Annals of palliative medicine最新文献

{"title":"Driving safety in patients with primary brain tumours and brain metastases in Canada: a scoping review.","authors":"Kevin Nishimura, Jennifer Yao, Sarah Lapointe, Rebecca Harrison, Manik Chahal, Mary Jane Lim-Fat, Saira Alli, Karine Michaud, Serge Makarenko, Mostafa Fatehi Hassanabad, Alan Nichol, Justin Oh","doi":"10.21037/apm-2025-1-136","DOIUrl":"10.21037/apm-2025-1-136","url":null,"abstract":"<p><strong>Background: </strong>Driving engages cognitive, sensory, motor, and visual functions, all of which may become compromised in patients with brain tumours or brain metastases. Many of these diagnoses are incurable and clinically dynamic, which poses added risk to safety on the road. While driving restrictions are essential for public safety, they may reduce patient independence and quality of life, particularly in palliative contexts. In Canada, no tumour-specific national guidelines exist, highlighting the need for a multidisciplinary framework that balances patient well-being and public safety.</p><p><strong>Methods: </strong>A scoping review was conducted using Medline, American Psychological Association (APA) PsycInfo, and Google Scholar to identify studies examining driving safety, licensing outcomes, fitness-to-drive assessments, or the impact of driving restrictions among patients with primary brain tumours or brain metastases. Canadian national and provincial driving policies were further reviewed and compared with international guidelines. Findings were synthesized to identify determinants of driving safety and gaps in current regulatory frameworks.</p><p><strong>Results: </strong>One hundred and seventy-five studies were initially screened and 13 met the inclusion criteria. Simulation-based and standardized driving assessments demonstrated that deficits in attention, executive function, visuomotor coordination, and visual processing were associated with impaired driving performance, even among patients with preserved functional status. Canadian guidance remains largely seizure-focused and defers to physician discretion, with limited incorporation of structured cognitive or functional assessment pathways. Canadian surveys revealed low physician confidence, limited awareness of existing resources, and variability in reporting practice. In contrast, international frameworks such as the United Kingdom Driver & Vehicle Licensing Agency provide tumour- and treatment-specific timelines, while Austroads emphasizes function-based assessment similar to Canada.</p><p><strong>Conclusions: </strong>Driving fitness assessment in patients with brain tumour is inconsistent in Canada, shaped by reliance on seizure history, heterogeneous provincial legislation, and lack of tumour-specific standards. Evidence supports a multidisciplinary, function-focused approach to driving fitness assessment that incorporates structured evaluation with ongoing reassessment. Development of national, brain-tumour specific guidelines is needed to ensure clear and safe decision-making for this patient population.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"23"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497367","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":"Integrating palliative and recovery-oriented perspectives: fostering innovative approaches in end-of life care for people with severe and persistent mental illness.","authors":"Loïc Moureau, Chantal Van Audenhove, Joris Vandenberghe","doi":"10.21037/apm-2025-aw-123","DOIUrl":"https://doi.org/10.21037/apm-2025-aw-123","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 2","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637753","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 schizophrenia with aggravation of psychiatric symptoms after cancer surgery: a case report and mini literature review.","authors":"Junji Yamaguchi, Ryoichi Sadahiro, Saho Wada, Eri Nishikawa, Tatsuto Terada, Rika Nakahara, Hiromichi Matsuoka","doi":"10.21037/apm-25-91","DOIUrl":"10.21037/apm-25-91","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer and comorbid psychiatric disorders, including schizophrenia, may experience aggravation of psychiatric symptoms during cancer treatment. Oncology hospitals without dedicated psychiatric wards sometimes face challenges in managing cases with severe psychiatric symptoms. Concerns exist that the worsening of psychiatric symptoms may lead to the interruption of cancer treatment.</p><p><strong>Case description: </strong>A woman in her 60s had chronic schizophrenia, with an estimated onset in her 20s. She had long been prescribed quetiapine (150 mg/day, oral), haloperidol (0.75 mg/day, oral), nitrazepam (10 mg/day, oral), and paroxetine (20 mg/day, oral). At X years, she was diagnosed with ovarian cancer and underwent surgery following discontinuation of the psychotropics. On day 2 after hospitalization, she became confused, hallucinatory, and delusional with severe agitation. Although initially stabilized, the patient exhibited worsening psychiatric symptoms again on day 7. Ultimately, the patient was mentally stabilized with adjusted doses of oral quetiapine (250 mg/day) and haloperidol (1.5 mg/day, oral) and was discharged on day 16. Thanks to the intervention, cancer treatment continued uninterrupted.</p><p><strong>Conclusions: </strong>Patients with comorbid schizophrenia and cancer may present severe psychiatric symptoms in the cancer perioperative period, even if schizophrenia is in a chronic phase. Postoperative delirium, withdrawal delirium, and exacerbation of schizophrenia were speculated to be the possible contributing factors in this case. When patients with cancer also have schizophrenia, oncologists and liaison psychiatrists need to carefully monitor their mental status to prevent interruptions in cancer treatment.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429960","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":"Acute-on-chronic liver failure: from definitions to management.","authors":"Abdurrahman Kadayifci, Sidart Pradeep, Eugenia Tsai","doi":"10.21037/apm-25-84","DOIUrl":"10.21037/apm-25-84","url":null,"abstract":"<p><p>Acute-on-chronic liver failure (ACLF) represents a rapidly progressive deterioration in chronic liver disease (CLD) marked by multi-organ dysfunction and high short-term mortality. Although consensus on a single definition remains elusive, the clinical phenotype is increasingly recognized across diverse populations, with regional differences in underlying liver disease and precipitants influencing diagnostic criteria and reported incidence. Bacterial infections, alcohol-associated hepatitis (AH), viral hepatitis flares, and drug-induced liver injury (DILI) are among the most common intrahepatic and extrahepatic triggers. The pathophysiology of ACLF reflects immune dysregulation and circulatory collapse, leading to organ failure (OF). This complex interplay may vary according to the number and type of failing organs, the severity of the underlying liver disease, and the nature of the precipitating event. Short-term mortality in ACLF remains high and increases in proportion to the number of OFs. Therapeutic options remain largely supportive, as no disease-modifying therapies have yet been established clinical benefit. Emerging therapies, such as liver support systems, have yet to demonstrate a clear long-term survival advantage. Liver transplantation (LT) remains the sole curative option with demonstrated survival benefit in carefully selected candidates. Due to the high risk of mortality in ACLF, early engagement of palliative care (PC) alongside evaluation for transplant is essential. Early recognition and timely triage remain central to improving outcomes in this high-risk population. This review explores the definitions, prognosis and clinical course of ACLF, emphasizing the importance of early recognition and intervention.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008801","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":"Integrating compassion early: palliative care's role in improving the quality of life and psychological well-being for individuals undergoing hematopoietic stem cell transplantation.","authors":"Lorinda A Coombs, Ashley Leak Bryant","doi":"10.21037/apm-2025-aw-125","DOIUrl":"10.21037/apm-2025-aw-125","url":null,"abstract":"<p><p>El-Jawahri A, LeBlanc TW, Kavanaugh A, et al. Multisite Randomized Trial of Inpatient Palliative Care Intervention for Patients Undergoing Hematopoietic Stem Cell Transplantation. J Clin Oncol 2025;43:2700-11.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951190","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":"Palliative care for people in prison: past, present and future.","authors":"Mary Turner","doi":"10.21037/apm-25-106","DOIUrl":"10.21037/apm-25-106","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951129","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 evolving role of radiotherapy in advanced non-small cell lung cancer: beyond symptom control.","authors":"Margherita Vianello, Karin Purshouse, Ian Fraser, Iain Phillips","doi":"10.21037/apm-25-103","DOIUrl":"10.21037/apm-25-103","url":null,"abstract":"<p><p>Non-small cell lung cancer (NSCLC) remains the leading cause of cancer mortality in the UK, with most patients presenting with locally advanced or metastatic disease. While palliative radiotherapy has historically aimed to alleviate symptoms, rapid advances in imaging, planning, and delivery-particularly stereotactic ablative body radiotherapy (SABR)-have expanded its role toward disease control. This review summarises the evolving evidence for external beam radiotherapy (EBRT) and SABR in advanced NSCLC. Low-dose thoracic EBRT remains effective for symptom relief, though higher-dose regimens may offer improved control in selected patients. Growing data support the use of local consolidative therapy, particularly SABR, to improve disease control in oligometastatic NSCLC. Trials such as SABR-COMET and that by Gomez et al. demonstrate substantial improvements in progression-free and overall survival with local consolidative therapy, though results are tempered by small sample sizes and heterogeneous populations. Multiple large-scale phase III trials are currently underway to further assess benefits of SABR in oligometastatic cancer and better define dose regimens. Systemic therapies have also rapidly evolved with significant advancements in targeted therapies, immunotherapy, and combination regimens. These are often used alongside radiation therapy, leading to concerns over increased toxicity. Large contemporary randomised trials are underway to update the evidence base in the context of modern systemic therapies. Ultimately, palliative radiotherapy remains central to advanced NSCLC management, with its role expanding from symptom control toward modifying disease progression and improving survival outcomes.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008158","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":"Body mass index but not percentage weight loss was associated with the race/ethnicity of patients with advanced lung cancer: a cross-sectional study.","authors":"Patricia S Bramati, Sonal Admane, James Troyer, Yi Huang, Eduardo Bruera, Rony Dev","doi":"10.21037/apm-25-113","DOIUrl":"10.21037/apm-25-113","url":null,"abstract":"<p><strong>Background: </strong>Patients with cancer often experience weight loss, which contributes to a decreased quality of life and signals a poor prognosis. The objective of this retrospective study is to investigate whether the self-reported race/ethnicity of patients undergoing palliative care is associated with weight loss.</p><p><strong>Methods: </strong>The charts of 1,253 patients with advanced lung cancer who had a Palliative Medicine consultation, during 2022, were identified and random sample of 94 Asian, 94 Black, 87 Hispanic and 91 non-Hispanic-White patients were selected for evaluation. Patient demographics, the Eastern Cooperative Oncology Group (ECOG) performance status, body mass index (BMI), weight history, symptom burden measured by the Edmonton Symptom Assessment System (ESAS), cancer treatments provided (chemotherapy, radiation, surgery, or immunotherapy), prescription of appetite stimulants [megestrol acetate, steroids, olanzapine, cannabinoids, metoclopramide, or mirtazapine), and nutritional laboratory markers (albumin, protein level, neutrophile-to-lymphocyte ratio (NLR)] were collected. Univariate and multivariable regression linear analysis were performed to explore whether a patient's self-identified race/ethnicity was an independent predictor of weight loss.</p><p><strong>Results: </strong>Among the different self-identified racial/ethnic groups of patients, no significant differences in age, gender, appetite stimulants received, and NLR were noted. The Asian and Hispanic cohort had significantly lower weight and BMI at first encounter, Palliative Medicine consultation, and final recorded visit compared to all other groups (P<0.01). The median time from the first encounter to the last recorded weight was 6.7 months for the whole cohort. Asian patients had significantly less total weight loss (8.2 kg) compared to Black (13.4 kg), Hispanic (9.1 kg), and non-Hispanic White (10.2 kg) patients (P=0.04); but all four groups experienced similar proportion of weight loss (%) (12.8 vs. 14.9 vs. 12.2 vs. 12.9; P=0.79), respectively. Asian patients had a higher median household income (P<0.001), less likely to live alone (P=0.02), and more likely to be married or have a significant other (P<0.001). In a multivariate analysis, the weight at first encounter but not race/ethnicity was the only independent predictor of percentage weight loss.</p><p><strong>Conclusions: </strong>In patients with advanced lung cancer, BMI and total weight loss but not percentage change in weight was significantly associated with self-identified race/ethnicity at the time of Palliative Medicine consultation. On multivariate analysis, the percentage loss in weight was significantly influenced by the weight at first encounter but not race/ethnicity. Racial/ethnic variations in BMI but not percentage weight loss should be accounted for when diagnosing cancer cachexia and more research is needed.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148771","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":"Through their eyes: a breast cancer survivor-led art workshop for undergraduate medical students.","authors":"Muna Alkhaifi, Rebecca Starkman, Elwyn Zhang, Malika Peera, Preet Ahluwalia, Ellen Paonessa, Sylvia Langlois, Sarah Kim, Joyce Nyhof-Young","doi":"10.21037/apm-25-110","DOIUrl":"10.21037/apm-25-110","url":null,"abstract":"<p><strong>Background: </strong>As breast cancer survivorship increases, medical education must better prepare students to provide patient-centred care. Traditional didactic methods often fall short in fostering the requisite empathy and understanding. Integrating arts-based learning with patient storytelling may offer an effective approach to support affective and reflective learning outcomes. The objective of this study was to explore the potential of a novel arts-based educational approach aimed at enhancing medical students' understanding of breast cancer survivor patients' experiences and empathy through mindful engagement and collaborative creation.</p><p><strong>Methods: </strong>We conducted a two-hour experiential workshop with 23 first- and second-year medical students at the University of Toronto. Participants heard directly from breast cancer survivors and engaged in a facilitated, clay-based art-making session to reflect on patient experiences. Data were collected via non-participant observers, post-workshop questionnaires focus groups with students, and interviews with patient participants. Quantitative data were analyzed descriptively, and qualitative data were examined using reflexive thematic analysis.</p><p><strong>Results: </strong>The 23 student participants (100% response rate) described the workshop as impactful, citing deeper emotional engagement, increased empathy, and stronger understanding of cancer survivorship. Key themes included meaningful learning, high-impact educational value, and the workshop's role as a valuable curricular addition. Patient participants reported feelings of empowerment and affirmation.</p><p><strong>Conclusions: </strong>Arts-informed, patient-centred education has the potential to enhance empathy and reflective practice among medical students. Future research should explore longitudinal impacts, curricular integration, and interdisciplinary scalability to further evaluate its potential in medical education.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148720","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":"Psycho-oncology on wheels-a qualitative feasibility study of implementing home-based psychosocial support within specialist palliative home care (SPHC): a study protocol.","authors":"Sarina Carter, Julia Thiesbonenkamp-Maag, Christina Gerlach, Laura Breitfelder, Anja Wiesegart, Hans-Christoph Friederich, Till Johannes Bugaj, Bernd Alt-Epping","doi":"10.21037/apm-25-70","DOIUrl":"10.21037/apm-25-70","url":null,"abstract":"<p><strong>Background: </strong>Psycho-oncological support is crucial for palliative cancer patients and their families, helping them to cope with psychosocial distress. Currently, this support is most often provided in inpatient settings or during regular outpatient appointments. A decline in general health and the cessation of tumour-specific treatment often lead to an abrupt end of the established therapeutic relationship, creating a gap in care precisely when patients and their families face a particularly burdensome situation. Specialist palliative home care (SPHC) offers comprehensive physical and psychosocial support within a home-based environment. This project aims to investigate whether pre-existing psycho-oncological care can be continued and integrated into home care with the help of SPHC logistics, focusing on feasibility and implementation. Therefore, psycho-oncologists who typically provide care for patients in a clinical setting will perform home visits for palliative cancer patients.</p><p><strong>Methods: </strong>Data will be collected through semi-structured interviews with patients, their relatives, psycho-oncologists, and SPHC staff to assess the feasibility of providing home-based psycho-oncological care. The interviews will explore factors such as the acceptability, satisfaction, and practicability of the intervention, while also identifying key facilitators and barriers to successful implementation.</p><p><strong>Discussion: </strong>By identifying facilitating and hindering factors, this study aims to determine how home-based psycho-oncological care can be implemented successfully using SPHC infrastructure. The findings can contribute to advancing research on appropriate psycho-oncological care for palliative patients in their homes and to establishing corresponding care structures.</p><p><strong>Trial registration: </strong>The study was registered at German Clinical Trials Register, ID: DRKS00034896.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148728","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}