Cancer Palliative Care Research Articles

Differences in Health Care and Palliative Care Use at the End of Life: A Comparison Study Among Lung Cancer, COPD, and Idiopathic Pulmonary Fibrosis

Patients with lung cancer, idiopathic pulmonary fibrosis (IPF), and chronic obstructive pulmonary disease (COPD) have high symptom burden, poor quality of life, and high healthcare utilization at the end of life. While proactive integration of palliative care in lung cancer can improve outcomes, it is unclear whether similar practices have been adopted in COPD and IPF care. Do patients with COPD and IPF have different patterns of healthcare and palliative care use at the end of life compared to lung cancer? We retrospectively identified deceased patients with lung cancer, COPD, or IPF with ≥1 outpatient visit at [removed] in the last six months of life. We compared outpatient palliative care and opioid prescriptions, inpatient palliative care, hospitalizations, intensive care use, and in-hospital death in the last 6 months of life between each group. We used multivariable logistic regression to calculate adjusted odds ratios of each outcome, with lung cancer as the reference group. Among 1,819 patients, patients with COPD and IPF were more likely to be male and older at the time of death, compared to patients with lung cancer. Compared to lung cancer, patients with COPD and IPF had a lower adjusted odds (p<0.001) of receiving outpatient palliative care (aOR COPD: 0.26, 95% CI: 0.19-0.36; aOR IPF: 0.48, 95% CI: 0.32-0.70), outpatient opioids (aOR COPD: 0.50, 95% CI: 0.40-0.63; aOR IPF: 0.40, 95% CI: 0.29-0.54), and a higher odds of end-of-life ICU use (COPD aOR: 2.88, 95% CI: 2.11-3.93; IPF aOR: 4.15, 95% CI: 2.66-6.49). Patients with IPF had higher odds of receiving inpatient palliative care (aOR: 2.02, 95% CI: 1.30-3.13, p=0.002). Patients with COPD and IPF are less likely to receive outpatient palliative care and opioid prescriptions and more likely to use end-of-life intensive care than patients with lung cancer. Further research should explore health system barriers contributing to differences in care patterns to optimize quality of life and align with patient goals of care.

Oncologists’ palliative care referral behaviour: testing utility of social exchange theory as an explanatory framework

BackgroundAdults and children with cancer are referred to palliative care infrequently or late. Oncologists often gatekeep these referrals. Social exchange theory is used to explain physician referral behaviour in various clinical settings. Its utility in a cancer palliative care setting is not known.MethodsWe used Karl Popper’s hypothetico-deductive approach to test the hypothesis. The hypothesis was that social exchange theory is a helpful framework for explaining oncologists’ palliative care referral behaviour in a cancer setting. The utility of the theoretical framework was tested against the empiric findings of a systematic review and original research.ResultsMost components of social exchange theory known to explain physician referral behaviour like beliefs about the provider or service, emotions triggered during the professional engagement, its symbolism and stigma, the complexity of the referral task, efforts needed to achieve it, its cost, benefit, and value were similar in a cancer setting. Empirical findings suggest that oncologists provided strategies and solutions to better palliative care integration instead of comparing their existing engagement with potential alternatives and choosing them.ConclusionSocial exchange theory was found to be helpful in explaining oncologists’ palliative care referral behaviour. To further develop the social exchange theory based on the data used to test it, it is recommended to include feedback and solutions as a component of the theoretical framework alongside a comparison level for alternatives.

Renal artery embolization in a case of renal cell carcinoma with intractable hematuria with acute myocardial infarction

Introduction: Renal artery embolization is a valuable treatment option for various renal tumors, both malignant and benign. The indications for this procedure include preoperative arterial embolization of large and vascular renal cell carcinoma to reduce intraoperative hemorrhagic complications, management of malignant renal tumors in patients who are not suitable candidates for surgery, treatment of symptomatic hematuria and palliative care for metastatic renal cancer. Case Report: In this case report, we present the case of a 56-year-old female with a known history of hypertension and cerebrovascular accident, who presented with complaints of hematuria and urinary retention. A diagnosis of left renal mass suggestive of renal cell carcinoma was made. The patient was planned for left radical nephrectomy and advised to discontinue aspirin for a week. However, on the morning of surgery, she experienced acute myocardial infarction and had to be hospitalized in intensive cardiac care. Aspirin was restarted, leading to recurrent severe hematuria. The patient underwent renal artery embolization, which successfully controlled the hematuria. Following cardiac stabilization, radical nephrectomy was performed three months later. The surgery and post-operative period were uneventful. Conclusion: This case study demonstrates the use of renal artery embolization as an effective modality for controlling hematuria, and temporizing management in a case of renal cell carcinoma where surgery was not immediately feasible due to a medical emergency.

Multidisciplinary palliative care of the older adult: a narrative review.

The aging of society has contributed to individuals living longer with chronic illnesses. This places them at risk to develop cancer. Treating older adults with chronic illnesses and cancer, places strain on oncologists as this group of individuals is heterogenous in nature, differing in their functional status, co-morbidities, etc. Integrating geriatrics into the care of the older adult with cancer has proven to be beneficial in helping to ameliorate the effects of aging and honing oncologic treatment regimens to be effective and efficient. The purpose of this unsystematic review is to demonstrate the importance that geriatricians can have, when participating on a multidisciplinary team (MDT) with oncology, in the administration of holistic palliative cancer care to the older adult; to present geriatric specific issues that are imperative to consider when managing the older adult with cancer; and to consider other members of the MDT inclusive of social work, pharmacy, and nursing. Data were identified by searching PubMed (January 2005 to July 2023) using the following search terms: multidisciplinary care and older adults and cancer care. The search was repeated using geriatrics, MDTs, chronic diseases, elderly. Non-English articles and observational studies were excluded. An additional review of literature was undertaken using relevant references of identified articles. Older adults are heterogenous in the aging process and thus using a geriatrician to perform comprehensive geriatric assessments (CGAs) can help to tailor the palliative care of the older adult with cancer. Providing for better predictions of the success of the proposed treatment. The overarching goal is to maintain the individual's quality of life and independence. MDTs, consisting of nursing, pharmacy and social work in addition to geriatricians and oncologists are instrumental in providing his level of care. Utilizing geriatricians on an MDT with oncology can help to provide the older adult with cancer palliative care that is holistic, effective and efficient in its delivery. While intellectually these models of multidisciplinary care are effective for the older adult with cancer, future research is needed as to the quality, cost-effectiveness and impact this care can have.

Care Coordination Between Family Physicians and Palliative Care Physicians for Patients With Cancer: Results of a Quality Improvement Initiative.

At our institution's cancer palliative care (PC) clinic, new referrals from oncologists were scheduled for consultation and ongoing follow-up by PC physicians without input from the patients' family physicians (FPs). FPs reported that they felt out of the loop. We implemented a quality improvement (QI) initiative aimed at systematically facilitating care coordination between FPs and PC physicians. A coordination toolkit was sent from the PC physician to the FP whenever the PC physician received a consultation request from an oncologist. The toolkit included an introduction to the PC physician team; an opportunity for the FP to choose how best to collaborate with PC physicians to meet the patient's PC needs; and contact information for access to 24/7 PC physician support. Responses from FPs regarding their preferred level of engagement with PC determined further care planning in the clinic. We measured feasibility, response rate, and qualitative surveys of FPs about the usefulness of the intervention. Two hundred fourteen new consultations were eligible for a standardized letter over the 6-month implementation period. Feasibility for sending the toolkit was 90.0% and response rate for collaborative care preference from FPs was 86.0%, with median response time of 3-4 days. 78.9% of FPs indicated they would prefer ongoing consultative care by the PC physician, while 18.6% indicated that PC physician consultation was not needed, or that the FP would provide primary PC after a one-time PC physician consultation. We successfully implemented a QI initiative to improve care coordination between FPs and PC physicians for patients with cancer. The coordination toolkit can protect the patient-FP primary PC relationship and optimize specialist PC resource utilization for complex patients.

Palliative care in the older adult with cancer and the role of the geriatrician: a narrative review.

Palliative care can offer individuals improved quality of care and life. While many individuals would benefit from palliative care, only a minority will receive it. Integrating palliative care with geriatrics can help relieve this deficit, help with basic symptom management, advanced care planning (ACP) and develop goals of care to assure that the care provided is congruent with the individual's priorities. The purpose of this narrative review is to demonstrate the importance that the geriatrician can have when participating in the administration of palliative care; to present geriatric-specific issues that are imperative to manage when palliatively treating the older adult with cancer. Data were identified by searching PubMed (January 2000 to July 2023) using the following search terms: palliative care, older adults, and cancer care. The search was repeated using geriatrics, pain, fatigue, anxiety, and depression. Non-English articles and observational studies were excluded. Additional review of literature was undertaken using relevant references of identified articles. Providing the right service at the right time for older adults with undergoing palliative care is imperative. It is important that clinicians, especially geriatricians, have basic skills in providing this level of care to older patients while working in conjunction with palliative care teams. Older adults are a heterogeneous group, thus utilizing comprehensive geriatric assessment helps the palliative care team to successfully treat individuals. Addressing goals of care, symptom management and ACP can help to maintain quality of life and independence of the older adult. The aging process can affect how the individual perceives and manage their symptoms related to their cancer care including pain, fatigue, anxiety/depression, etc. Embedding primary care geriatrics in the palliative care arena helps to provide more access to this care. This integration helps providers address basic symptom management, advance care planning and work with individuals on goals of care to assure the care being provided is congruent individual's priorities. Older adults respond to symptoms different than their younger counterparts. Management of these symptoms has to be addressed in a manner commiserate with their age.

Prognostic risk stratification using C-reactive protein, albumin, and associated inflammatory biomarkers in patients with advanced cancer in palliative care

PurposeTo evaluate the prognostic value of C-reactive protein (CRP), albumin, CRP/albumin ratio (CAR), and modified Glasgow Prognostic Score (mGPS) at different thresholds in patients with advanced cancer in palliative care. MethodsProspective cohort study with patients evaluated at a palliative care unit in Brazil between July 2016 and March 2020. We included patients ≥ 20 years old, both sexes, able to provide the necessary information or accompanied by someone able to do so, and Karnofsky Performance Status ≥ 30 %. The exclusion criteria were the absence of laboratory data and previous diagnosis of autoimmune and infectious diseases. The thresholds analyzed were: CRP < 5 vs. 5-10 vs. > 10 mg/L, albumin < 2.4 vs. 2.4-2.9 vs. 3.0-3.5 vs. > 3.5 g/dL; CAR <1.2 vs. 1.2–2.0 vs. > 2.0, and mGPS equal to 0 vs. 1 vs. 2. Kaplan-Meier curves and Cox regression models (with hazard ratios [HR] and 95% confidence interval [CI]) were used to evaluate prognostic value, and the concordance statistic (C-statistic) was used to evaluate the predictive accuracy of these thresholds to predict death within 90 days. ResultsA total of 1,877 patients were included. Median overall survival was 51 (19;124) days and decreased in line with the deterioration of the inflammatory biomarkers. According to the Cox regression models, HR increased as the thresholds worsened (CRP: 1.74 [95% CI, 1.50-2.02] to 2.30 [95% CI, 2.00-2.64]; albumin: 1.77 [95% CI, 1.52-2.07] to 2.60 [95% CI, 2.15-3.14]; CAR: 1.47 [95% CI, 1.21-1.77] to 2.35 [95% CI, 2.05-2.69]; mGPS: 1.78 [95% CI, 1.40-2.23] to 1.89 [95% CI, 1.65-2.15]). All the inflammatory biomarkers evaluated showed discriminatory accuracy for predicting death (C-statistic >0.70), with CAR as the best parameter (C-statistic: 0.80). ConclusionOur results suggest that CRP, albumin, CAR, and mGPS can be used as clinically meaningful biomarkers to stratify patients with advanced cancer in palliative care according to the severity of these indicators.

Analysis of opioid analgesics consumption in Africa: a longitudinal study from a 20-year continental perspective

Opioid analgesics are essential for managing acute and chronic pain in diseases such as cancer. Inadequate opioid access remains a major public health concern in low-income regions including Africa. This study aimed to provide updated and comprehensive data on changes in opioid consumption, specifically in Africa. This longitudinal study has updated and expanded upon the International Narcotics Control Board data obtained from 1999 to 2021, assessing opioid consumption trends across all African countries. The defined daily doses for statistical purposes (SDDD) was used to determine the changes in opioid consumption in Africa. In addition, we used sub-analyses of the data to delve into individual substances, income levels, cancer incidence, cancer mortality, and sub-regional cluster analysis (based on the language spoken) to identify possible disparities and inform further research and tailored solutions. Our results indicate a persistently low and stagnant trend in opioid consumption between 2001-03 and 2019-21, from 73 SDDD (95% CI 69-77) to 55 SDDD (32-79). In-depth analysis revealed a morphine consumption increase from 735 SDDD in 1999 to 1115 SDDD in 2021. Moreover, opioid consumption was closely related to country-level income levels, with most of the low-income and lower-middle-income African countries reporting low opioid consumption. Notably, the escalating incidence and mortality rates associated with cancer in Africa indicated a misalignment with the trajectory of opioid use. Additionally, French-speaking African countries exhibited lower opioid usage than the rest of the continent, suggesting avenues for research into cultural, political, and social aspects. In the context of global doubling in opioid consumption, Africa has shown insufficient and stagnant opioid consumption during the last 20 years. These findings underscore the need for policy reform to facilitate safe and responsible opioid access in Africa, particularly for legitimate indications such as cancer pain and palliative care. None. For the French translation of the abstract see Supplementary Materials section.

Gastrostomies and clinical outcomes: a cohort of different enteral feeding techniques in advanced cancer palliative care

Gastrostomies and clinical outcomes: a cohort of different enteral feeding techniques in advanced cancer palliative care

Rural palliative care in cancer: Using telemedicine to bridge the gap.

e13807 Background: Despite the rapid growth in palliative care (PC) services, many rural regions remain without access to specialty palliative care. Community-based telemedicine may offer solutions to underserved populations from rural areas within the United States. Methods: This is a retrospective review of the creation of 2 separate rural clinics attached to the VCU Massey Comprehensive Cancer Center at CMH in South Hill, VA in 2018 (with interruption related to the Covid-19 pandemic) and in Tappahannock, VA in 2021. In addition to operational descriptions a chart review was conducted of all encounters for these clinics. Care provided was coordinated by the University PC service and the oncology clinics, including nurses and oncologists. Regulatory, legal, Information Technology (IT), and systems logistics were developed in partnership for 6-9 months prior to each pilot. There were over 100 encounters from the two periods of care for CMH (2018 until paused for pandemic towards the end of 2020; and March of 2021 to current) and greater than 50 at Tappahannock. All visits were conducted in the rural oncology clinics with assistance of oncology nursing during the encounter. Results: The average patient age was 57, and over 90% had solid tumors. On average, patients had 1-2 telemedicine visits. The most common reason for referral was symptom management, predominantly pain. Edmonton Symptom Assessment scales were collected at all visits by oncology nursing. Physical exams were completed with electronic stethoscopes and supported by oncology nursing. Medications were prescribed to rural pharmacies electronically directly by the PC physician; for the periods of clinic over the course of the Covid-19 public health emergency this included prescriptions for controlled substances (almost exclusively long and short acting opioids). For patients requiring advance care planning documents were completed electronically or by trained interdisciplinary team members in clinic in partnership with the PC physician. Technological issues occurred rarely (less than 1% of visits) and resolved without IT involvement. Conclusions: Our pilot program integrated specialist palliative care into two rural oncology clinics providing supportive care, including symptom management and goals of care discussions. Further research should define optimal integration of PC telemedicine into rural oncology.

Knowledge, attitudes, and current practices toward lung cancer palliative care management in China: A national survey.

11143 Background: To demonstrate the status and differences in knowledge, attitudes, and practices (KAP) of lung cancer palliative care (LCPC) management, and to measure patient controlled analgesia (PCA) in cancer pain management in of China. Methods: A questionnaire on LCPC management was used in this study, which involved a total of 2093 participants from 706 hospitals in China. Seven major components make up the questionnaire, including chi-square tests or Fisher exact probabilities to measure the differences in KAP between hospitals grades. Comparing distributions of ordered data between groups was done using the Kruskal-Wallis H test or the Mann-Whitney U test. Multiple choice questions use multiple response cross analysis. Correlation was evaluated by the Spearman correlation coefficient. Results: 84.2% participants believed that anti-tumor therapy is equally important as palliative care. The satisfaction rate of participants from grade 3 hospitals, which was significantly higher than that of grade 2 and grade 1 hospitals (χ²=27.402, P=0.002). The most common symptoms requiring LCPC was pain. The major barriers toward to LCPC were “Patients and families are concerned about the safety of long-term use of palliative care related drugs”. The most common reasons for the use of PCA treatment were 31.1% participants thought “Patients with systemic application of large doses of opioids or adverse reactions to opioids that cannot be tolerated”. The top three barriers toward PCA treatment of cancer pain were (i) worry about adverse reactions of drug overdose, (ii) worry about opioid addiction, and (iii) increase of patients' economic burden. In the past 24 months, 33.9% of the participants had not participated in online or offline training related to palliative care of lung cancer. Conclusions: Chinese healthcare workers are in need of training for lung cancer palliative care and, in particular, for controlling cancer pain symptoms.

Disparities in cancer care utilization in patients with brain tumors: A nationwide analysis.

e23142 Background: Brain tumors are highly aggressive and are associated with poor prognosis. Minority populations still experience inequities in the delivery of cancer care, despite concerted efforts to reduce such disparities. We studied disparities in receipt of cancer care for patients with primary brain tumor. Methods: National Inpatient Sample 2017-2020 was queried to identify the patients admitted with brain tumor. Results of the study were reported in accordance with the STROBE guidelines. We divided the cases into two groups i.e., the patients undergoing curative cancer care (CC) and palliative care (PC). We performed descriptive analysis and analyzed predictors of getting PC or CC using logistic regression analysis. Results: Among 144,355 patients hospitalized for primary brain tumor, 33,645 (23.3%) received PC. Mean age of PC group was 60±20.1 years, while the CC group had mean age of 52.9±21.3 years ( P &lt; 0.01). Compared to patients &lt; 45 years, the patients with age 46-64 years and ≥65 years were more likely to receive PC (OR = 1.9, 95% CI 1.6-2.4 and OR = 2.23, 95% CI 1.8-2.8, P &lt; 0.01, respectively). The proportion of Black patients in the PC group was more compared to the CC group (10.4% vs 7.6%). However, the proportion of White patients in the PC group was lower than the CC group (74.8% vs 77.9%), P &lt; 0.001. Black patients were more likely to receive PC (OR = 1.5, 95% CI 1.3-1.7, p &lt; 0.01), while no difference was observed in other ethnic or racial groups. Compared to CC group, PC group had a higher percentage of patients with Medicare (50.9% vs 35.9%), Medicaid (14.4% vs 13.8%) and a lower percentage of patients with private insurance (31.9% vs 47.0%) p &lt; 0.01. Patients with private insurance were less likely to receive PC (OR = 0.7, 95% CI 0.6-0.8, p &lt; 0.01). PC group had a higher percentage of low-income group patients compared to the CC group ($1-$49,999: 22.5% vs 20.6% and $50,000-$64,999: 25.3% vs 24.2%, P &lt; 0.01). Patients in teaching hospitals had decreased odds of PC (OR 0.8, 95% CI 0.7-0.9, P = 0.01) compared to non-teaching hospitals. Patients with major depressive disorder (OR 1.3, 95% CI 1.1-1.4, P &lt; 0.01), electrolyte disorders (OR 1.6, 95% CI 1.5-1.8, P &lt; 0.01), and atrial fibrillation (OR 1.3, 95% CI 1.1-1.5, P = 0.01) had increased odds of receiving PC. Conclusions: The patients who underwent PC were older, more likely to be Black, and of low-income groups. Patients in teaching hospital had a decreased likelihood of undergoing PC. The health care disparities should be addressed to achieve a better quality of care across all groups. [Table: see text]

Deathbed experiences and meaning-making: Perspectives of family caregivers of patients who received cancer palliative care.

The deathbed symbolizes a time when the patient is dangerously ill and where death is imminent. The memories of family caregivers during this time can potentially shape their meaning-making of the patient's death and bereavement adjustment. We aimed to understand the experiences of family caregivers at the deathbed of patients receiving palliative care. We also examined caregiver's meaning-making that occurred after the patient's death. In this retrospective qualitative study, family caregivers of cancer patients who received palliative care in Singapore were recruited through purposive sampling. In-person, semi-structured interviews were individually conducted with study participants to understand their experiences from a caregiver's perspective before and after the death of the patient. Thematic content analysis method was conducted. A total of 25 bereaved family caregivers were interviewed, with spouses, adult children, and others comprising one-third each of the sample. Six themes emerged from caregivers' recollected experiences around the patient deathbed: Lasting image of the patient, A time of intense emotions, Healthcare providers prepare caregivers, A time for saying goodbye, Rituals provide comfort, and Impact on family ties. Four themes emerged surrounding post-loss meaning-making: An end to the pain and suffering, "Have I done enough?," Significance in the timing of events, and Gaining strength and personal growth. The deathbed is a salient time for family caregivers as they prepare for patient's death. There are opportunities to provide support to the family based on the study findings.

Association of the muscle mass phenotype as assessed by a grading system with the quality of life of patients with incurable cancer in palliative care

BackgroundLoss of muscle mass (MM) is common in advanced stages of cancer, with an impact on worsening quality of life (QoL). In the current study the relationship of a previously proposed simple grade system to assess MM phenotypes with QoL was investigated to strengthen its clinical significance. AimTo verify whether the MM phenotypes, which were evaluated by using a grading system, are associated with the quality of life (QoL) of patients with incurable cancer. MethodsSecondary data from a cohort of patients with incurable cancer in palliative care, were analyzed. The grade system considers measurements of the muscle area arm and handgrip strength. Based on these measurements, patients are classified as probably non-sarcopenic (Nsarc), probably sarcopenic (PSarc), and sarcopenic (Sarc). The outcome measure was QoL domains assessed by the EORTC QoL Questionnaire Core-15. Logistic regression models were used to verify the association of the domains of QoL with the MM phenotypes. ResultsA total of 770 patients were included, median age 62 years and 56.6% females. The PSarc group had significantly worse scores in the QoL domains when compared to the Nsarc group (physical p= 0.001, emotional p= 0.018, fatigue p<0.001, nausea p= 0.017, insomnia p= 0.001, appetite loss p= 0.002, and global health p= 0.043). Adjusted logistic regression analysis showed an increased risk of worse QoL in the PSarc and Sarc, when compared to NSarc, respectively (Odds ratio [OR], 95% confidence interval [CI]): physical (OR: 2.54, CI: 1.78-3.62 and OR: 7.18, CI: 4.24-12.17), emotional (OR: 1.61, CI: 1.15-2.24 and OR: 1.49, CI: 1.01-2.20), fatigue (OR: 1.89, CI: 1.35-2.64 and OR: 1.83, CI: 1.23-2.71), insomnia (OR: 2.01, CI: 1.43-2.83 and OR: 3.11, CI: 2.04-4.75), while an appetite loss was associated with the PSarc (OR: 1.40, CI: 1.02-1.96), together with global health in the Sarc group (OR: 1.56, CI: 1.06-2.29). ConclusionThe severity of the MM phenotype was associated with a worse QoL domains. Our results highlight the importance of MM preserving to affecting QoL status. The grading system can be useful for predicting the QoL in those patients, and its usefulness can potentially impact clinical and therapeutic decision-making.

Paediatric oncologists' perspectives on Strategic solutions to develop Integrated Cancer Palliative Care: feedback intervention theory as an explanatory Framework.

Globally, children with cancer often experience delays in palliative care referral or are infrequently referred. Therefore, we conducted a qualitative study to gain insight from paediatric oncologists into what enables or deters palliative care referral. Strategic solutions to develop integrated palliative care was a critical study theme. In this paper, we have explained and interpreted these strategic solutions through the lens of feedback intervention theory. The study findings were interpreted using Kumar's six-step approach that enabled systematic evaluation of a theory's appropriateness and alignment with the researcher's paradigm, methodology, and study findings. It also explained how theory informed analysis and elucidated challenges or the development of new models. The feedback intervention theory appraises the discrepancy between actual and desired goals and provides feedback to improve it. Strategic solutions generated from the study findings were coherent with the aspects elucidated in theory, like coping mechanisms, levels of feedback hierarchy, and factors determining the effect of the feedback intervention on performance. Paediatric oncologists suggested integrating palliative care providers in the team innocuously, improving communication between teams, relabelling palliative care as symptom control, and working with a skilled and accessible palliative care team. The paper proposes an infinite loop model developed from the study, which has the potential to foster integrated palliative care through excellent collaboration and continuous feedback. Applying feedback intervention theory can bridge the gap between actual and desired practice for integrated cancer palliative care in paediatric oncology.

Knowledge, attitudes, and current practices toward lung cancer palliative care management in China: a national survey.

The present investigation seeks to illuminate the current state and disparities in the knowledge, attitudes, and practices (KAP) among healthcare professionals regarding the management of lung cancer palliative care (LCPC) in China, while simultaneously assessing the prevalence and context of patient-controlled analgesia (PCA) usage in the management of cancer-related pain. A total of 2093 healthcare practitioners from 706 hospitals across China completed a structured questionnaire that probed various facets of LCPC management. The questionnaire consisted of seven thematic sections, incorporating chi-square tests and Fisher's exact probabilities to statistically assess the discrepancies in KAP among healthcare professionals across different hospital grades. Ordered data distributions among hospital grades were compared using non-parametric Kruskal-Wallis H and Mann-Whitney U tests. Multiple-choice items were subjected to multiple-response cross-tabulation analysis, while the Spearman rank-order correlation coefficient was employed to gauge potential associations among variables. Around 84.2% of the respondents perceived anti-tumor therapy to be of equal importance to palliative care. Statistically significant differences (χ² = 27.402, P = 0.002) in satisfaction levels were observed, with participants from Tertiary hospitals demonstrating higher satisfaction compared to those from Secondary and Primary hospitals. Pain emerged as the most prevalent symptom necessitating LCPC. Major impediments to LCPC adoption included patients' and families' concerns about the safety of long-term palliative care-related drug use. 31.1% of the respondents cited the most frequent rationale for PCA use as cases involving patients who required systemic administration of large opioid doses or exhibited intolerable adverse reactions to opioids. The principal deterrents against the use of PCA for cancer pain management were (1): apprehension about adverse drug reactions due to overdose (2), concern about the potential for opioid addiction, and (3) the anticipated increase in patients' economic burdens. Over the preceding 24-month period, 33.9% of the surveyed healthcare practitioners reported no engagement in either online or offline LCPC-related training initiatives. This study emphasizes the pressing need for comprehensive training in LCPC among Chinese health personnels, particularly focusing on the effective management of cancer pain symptoms.

Parenteral Nutrition in Palliative Cancer Care: Detrimental, Futile, or Beneficial?

Palliative cancer care patients may live for a long time, but malnutrition worsens the prognosis. Parenteral nutrition (PN) is suitable for replenishing a calorie deficit, but its advantages and tolerance late in the cancer trajectory are debated. We examined symptom development in hospitalized patients with and without PN. A total of 21 palliative cancer care patients receiving PN and 155 palliative cancer care patients not receiving PN during hospitalization in a specialized unit were retrospectively compared. We studied symptom intensity at admission, symptom relief during the hospital stay, and survival. The patients had locally advanced or metastatic cancer, a mean age of 70 years, and their median ECOG performance status was III. Symptom burden at admission was similar in the compared groups. Symptom relief during hospitalization was also similar. However, patients already on PN at admission reported more nausea and patients receiving PN during hospitalization reported better nausea relief compared to patients not receiving this intervention. Overall median survival was less than two months and similar in the compared groups. Based on a limited number of observations and a suboptimal study design, we were not able to demonstrate an increased symptom burden for palliative cancer care patients receiving PN late in the disease trajectory.

Exploring Holistic Cancer Care and Survivorship in India Through the Kerala Model of Palliative Care: Role of Community Nurse and Outpatient Meetings.

Support groups and meetings are self-help gatherings that provide a unique sense of community, unconditional acceptance, and information on cancer and its treatment. This cross-sectional study examined 12 outpatient meetings within the Kerala model of palliative care, a community-based service provided to patients irrespective of disease, stage, or prognosis starting from the time of diagnosis. The study focused on the pivotal role of community nurses in facilitating these meetings, with participants including cancer patients and survivors. Using in-depth interviews (n = 52) and participant observations, this research used a qualitative approach and explored the dynamics and outcomes of outpatient meetings. Findings highlight the indispensable contributions of these community nurses serving as linchpins in providing support, guiding discussions, and offering crucial education. Outpatient meetings effectively addressed psychosocial concerns, combatted stigmas associated with cancer, and promoted informed decision making in cancer care. The study emphasizes the need for recognizing the role played by community nurses in improving psychosocial support and diminishing stigma, and ultimately the quality of life of patients and survivors through the palliative cancer care within the Kerala model. We also underscore the need for policy initiatives, resource allocation, and training programs tailored to support these frontline health care providers effectively.

Neumopaliativo: el cuidado paliativo en patología respiratoria

Respiratory illnesses are an important cause of morbidity and mortality. Lung cancer is the leading cause of cancer and the leading cause of cancer mortality. Worldwide, chronic obstructive pulmonary disease (COPD) is the third leading cause of death, after cardiovascular and neoplastic diseases. Fibrosing interstitial lung disease has maintained a progressive increase in incidence, with high mortality. This is how respiratory palliative care has acquired relevance in this area of medicine, improving not only quality of life, but also, as is the case with lung cancer, survival. The aim of this article is to demonstrate the need for respiratory palliative care in cancer and non-cancer lung disease, allowing for an earlier and more timely referral for our patients.

Características de la enfermedad inflamatoria intestinal pediátrica en un hospital de la capital de Córdoba, Argentina

IntroductionInflammatory Bowel Disease is an immune mediated, chronic inflammatory disorder of the gastrointestinal tract. It includes ulcerative colitis (UC), Crohn's disease (CD) and IBD-unclassified (IBD-U). About 25-30% of patients with CD and 20% of patients with UC are diagnosed in the pediatric age. The objective of this study was to describe the onset characteristics, behavior and treatment of a group of patients in a reference center in Argentina. Materials and MethodsThis is a retrospective study that describes all IBD patients aged between 1 and 16 years that attended to the Department of Pediatric Gastroenterology between 2012 and 2020 in a referral center in Cordoba Province. ResultsTwenty-two patients were included in the registry; 59.1% were girls. Mean age at diagnosis was 7.7 years. UC was diagnosed in 15 patients (68.2%), CD in 3 patients (13.6%) and IBD-U in 4 patients (18.2%). The median delay between the onset of symptoms and the diagnosis of IBD was 4 months for UC, 7 months for CD and 15 months for IBD-U. The most common symptom at diagnosis was recurrent abdominal pain. We found 36.4% of patients had anemia at diagnosis. In patients with CD, the involvement of all patients was ileocolonic, and nearly 60% of UC and IBD-U patients had pancolitis extention. Four out of 16 patients had clinical remission of their disease activity (25%) after twelve weeks of treatment. ConclusionsThis is the first series of cases that describe a significant number of patients outside of Buenos Aires, Argentina. We found that UC was the most frequent form of IBD and abdominal pain was the most frequent symptom at diagnosis. More national series of pediatric IBD patients, including patients from the public and private healthcare system, are needed in order to improve the clinical description of inflammatory bowel disease and response to therapy..