Annals of palliative medicine最新文献

{"title":"The ethical and existential dimension of palliative care.","authors":"Carlo Leget, Mai-Britt Guldin","doi":"10.21037/apm-25-97","DOIUrl":"10.21037/apm-25-97","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951214","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":"Prospective symptom burden assessment in patients with cancer and non-cancer advanced diseases.","authors":"Charles B Simone","doi":"10.21037/apm-2026-01","DOIUrl":"https://doi.org/10.21037/apm-2026-01","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 1","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148733","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 role of Quad Shot in palliative radiotherapy: narrative review of the evidence and applications in advanced head and neck cancer.","authors":"David J Crompton, Homan Mohammadi, Michelle A Wear, Katey M Wert, Phillip Pirgousis, Samip Patel, Oluwafunmilola T Okuyemi, Jeffrey R Janus, David M Routman, Scott C Lester, Daniel J Ma, Samir H Patel, Yujie Zhao, Shenduo Li, Adam L Holtzman","doi":"10.21037/apm-25-80","DOIUrl":"10.21037/apm-25-80","url":null,"abstract":"<p><strong>Background and objective: </strong>Palliative radiotherapy (RT) plays a key role in managing advanced, recurrent, and metastatic head and neck cancers (HNCs), aiming to relieve symptoms and improve quality of life (QOL). The Quad Shot (QS) regimen, delivering 14.0 to 14.8 Gy in 4 fractions over 2 days repeated every 3 to 4 weeks, has emerged as an attractive treatment option. This review evaluates the efficacy, toxicity, and convenience of QS compared to other palliative RT regimens.</p><p><strong>Methods: </strong>We performed a narrative review of published literature on QS and other palliative RT regimens for HNC. Studies evaluating symptom relief, tumor response, toxicity profiles, and treatment logistics were included.</p><p><strong>Key content and findings: </strong>QS achieves rapid symptom relief with minimal toxicity, with reported partial or complete response rates of 60% to 85% and palliative symptom control in over 70% of patients. Compared to conventional and stereotactic regimens, QS offers shorter treatment duration, favorable tolerance, and repeatability. Two case reports are described in this review, and appropriate patient selection, institutional target volume definitions, prescription doses, and recommended dose constraints are discussed. Future directions of QS include combination immunotherapy, minibeam RT, personalized ultrafractionated stereotactic adaptive RT, and reirradiation with particle therapy (e.g., proton and carbon ion).</p><p><strong>Conclusions: </strong>The QS regimen is an effective, convenient, and well-tolerated palliative RT approach for advanced HNC, particularly for patients with significant comorbid conditions or poor prognosis. Ongoing studies will clarify the role of QS alongside systemic therapies and advanced technologies.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 1","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148743","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 rehabilitation is relationship-centered care.","authors":"Christopher M Wilson, Christina Papadimitriou","doi":"10.21037/apm-25-107","DOIUrl":"10.21037/apm-25-107","url":null,"abstract":"<p><p>People with life-threatening illness frequently experience progressive functional decline and shifting priorities that require a flexible, individualized approach to rehabilitation. However, rehabilitation services within palliative care remain underutilized and are often poorly understood. This clinical practice review describes the importance of integrating relationship-centered care principles into palliative rehabilitation to enhance communication, shared decision-making, and alignment of care with patient values. A data-driven case vignette of a hospitalized patient illustrates the complexities and missed opportunities that can occur when rehabilitation care is not guided by relationship-centered principles. A review of the literature was conducted using PubMed, CINAHL, and Google Scholar from 2015 through 2025. Search terms included \"palliative rehabilitation, relationship-centered care, shared decision making, communication, person-centered care, interdisciplinary rehabilitation, and advanced illness\". Reference lists of key articles and reviews were also examined. Articles were included if they addressed communication, decision-making, or relational aspects of care within rehabilitation or palliative contexts. Both empirical and conceptual papers were reviewed, along with consensus documents from professional and governmental agencies and clinical summaries from authoritative book chapters. Only English-language publications focusing on adult populations were included. The literature indicates that palliative rehabilitation differs from conventional models by emphasizing adaptation to changing patient goals, unpredictable disease trajectories, and the psychosocial realities of serious illness. Relationship-centered care appreciates that rehabilitation care takes place within systemic and relational structures of care such as reimbursement requirements, time pressures, trustworthy relationships and power imbalances. The case vignette demonstrates how collaborative, values-based decision-making is challenging but essential to improve to better align with one's medical circumstances and patient and professional priorities. Literature reviews and our clinical experiences underscore the importance of flexible communication strategies, interdisciplinary collaboration, and an appreciation of the relational dimensions inherent in therapeutic encounters. Palliative rehabilitation represents a critical intersection of physical restoration, emotional support, and relational care. Although these challenges are often most evident during hospitalization, integrating relationship-centered principles into any rehabilitation setting can optimize quality of life, preserve dignity, and improve alignment of care with patient goals. These insights have implications for clinical training, interdisciplinary practice models, and policy initiatives aimed at expanding access to rehabilitation for individuals with advanced disease.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008752","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 critical intersection of survivorship and palliative care in people with metastatic breast cancer.","authors":"Muna Al-Khaifi, Jashmira K Bhinder, Ayush Patel, Samantha K F Kennedy, Shing Fung Lee, Edward Chow, Henry C Y Wong, Charles B Simone, Maria Vassiliou, Nicolas H Hart, Eva Oldenburger","doi":"10.21037/apm-25-77","DOIUrl":"10.21037/apm-25-77","url":null,"abstract":"<p><p>Metastatic breast cancer (MBC) remains incurable, but as survival improves, individuals are living longer and experience complex, evolving needs that span medical, psychosocial, and existential domains. These needs are often inadequately addressed by existing care models. Survivorship programs frequently exclude those with incurable disease, while palliative care is commonly delayed due to stigma, misperceptions, and systemic barriers. This paper explores the critical intersection of survivorship and palliative care in the context of MBC, advocating for an integrated, person-centered model that combines the strengths of both approaches. A blended model offers a comprehensive framework that prioritizes quality of life, enhances care coordination, and ensures timely, values-aligned interventions across the full course of illness. Key components of this approach include interprofessional collaboration, proactive needs assessment, caregiver inclusion, and culturally responsive support. Successful implementation depends on clear role definition among providers, sustainable system-level investment, and the active involvement of patients and caregivers in designing flexible and inclusive care pathways. This model reframes MBC as a long-term condition that requires sustained, holistic support rather than being seen solely as a terminal diagnosis. By doing so, it enables individuals to receive the care they need to live with dignity, purpose, and consistent support throughout their journey.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008779","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":"Cognitive cost or disease control in the management of brain metastases from small cell Lung cancer?-an ongoing debate.","authors":"Raquel Ciervide, Mercedes López, Rafael García, Ovidio Hernando","doi":"10.21037/apm-25-101","DOIUrl":"10.21037/apm-25-101","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951126","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":"Compounding or confounding?-addressing context-specific disparities in access to outpatient specialty palliative care.","authors":"Hannah Nettelblad, Rubina Ratnaparkhi, Sharon Fitzgerald-Wolff, Elaine Pope, Ian Cook, Melissa Javellana, Andrea Jewell, Christian T Sinclair, Lori Spoozak","doi":"10.21037/apm-2025-aw-109","DOIUrl":"10.21037/apm-2025-aw-109","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Despite proven benefit of outpatient specialty palliative care on symptom burden, quality-of-life, and survival, only 20-30% of eligible patients with gynecologic cancers receive a referral, even in high-resource health systems. Socioeconomically disadvantaged and culturally marginalized populations face inequitable access to specialty palliative care. However, the relationships between social determinants of health (SDOH) and palliative care utilization remain understudied. We evaluated rates of outpatient specialty palliative care referral and assessed disparities associated with SDOH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A single institution retrospective cohort quality improvement study evaluated gynecologic oncology patients receiving care in Kansas City, Kansas (midwestern United States) who met American Society of Clinical Oncology (ASCO) criteria for referral to outpatient specialty palliative care from 2019-2022. Eligible patients were stratified based on whether or not they were referred to an outpatient specialty palliative care provider. Groups were compared based on clinical factors [age, cancer site, stage, primary versus recurrent disease status, body mass index (BMI)], and SDOH (race, ethnicity, primary language, insurance status, having a primary care provider (PCP), distance from the hospital, rurality, and Area Deprivation Index (ADI). Descriptive statistics and multivariable logistic regression were performed, and odds ratios were calculated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During the study period, 432 gynecologic oncology patients were eligible for referral to outpatient specialty palliative care, of which 191 (44%) were referred and 146 (34%) ultimately saw a palliative care provider. Patients who received a palliative care referral more frequently had recurrent disease and lower BMI. Patients were referred to a palliative care provider less commonly if they lived in a rural or disadvantaged (&gt;70th percentile ADI) county, lived further from a National Cancer Institute (NCI)-designated cancer center, or if they were established with a PCP. On multivariable logistic regression evaluating rurality, distance, deprivation, and primary care access, only rurality and primary care access remained significant. Rural patients were less likely to be referred to a palliative care provider [odds ratio (OR) 0.3, 95% confidence interval (CI): 0.17-0.54, P&lt;0.001], and patients without a PCP were more likely to be referred to palliative care provider (OR 1.8, 95% CI: 1.1-2.95, P=0.01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Gynecologic cancer patients were less commonly referred to outpatient specialty palliative care if living in a distant, rural or disadvantaged county or if established with primary care. For our patient population, rurality and access to primary care were the primary SDOH driving referral to palliative care. This analysis demonstrates the importance of understanding effects of SDOH to tailor qualit","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148793","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":"Effectiveness of emotional freedom techniques in patients with persistent postural-perceptual dizziness: study protocol for a multicenter, pragmatic, pilot randomized controlled trial.","authors":"Hyeon-Ji Yu, Eui-Ju Lee, Soon-Hyung Ahn, Won-Kyoung Moon","doi":"10.21037/apm-25-87","DOIUrl":"10.21037/apm-25-87","url":null,"abstract":"<p><strong>Background: </strong>Persistent postural-perceptual dizziness (PPPD) is a chronic vestibular disorder with psychological components. Cognitive behavioral therapy (CBT) is commonly used to manage its emotional aspects; however, emotional freedom techniques (EFT)-which combine cognitive reframing with acupoint tapping-have shown efficacy in various psychiatric conditions. Despite its potential, EFT has not been evaluated for PPPD. This study aims to address this gap through a pragmatic clinical trial.</p><p><strong>Methods: </strong>Thirty patients aged 19-65 years diagnosed with PPPD will be recruited from multiple centers and randomly assigned (1:1) in a blinded manner to either an intervention group or a control group. Key exclusion criteria are severe psychiatric or neurological disorders. The intervention group will receive EFT alongside conventional treatment, including acupuncture and herbal medicine, while the control group will receive conventional treatment alone. The study will last 4 to 8 weeks, comprising nine visits. All treatments will adhere to standardized protocols across centers.</p><p><strong>Discussion: </strong>PPPD is associated with substantial functional and psychological burden, highlighting the need for effective non-pharmacological interventions. Given prior evidence supporting EFT in conditions involving emotional dysregulation, its application to PPPD warrants systematic evaluation. Although the sample size in this pilot trial is limited, the study is designed to assess the feasibility and potential clinical value of EFT, and its findings may serve as foundational data for future large-scale confirmatory research.</p><p><strong>Trial registration: </strong>Clinical Research Information Service, Republic of Korea. Identifier: KCT0010114. Registered on 09 December 2024.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":"15 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148738","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":"Role of shared decision-making and early palliative care in progressive long-term neurological conditions.","authors":"Mithila Vijay, Krishnan Padmakumari Sivaraman Nair","doi":"10.21037/apm-25-71","DOIUrl":"10.21037/apm-25-71","url":null,"abstract":"","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951174","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":"Medical marijuana for management of cancer pain: a narrative review.","authors":"Andrew M Mendelson, Austin Nguyen, Lynn R Kohan","doi":"10.21037/apm-25-85","DOIUrl":"10.21037/apm-25-85","url":null,"abstract":"<p><strong>Background and objective: </strong>The increasing legalization of medical marijuana in the United States (US) has spurred ongoing interest in its clinical application for the management of cancer-related pain. Although medical marijuana is legal in 40 states and the District of Columbia, its effect on pain pathways and variability in patient responses remain key areas of investigation. The purpose of this narrative review was to examine the prevalence and efficacy of marijuana use in the treatment of cancer-related pain.</p><p><strong>Methods: </strong>A research librarian conducted a literature search in PubMed and EMBASE for articles published between January 01, 2018 and August 2025. Search terms included but were not exclusive to cancer Cannabis AND cancer pain; Marijuana AND cancer pain management; Cannabinoids AND cancer-related pain; Medical cannabis AND oncology pain; THC CBD AND cancer pain relief. Twenty articles were identified and three database reviewers (A.M.M., A.N., and L.R.K.) independently screened titles and abstracts for relevance. Full-text articles were then reviewed with full consensus for final inclusion.</p><p><strong>Key content and findings: </strong>This narrative review examines the current understanding of the mechanisms of action and clinical efficacy of medical marijuana for cancer pain. We explore the pharmacological mechanisms underlying its analgesic properties, including its interaction with cannabinoid receptors and modulation of pain-related pathways. We also review and synthesize existing clinical evidence on the effectiveness of medical marijuana in reducing pain, improving quality of life, and minimizing opioid use in cancer patients.</p><p><strong>Conclusions: </strong>Overall, there continues to be limited evidence to support the use of medical cannabis for treatment of cancer-related pain. While significant progress has been made in this domain of pain management research, current federal regulations classifying marijuana as a Schedule I substance continue to limit large research studies. As the legal landscape evolves, an emphasis on future randomized controlled trial studies focused on the challenges related to medical marijuana dosing, side effects, and long-term safety will help advance the field and future cancer patients.</p>","PeriodicalId":7956,"journal":{"name":"Annals of palliative medicine","volume":" ","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008750","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}