","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":"A phenomenological study of routine, independence, and help-seeking in home hospice patients living alone with terminal illness.","authors":"Paul Bashyam, Hui Fen Rachel Lee, Xiangyi Chen","doi":"10.21037/apm-2026-0061","DOIUrl":"https://doi.org/10.21037/apm-2026-0061","url":null,"abstract":"<p><strong>Background: </strong>Patients living alone with terminal illness in home hospice face challenges distinct from those living with caregivers. While prevailing research describes patterns of service use, less is known about the lived meanings that shape how these patients organize their days and decide when to seek assistance. This study describes the lived experience of solo-dwelling adults receiving home hospice care and the conditions under which help is sought or refused. This addresses a gap that limits person-centred planning for patients who wish to remain at home.</p><p><strong>Methods: </strong>Twelve patients of a home-hospice programme in Singapore who lived alone without caregivers were purposively recruited via clinician referral and partook in semi-structured, audio-recorded interviews. Transcripts were analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Four themes were identified: (I) independence functioned as a cognitive stance to reject a dependent identity and maintain personal agency; (II) daily routine served as a lifeline and a filter for interventions; support was accepted if it integrated into the existing physical rhythm without disrupting it; (III) patients organised relationships through obligation avoidance, preferring paid or low-demand community sources to protect dignity and control; and (IV) rather than by medical prognosis, help-seeking was conditional and time-bound, typically activated when key elements of their physical function could no longer be maintained.</p><p><strong>Conclusions: </strong>Findings describe a selective, purposeful negotiation of solo-dwelling with terminal illness. Care planning should begin by mapping the patient's routine, then add supports that extend it and minimise obligation. Plans should include patient-defined thresholds for escalation when routine fails.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"69"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147037","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}