Palliative Situation Research Articles

My virtual escape from patient life: a feasibility study on the experiences and benefits of individualized virtual reality for inpatients in palliative cancer care

BackgroundCancer patients benefit from Virtual Reality (VR) in burdensome situations, but evidence is scarce for palliative situations. Based on earlier work in palliative care, individualized VR interventions like seeing the patient’s home may address a patient’s wish to be at home and thus have a greater effect compared to standard VR content. Yet, some patients and relatives may be concerned about their privacy. Also, patient stakeholders raised concerns about triggering depressed mood or homesickness.AimTo test the feasibility and safety of individualized vs. standard 360°video VR interventions in palliative cancer inpatients.MethodsProspective observational study with patient-reported outcome measurement using validated instruments of well-being (MDBF), symptoms and psychosocial burden (IPOS), cybersickness (SSQ), presence experience (SPES), subjective benefit (2 items), content analysis of interviews, and field notes. Individualized VR content was recorded with action camcorder-technology to protect the patients’ privacy.ResultsSeventeen patients participated, median age 65 years (range 20–82), 9 women (53%), 8 single or widowed (47%), 4 childless (23.5%), 4 academics (23.5%), with a median length of stay of 9 days (1–75) in the hematology (10), palliative care (3), or radiotherapy (2) unit of a German university hospital. Eight patients (53.3%) chose their own home environments or family for individualized VR-content. All participants enjoyed the intervention. Compared to standard VR content the individualized VR tended to have a stronger effect on well-being and emotional touch. It was not inferior in terms of psychosocial burden and cybersickness. No subjective and relevant side effects occurred. The patients well tolerated the assessments. However, most patients demanded a lighter headset and a desire for more interactivity.ConclusionsIndividualization of VR content shows potential for enhancement of immersion, which improves the VR experience and does not harm in terms of depressed mood or worsening of symptoms. The patients’ and family desire for privacy is feasible with the support of family members who recorded the individualized videos, which is easily manageable today. We suggest a pragmatic randomized clinical trial to compare the effects of individualized vs. standard VR-content.Trial registrationRegistered at German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS); registration number: DRKS00032172; registration date: 11/07/2023.

Dealing with assisted suicide-knowledge, attitudes and experiences of members of the German Association for Palliative Medicine

In February 2020, the Federal Constitutional Court declared §217 of the German Criminal Code void. Ever since, assisted suicide services have been legal in Germany. This study aims to describe the knowledge, attitudes and experiences of members of the German Association for Palliative Medicine (DGP) regarding assisted suicide. Online survey with members of the DGP from July to September 2023 using Qualtrics®. The study group developed the questionnaire based on current literature; it was adapted following an initial application among young physicians and an interprofessional panel of experts with consensus voting. Data was analysed using descriptive and explorative statistics. 991 DGP-members (18%) participated, of which physicians made up 57.0% (n = 545/957) and nurses 23.4% (n = 224/957). Of the participants, 197/851 (23.1%) incorrectly stated that assisted suicide is prohibited by professional code, 430/914 (47.1%) rejected arestriction of palliative care teams to suicide prevention measures, and 766/930 (82.4%) rejected personal involvement in assisted suicide regardless of a patient's health status. For patients in palliative situations, 473/926 (51.1%) could imagine participating in assisted suicide, and 71% wantednew legislation regulating assisted suicide. There are gaps in the knowledge of the participating members of the DGP regarding the legal and professional status of assisted suicide. Further educational work is needed in this regard. The participants can more easily imagine assisted suicide for people in palliative disease trajectories. As in surveys of members of other medical societies, the attitudes of more experienced staff are reflected. Compared to younger healthcare professionals, they have amore restrictive attitude towards the concept of assisted suicide.

525. PALLIATIVE MULTIMODALITY-THERAPY, EVEN WITH ABBREVIATED IMMUNOTHERAPY CAN MAKE CURATIVE SURGERY FOR SYNCHRONOUS LUNG AND ESOPHAGEAL CANCER POSSIBLE: A CASE REPORT

Abstract Background Synchronous lung and esophageal carcinomas are problematic. When both cancers are locally advanced, combined surgical treatment is rarely possible because of high-risk or insufficient respiratory reserve. Palliative treatment including immunotherapy can sometimes offer significant tumor response and potentially prolong survival in patients with PDL-1 tumor expression. However the place of immunotherapy for potentially rendering inoperable patients operable is still unknown. Methods Case report: A 78-year-old male with smoking history was diagnosed with synchronous locally advanced adenocarcinoma of the Gastroesophageal Junction (GEJ) cT3cN1cM0 and bilateral lung adenocarcinomas stage 4a, cT2cN1cM1a (right lower lobe 43mm confirmed by CT-guided biopsy, left upper lobe 32mm and additional S6 left lower lobe nodule). The patient was considered incurable by MDT and palliative treatment was offered as both cancers had significant PDL-1 expression (GEJ: CPS score >1, Lung: PDL-1 expression 90%). Pembrolizumab immunotherapy was started but poorly tolerated (severe myositis) and stopped again after only 6 weeks. The left-sided lung cancer had by then already regressed and stereotactic irradiation (SBRT 5x12Gy) of the right-side lung cancer was administered resulting in further local tumor control (figure). Endoscopic tumor re-evalution showed a Siewert type 2 tumor (uT3N1) similar to the initial endoscopy 15 months before. Both side lung adenocarcinomas remained regressed and the left lower lobe nodule was unchanged (6mm). Mediastinal lymph node staging by EBUS was negative. Thirteen months after initial diagnosis, 4 cycles of neo-adjuvant chemotherapy (FLOT) were administered. Combined synchronous surgery was finally done 16 months after initial diagnosis. A minimally invasive combined resection included a laparoscopic & thoracoscopic Ivor-Lewis MIE, left thoracoscopic wedge of the lower lobe nodule and a right lower lobectomy with radical lymph node dissection. Post-operative course was smooth: Clavien-Dindo score 1, hospital stay 18 days. Final pathology Distal third adenocarcinoma (1.5x1.2cm above Z-line) with major partial response ypT2N0M0, R0, 0/43 lymph nodes (subcarinal signs of nodal response), right lower lobe tumor of 60x55mm with residual 1.2mm focus of residual viable adenocarcinoma (ypTisN0M0, R0) and left lower lobe hamartoma (6mm). Follow-up showed no recurrence 9 months after surgery (25 months from initial diagnosis). Conclusions: 1) Despite much abbreviated palliative immunotherapy (6 weeks), SBRT and FLOT our patient was down-staged within 16 months from an initially palliative situation to a potential cure with complete resection of all tumors. 2) Synchronous combined radical laparoscopic & thoracoscopic Ivor-Lewis esophagectomy with lung lobectomy can be feasible after immuno-, chemo- and radiotherapy even in elderly patients.

South African palliative care provider perspectives on emergency medical services in palliative situations

IntroductionDue to the frequent intersection of Emergency Medical Services (EMS) with palliative situations and the increasing global need for palliative care, there has been increased recognition of the need for palliative care integration with EMS. However, EMS and palliative care systems remain segregated in many Low-to-Middle Income Country contexts, as in South Africa (SA). The aim of this study was to gather perspectives of palliative care providers in SA concerning EMS in palliative situations. MethodsA qualitative design employing individual semi-structured interviews was implemented. Ten interviews with experienced doctors and nurses holding post-graduate palliative medicine qualifications were conducted. Verbatim transcriptions of interviews were subjected to content analysis with an inductive-dominant approach to develop codes and categories. ResultsFour categories were developed: (1) Disposition towards EMS, (2) Perceived EMS challenges, (3) Positive EMS impact across patients’ palliative care journeys and (4) Methods of EMS and palliative care system integration. Participants maintained an overall positive view of EMS and palliative care integration, noting the beneficial impact of EMS and suggesting various methods of integration, while also highlighting challenges and concerns. ConclusionEMS and palliative care integration would be mutually beneficial to both systems while benefiting patient well-being and the broader healthcare system. Potentially low-cost, high-impact interventions suggested by participants, such as palliative care cards for patients and enhancing EMS and palliative care system communication, represent efficacious and judicious use of limited resources within the SA context. Pilot studies investigating these suggestions should be conducted.

Contributions of the Communication and Management of Bad News in Nursing to the Readaptation Process in Palliative Care: A Scoping Review

Background: Delivering bad news is a sensitive and challenging aspect of nursing healthcare, requiring a holistic approach that respects patients’ preferences, cultural values, and religious beliefs to promote adaptation to the person’s state of health. Aim: We aim to map the evidence of the dimensions present in the communication and management of bad news by nurses to a person in a palliative situation, their caregivers, and their family members. Methods: Based on the Joanna Briggs Institute methodology, the search was conducted through MEDLINE Complete (EBSCOhost), CINAHL Complete (EBSCOhost), SciELO, and the Open Access Scientific Repository in Portugal. From a total of 756 articles, 14 were included, published between 2018 and 2023. Results: Structure components in bad news are influenced by the characteristics of the palliative patients, their caregivers, their family members, the nurses, and the organizational environment. Promoting the quality of the communication process is desirable through continuous and advanced training in end-of-life care, training in bad news, religiously and culturally sensitive nursing interventions centered on hope and maintaining faith, emotional management, and the utilization of a checklist protocol. Conclusions: Honest communication allows people to actively participate in the decision-making process and in the trajectory of the care plan that is focused on themselves and their preferences, which has outcomes in functional capacities and readaptation.

The challenge of nutrition in palliative care: Eating and drinking - beneficial even at the end of life?

Food and nutrition play a major role in our lives. They include physical, psychological as well as cultural and social aspects. Illnesses increase the risk of altered food intake/absorption - of malnutrition. This applies in particular to palliative situations. The causes of malnutrition can be diverse. Malnutrition often leads to reduced performance and can therefore have a major impact on the quality of life and independency of patients. The aim of nutritional therapy interventions is therefore to maintain or improve the quality of life of patients with a life-threatening illness. The initially defined goals can change as the disease progresses. At the beginning of a life-threatening illness, adequate nutritional interventions are usually very effective. However, the benefits of nutritional therapy often change as the disease progresses and they often lose importance. For this reason, decision-making is an important process: Depending on the phase of illness, the prognosis and the patient's preferences, the nutritional therapy interventions needs to be reconsidered in regard of indication, individual benefit and the desired treatment goal on a regular base. As every medical intervention, nutritional therapy must regularly be adapted to the treatment goal if necessary.

Specialized expertise among healthcare professionals in palliative care - A scoping review

BackgroundThe generalist-plus-specialist palliative care model is endorsed worldwide. In the Netherlands, the competencies and profile of the generalist provider of palliative care has been described on all professional levels in nursing and medicine. However, there is no clear description of what specialized expertise in palliative care entails, whereas this is important in order for generalists to know who they can consult in complex palliative care situations and for timely referral of patients to palliative care specialists.ObjectiveTo gain insight in the roles and competencies attributed to palliative care specialists as opposed to generalists.MethodsA scoping review was completed based on PRISMA-ScR guidelines to explore the international literature on the role and competence description of specialist and expert care professionals in palliative care. Databases Embase.com, Medline (Ovid), CINAHL (Ebsco) and Web of Science Core Collection were consulted. The thirty-nine included articles were independently screened, reviewed and charted. Thematic codes were attached based on two main outcomes roles and competencies.ResultsFive roles were identified for the palliative care specialist: care provider, care consultant, educator, researcher and advocate. Leadership qualities are found to be pivotal for every role. The roles were further specified with competencies that emerged from the analysis. The title, roles and competencies attributed to the palliative care specialist can mostly be applied to both medical and nursing professionals.DiscussionThe roles and competencies derived from this scoping review correspond well with the seven fields of competence for medical/nursing professionals in health care of the CanMEDS guide. A specialist is not only distinguished from a generalist on patient-related care activities but also on an encompassing level. Clarity on what it entails to be a specialist is important for improving education and training for specialists.ConclusionThis scoping review adds to our understanding of what roles and competencies define the palliative care specialist. This is important to strengthen the position of the specialist and their added value to generalists in a generalist-plus-specialist model.

Time-Related Outcome Following Palliative Spatially Fractionated Stereotactic Radiation Therapy (Lattice) of Large Tumors – A Case Series

Lattice radiation therapy (LRT), a form of spatially fractionated radiation therapy, holds promise for treating large tumors. Despite its introduction in clinical practice around 2010, there remains limited information on its time-related outcomes despite consistently high response rates and tolerability. We assessed the time-related outcome of our palliative LRT cohort. We conducted an analysis of our LRT program, which involved 45 palliative patients with 56 lesions larger than 7 cm, treated between January 2022 and November 2023. Prospectively defined treatment protocols included delivering 20 to 25 Gy/5 fractions to the tumor with a stereotactic simultaneously integrated boost (SIB) of 60 to 65 Gy to lattice vertices (n = 45/56) or, mainly in preirradiated lesions, single fraction stereotaxy with 1 × 15 to 20 Gy to vertices only (n = 11/56). Follow-up (FU) intervals were determined based on clinical considerations, considering the mostly highly palliative situation of included patients. Outcome assessments focused on subjective benefit and objective radiologic FU response. The mean/median FU was 5.5/4.0 months (0.3-21 months). A total of 25/45 (56%) patients died after a mean/median of 3.9/2.0 months (0.3-14 months). Fourteen of 56 lesions (25%) were previously irradiated, with a mean/median of 18/13 months (4-72 months) prior to LRT. The mean/median gross tumor volume (GTV) measured 797/415 cc (54-4027 cc) and 14/13 cm (7-28 cm). Subjective statements at LRT completion were available from 37 symptomatic patients: 32/37 (87%) reported fast symptom relief, and 5/37 felt no change under LRT or at LRT completion. Early tolerance was excellent (G0-1). FU imaging was available from 40/56 lesions (71%): progression in 3/40 at first exam one at 1.5 and 4 months post-LRT, and stable disease (±10%) in 5/40 assessed at 2, 3, 3, and 4 months post-LRT. First measure shrinkage of 48%/30% (10%-100%) was found in 32/40 lesions (80%) after a mean/median of 2.8/3 months (0.3-7 months). Maximum shrinkage over time based on 21 cases with at least 1 FU imaging measured a mean/median of 62%/60% after 6.2/5.5 months. The duration of radiologic response was a mean/median of 7.4/7.0 months (1-21 months). Short-course LRT emerged as an effective and well-tolerated palliative option for very large lesions, whether treatment-naïve or previously irradiated. Nearly 90% of symptomatic patients reported significant subjective benefit, and 80% of assessed lesions demonstrated tumor shrinkage ≥10%, with a mean response duration of >6 months.

Patients with stage IV colorectal carcinoma selected for palliative primary tumor resection and systemic therapy survive longer compared with systemic therapy alone - A retrospective comparative cohort study.

To compare the survival of palliative stage IV colorectal cancer patients selected for primary tumor resection and systemic treatment (PTR+SYST) to patients with systemic treatment only (SYST). About 20-25% of all colorectal cancer patients are diagnosed with stage IV disease. The benefit of primary tumor resection in the palliative situation is therefore of high concern. However, empirical evidence from randomized and observational studies is inconsistent. Mortality after PTR and systemic treatment was compared to systemic treatment alone in a retrospective observational cohort of patients diagnosed 2012-2020 from the cancer registry in the federal state of Brandenburg (Germany), excluding patients with rectal cancer of the lower two-thirds, emergency procedures, unknown ECOG status, ECOG >2, unknown metastatic status or unclear grading. Of 480 patients, 416 died during an average follow-up of 23 months in mean. 12-months survival was 75% after PTR+SYST compared with 49% after SYST (HR=0.39, 95% CI 0.29-0.53, P<0.001). The difference persisted to 36 months (28% vs. 13%, HR=0.53, 95% CI 0.43-0.66, P<0.001). Results were similar after multivariate adjustment, propensity score matching and delayed entry. Patients with stage IV colorectal carcinoma who are selected for primary tumor resection in combination with systemic therapy and who receive such treatment survive longer compared with patients who receive only systemic treatment. Whether the difference is due to selection of patients or PTR remains unclear. At present, current practice of selecting patients for PTR appears to do no harm.

#2745 New strategies for capturing undiagnosed chronic kidney disease in patients at risk

Abstract Background and Aims Chronic Kidney Disease (CKD) is recognized as a health problem in the general population. The worldwide incidence of chronic kidney disease (CKD) is increasing, driven by aging populations and a higher prevalence of type 2 diabetes (T2D) and hypertension. The CKD is generally asymptomatic, and the diagnosis depends on the laboratory monitoring of the patients. The KDIGO consensus statement recommend the implementation of screening programs in patients at high risk of CKD development. We present the first results of a sentinel surveillance program of CKD in a healthcare area for detecting undiagnosed CKD in patients at risk. Method Our health department covers the metropolitan area of Valencia, attending 341, 972 citizens through 31 primary care centers. A CKD screening program has been established in this population based on a middleware clinical decision support (CDS) system “CDS-Ripple Down - Abbott Diagnostics” integrated in an electronic request system and in the electronic health records. When a general practitioner doctor order a lab test, the middleware CDS system detects high risk patients for CKD defined by age: &amp;gt;65 to &amp;lt;90, diabetes mellitus, hypertension, or obesity. Automatically, the system adds serum creatinine, estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR) and urine sediment analysis if it has not been requested (sentinel program). Then, the patients are classified into KDIGO stages based on eGFR and UACR and the CDS system detect those with progression (Fig. 1). Only patients with UACR &amp;gt; 300 mg/g, eGFR &amp;lt; 30 ml/min/1.73, or progression were referred to nephrology. A nephrologist then decides whether patients require a face-to-face visit or provides recommendations to primary care physicians. Results From 01/11/2023 to 31/12/2023, 4, 989 reports were generated by CDS-system corresponding to 122 laboratory test per day. 99, 33% were added by the sentinel program. 3, 970 (79.6%) patients did not have CKD (KDIGO G1-2 or UACR &amp;lt;30 mg/g), 887 (17.8%) patients CKD not suitable for referral to Nephrology (KDIGO 3 and UACR 30-300 mg/g without progression, and 130 (2, 6%) were referred to Nephrology. (Fig. 2) Patients referred to Nephrology had a median age of 79 years [IQR: 72-85], 68 (52, 3%) were women. Twenty-seven patients (20%) were classified as KDIGO G2 A3, 19 (14, 6%) as KDIGO G4 A1 and 18 (13, 8) as KDIGO G2 A2. Fifty-seven patients (43, 8%) have been scheduled to face-to-face at nephrology consultation (1.1% of the total sample), and 73 (56, 1%) have been referred to their primary care doctors with recommendations (1.5% of the total sample). Among the patients referred to Nephrology by the CDS system, the reasons for not scheduling a face-to-face visit in Nephrology were mild decrease in eGFR (n = 18), UACR A2 (n = 24), elderly patients with low Kidney Failure Risk Equation (n = 5), urological pathology (n = 10), dependent patient and/or palliative situation (n = 5) and other causes (n = 11). Conclusion A novel CKD automatic screening method for capturing undiagnosed CKD among patients at risk has been developed. After screening around 5 000 patients at risk in two months, 2.6% of them presented criteria for referral to Nephrology. Only 1.4% required face-to-face visit. If we continue at this screening rate, it is expected that half of our population at risk of developing CKD will have been screened in less than one year. Computer systems with algorithms programmed and improved by a multidisciplinary team can establish a sentinel route (reviewing patients medical records), interpreting analytical values (calculating progressions, KDIGO stages, KFRE risk...) and producing automatic interpretive reports that integrates all the elements of CKD clinical attention allowing us to carry out this population screening.

Staging and systemic treatment of ocular and periocular metastases

Metastases of malignant diseases are the most frequent tumors diagnosed in the human eye. They occur in approximately 5-10% of patients with solid tumors during the course of the disease. Their frequency is particularly high in patients with breast and lung cancer. Many highly sensitive periorbital tissues can be affected by the localization of the metastatic lesions and pose anumber of clinical challenges. The main goal of the therapy of ocular metastases consists of the control of tumor growth (including the control of other possible manifestations throughout the body), the preservation of the affected eye and the minimization of potential iatrogenic damage to adjacent tissues. Overall, the purpose of this strategy is also to maintain the quality of life and especially the eyes and vision of the patient. Furthermore, pain should be avoided or at least alleviated. Of special importance is the differentiation between a curative or palliative situation. Patients with ocular metastases usually undergo systemic treatment appropriate for the underlying tumor entity, which is often accompanied by concomitant or sequential radiotherapy. In addition to classical chemotherapy, targeted treatment, treatment with monoclonal antibodies and antibody-drug conjugates as well as immunotherapy with checkpoint antibodies are currently available for many cancer types. This review article gives an overview of the currently available treatment options for patients with ocular metastases of solid tumors.

Clinical approach for solid intraocular metastases

Intraocular metastases arising from solid tumors are found in approximately 2% of patients with metastatic tumor diseases and are therefore more frequent than originally assumed. They often affect the uvea and are associated with apoor prognosis. Due to the difficult diagnosis and an inconsistent treatment regimen, ophthalmologists have aspecial responsibility here. This article gives a summary of the various types of intraocular metastases with respect to clinical features, diagnostics, treatment and prognosis as well as recommendations for follow-up care. A selective literature search was carried out on the topic of intraocular metastases using PubMed and Google Scholar. Intraocular metastases most frequently affect the uvea, specifically the choroid. In most cases the underlying disease is breast or lung cancer, but other rarer primary tumors have also been reported in the literature. Metastatic lesions can show very different morphological manifestations but can be distinguished based on the corresponding structure of manifestation in the eye and with the aid of targeted staging, thus providing valid information on the type of primary tumor. The treatment is partly experimental and usually depends on the primary tumor and leading symptoms of the patient. A differentiation between acurative or palliative treatment situation must always be made. Intraocular metastases are the most frequent intraocular tumor and are usually associated with apoor prognosis. Accurate diagnostics for finding the treatment as well as interdisciplinary collaboration and the presentation of the patient on the tumor board are essential.

Challenges for palliative care in times of COVID-19: a scoping review.

Many of the essential practices in palliative care (PC) had to be adapted to the COVID-19 pandemic. This global spread of the infectious respiratory disease, caused by SARS-CoV-2, created unprecedented obstacles. The aim of this research was to comprehensively assess the experiences and perceptions of healthcare professionals, individuals, and families in palliative and end-of-life situations during the COVID-19 pandemic. A scoping review was conducted using the databases CINAHL Complete, MEDLINE, Scopus, SciELO, Cochrane Central Register of Controlled Trials, Psychology and Behavioral Sciences, MEDIClatina, and Portugal's Open Access Scientific Repository. The review followed the JBI® methodological approach for scoping reviews. Out of the initially identified 999 articles, 22 studies were included for analysis. The deprivation of relationships due to the safety protocols required to control the spread of COVID-19 was a universally perceived experience by healthcare professionals, individuals in PC, and their families. Social isolation, with significant psychological impact, including depersonalization and despair, was among the most frequently reported experiences by individuals in palliative situation. Despite healthcare professionals' efforts to mitigate the lack of relationships, the families of these individuals emphasized the irreplaceability of in-person bedside contact. https://osf.io/xmpf2/.

Quelle connaissance et quelle perception ont les professionnels de santé d’un Centre de lutte contre le cancer à propos des pratiques palliatives encadrées par la loi Claeys-Leonetti : étude PAL PRAT

Introduction: The issue of end-of-life care is the subject of a sensitive debate in French society, particularly regarding the possibility for certain patients to have access to medical assistance in dying. The aim of this study was to assess the knowledge and opinion of healthcare providers on the care practices for patients at the end of life, as well as to highlight any specificities in their discourse.Method: A survey of healthcare providers' opinions, composed of closed and open questions, that were analyzed using a lexicometric approach, was distributed in a cancer center.Results: The results of the study reveal a good knowledge of the different procedures. Professionals considered that advance directives should be systematically collected; a majority of them differentiated euthanasia from deep continuous sedation and perceived the latter as a means of relieving patients' suffering without inducing death. The different procedures related to the active assistance in dying were known by a majority of professionals and the survey did not identify a dominant trend concerning the will to practice euthanasia if the legal framework allowed it. Half of the participants considered their training insufficient, indicating the need to fill this gap.Discussion: This survey underlines the importance of training and support for the professionals caring for patients in palliative situation and their relatives in France.

Evaluation of Five-year Overall Survival Rates Among 18,331 Head and Neck Cancer Patients Exposed to Different Targeted Therapies Through Real-world Data in a Case-controlled Study.

Targeted therapy is an important and fast developing aspect of modern tumor therapy including therapy of head and neck cancer (HNC). Surgically treated patients often experience significant limitations to their ability to swallow, speak, or mimic expressions. In cases of recurrent tumors or palliative situations, targeted therapies such as immune checkpoint inhibitors (ICI) are frequently employed. This study compared different targeted therapies focusing on survival probability. Data from patients with head and neck cancer treated with different therapy regimens from the TriNetX network were analyzed. Two groups were formed: Cohort I received one targeted therapy, whereas patients in cohort II received a different targeted therapy. Cohorts I and II were matched 1:1 with respect to certain confounders. After defining the primary outcome as "death", a Kaplan-Meier analysis was performed, and the risk ratio (RR), odds ratio (OR), and hazard ratio (HR) were calculated. A total of 18,331 patients with HNC treated with targeted therapy were analyzed. Patients treated with VEGF inhibitors had a significantly longer overall survival than patients treated with c-MET or EGFR inhibitors. Patients treated with PI3K inhibitors showed a significantly reduced survival probability compared to those treated with c-MET, mTOR, and RET inhibitors. EGFR inhibitors are one of the most frequently used targeted therapies in HNC. However, in the present analysis, a survival advantage of patients treated with c-MET inhibitors or VEGF inhibitors was observed compared to those treated with EGFR inhibitors.

Sichtweisen einer Stichprobe überwiegend jüngerer Ärztinnen und Ärzte zum ärztlich-assistierten Suizid

ZusammenfassungHintergrundAm 26.02.2020 hat das Bundesverfassungsgericht den § 217 StGB, der die geschäftsmäßige Förderung der Selbsttötung unter Strafe stellte, für nichtig erklärt. Seitdem wird eine mögliche gesetzliche Neuregelung diskutiert. Ziel dieser Studie war es, Wissen, Erfahrungen und Einstellungen jüngerer Ärztinnen und Ärzte zur Suizidassistenz zu untersuchen.MethodenVon November 2022 bis März 2023 wurde eine quantitative Umfrage in Fortbildungskursen zur Notfallmedizin, Intensivmedizin und Hämatologie durchgeführt und deskriptiv ausgewertet.ErgebnisseInsgesamt wurden 1163 Datensätze (Rücklaufquote 82,1 %) ausgewertet. 90,8 % der Befragten hatten bereits Sterbende betreut. 62,3 % befürworteten eine Suizidassistenz nur bei Menschen in palliativen Behandlungssituationen, 20,1 % befürworteten Suizidassistenz unabhängig vom Gesundheitszustand des Menschen. 33,1 % wurden bereits um Suizidassistenz gebeten. 3,3 % hatten persönlich bei einer Suizidassistenz mitgewirkt. 71,0 % kannten den Inhalt des Bundesverfassungsgerichtsurteils zum § 217 nicht, 72,0 % waren über die Gesetzesvorschläge zur Neuregelung des assistierten Suizids nicht informiert. 66,4 % sahen Ärztinnen und Ärzte als die richtigen Ansprechpartner, um über die Zulässigkeit eines Suizidwunsches zu entscheiden.DiskussionDie Untersuchung zeigt, dass jüngere Ärztinnen und Ärzte einen deutlichen Unterschied in ihrer Haltung zur Suizidassistenz zwischen Menschen ohne Vorerkrankungen und solchen in palliativen Behandlungssituationen machen. Weitere Untersuchungen über die Ursachen der häufigen Unkenntnis der normativen Grundlagen sind notwendig. Die Ergebnisse legen nahe, dass mehr Aufklärungsarbeit über Suizidalternativen und palliativmedizinische Versorgungsmöglichkeiten geleistet werden muss.

Organ preservation with durvalumab-based immunotherapy in combination with chemoradiation as definitive therapy for early stage, cT1, and cT2N0 esophageal adenocarcinoma with indication for radical surgery: A prospective, multicenter study of the FLOT-AIO Gastric Cancer Group (IKF-t057/PRESTO trial).

TPS431 Background: The outcome of patients (pts) with adenocarcinomas of stomach and esophagogastric junction (GEJ) remains unsatisfactory (5-year survival rates of 24-84%), whereby surgical resection is considered as cornerstone of the curative treatment for pts with early stage esophageal adenocarcinoma (EGA), however, it is associated with mortality, morbidity and an impact on the patient’s quality of life. Recent investigations showed that in locally advanced stage EGA surgery with neoadjuvant chemoradiotherapy (CROSS trial) is beneficial over surgery alone. Further benefit was achieved for locally advanced EGA by perioperative treatment with FLOT acc. to FLOT4- trial data. Immuno-oncology (IO) therapy by using checkpoint inhibitors is approved in the palliative and adjuvant EGA situation. In this trial we aim for the organ preservation treatment of EGA pts with a combination of the anti PD-L1 antibody durvalumab- FLOT - and chemoradio-therapy. Methods: This is a multicenter, single arm, open-label, phase II trial including a total of 32 pts with T1-T2N0 EGA (including GEJ) with indication for radical surgery. Enrolled pts will receive immunotherapy with durvalumab (1500 mg Q4W) in parallel to 2 cycles FLOT (50 mg/m2 docetaxel, 85 mg/m2 oxaliplatin, 200 mg/m2 calcium folinate and 2600 mg/m2 5FU, Q2W) induction followed by 3 cycles of mFOLFOX (85 mg/m2 oxaliplatin, 200 mg/m2 calcium folinate, 400 mg/m2 5FU bolus and 1600 mg/m2 5FU over 48h, Q2W) plus concomitant radiation (25 daily fractions with 2.0 Gy = Σ50Gy). 8 weeks after last treatment, pts will undergo tumor assessment by esophagogastroduodenoscopy with biopsies, endoscopic ultrasonography, and CT- or MRI-scans. Surgical resection would be offered only to pts in whom a locoregional persistence is confirmed. Pts with complete remission will enter the maintenance phase and will receive durvalumab monotherapy (1500 mg, Q4W) for a maximum of 12 cycles accompanied by regular tumor re-evaluation. Primary endpoint is the rate of cCR/pCR at time of re-evaluation. Secondary endpoints include rate of cCR/pCR at 1, 2 and 3 years, rate of salvage surgery, 90 day and 1 year mortality after start of treatment, safety and quality of life. In this exploratory trial a cCR/pCR rate of ≥75% would indicate that the study treatment should be further investigated, whereas a rate &lt; 55% indicates no further investigation. First patient was enrolled on 2023-08-28. Currently one patient is recruited. Clinical trial information: NCT05713838 .

Experiential workshop on innovative teaching methods to improve palliative care education.

Introduction: To improve the knowledge, skills, and attitudes of healthcare providers for delivering quality generic palliative care, innovation in palliative care education and empowerment of the teaching staff are key.&#x0D; Context for the workshop: The World Health Organization states that “Palliative care improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening illness, whether physical, psychological, social or spiritual. The quality of life of caregivers improves as well.”. Per definition palliative care is patient-centred integrated care. Or at least it should be.&#x0D; International research shows that nurses (and other healthcare providers) lack core competencies to deal with palliative care situations adequately. One of the underlying reasons is that the possibilities for practical internship in palliative care are limited and that there are few options for gaining bed-side practical experience with regard to supporting patients during the dying phase. Another cause is that the knowledge, skills and attitudes of nurse educators to teach something something as complex as palliative care are not sufficiently developed.&#x0D; In a participatory approach four European institutes for higher education (KAMK (Finland), UnitBv (Romania), Howest (Belgium), PMU (Austria)), a hospice (Casa Speranţei Braşov, Romania), and the European Association for Palliative Care joined forces to support teaching staff and build up their capabilities. Funded by the Erasmus+ KA203 programme the NursEduPal@Euro partnership developed innovative, attractive and immersive ways to train palliative care core competencies as an important step to improve the quality of palliative nursing education.&#x0D; Objective, structure and targeted audience of the workshop: During the 5 topics of the workshop, the NursEduPal@Euro team provides an inspiring experience with less traditional teaching methods for the participants. Starting from core competencies that bachelor degree nurses need to acquire to enable them to provide generalist palliative care, an immersive demonstration is given of innovative educational tools suited to accomplish the acquisition of those competencies. The input for all methodologies is a golden standard case telling the story of Maggie and Ben, an elderly couple that is dealing with issues of chronic disease, informal care giving and the end of life. The objective of the workshop is to promote the use of the demonstrated tools in palliative care education of (future) healthcare providers throughout Europe.&#x0D; The 90-min workshop consists of the following parts: (1) Introduction of the NursEduPal@Euro project and the core competencies in palliative care (10 min), (2) Engage in design thinking to creative complex problem solving (20 min), (3) The game is on: a taste of a serious educational escape game (25 min), (4) Experience the strength of simulation as a learning tool (25 min), (5) Evaluation of the workshop by the audience with an online tool, directions on how to freely access the learning tools, and closing remarks (10 min).&#x0D; Anyone interested in education is welcome: we are not only addressing the teaching staff of educational institutions, but also educators who are committed to promoting lifelong learning for the healthcare workforce.

Video Assisted Thoracoscopy Talc Pleurodesis in the Management of Metastatic Pleural Effusion

Introduction: Metastatic pleural effusion complicates many cancers and impairs patients' quality of life. In a palliative situation, the decision between thoracoscopy talc pleurodesis, tube chest, iterative punctures or abstention is difficult and often operator dependent. Materials and methods: We report a study of 87 patients with metastatic pleural effusion treated by video assisted thoracoscopy talc pleurodesis. Results: Breast cancer constitutes the primary site causing metastatic pleural effusion in approximately half of cases, followed by bronchopulmonary cancers and finally digestive cancers. The complete response rate in the short and medium term is very satisfactory. We did not report any complications apart from one case of empyema. Conclusion: video assisted thoracoscopy talc pleurodesis constitutes an interesting treatment for recurrence of metastatic pleural effusion.

The use of emergency medical services for palliative situations in Western Cape Province, South Africa: A retrospective, descriptive analysis of patient records.

An estimated 56.8 million people require palliative care annually, while only 14% receive such care. This imbalance is particularly acute in low-to middle-income countries (LMICs), where up to 80% of patients requiring palliative care reside. To correct this imbalance, integration between palliative services and other disciplines has been recommended. While improved palliative care integration is a priority in the South African (SA) LMIC context, emergency medical services (EMS) and palliative care remain non-integrated. This has resulted in poor palliative situation management by EMS and a lack of research concerning their intersection. To examine EMS use for palliative situations in the Western Cape (WC) Province of SA by describing frequency of intersection, patient characteristics and outcomes. An observational, descriptive, retrospective patient record review was employed at two hospitals with palliative care services in the WC. All patient records of those who arrived at the hospitals between 1 January 2020 and 31 December 2020 via EMS conveyance leading to palliative care provision were included in the study. In total, 1 207 unique patients received palliative care services at both hospitals during the study period. Of these, 395 (33%) made use of EMS for hospital conveyance on 494 occasions. The median (range) patient age was 60 (20 - 93) years, and most transports involved male patients (54%, n=265). Family members were the primary caregivers in most instances (89%, n=440), dyspnoea was the chief complaint (36%, n=178) and cancer was the most frequent diagnosis (32%, n=159). The median length of hospital stay was 6 days, with most patients discharged home (60%, n=295). EMS in SA frequently encounter palliative situations for symptoms that may be managed within their scope of practice. Consequently, it appears that EMS have an important role to fulfil in the care of patients with palliative needs. Integrating EMS and palliative care may result in improved palliative care provision and, therefore, EMS and palliative care integration would be beneficial in SA.