Annals of palliative medicine最新文献

{"title":"Catatonia in the medically ill and dying: a review for palliative care clinicians.","authors":"Gregg A Robbins-Welty, Lauren Gensler, Ben Kalivas, Jo Ellen Wilson, Joshua R Smith, Paul Lindenfeld, Paul Riordan, Andrew Coulter, Dan Fishman, Paul Noufi","doi":"10.21037/apm-25-76","DOIUrl":"https://doi.org/10.21037/apm-25-76","url":null,"abstract":"<p><p>Catatonia is a severe and potentially life-threatening but often reversible neuropsychiatric syndrome. While commonly associated with psychiatric disorders, it is increasingly recognized in medically ill populations, including patients with serious illness. Catatonia frequently overlaps with delirium, dementia, and end-of-life changes, and can mimic irreversible decline, contributing to missed diagnoses and goal-discordant care. Palliative care (PC) clinicians are uniquely positioned to identify and treat catatonia in this context, yet awareness and familiarity with its assessment and management remain limited outside of psychiatric settings. This review aims to synthesize current evidence and provide practical guidance to help PC clinicians recognize, assess, and manage catatonia in patients with serious illness. We highlight the epidemiology, pathophysiology, clinical features, assessment and management of catatonia in seriously ill patients, with a focus on practical application for PC clinicians. We also provide guidance on screening, diagnosis, and treatment-emphasizing the use of bedside tools such as the Bush-Francis Catatonia Rating Scale and the lorazepam challenge-and review first-line and adjunctive therapies, including benzodiazepines and electroconvulsive therapy. Clinical overlap with delirium and other forms of altered mental status is discussed, as is the importance of incorporating catatonia into routine diagnostic frameworks and prognostic conversations. Recognizing and treating catatonia can relieve suffering, restore communication, and shift clinical trajectories in ways that support patients' goals of care. Awareness of catatonia among PC teams can lead to earlier diagnosis, effective treatment, and better alignment of care with patient values.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 6","pages":"600-616"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706932","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 wish to hasten death: normalize talking, not doing!","authors":"Raymond Voltz, Cristina Monforte Royo","doi":"10.21037/apm-25-69","DOIUrl":"https://doi.org/10.21037/apm-25-69","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 6","pages":"538-539"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706894","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":"Patient Reported Outcomes/Metrics Program Trial (PROMPT)-palliative radiation: protocol of a prospective observational feasibility study.","authors":"Hiba Othman, Breffni Hannon, Zhihui Amy Liu, Srinivas Raman, Edel Sexton, Cory Kasper, Héloïse Auger, Chiaojung Jillian Tsai, Aisling Barry, Philip Wong","doi":"10.21037/apm-25-19","DOIUrl":"10.21037/apm-25-19","url":null,"abstract":"<p><strong>Background: </strong>Palliative radiotherapy (RT) is commonly used to relieve symptoms and improve quality of life (QOL) for patients with metastatic cancer. Timely recognition of treatment related symptoms and adverse events (AEs), however, remains challenging, as reporting often depends on clinic visits and patient recall. This study explores the feasibility of integrating biometric monitoring, specifically the smart shirt from the Hexoskin Medical System (HMS), to monitor patients with metastatic cancer receiving palliative RT for symptom management. This is complemented by Zamplo, a digital health platform to allow patients and caregivers to report symptoms and well-being.</p><p><strong>Methods: </strong>The PROMPT trial is a prospective observational feasibility study that aims to recruit 100 patients with metastatic cancer undergoing palliative RT. Adult patients with a confirmed cancer diagnosis who can wear the HMS shirt and use the Zamplo platform are included. To improve accessibility and trial opportunity, patients are fitted with one of 11 sex-adjusted HMS shirt sizes, provided a smartphone, and taught to use Zamplo account. Patients are encouraged to wear the HMS shirt for a minimum of 4 hours daily at baseline, during RT and periodically during follow-up. Patient-reported outcomes (PROs) are being collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the EuroQol 5-Dimension 5-Level, the Person-Centred Coordinated Care Experiences Questionnaire for Cancer Patients (PCC-CA-6), and Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events through Zamplo at baseline and on days 30, 90 and 365, and through ad-hoc patient entries. Zamplo data are complemented with routine clinical symptom screening using ESAS. The primary endpoint is to recruit 100 patients within a 12-month period and to report the frequency of grade 2 or above AEs within 30 days of RT.</p><p><strong>Discussion: </strong>HMS shirt may improve detection and timely management of RT-related AEs and help identify key biometric variables that predict or correspond to AEs and changes in patient well-being. Whereas patients typically accept wearing wrist-worn activity trackers (ATs), this study will determine whether remote monitoring using the HMS shirt is acceptable and feasible in a palliative cancer population.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT04983199.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 6","pages":"570-578"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706937","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":"HR20013, a fixed-dose intravenous combination of fosrolapitant and palonosetron, for the prevention of cisplatin-induced nausea and vomiting: putting the PROFIT trial into perspective.","authors":"Luigi Celio, Andrea Antonuzzo","doi":"10.21037/apm-25-62","DOIUrl":"https://doi.org/10.21037/apm-25-62","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 6","pages":"624-629"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706922","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":"Symptom prevalence in palliative care patients admitted to the emergency department: are there differences between patients with cancer and non-cancer illness?","authors":"Paolo Cotogni, Elisa Costantini, Giorgia Macchi, Antonio Scarmozzino","doi":"10.21037/apm-25-93","DOIUrl":"10.21037/apm-25-93","url":null,"abstract":"<p><strong>Background: </strong>The rising prevalence of serious illnesses has increased the demand for emergency department (ED) services. Patients with advanced chronic conditions frequently present to the ED with distressing symptoms. Although symptom prevalence has been well described in oncology populations, fewer studies have assessed non-cancer illnesses, particularly in the ED. This study aimed to compare symptom prevalence in patients with cancer and non-cancer illness awaiting hospitalization after ED admission and referred to the hospital palliative care (PC) team.</p><p><strong>Methods: </strong>We conducted a prospective, observational, cohort study over 2 years [2023-2024] at a tertiary university hospital. Adults with serious illness referred from the ED to the hospital PC team were eligible if they had ≥1 symptom scoring ≥4 in a numeric rating scale (NRS) ranging from 0 to 10. Thirteen symptoms were evaluated, encompassing physical, psychological, and spiritual domains. Prevalence was analyzed descriptively and compared between cancer and non-cancer groups using Fisher's exact test.</p><p><strong>Results: </strong>Among 542 patients screened, 416 met eligibility criteria: 141 (34%) with cancer and 275 (66%) with non-cancer illness. Nearly all patients reported at least one symptom ≥4. Compared to non-cancer patients, those with cancer more often experienced pain (49% vs. 31%, P<0.001), fatigue (84% vs. 75%, P=0.02), appetite loss (54% vs. 32%, P<0.001), nausea (22% vs. 13%, P=0.02), vomiting (16% vs. 6%, P=0.004), and diarrhea (11% vs. 4%, P=0.01). In contrast, dyspnea was significantly higher in non-cancer illness (62% vs. 35%, P<0.001). Several symptoms were common in both groups without significant differences.</p><p><strong>Conclusions: </strong>This study shows that seriously ill patients presenting to the ED experience substantial symptom burden, but with distinct profiles between cancer and non-cancer conditions. In this sample, pain, fatigue, and gastrointestinal symptoms predominate in cancer, while dyspnea characterizes non-cancer illness. These findings underscore the need for systematic symptom screening and early PC referral in the ED to ensure equitable, timely, and effective symptom relief across all serious illnesses.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 6","pages":"558-569"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706918","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":"Community-based palliative care in Kenya: its history, current status, challenges and future.","authors":"John Weru, Richard A Powell","doi":"10.21037/apm-25-64","DOIUrl":"10.21037/apm-25-64","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"523-527"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145487433","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":"Supporting the journey: palliative care for patients with gastrointestinal cancers.","authors":"Khaldoun Almhanna, Dana Guyer","doi":"10.21037/apm-25-105","DOIUrl":"https://doi.org/10.21037/apm-25-105","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 6","pages":"528-530"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706967","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":"Delirium due to Trousseau syndrome in a patient with cancer and a history of recurrent infection-induced delirium: a case report and mini literature review.","authors":"Junji Yamaguchi, Ryoichi Sadahiro, Saho Wada, Eri Nishikawa, Kentaro Horiuchi, Tatsuto Terada, Rika Nakahara, Hiromichi Matsuoka","doi":"10.21037/apm-25-65","DOIUrl":"10.21037/apm-25-65","url":null,"abstract":"<p><strong>Background: </strong>It is common for patients with cancer to present with delirium during cancer treatment due to various causes, such as infection, electrolyte abnormalities, medications, and brain metastasis. Furthermore, delirium may also occur when a patient with cancer develops Trousseau syndrome. Delirium due to Trousseau syndrome in a cancer patient with a history of repeated delirium might be mistaken for previous episodes, which could lead to overlooking a stroke.</p><p><strong>Case description: </strong>A male aged 90 years with gallbladder cancer was admitted to the hospital. During hospitalization, he experienced recurrent episodes of cholangitis and fever, accompanied by delirium. His inflammatory response decreased, and his fever resolved following antibiotic treatment. After recovery, he experienced a loss of appetite, and olanzapine (2.5 mg/day) was started on Day 17 of hospitalization. However, early on Day 21, he suddenly became restless, moaned loudly, and exhibited signs of delirium. Initially, delirium due to olanzapine or reinfection was suspected. However, a new stroke was suspected because of speech impairment as well as the sudden onset of delirium. Head magnetic resonance imaging revealed a fresh stroke in the right basal ganglia, which was identified as the cause of the delirium.</p><p><strong>Conclusions: </strong>Patients with cancer are more prone to developing stroke due to the hypercoagulable state associated with malignancy. Even in the absence of obvious neurological signs, such as hemiplegia, the possibility of Trousseau syndrome needs to be considered when a patient presents with atypical or sudden-onset delirium.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"617-623"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562333","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":"Resident perceptions of a novel virtual serious illness communication skills curriculum incorporating medical management: qualitative analysis of participant group interviews.","authors":"Dmitry Kozhevnikov, Ambrose H Wong, Karen Jubanyik, Stephanie Tu, Matthew S Ellman, Laura J Morrison","doi":"10.21037/apm-25-72","DOIUrl":"https://doi.org/10.21037/apm-25-72","url":null,"abstract":"<p><strong>Background: </strong>Emergency medicine (EM) and internal medicine (IM) physicians care for patients in settings where prompt recognition of and effective communication about acute decompensation and the potential for imminent death is crucial to providing goal-concordant care. Competence in these tasks requires dedicated training and facilitated practice in serious illness communication (SIC). Existing simulation-based SIC curricula typically utilize cases in which the diagnosis and prognosis are already established in a medically stable patient, representing a missed opportunity for learners. To fill this gap, the authors aimed to explore IM and EM resident perceptions of a novel, entirely virtual SIC curriculum, Managing Acute Decompensation in Life-limiting Illness (MADLI), that required participants to assess and manage a clinically decompensating seriously ill patient while simultaneously incorporating newly learned SIC skills.</p><p><strong>Methods: </strong>Sixteen participants were recruited from the EM and IM residency programs at a large, tertiary, academic medical center. Using a \"flipped classroom\" approach, residents asynchronously viewed a 20-minute didactic video introducing evidence-based communication frameworks. In small peer groups led by a trained faculty facilitator, they then participated in a 60-minute simulated clinical encounter involving an acutely decompensating patient and their surrogate decision maker, played by an SIC-trained actor. Lastly, residents participated in a 30- to 60-minute semi-structured group interview. Qualitative thematic analysis was performed to identify overarching themes that resulted from the interview data.</p><p><strong>Results: </strong>Qualitative analysis of group interview transcripts yielded 3 major themes that reflect the trainee experience with the MADLI curriculum: (I) simulation unmasked moral challenges; (II) simulation facilitated safe practice and identification of knowledge gaps for SIC skills; and (III) task switching and case realism were virtual SIC curricular elements that promoted learner engagement and effective learning. Additionally, integrating medical management and SIC tasks was perceived as novel, challenging, and realistic. Residents who completed the MADLI curriculum viewed it as an effective modality to teach SIC.</p><p><strong>Conclusions: </strong>Simulation-based curricula for EM and IM residents that combine medical management, prognostication, and complex SIC into a single virtual, simulated patient encounter can address critical gaps in resident education related to the management of seriously ill patients at high risk of imminent death. Incorporating a trained actor and task-switching enhanced realism and learner engagement, highlighting the value of this model as a feasible approach to advancing IM and EM resident SIC skills.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 6","pages":"540-551"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706961","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":"Beyond symptom management: the ethics and psychiatry of palliative medicine.","authors":"Charles B Simone","doi":"10.21037/apm-2025-04","DOIUrl":"https://doi.org/10.21037/apm-2025-04","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"14 6","pages":"635-636"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706895","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}