Annals of palliative medicine最新文献

{"title":"Holistic Palliative Care.","authors":"Charles B Simone","doi":"10.21037/apm-20262-07","DOIUrl":"https://doi.org/10.21037/apm-20262-07","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"80"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147884","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":"15 5","pages":"77"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147032","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":"Myofascial pain with psychosomatic features in an octogenarian female gastric cancer survivor treated with a psychosomatic approach: a case report.","authors":"Hideaki Hasuo, Hiroyuki Otani, Hiromichi Matsuoka, Yoshinobu Matsuda, Mariko Shimazu, Aya Kuroda, Junji Nishiyama","doi":"10.21037/apm-2026-0043","DOIUrl":"https://doi.org/10.21037/apm-2026-0043","url":null,"abstract":"<p><strong>Background: </strong>Non-cancer-related pain in cancer survivors can be difficult to assess when symptoms are interpreted as cancer progression and when impaired bodily awareness limits engagement in self-care. Myofascial pain with psychosomatic features accompanied by marked alexisomia has rarely been described in gastric cancer survivors. This case report describes the clinical application of a structured, multi-stage psychosomatic approach for refractory myofascial pain with psychosomatic features in an octogenarian female gastric cancer survivor.</p><p><strong>Case description: </strong>An octogenarian woman with recurrent gastric cancer, who had achieved complete response after pembrolizumab therapy, developed refractory episodic nocturnal pain in the bilateral upper back. The pain was unresponsive to nonsteroidal anti-inflammatory drugs and opioids. Computed tomography and clinical evaluation revealed no evidence of metastatic recurrence or structural lesions. Physical examination showed marked bilateral upper-back muscle tension and multiple trigger points, although the patient was initially unaware of this tension and attributed the pain to cancer progression. The Shitsu-Taikan-Sho Scale (STSS) score was 85, indicating marked alexisomic tendencies. A multidisciplinary home-based palliative care team implemented a four-stage psychosomatic approach: establishment of a therapeutic relationship, biopsychosocial assessment, development of insight into mind-body interactions using physical examination findings including the Armchair Sign, and introduction of self-care strategies such as progressive muscle relaxation. After the intervention, the worst Numerical Rating Scale pain score decreased from 7 to approximately 4, the STSS score improved from 85 to 62, and nighttime emergency nursing visits ceased.</p><p><strong>Conclusions: </strong>This single case suggests that a structured psychosomatic approach combining physical examination, assessment of alexisomia, and facilitation of mind-body awareness may be feasible and clinically useful for supporting self-care in selected cancer survivors with refractory myofascial pain and psychosomatic features. Further studies are needed to clarify its generalizability and therapeutic contribution.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"79"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147256","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":"Assessing palliative care education and attitudes among radiation oncology residents.","authors":"Riley P McDougall, Malcolm D Mattes, Yolanda D Tseng, Emily J Martin, Charles B Simone, Jared R Robbins","doi":"10.21037/apm-2026-0037","DOIUrl":"https://doi.org/10.21037/apm-2026-0037","url":null,"abstract":"<p><strong>Background: </strong>Palliative care (PC) plays a vital role in radiation oncology (RO), but the breadth, quality, and effectiveness of formal PC education and radiation-specific palliative care (RSPC) during residency vary widely. A better understanding of how RO residents view their current training and where they see room for improvement can help guide future educational efforts. The study aims to evaluate RO residents' experiences with and attitudes toward PC and RSPC education, identify perceived gaps in training, gather suggestions for important topics, and determine preferred ways to optimally incorporate PC teaching into the existing resident schedule framework.</p><p><strong>Methods: </strong>From January through May 2025, a national cross-sectional survey was sent to 552 PGY-3 to PGY-5 U.S. RO residents using a REDCap-based online platform. The anonymous survey collected demographic information and inquired about the adequacy of current PC education, areas of additional instruction, and preferred learning formats and scheduling. Quantitative data were summarized descriptively, and mapped to the corresponding structured categories where relevant.</p><p><strong>Results: </strong>A total of 110 responses were received (response rate 19.9%). Most respondents identified as White (60.9%) and male (65.4%) from programs with 5-9 (40.7%) or 10-14 (35.2%) residents. While 89.0% reported access to a dedicated PC specialist, only 27.5% reported access to an RSPC specialist. Nearly all respondents supported the need for formal training in RSPC (96.0%) and general PC (84.2%). Although 45.5% reported faculty-led instruction in PC or RSPC, 15.8% indicated receiving no formal training in either area. Topics of greatest interest included symptom management, hospice care, ethical issues for PC, spinal stereotactic body radiation therapy (SBRT), and on-call management for RSPC. Residents preferred case-based, quarterly modules lasting 30-60 minutes as the most feasible educational format.</p><p><strong>Conclusions: </strong>RO residents widely recognize the importance of structured PC and RSPC training but report significant variability in current educational offerings. Programs may enhance preparedness and patient care by integrating concise, case-based, and specialty-relevant PC content into existing curricula. These findings highlight the need for standardized national efforts to strengthen PC education within RO training.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"71"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149234","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":"Top reviewers for Annals of Palliative Medicine from 2025.","authors":"Charles B Simone","doi":"10.21037/apm-20262-06","DOIUrl":"https://doi.org/10.21037/apm-20262-06","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"67"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147251","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":"Narrative review of pharmacologic and interventional strategies for cancer pain management in adults with incurable disease.","authors":"Giuliano Lo Bianco, Alaa Abd-Elsayed, Sebastiano Mercadante","doi":"10.21037/apm-2026-0066","DOIUrl":"https://doi.org/10.21037/apm-2026-0066","url":null,"abstract":"<p><strong>Background and objective: </strong>Cancer pain affects 55-95% of patients with advanced malignancy and remains inadequately controlled in approximately two-thirds of those with metastatic disease. Management is shifting toward a multimodal, mechanism-based and personalised approach. This narrative review summarises current evidence and international guideline recommendations on cancer pain management in adults, with a clinical focus on incurable disease.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Embase and the Cochrane Database of Systematic Reviews were searched from 1 January 2000 to 30 April 2026, supplemented by handsearching of international oncology, palliative-care and pain-medicine guidelines and of the 2025 multi-society consensus on opioid conversion. Systematic reviews, meta-analyses, randomised trials and current guidelines were prioritised.</p><p><strong>Key content and findings: </strong>Opioids are indicated for moderate-to-severe pain caused by cancer or its treatment and in palliative care; this indication should not be extrapolated to chronic non-cancer pain, where their benefit is small and comparable to non-opioid alternatives. The distinction is mechanistic: µ-opioid receptor agonism damps transmission from intact, continuously driven nociceptors, whereas nerve injury dismantles part of that target, so that antidepressants and anticonvulsants-not opioids-are first-line for neuropathic pain; methadone, buprenorphine, tapentadol and tramadol are partial exceptions owing to their additional non-opioid mechanisms. Titration and rotation remain central, with conversion ratios used as a starting framework rather than a fixed rule. Methadone, including intravenously, is valuable in neuropathic and opioid-refractory pain under specialist oversight. Rapid-onset transmucosal fentanyl outperforms oral morphine for breakthrough pain. Evidence does not support routine use of cannabinoids. Intrathecal drug delivery benefits carefully selected refractory patients, but the limitations of the published literature highlight the risk of premature procedural escalation before systemic optimisation. Non-pharmacologic interventions, palliative radiotherapy and pharmacogenomic-guided prescribing complete the framework.</p><p><strong>Conclusions: </strong>Effective cancer pain management combines mechanism-based pharmacotherapy with evidence-informed interventional strategies and psychosocial support. Methadone, intrathecal therapy and emerging biased agonists each have a defined place, but none replaces clinical judgement and prior optimisation of systemic therapy. Restrictive frameworks developed for chronic non-cancer pain should not be applied to incurable cancer, where under-treatment remains the dominant risk; conversely, opioid efficacy in cancer pain does not endorse their use in non-cancer, particularly neuropathic, pain.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"72"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147703","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":"Do pacemakers prolong the dying process in a palliative setting?-a retrospective matched cohort analysis.","authors":"Heleen Bollen, Rik Willems, Johan Menten","doi":"10.21037/apm-2026-0027","DOIUrl":"https://doi.org/10.21037/apm-2026-0027","url":null,"abstract":"<p><strong>Background: </strong>Clinicians caring for end-of-life patients regularly receive questions from patients and relatives about whether the pacemaker (PM) has to be deactivated. The possible life-prolonging effect of an active PM on the dying process of a palliative patient remains a scientific and clinical question in the literature and is a challenge for caregivers and patients in the end-of-life phase. This study analyzed whether there is a possible life-prolonging effect of an active PM in palliative patients.</p><p><strong>Methods: </strong>The time that 83 terminal palliative PM patients passed at a palliative care until death is compared with the time that 163 matched control terminal non-PM patients passed at the same palliative care unit (PCU). The non-PM patients are matched for age, gender, and underlying diseases.</p><p><strong>Results: </strong>The survival curves of PM and matched control non-PM patients were, for most of the time, exactly superimposed. Some PM patients died in the period 10-45 days after intake at the PCU a few days earlier than the control patients. This may be explained by their higher cardiovascular morbidity, more frequent previous cardiac surgery, more diabetes mellitus, and impaired kidney function.</p><p><strong>Conclusions: </strong>There is no evidence that an active PM prolongs the dying process in terminal PCU patients; a few PM patients died even earlier than their matched control non-PM patients.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 5","pages":"70"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147160","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":"Introduction to the special series: multidisciplinary and holistic palliative care.","authors":"Eva Oldenburger, Johan Menten","doi":"10.21037/apm-2026-0048","DOIUrl":"https://doi.org/10.21037/apm-2026-0048","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547779","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 right to function at end of life: aligning advance care planning with palliative rehabilitation.","authors":"Christopher M Wilson, Ann M Henshaw, Mark C Navin","doi":"10.21037/apm-2026-1-0022","DOIUrl":"10.21037/apm-2026-1-0022","url":null,"abstract":"<p><p>Movement and bodily autonomy are integral to life and participation in meaningful activities. Current advance care planning (ACP) and advance directive processes do not consistently elicit discussions or documentation about these topics. The problem is especially serious when continued movement increases the risk of falling or other negative health events. This review article integrates available evidence and the authors' clinical experience to argue that ACP should include functional goals and that rehabilitation professionals should be regular members of end-of-life care teams. We address clinical, ethical, and system-level barriers to change and we present a composite case vignette to illustrate the implications and complexities that can occur when function and bodily autonomy are not considered during ACP activities. Rehabilitation providers such as physical therapists, occupational therapists, and speech-language pathologists provide support and interventions to help mitigate risk while facilitating functional independence. However, because discussions around mobility goals at the end of life do not consistently occur, rehabilitation professionals are inconsistently involved as care team members for people who are dying. Without access to rehabilitation, patients may face well-intentioned but overly restrictive care decisions that limit their participation in meaningful life activities. Including functional priorities in ACP, and rehabilitation professionals on care teams, will better align end-of-life care with what dying patients value.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429628","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":"Operational phenotyping for chronic low back pain: a narrative review and methodology for developing routing and escalation pathways across spine care.","authors":"Kai-Uwe Lewandrowski, Matthias Pumberger, Friederike Schomig, Biswadjiet Sanjay Harhangi, Alexander R Vaccaro, Morgan P Lorio","doi":"10.21037/apm-2026-1-0026","DOIUrl":"10.21037/apm-2026-1-0026","url":null,"abstract":"<p><strong>Background and objective: </strong>Chronic low back pain (CLBP) is clinically heterogeneous and generates substantial symptom burden, functional limitation, psychological distress, work disability, and health-care utilization. Existing phenotyping approaches often describe subgroups but do not specify how subgroup assignment changes routing, conservative-care dose, imaging, interventional escalation, surgical evaluation, or outcome monitoring. The objective of this narrative review was to define operational phenotyping as a practical method for developing routable, auditable spine-care pathways and to distinguish this methodology from descriptive subgrouping, Subgroups for Targeted Treatment Back Screening Tool (STarT Back)-style risk stratification, and machine-learning phenotyping.</p><p><strong>Methods: </strong>We conducted a narrative review using structured methods. PubMed/MEDLINE was the primary database, supplemented by Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus/Web of Science when available, guideline and trial-registry review, and reference-list screening. Searches covered January 2000 through January 2026. Studies were synthesized using an Inputs-Decision-Pathway-Outcome (IDPO) framework. The Berlin deep-phenotyping program was used as a contextual exemplar of multidomain measurement, not as evidence of treatment efficacy.</p><p><strong>Key content and findings: </strong>The synthesis yielded five operational findings. First, phenotype labels are implementation-ready only when linked to explicit pathway decisions. Second, minimal universal inputs should be separated from targeted add-ons. Third, escalation gates require illustrative thresholds and safety overrides rather than open-ended care drift. Fourth, diagnostic procedures, including diagnostic medial branch blocks, may themselves define a pain generator phenotype and should not be treated only as downstream treatment. Fifth, surgical referral should be framed as entry into shared decision-making evaluation rather than an automatic indication for surgery.</p><p><strong>Conclusions: </strong>Operational phenotyping is best understood as a methodology for developing a field guide rather than a completed field guide for all settings. It translates deep phenotyping and stratified-care concepts into locally deliverable pathways by requiring the same four elements for each phenotype: feasible inputs, explicit decision logic, an actionable pathway, and measurable outcomes.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429697","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}