Cancer Palliative Care Research Articles

Fatigue Prevalence Among Palliative Care Cancer Patients in Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia: A Cross-Sectional Study.

Objective: The aims of the current study are to assess the prevalence of cancer-related fatigue, to examine the difference in cancer-related fatigue severity in relation to patients' characteristics (age, gender, type of cancer, and palliative performance status), and to explore the correlation between cancer-related fatigue and pain, dyspnea, insomnia, and depression among palliative care patients. Methods: A cross-sectional descriptive observational study conducted at Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia. The study included cancer patients who received palliative care services from January 2016 to December 2021. Clinical data of study participants were retrospectively collected from Palliative Care department patient registry. Symptoms were assessed and scored using Edmonton Symptom Assessment Scale. Data analysis was performed using SPSS statistical software. Results: A total of 2616 patients were included in the study, 52.3% were females and 47.7% were males. The median age of study participants was 56 years (range: 2-101 years). Among all study population, the highest reported cancer type was gastrointestinal malignancy (33.5%), while the least was unknown primary malignancy (1.4%). With regards to Edmonton Symptom Assessment Scale, pain (86.4%) and fatigue (83%) were the highest reported symptom in comparison to constipation (17.3%) and insomnia (7.1%). Conclusion: Cancer-related fatigue is a prevalent and concerning issue among palliative care patients. It is essential that healthcare providers recognize the prevalence of fatigue among patients with life-limiting illnesses, assess patients for fatigue routinely, incorporate strategies for managing fatigue, work closely with affected individuals and their families in order to guide the establishment of a personalized care plan that addresses the patient's unique needs and preferences.

Novel method for predicting nonvisible symptoms using machine learning in cancer palliative care

End-of-life patients with cancer may find expressing their symptoms difficult if they can no longer communicate verbally because of deteriorating health. In this study, we assessed these symptoms using machine learning, which has excellent predictive capabilities and has recently been applied in healthcare. We performed a retrospective clinical survey involving 213 patients with cancer from August 2015 to August 2016. We divided the reported symptoms into two groups—visible and nonvisible symptoms. We used decision tree analysis, an analytical machine learning method that organizes and analyzes information in the form of a tree diagram to visually represent the information structure. Our machine learning model used patient background data and visible symptoms to predict nonvisible symptoms: pain, dyspnea, fatigue, drowsiness, anxiety, delirium, inadequate informed consent, and spiritual issues. The highest and/or lowest values for prediction accuracy, sensitivity, and specificity were 88.0%/55.5%, 84.9%/3.3%, and 96.7%/24.1%, respectively. This work will facilitate better assessment and management of symptoms in patients with cancer. This study was the first to predict nonvisible symptoms using decision tree analyses for patients with cancer receiving palliative care. Notably, applications based on our results may assess symptoms to the same extent as healthcare professionals.

The commodification of academic publishing – Relevance to cancer palliative care literature

ABSTRACT The commodification of academic publishing refers to the process of turning academic research and scholarship into a marketable product that can be bought and sold for profit. This has become an increasingly prevalent issue in recent years, as academic publishing has become dominated by a small number of large commercial publishers who control access to research and charge exorbitant fees for access to academic articles. In the context of cancer palliative care literature, the commodification of academic publishing has several important implications. First, it means that access to important research on cancer palliative care may be restricted to those who can afford to pay for it, effectively limiting its dissemination and impact. This is particularly problematic in low-income countries or regions where resources for cancer palliative care are already limited. Second, the commodification of academic publishing can lead to the proliferation of predatory journals that publish low-quality or even fraudulent research for profit, which can lead to misleading or harmful information being disseminated to practitioners, policymakers and the public. Finally, the emphasis on profit in academic publishing can create pressure for researchers to prioritise publishing in high-impact journals rather than focusing on research that is most relevant to the needs of cancer palliative care patients and their families. This can create a skewed incentive structure that values prestige over impact, potentially undermining the quality and relevance of research in this field. In summary, the commodification of academic publishing has significant implications for cancer palliative care literature, including issues of access, quality and relevance. It is important for researchers, policymakers and publishers to work together to address these challenges and ensure that the best research is made accessible to all those who need it, regardless of their ability to pay.

Non-Pharmacologic Approaches to Sleep Problems for Palliative Care Cancer Patients: A Systematic Review.

This present systematic review aims to examine the effectiveness of non-pharmacological approaches to sleep problems for cancer patients in palliative care. In this review, the data of the last 5 years from 2018 to 2023 are included in Scopus, Web of Science, CINAHL, PubMed, Medline, Ulakbim National Database and Cochrane Library databases were scanned using the keywords "palliative care, sleep disorder, non-pharmacologic, insomnia, cancer, randomized controlled trial" in English and Turkish. As a result of the search, we identified 90 articles. This review was based on Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 Statement recommendations. This current review comprised 5 randomized controlled trials. The included studies were found to examine methods such as aromatherapy, massage, therapeutic touch, and white light, leaving out other methods (sleep hygiene, exercise, etc.), which are effective in treating insomnia. We established that the methods discussed in these studies were highly effective in improving sleep quality. Non-pharmacological methods for treating sleep problems in cancer patients in palliative care have been shown to be effective. We consider it important that nurses were involved in these studies. On the other hand, we would recommend that studies be conducted to evaluate the effect of other nonpharmacologic methods on sleep problems.

Identifying cultural, demographic, personal health and cancer-related barriers to integrative oncology care: a retrospective case-cohort study.

Integrative oncology (IO) provides complementary and integrative medicine within conventional supportive and palliative cancer care. The present study set out to identify barriers to attending an integrative physician (IP) consultation, provided without charge within an IO treatment program. Electronic files of adult oncology patients undergoing chemotherapy were studied. Patient-related characteristics were examined to identify factors associated with attendance at the IP consultation: socio-demographic (age, gender, country of birth, place of residence, primary language spoken); health- related (BMI, smoking, independent functioning); and cancer- related (primary tumor site, localized vs. metastatic). Only 257 of the 1912 patients studied (13.4%) attended the IP consultation, with female patients more likely to attend (p < 0.001), as well as younger patients (p = 0.002); those residing outside the Jerusalem municipality (p = 0.008); and patients whose primary language was Hebrew (p < 0.001). Non-smokers and functionally independent patients were also more likely to attend (p = 0.007 and 0.008, respectively), as were those diagnosed with breast/gynecological (p = 0.005) or gastrointestinal tumors (p = 0.002). Multivariate analysis showed a significantly greater likelihood of attending the consultation among females (OR 1.619, 95% CI 1.065-2.460; p = 0.024); younger patients (OR 1.019, 95% CI 1.007-1.031; p = 0.001); non-Arabic speakers (OR 8.220, 95% CI 3.310-20.413; p < 0.001); and patients diagnosed with a tumor other than lung cancer (OR 2.954, 95% CI 1.259-6.933; p = 0.013). Further prospective research addressing socio-demographic, personal health- and cancer-related characteristics of oncology patients is needed to address potential barriers to the provision of IO care within a diverse, equitable and inclusive setting of care.

Jordanian Patients’ Perspectives of the Role of Complementary Medicine in the Treatment of Cancer

Background: In recent years, Jordan has seen a rise in the prevalence of cancer cases. Many Jordanian cancer patients have reported a readiness to try to alleviate their symptoms, and thus improve their quality of life by adopting a blend of traditional, complementary and integrative (TCI) medicines. Currently, hospitals in Jordan offer no or limited complementary medicine (CM) services as part of oncology or palliative cancer care. Purpose: This study examines the perspectives of Jordanian cancer patients regarding the desirability of integrating a range of CM approaches with the conventional treatments offered by hospitals. Methods: In this descriptive study, 253 patients formed a convenient sample and were asked to complete the Questionnaire on Integrating Complementary Medicine in Oncology Treatment. Results: More than 40% of the patients were found to have used CM during chemo or radiotherapy. Different types of herbal medicine were the most used treatments. More than a half of the participants showed willingness to seek advice from healthcare professionals on the use of CM for cancer treatment if it was integrated into their oncology treatment. Participants expected CM to improve their symptoms of pain, nausea and vomiting, as well as changes in appetite. Conclusion: Since there can be some safety issues involved with CM approaches, training should be given to care providers on how to best help their cancer patients based on evidence-based culturally sensitive consultation. Implications for Nursing: More research is needed to be done into the perspectives of healthcare providers and care givers on CM use and its usefulness alongside the conventional medical treatments.

The impact of the 4R Oncology model of team-based care delivery on timing and sequence of guideline recommended interdependent care in breast and lung cancers.

1523 Background: Team-based care improves quality, reduces fragmentation and lowers clinician burnout related to ad hoc care coordination. A key principle of teamwork is managing timing and sequence of interdependent care (Vogel JOP 2016). The 4R Oncology model featured by the NCI ASCO Teams project fosters effective teamwork by facilitating systematic timing / sequence of interdependent care (Trosman JOP 2016). 4R is Right Info / Care / Patient / Time. Using 4R, a large health system created a high-functioning care team and conducted optimizations of interdependent care in breast and lung cancers Oct 2020 - Dec 2021 (Liu JCOOP 2022). Optimizations focused on guideline-based care with suboptimal timing / sequencing in respective cancers. We present results of these optimizations. Methods: We compared data from electronic health record on timing and sequence of care between historical control cohorts of patients who received care pre-4R (breast n=270, lung n=173) to the post-optimization 4R cohorts (breast n=208, lung n=139). Patient and tumor characteristics between control and 4R cohorts in both breast and lung cancers were similar. Results: Timing and sequence of care for 5 of the 6 breast cancer metrics and all 6 lung cancer metrics was significantly improved between the control and 4R cohorts. Despite significant increase, the rate of timely care for some metrics remained low, such as referrals based on distress screening in breast cancer and palliative care in lung cancer. Conclusions: The 4R Oncology model is effective in applying teamwork principles and improving timing and sequence of guideline-based care. Opportunities for further improvement exist to expand the benefit of 4R to a higher number of patients. A learning system being established in our institution will inform iterative care optimizations.[Table: see text]

Abstract 92: Using Innovative Technology and Collaborative Efforts to Reduce Disparities and Inequities in Cancer Care and Improve the Lives of Patients in Low-Middle Income Countries in Sub-Saharan Africa: South African and Lesotho Experience of the ECHO Model

Abstract Purpose: Sub-Saharan Africa has huge disparities and inequities in cancer care. Some low resource countries have no facilities or trained oncologists and other healthcare professionals for cancer care. Patients often must travel long distances to access specialised cancer care such as radiotherapy, chemotherapy and palliative care. Patients with cancer in Lesotho who needed chemotherapy had to be flown to India; those who needed radiotherapy were referred to South Africa. Majority of the cancers diagnosed in the Northern cape province and Lesotho are in late stages and need treatment with chemotherapy and radiotherapy as part of the multimodality therapy. Methods: The Northern Cape Cancer Centre of Excellence and Research (NCCanCER) at Kimberley Hospital in South Africa collaborated with the Senkatana Hospital in Lesotho. Oncologists, specialist oncology nurses and IT personnel were trained at Project ECHO Institute in Albuquerque, NM to use the ECHO model for training, transfer of skills and mentorship. NCCanCER assisted Lesotho to set up a chemotherapy facility at Senkatana Hospital. An initial visit to the Kimberley Hospital Oncology Department for benchmarking was done by oncology staff from Lesotho. NCCanCER oncology staff went to Lesotho to provide on-site training in chemotherapy administration. Weekly virtual ECHO clinics were run from the Hub at Kimberley with spoke sites in Lesotho, Upington, Springbok and Kuruman. At the ECHO clinics, management of patients are discussed using evidence-based management protocols for continued training, transfer of skills, support and mentorship. Results: Doctors, nurses, pharmacists, social workers, clinical psychologists and community healthcare workers have been trained to provide cancer care and palliative care services in the underprivileged and underserved areas of the Northern cape and Lesotho. The first chemotherapy facility was opened in Lesotho in July 2022 and patients in Lesotho are no longer flown to India for chemotherapy. Patients in remote areas of the Northern cape province of South Africa can now receive chemotherapy and palliative care closer to their homes. There is continuous training, transfer of skills, expertise and mentorship of oncology staff. Conclusion: The ECHO model is useful in democratizing knowledge, transfer skills and expertise to improve care to patients in low resource countries. Citation Format: Daniel Osei-Fofie, Kabelo Mputsoe Cekwane, Mobashshar Hassan, Sophie Victoria Masuabi, Pearl Ntsekhe. Using Innovative Technology and Collaborative Efforts to Reduce Disparities and Inequities in Cancer Care and Improve the Lives of Patients in Low-Middle Income Countries in Sub-Saharan Africa: South African and Lesotho Experience of the ECHO Model [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 92.

Challenges and strategies to improve the provision of end-of-life cancer care in rural and regional communities: Perspectives from Australian rural health professionals.

To identify challenges and strategies to improve the provision of end-of-life (EOL) cancer care in an underserved rural and regional Australian local health district (LHD) from the perspective of general practitioners (GPs) and specialist clinicians while exploring the benefits of adopting a generalist health care approach to delivering EOL care in rural and regional communities. Rural and regional Australia. General practitioners and palliative care and cancer care specialists (medical and nursing) involved in the provision of EOL care to people with advanced cancer in the rural and regional areas of an Australian LHD. Qualitative descriptive study involving 22 participants in four face-to-face and online focus groups. Thematic analysis of the transcripts identified key issues affecting EOL care for people with advanced cancer in rural and regional areas of the LHD. Four themes including geographical remoteness, system structures, medical management and expertise and training emerged from the focus groups. Key barriers to effective EOL care included insufficient remuneration for GPs and other clinicians (especially home visits), resource limitations, limited community awareness of palliative care and lack of confidence and training of clinicians. Continuity of care was identified as an important facilitator to effective EOL care. Participants suggested greater Medicare rebates for palliative care and home visits, adequate equipment and resources, technology-enabled clinician training and greater rural-based training for specialist PC clinicians may improve the provision of EOL care in regional and rural communities. Rural-based clinicians delivering EOL cancer care appear to be disproportionately affected by geographical challenges including resource and funding limitations. A multi-pronged strategy aimed at greater interdisciplinary collaboration, community awareness and greater resourcing and funding could help to improve the provision of EOL care in underserved rural and remote communities of Australia.

Cancer pain: way to overcome

Cancers are among the leading causes of morbidity and mortality worldwide. Cancer itself or cancer treatment often causes pain which can affectthe quality of life. Cancer pain management is an essential part of cancer treatment and palliative care. Cancer patients may require pain management at any stage of their disease, not only at the end. Expert opinion and statistics from country experiences from numerous low-income countries, where treatment coverage is typically inadequate or non-existent, indicate that around 80% of cancer patients feel moderate or severe pain that lasts on average 90 days. As a result, cancer pain is a major source of avoidable unnecessary suffering. Cancer pain management plans often involve pharmacological and nonpharmacological therapies and psycho-social and spiritual support. Palliative care and pain management are critical components of Universal Health Care. The medical use of narcotic drugs is essential for the treatment of pain and suffering. Therefore appropriate provisions must be made to assure their availability for such purposes. Some obstacles exist that limit the appropriate management of cancer-related discomfort. Communication difficulties, lack of pain management training and education, ethnic/cultural/ religious disparities, opiophobia among health professionals and the general public, and restricted availability to opioids are the primary barriers to successful cancer pain treatment. To combat cancer pain and reduce the suffering of these incurable people, education and training of health professionals on cancer pain management, provision of suitable holistic supports, opioids should be made accessible and available, and general awareness development are some examples. All government and nongovernment players must come forward and work together to win this battle. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 187

Development of Cancer Palliative Care in Turkey.

Palliative care is an important component of integrated, person-centered health care. It can be provided alone or in combination with the patient's medical treatment, not only by the palliative care team but also by the healthcare team caring for the patient. The concept of palliative care was developed in 2010 along with the establishment of the National Cancer Control Program in Turkey, and today there are many palliative care units, especially in metropolitan hospitals, that provide comprehensive palliative care. One-third of patients who come to the palliative care unit for treatment of pain, malnutrition, and respiratory problems are cancer patients. The care needs of all patients presenting to the palliative care unit are assessed, and a multidisciplinary team plans comprehensive palliative care for patients. Theoretical and practical patient care training is provided by palliative care nurses for family members or caregivers. Considering the burden of cancer as well as the increasing life expectancy at birth, it can be stated that the actual need for palliative care in Turkey will be much greater in the near future.

Symptom clusters in palliative-stage cancer correlate with proinflammatory cytokine cluster

Patients with palliative-stage cancer often suffer from a variety of debilitating symptoms which have been shown to appear in clusters. It is suggested that cytokines cause many such symptoms, and elevated cytokine production has been shown to correlate with symptoms. However, symptom clusters have not been thoroughly analyzed in relation to cytokine clusters. The aim of the present study was to identify symptom clusters and cytokine clusters in Swedish cancer patients, and to investigate correlations between the identified symptom clusters and cytokine clusters. The EORTC Quality of Life Questionnaire Core 15 Palliative Care questionnaire was completed by 110 cancer patients, with blood samples taken at two time points four weeks apart. Meso scale discovery (MSD) assays were used to analyze 23 cytokines. Statistical analysis was performed using principal component analysis (PCA) of symptoms and cytokines, followed by correlation analysis of the obtained clusters. Three symptom clusters were identified: (I) pain-sleep disorder, (II) gastro-intestinal-fatigue, (III) physical functioning. The cytokines were divided into three clusters that can be characterized as (I) pro-tumorigenic, (II) cell-mediated immune response and (III) proinflammatory. At the second time point, a fourth cytokine cluster was isolated (IV) immunostimulation. Correlations were found at both time points between the proinflammatory cytokine cluster and the physical functioning symptom cluster, and at the week four time point between the proinflammatory cytokine cluster and the gastro-intestinal-fatigue symptom cluster. We show a correlation between symptom clusters and the proinflammatory cytokine cluster. Proinflammatory cytokines are known to cause symptoms that resemble palliative cancer symptoms. Increased knowledge of biochemical processes and their effect on patients' wellbeing may give clues for counteracting symptoms that affect quality of life (QOL) in palliative cancer care.

Navigating the challenges of neuro-oncology in Africa: addressing diagnostic and treatment barriers in the region: a correspondence

Navigating the challenges of neuro-oncology in Africa: addressing diagnostic and treatment barriers in the region: a correspondence

Oncology nursing on the move: a contemporary issue on Chinese oncology nursing in cancer care.

Cancers have become the primary cause of death among Chinese residents, seriously affecting their health and life. Oncology nursing is a specialized nursing practice focusing on cancer education, prevention, screening, early detection, and palliative and hospice care. China has made tremendous progress in developing oncology nursing. However, to ensure more individuals can get cancer care, the country's healthcare system still confronts several problems in oncology nursing that need to be addressed to ensure that more individuals can receive cancer care. This article reviews the current development of oncology nursing in China, especially in pain symptom control, palliative care, end-of-life care, education and training. The challenges faced in oncology nursing in China and the suggestions for developing oncology nursing in China are also discussed and proposed in this review. The growth of research on oncology nursing by Chinese nursing scholars and concerned policymakers is anticipated to ultimately improve oncology nursing and the quality of life of patients with cancer in China.

Communication and information sharing with pediatric patients including refugees with advanced cancer, their caregivers, and health care professionals in Jordan: a qualitative study.

Effective communication in pediatric palliative cancer care is an important aspect of practice to enhance patient- and family-centered care, and to optimize decision-making. However, little is known about communication preferences practices from the perspectives of children, caregivers and their health care professionals (HCPs) in the Middle Eastern region. Furthermore, involving children in research is crucial but limited. This study aimed to describe the communication and information-sharing preferences and practices of children with advanced cancer, their caregivers, and health care professionals in Jordan. A qualitative cross-sectional study was conducted using semi-structured face to face interviews with three groups of stakeholders (children, caregivers and HCPs). Purposive sampling recruited a diverse sample from inpatient and outpatient settings at a tertiary cancer center in Jordan. Procedures were in line with the Consolidated criteria for reporting qualitative research (COREQ) reporting guidelines. Verbatim transcripts were thematically analyzed. Fifty-two stakeholders participated: 43 Jordanian and 9 refugees (25 children, 15 caregivers and 12 HCPs). Four major themes emerged: 1) Hiding information between the three stakeholders which includes parents who hide the information from their sick children and ask the HCPs to do so to protect the child from distressful emotions and children who hide their suffering from their parents to protect them from being sad; 2) Communication and sharing of clinical versus non-clinical information; 3) Preferred communication styles such as use of a companionate approach by acknowledging patients and caregivers' suffering, building a trustful relationship, proactive information sharing, considering child age and medical status, parents as facilitators in communication, and patients' and caregivers' health literacy; 4) Communication and information sharing with refugees where they had dialect issues, which hindered effective communication. Some refugees had unrealistically high expectations regarding their child's care and prognosis, which posed challenges to communication with staff. The novel findings of this study should inform better child-centered practices and better engage them in their care decisions. This study has demonstrated children's ability to engage in primary research and to express preferences, and parents' ability to share views on this sensitive topic.

Clinical usefulness of the Patient-Generated Subjective Global Assessment and modified Glasgow Prognostic Score in decision making concerning the indication of enteral nutritional therapy in patients with incurable cancer receiving palliative care

ObjectivesThis study aimed to identify the clinical usefulness of assessing nutritional status using validated tools for the indication of enteral nutrition for patients with incurable cancer in palliative care. MethodsIn this prospective cohort study, patients were assessed for nutritional risk using the Patient-Generated Subjective Global Assessment and for cancer cachexia (CC) using the modified Glasgow Prognostic Score upon enrollment and after ∼30 d. The outcome was stable or improved Karnofsky Performance Status. Logistic regression models were used, providing the odds ratio (OR) and 95% confidence interval (CI). ResultsA total of 180 patients participated. The only nutritional status parameter that was associated with function was CC. The less severe the CC, the more likely Karnofsky Performance Status was to remain stable or improve over 30 d (non-cachectic: OR = 1.95; 95% CI, 1.01–3.47; malnourished: OR = 1.06; 95% CI, 1.01–1.42). Furthermore, white skin color (OR = 1.79; 95% CI, 1.04–2.47), higher educational level (OR = 1.39; 95% CI, 1.13–2.78), and inadequate calorie intake (OR = 1.96; 95% CI, 1.02–2.81) were also associated with the outcome. ConclusionsUsing the modified Glasgow Prognostic Score to identify the existence and severity of CC, which is associated with function, has the potential to help clinical decision making concerning the indication of enteral nutrition in patients with incurable cancer receiving palliative care.

Perceptions toward issues in cancer care for people with mental illness among psychiatric care providers: A questionnaire study.

To reduce cancer care disparities in people with mental illness, this study aimed to quantify psychiatric care providers' perceptions regarding issues that are insufficiently addressed or difficult to address. Psychiatric care providers at 23 psychiatric hospitals in Japan were surveyed using mail questionnaires. Respondents were asked to rate 15 items with four categories related to insufficiencies/difficulties in cancer care for patients with mental illness on a five-point Likert scale. We analyzed the proportion of respondents who answered "insufficient/difficult" for each item. A total of 255 (76.3%) psychiatric care providers responded. For questions related to the skills and attitudes of psychiatric professionals, 48.3%-58.4% of respondents perceived that efforts for supporting cancer screening and treatment were insufficient. For the questions related to collaborations between cancer and psychiatric care providers, 75.3% of respondents perceived that inpatient visits between psychiatric and cancer hospitals were insufficient. For the questions related to in-psychiatric-hospital medical systems, 50.2%-87.2% of respondents perceived that support for screening, diagnosis/treatment, and palliative care for psychiatric inpatients were insufficient/difficult. 41.9%-57.4% of respondents perceived that social services in the community were insufficient. This study clarified the level of insufficiency/difficulty perceived by psychiatric care providers regarding issues related to cancer care for people with mental illness. Psychiatric care providers are required to have knowledge and skills in cancer screening and treatment. To improve access to cancer prevention, treatment, and palliative care, it may be helpful to establish systems to promote coordination between cancer hospitals and psychiatric hospitals.

Palliative Care in a Specialized Palliative Cancer Care Unit in Portugal: A Complex Reality.

Introduction The goal of palliative care (PC) is to improve the quality of life of patients and their families through the involvement of a multidisciplinary team. PC improves symptom control and end-of-life care. Despite the fact that the benefits of PC have long been acknowledged, Portugal's demands are currently unmet. The majority of patients have been identified as havinga high level of complexity and are referred for symptom management and end-of-life care. Study aim The study aimed to analyze the sociodemographic, disease and hospitalization characteristics of the patients admitted to a specialized PC unit. Materials and methods Weconducted a retrospective, single-center study of palliative care patients admittedto a Portuguese oncology institute's acute palliative care unit during a three-month period. Patients' information such as social demographics, clinical data,patient and family member's psychological, social, nutritional and spiritual counseling and knowledge on diagnosis and therapy objectives were collectedfrom physician's records and analyzed usingSPSS Statistics for Windows, Version 23.0 (IBM SPSS Statisticsfor Windows). Results A total of 41 patients were included, with a mean age of 66.4 years. Spouses were the primary caregivers. There was no indication for targeted therapy in any of the patients. Prior to hospitalization, 58.5% did not receive follow-up by PC. The most frequently reported symptoms were pain (75.6%), tiredness (68.3%), anorexia (61%) and emotional distress (58.5%). Patients were referred to counseling for psychological (43.3%), spiritual (19.5%), nutritional (58.5%)and social services (34.1%). During hospitalization, 75% of patients died; out of which, 70.9% were not previously followed up on by the PC team. Conclusion PC patients are complex, with multiple clinical-psychological-social-spiritual issues, and their management in non-PC wards can be challenging. Since the use of a multidisciplinary approach can improve patients' and families' quality of life, it is critical to train, expand and integrate the PC teams into the existing teams, allowing patients a better quality of life until they pass.

Spiritual/religious coping strategies and religiosity of patients living with cancer in palliative care

The palliative care provided to cancer patients should also contemplate the psychological and spiritual dimensions of care. This study aimed to compare religiosity and spiritual/religious coping (SRC) of cancer patients in palliative care with a group of healthy volunteers and determine whether sociodemographic characteristics affected this association. This was a case-control study conducted with 86 patients living with cancer from an outpatient palliative care clinic of the São Paulo State University (UNESP) medical school, Botucatu, Brazil and 86 healthy volunteers. The brief Spiritual/Religious Coping Scale (SRCOPE) and the Duke University Religion (DUREL) Index were used as a brief measure of 'religiosity'. All 172 participants reported to be religious and, overall, made very little use of SRC strategies. DUREL scores were negatively associated with religious practice (P<0.01) and positive SRC (P<0.01). Age was associated with non-organisational religious activities and intrinsic religiosity (P<0.01); and income was associated with intrinsic religiosity (P<0.04). Positive SRC was negatively associated with the palliative group (P=0.03) and DUREL index (P<0.01). Negative SRC was positively associated with the palliative group (P=0.04) and negatively associated with education level (P=0.03) and practice of religion (P<0.01). All participants reported to be religious; however, their use of SRC strategies was very low. Positive religious coping was the most prevalent score. Negative religious coping was more common in the palliative care group compared to healthy volunteers. There is an association between religious coping and religiosity in palliative cancer care patients.

Potential, Limitations and Risks of Cannabis-Derived Products in Cancer Treatment.

The application of cannabis products in oncology receives interest, especially from patients. Despite the plethora of research data available, the added value in curative or palliative cancer care and the possible risks involved are insufficiently proven and therefore a matter of debate. We aim to give a recommendation on the position of cannabis products in clinical oncology by assessing recent literature. Various types of cannabis products, characteristics, quality and pharmacology are discussed. Standardisation is essential for reliable and reproducible quality. The oromucosal/sublingual route of administration is preferred over inhalation and drinking tea. Cannabinoids may inhibit efflux transporters and drug-metabolising enzymes, possibly inducing pharmacokinetic interactions with anticancer drugs being substrates for these proteins. This may enhance the cytostatic effect and/or drug-related adverse effects. Reversely, it may enable dose reduction. Similar interactions are likely with drugs used for symptom management treating pain, nausea, vomiting and anorexia. Cannabis products are usually well tolerated and may improve the quality of life of patients with cancer (although not unambiguously proven). The combination with immunotherapy seems undesirable because of the immunosuppressive action of cannabinoids. Further clinical research is warranted to scientifically support (refraining from) using cannabis products in patients with cancer.