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Swenne J, Nissen RD, Hansen TF, Jensen LH, Søndergaard J, Stie M. Lived experiences of life with newly diagnosed advanced cancer - a qualitative interview study. Int J Qual Stud Health Well-being 2025; 20:2453296. [PMID: 39866140 PMCID: PMC11774151 DOI: 10.1080/17482631.2025.2453296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Accepted: 01/10/2025] [Indexed: 01/28/2025] Open
Abstract
BACKGROUND Incurable cancer significantly affects an individual's life, requiering comprehensive palliative care (PC). With early PC now recommended but poorly integrated, it is essential to address patients' experiences and concerns to ensure successful early PC integration. AIM This study aims to investigate the experiences of life in the initial period following a diagnosis of incurable cancer to inform early PC integration. METHODOLOGY The study employed a phenomenological hermeneutical framework, drawing inspiration from interpretive descriptive methodology. Thirteen participants diagnosed with incurable cancer were purposively recruited. Data were generated through semi-structured, in-depth interviews exploring patients' experiences of lived life, their needs and wishes. Data analysis followed an iterative process of constant comparison and thematic development. RESULTS One main theme was identified throughout the analysis: Standing still in the storm. Three sub-themes were identified reflecting varying manifestations innhow doing so, and navigating their challenging circumstances. peace: 1) The urge to take action, 2) Clarity and awakening in the face of reality, and 3) Changed self-perception. As their understanding of their illness deepened, the patients experienced a shift towards reconciliation. CONCLUSION The experiences of patients living with incurable cancer reveal a complex interplay of psychological, emotional, and existential responses. It is essential that healthcare professionals address existential concerns within clinical care. By acknowledging and supporting patients' existential struggles, discussions about sensitive topics becomes more natural and better recieved by the patients. .
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Affiliation(s)
- Johanna Swenne
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Ricko Damberg Nissen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Torben Frøstrup Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lars Henrik Jensen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mette Stie
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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2
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Ostapenko LJ, Hill KA. Palliative Care Principles for the Preoperative Process. Int Anesthesiol Clin 2025; 63:77-85. [PMID: 40353353 DOI: 10.1097/aia.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2025]
Affiliation(s)
- Laura J Ostapenko
- Department of Anesthesiology and Perioperative Medicine, MaineHealth-Maine Medical Center, Portland, Maine
- Spectrum Healthcare Partners, South Portland, Maine
| | - Katherine A Hill
- Departments of Surgery and Medicine,West Virginia University, Morgantown, West Virginia
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Makam AN, O'Riordan DL, Heitner R, Bowman B, Spetz J, Pantilat SZ. Palliative Care Services in Long-Term Acute Care Hospitals: A National Survey Study. J Pain Symptom Manage 2025; 70:e34-e43. [PMID: 40139575 DOI: 10.1016/j.jpainsymman.2025.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 03/04/2025] [Accepted: 03/11/2025] [Indexed: 03/29/2025]
Abstract
CONTEXT Virtually every patient in a long-term acute care hospital (LTACH) has a serious illness and thus, potentially eligible for palliative care (PC). OBJECTIVES To evaluate the scope, structure, and staffing of PC programs in LTACHs METHODS: Descriptive cross-sectional survey of LTACH leaders affiliated with the National Association of Long Term Hospitals (NALTH) linked with publicly available hospital data to determine presence, structure, and staffing of PC service, and perceptions among leaders of LTACHs without PC services. RESULTS Among 42 respondent LTACHs (50.6%) , 24 (57%) reported having a PC program. LTACHs with versus without PC were more often part of a healthcare system (75% vs. 59%) but not an LTACH chain (38% vs. 53%). Most externally contracted PC services (75%), provided in-person consultation at least most weekdays (82%), were financed by professional billing (71%) and/or hospital support (64%), and were well regarded. The most common staffing discipline was physicians (55%); 10% met the interdisciplinary team definition. Half (55%) reported seeing fewer than 50% of patients perceived to benefit from PC; 36% reported interest in PC training for their staff. Among the 18 LTACHs without PC, most (78%) perceived that PC was beneficial, and recognized recruiting staff, financing, and LTACH/host hospital leadership as barriers. CONCLUSIONS Independently owned, nonprofit LTACHs embedded within healthcare systems more often reported having PC services, with variability in structure and opportunities for further expansion and training. Despite positive regard for PC, barriers of staffing and financing will need to be overcome to establish PC services in LTACHs.
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Affiliation(s)
- Anil N Makam
- Division of Hospital Medicine (A.N.M.), San Francisco General Hospital, Department of Medicine, University of California, San Francisco, California, USA; UCSF Philip R. Lee Institute for Health Policy Studies (A.N.M., J.S.), San Francisco, California, USA; UCSF Action Research Center for Health Equity (A.N.M.), San Francisco, California, USA.
| | - David L O'Riordan
- Division of Palliative Medicine (D.L.O.R., S.Z.P.), University of California, San Francisco, California, USA
| | - Rachael Heitner
- Center to Advance Palliative Care (R.H., B.B.), New York, New York, USA; Department of Geriatrics and Palliative Medicine (R.H., B.B.), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brynn Bowman
- Center to Advance Palliative Care (R.H., B.B.), New York, New York, USA; Department of Geriatrics and Palliative Medicine (R.H., B.B.), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joanne Spetz
- UCSF Philip R. Lee Institute for Health Policy Studies (A.N.M., J.S.), San Francisco, California, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine (D.L.O.R., S.Z.P.), University of California, San Francisco, California, USA
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Mayan I, Casarett D, Lyons K, Sabar R. A Digital Tool to Enhance Palliative Care Access and Uptake in Patients With Serious Illness. J Pain Symptom Manage 2025; 70:e81-e87. [PMID: 40216208 DOI: 10.1016/j.jpainsymman.2025.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2025] [Revised: 03/30/2025] [Accepted: 04/03/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND Palliative care improves quality of life in patients with serious illness, but access and uptake remain low. MEASURES To determine the impact of a digital, patient facing web application (Epilog) on the uptake of a palliative care benefit in a culturally, health literacy, and racially diverse group of patients with serious illness in South Africa. INTERVENTION We analyzed data from Discovery Health, a South African commercial health plan. Participants were at least 18 years old, had stage four solid tumor or hematologic malignancy, and lived at home. They were enrolled for a fourteen-week intervention that took place between April 2023 and July 2023. Participants used the digital tool (Epilog) that supports patients in managing their symptoms, preferences and choices. Outcome was uptake of the palliative care benefit which includes a consultation with a palliative trained physician and access to a nurse and social worker experienced in palliative care. Patients who did not enroll were offered the palliative care benefit in the usual manner, by phone with the health plan care manager. OUTCOMES About 69 participants out of 138 enrolled with Epilog made use of the palliative care benefit. About 123 out of 4000 control patients made use of the same benefit (50% vs. 3%; P < 0.001). CONCLUSIONS Results of this preliminary study highlight the need for additional investigation of the benefits of the Epilog tool in patients with serious illness.
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Affiliation(s)
- Inbal Mayan
- Center for Advanced Hindsight (I.M.), Duke University, Durham, North Carolina, USA; University of California (I.M.), Global Brain Health Institute, San Francisco, California, USA; Sabar Health (I.M., R.S.), Netanya, Israel.
| | - David Casarett
- Division of Geriatrics and Palliative Care (D.C., K.L.), Duke School of Medicine, Durham, North Carolina, USA
| | - Kiira Lyons
- Division of Geriatrics and Palliative Care (D.C., K.L.), Duke School of Medicine, Durham, North Carolina, USA
| | - Ron Sabar
- Sabar Health (I.M., R.S.), Netanya, Israel
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Chin MM, Nguyen AD, Jones A, Steyl A, Geddie PI, Cruz Z, Serafimovska D, Warner T, Nanda A, Avgeropoulos NG, Harris A, Salcedo D, Kollas C, Laughlin AI. Electronic Health Record-Enabled Identification and Targeted Multipronged Intervention to Reduce Readmission and Length of Stay Among Patients With Metastatic Cancer. JCO Oncol Pract 2025:OP2400708. [PMID: 40489726 DOI: 10.1200/op-24-00708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 02/17/2025] [Accepted: 04/22/2025] [Indexed: 06/11/2025] Open
Abstract
PURPOSE Patients with metastatic cancer experience increased rates of unplanned acute care, hospitalizations, and mortality. Risk-stratification techniques have been developed, but research studying the sustainable implementation of targeted interventions are lacking. We aimed to demonstrate an integrated program through the early identification of patients with high-risk cancer and multipronged intervention to reduce acute care utilization and mortality. METHODS We conducted a prospective quality improvement project within a health system, including the main tertiary, specialty, and community hospital settings. We used the electronic health record (EHR) to identify admitted patients with metastatic cancer. Targeted interventions included (1) coordination of care, (2) inpatient consultation, (3) patient education and symptom management, and (4) post-discharge follow-up. Six-hundred intervention and 103 baseline patients were included. Primary outcome variables were 30-day readmission, hospital length of stay (LOS), and 30-day mortality. We used quality control run charts to identify special cause variation and multivariable Cox regressions to identify associations between groups while adjusting for demographic factors. A P < .10 was considered significant. RESULTS There was special cause variation with a 9.4% decrease in 30-day readmission (41.2% at baseline to 31.8% postintervention). LOS decreased by 1.14 days (5.65 days at baseline to 4.51 days). Survival analyses confirmed a reduction in 30-day readmission (hazard ratio [HR], 0.69 [0.46-1.01]; P = .057) and a significant increase in the hazard rate of discharge in the intervention group compared with the baseline group (HR, 1.26 [1.01-1.56]; P = .034), translating to a 1-day decrease in LOS. There was no statistically significant change in 30-day mortality. CONCLUSION EHR-enabled risk stratification and identification of patients with high-risk metastatic cancer enabled delivery of targeted intervention in a real-world setting, resulting in decreased 30-day readmission and LOS.
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Affiliation(s)
- Michelle M Chin
- University of Central Florida College of Medicine, Orlando, FL
| | | | | | | | - Patricia I Geddie
- Orlando Health Cancer Institute, Orlando, FL
- Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Akash Nanda
- Orlando Health Cancer Institute, Orlando, FL
| | | | | | | | - Chad Kollas
- Orlando Health Cancer Institute, Orlando, FL
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Walsh AK, Cloyd JM. ASO Author Reflections: What is the Current Role for Palliative Care Within Surgical Oncology? Ann Surg Oncol 2025; 32:3948-3949. [PMID: 40111629 PMCID: PMC12049381 DOI: 10.1245/s10434-025-17191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Accepted: 02/26/2025] [Indexed: 03/22/2025]
Affiliation(s)
- Amanda K Walsh
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Allcroft P, De Pasquale CG, Lim D, Amgarth‐Duff I, Agar MR. Elements of effective palliative care interventions in advanced heart failure: A narrative review. ESC Heart Fail 2025; 12:1759-1775. [PMID: 40108827 PMCID: PMC12055421 DOI: 10.1002/ehf2.15243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Accepted: 01/23/2025] [Indexed: 03/22/2025] Open
Abstract
People with advanced heart failure experience significant biopsychosocial needs and have a poor prognosis. International guidelines have called for integrating palliative care in heart failure management. This review explores the elements of effective palliative care interventions in advanced heart failure. PubMed, Embase, CINAHL and Cochrane Reviews were searched following an a priori review protocol for clinical trials of advanced heart failure and palliative care. The risk of bias was assessed using Risk of Bias 2 (RoB2). A qualitative, emergent approach was used to synthesize context + mechanism = outcome. Twenty-one papers from 18 studies were the data source. The efficacy of palliative care in advanced heart failure was mixed. Five studies reported significant improvement in health outcomes compared with the usual care control group. Timing may be necessary in accounting for improvement in quality of life (occurring on or about 3 months) and functional and symptomatic improvements (occurring on or about 6 months or longer). Effective models of secondary palliative care in advanced heart failure include interdisciplinary teams comprising primary care, cardiology and palliative care, routine check-ins, personalized care plans that explore goals, evidence-based symptom management and counselling. Integrating palliative care with heart failure management could improve patient outcomes. Future research and policy development may wish to consider when, how and what palliative care modalities are to be incorporated into the care of patients with advanced heart failure.
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Affiliation(s)
- Peter Allcroft
- Southern Adelaide Palliative ServiceSouthern Adelaide Local Health NetworkBedford ParkSouth AustraliaAustralia
- IMPACCT: Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
- Flinders Medical CentreBedford ParkSouth AustraliaAustralia
| | | | - David Lim
- IMPACCT: Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Ingrid Amgarth‐Duff
- IMPACCT: Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Meera R. Agar
- IMPACCT: Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
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8
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Alqahtani AJ, Mitchell GK, Crossland L, Alyami HM. Enhancing end-of-life care for advanced heart failure patients in Saudi Arabian emergency departments (EDs): Perspectives of ED staff on challenges. Australas Emerg Care 2025; 28:150-156. [PMID: 39915145 DOI: 10.1016/j.auec.2025.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 01/22/2025] [Accepted: 01/28/2025] [Indexed: 05/16/2025]
Abstract
BACKGROUND Providing care for patients nearing the end of life who have advanced heart failure presents significant challenges, especially in emergency settings where the primary focus is on life-saving interventions. Exploring the perceptions of emergency department staff is essential for identifying barriers and improving care delivery in this critical context. METHODS A qualitative study was conducted in two hospitals in Saudi Arabia. Semi-structured interviews were completed with thirty emergency staff. A thematic analysis was used to identify the challenges in delivering care for patients nearing the end of life. RESULTS Seven themes were identified: current practices for advanced heart failure patients, communication barriers, inadequate training in end-of-life care, limitations in emergency department design, heavy workloads, the influence of cultural and religious factors, and the importance of psychological and emotional support for patients and families. The findings highlight the need for structured training, cultural sensitivity, and improved environments to address these challenges. CONCLUSIONS This study emphasizes the complexities of providing care for patients nearing the end of life in emergency settings. Addressing gaps in communication, training, and cultural competence is critical. Tailored strategies for Saudi Arabia's unique context are essential to enhance care for advanced heart failure patients.
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Affiliation(s)
- Ali Jaber Alqahtani
- Emergency Medical Care, Faculty of Medical and Health Sciences, Liwa College, PO Box 41009, Abu Dhabi, UAE
| | - Geoffrey Keith Mitchell
- General Practice and Palliative Care, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Lisa Crossland
- Research Support Services and Systems, Evidence Research and Clinical Trials, Planning Funding and Outcomes, Health New Zealand, Whangarei, New Zealand
| | - Hanan Mesfer Alyami
- Medical and Surgical Nursing, Department of Medical and Surgical Nursing, College of Nursing, Princess Nourah Bint Abdulrahman University, Riyadh 13412, Saudi Arabia.
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Oprea Y, Deutsch A, McLellan B, Markova A. Palliative oncodermatology: Management of malignancy-related cutaneous symptoms in the palliative care setting. J Am Acad Dermatol 2025; 92:1351-1359. [PMID: 39955005 PMCID: PMC12101948 DOI: 10.1016/j.jaad.2025.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 02/07/2025] [Accepted: 02/11/2025] [Indexed: 02/17/2025]
Abstract
Dermatologists play a critical role in interdisciplinary cancer care, and as the field of supportive oncodermatology has evolved, a new subdivision has emerged: palliative oncodermatology. In cancer patients awaiting definitive treatment, those unable to undergo surgery or other invasive interventions, and those in the terminal stages of their illness, there is a need for symptom-based, noncurative strategies that address symptoms of cutaneous malignancies as well as cutaneous complications of systemic malignancies. The integration of palliative care principles in the management of such cutaneous complications strives to alleviate suffering and enhance quality of life. Here, we review the complications associated with cutaneous malignancies and metastases, along with skin symptoms of systemic malignancies. We also explore treatment options that emphasize symptom relief and comfort, highlighting the role of dermatologists in managing these challenges and coordinating supportive care in palliative settings.
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Affiliation(s)
- Yasmine Oprea
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Alana Deutsch
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Beth McLellan
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Torres-Tenor JL, García-Leal A, Hui D, Bruera E, Martínez-Marín V, Castaño-Cantos A, Alonso-Babarro A. Unscheduled hospitalization as a potential trigger for specialist palliative care referral in patients with high grade glioma: a retrospective analysis in a tertiary hospital. J Neurooncol 2025; 173:361-368. [PMID: 40048038 DOI: 10.1007/s11060-025-04993-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Accepted: 02/26/2025] [Indexed: 05/27/2025]
Abstract
PURPOSE Guidelines recommend early palliative care for patients with cancer, including high grade glioma (HGG), but referrals to palliative care are often delayed. Our study aimed to describe characteristics and outcomes of patients with HGG with a first unscheduled hospitalization, and assess if it should trigger palliative care referral. METHODS Retrospective study of medical oncology outpatients with HGG at a tertiary hospital, analyzing first unscheduled hospitalizations. Primary variable: Overall Survival (OS) after admission. RESULTS 133 HGG consecutive patients were referred to the medical oncology outpatient clinic. By the study's end, 90% (N = 119) had died, with a median OS from diagnosis of 11 months (95% CI 10-14). Unscheduled hospitalizations occurred in 53% of patients (N = 71) and were associated to reduced median OS from diagnosis: 10.5 months vs. 14 months, HR (95% CI) = 1.9 (1.3-2.7), p = 0.0012. Mortality during hospitalization was 24% (N = 17). Median OS after admission was 2.5 months (95% CI 2-4). Poor ECOG performance status (p = 0.059), no prior cancer treatment (p = 0.0003), longer diagnosis-to-admission time (p = 0.0147), admission to acute palliative care unit (p = 0.0012), and discharge to Hospice (p < 0.0001) associated with lower survival. Of admitted patients, palliative care assessed 39% (N = 28) during hospitalization, 28% (N = 20) before, and 24% (N = 17) after. Median OS after admission was shorter for those referred before/during hospitalization: 2 months vs. 7 months, HR (95% CI) = 0.4 (0.2-0.7), p = 0.0012. CONCLUSION The first unscheduled hospitalization in HGG patients could signal poor prognosis, yet palliative care referrals often occur late, highlighting missed opportunities for earlier intervention and suggesting unscheduled hospitalization as a potential trigger for referral.
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Affiliation(s)
- Juan Luis Torres-Tenor
- Department of Palliative Care, La Paz Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain.
| | | | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, TX, USA
| | | | | | - Alberto Alonso-Babarro
- Department of Palliative Care, La Paz Hospital, Paseo de la Castellana 261, Madrid, 28046, Spain
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11
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Seecof OM, Jang C, Abdul Hay M. Impact of Palliative Care Referral on End-of-Life Outcomes for Patients With Hematologic Malignancy. Am J Hosp Palliat Care 2025; 42:550-559. [PMID: 39041816 DOI: 10.1177/10499091241266991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
ContextCompared to patients with solid malignancies, less is known about the role of palliative care in patients with hematologic malignancies, leading to underutilization of palliative care.ObjectivesEvaluate the timing and impact of palliative care referrals on end-of-life outcomes over a 5-year period with intent to improve the utilization of palliative care in patients with advanced hematologic malignancies.MethodsA retrospective cohort of patients from an urban, NCI-designated comprehensive cancer center, aged 18 years and older with a diagnosis of an advanced hematologic malignancy were separated into groups of early, late, very late, or no specialty palliative care. Logistic regression models were constructed to examine variables associated with timing of palliative care referral. Groups were compared using the Kruskal Wallis test and Dunn's test with a Bonferroni correction method.Results222 patients with advanced hematologic malignancies who died between July 1, 20218 and June 30, 2023 were included. 50 (23%), 41 (18%), and 51 (23%) patients received an early, late, and very late palliative care referral, respectively and 80 (36%) patients did not receive a palliative care referral. There was a significantly high completion of ACP documentation among the palliative care cohorts. There was no significant difference among all cohorts in end-of-life outcomes in the last 14 or 30 days of life.ConclusionACP documentation improved with palliative care, however, end-of-life outcomes did not. These results are likely due to the majority of late, inpatient palliative care referrals. Future studies with targeted interventions are needed to improve these outcomes.
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Affiliation(s)
- Olivia M Seecof
- NYU Grossman School of Medicine, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Charley Jang
- NYU Grossman School of Medicine, New York, NY, USA
| | - Maher Abdul Hay
- NYU Grossman School of Medicine, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
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12
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Olivier T, Prasad V. LUNAR: Full Moon or Eclipse? An exploration into tumor treating fields in lung cancer. Transl Oncol 2025; 56:102397. [PMID: 40245752 PMCID: PMC12020894 DOI: 10.1016/j.tranon.2025.102397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 11/10/2024] [Accepted: 04/09/2025] [Indexed: 04/19/2025] Open
Abstract
The LUNAR trial investigated the addition of Tumor Treating Fields (TTFs) to "standard therapy" in patients with metastatic lung cancer after at least one line of platinum-based chemotherapy. The "standard therapy" was either an anti-PD(L)1 therapy (immunotherapy) or docetaxel. The addition of TTFs provided a 3.3 months median survival gain. We raised concerns about LUNAR results internal and external validity. First, patient selection and the control arm do not mirror current practice. Two-thirds of patients did not receive prior immunotherapy, which is standard in first-line treatment. Also, the "choice" of the "standard therapy" was restricted by drug availability, resulting in 41 % of patients not receiving immunotherapy during the trial - those allocated to receive docetaxel - had no prior exposure to immunotherapy. Some patients may have harbored actionable mutations, and did not receive targeted therapy. Second, we raised statistical questions. The sample size was shrunk after an unplanned analysis, with unshared and unclear justifications. The decision may have been influenced by a chance deviation in data favoring the intervention. Also, as significantly more patients were censored after withdrawals in the TTFs group, informative censoring could have amplified the survival gain. Third and last, without a sham-control design (the equivalent of placebo for devices), it's hard to isolate the impact of TTFs from the extra-attention associated with its administration (continuous 24/7 support, frequent home-based interactions). Overall, LUNAR do not apply to clinical settings where immunotherapy and molecular testing is offered, and many factors may have artificially boosted the reported survival gain. A sham-controlled trial is needed to answer whether TTFs are beneficial.
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Affiliation(s)
- Timothée Olivier
- Oncology Service, Geneva University Hospital, 4 Gabrielle-Perret-Gentil Street, 1205, Geneva, Switzerland.
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St, 2nd Fl, San Francisco, CA, 94158, USA
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13
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Walsh AK, Guo MZ, Leuschner T, Ejaz A, Pawlik TM, Wells-Di Gregorio S, Waterman B, Cloyd JM. The Role of Specialty Palliative Care in Elective Surgical Oncology: A Systematic Review. Ann Surg Oncol 2025; 32:3879-3888. [PMID: 40000563 PMCID: PMC12049279 DOI: 10.1245/s10434-025-17076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Accepted: 02/09/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND Unlike advanced cancer populations, for whom early and routine specialty palliative care (PC) referral has demonstrated clear benefits for quality of life and symptom control, evidence supporting PC for patients undergoing curative-intent cancer surgery has been inconclusive. METHOD A systematic review of the PubMed, Embase, Cochrane Library, and MEDLINE databases was performed to identify all studies evaluating the role of PC for patients undergoing curative-intent surgery for cancer. RESULTS Among the 12,886 publications initially retrieved, 14 met all inclusion criteria: two cross-sectional studies comprised of physician surveys, four cohort studies, five qualitative studies, one prospective trial, and two randomized controlled trials (RCTs). In non-randomized studies, PC was associated with increased advanced care planning and symptom control; however, both the PERIOP-PC and SCOPE RCTs found no significant improvement in quality of life with routine perioperative PC among patients undergoing major abdominal cancer surgery. Qualitative studies characterized patient experiences and physician perspectives of PC. CONCLUSION This systematic review summarizes the existing literature on the role of PC in surgical oncology, highlighting the unique considerations and unmet needs of surgical patients that differ from those with advanced cancer. While the routine use of perioperative PC for patients undergoing cancer surgery is not supported, future research should focus on identifying high-risk patients who would most benefit from specialty PC and innovative methods of delivering supportive care in surgical oncology.
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Affiliation(s)
- Amanda K Walsh
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Marissa Z Guo
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thomas Leuschner
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, Division of Surgical Oncology, University of Illinois Health, Chicago, IL, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sharla Wells-Di Gregorio
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brittany Waterman
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan M Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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14
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Maheta BJ, Singh NK, Bergman J, Brown-Johnson CG, Gunturi A, Interrante N, Leppert JT, Lorenz KA, Raspi IG, Giannitrapani KF. Perioperative Integration of Palliative Care and Urology for Patients With Serious Urologic Illness: A Qualitative Need Finding Inquiry. J Pain Symptom Manage 2025; 69:603-610.e6. [PMID: 40057247 DOI: 10.1016/j.jpainsymman.2025.02.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 02/19/2025] [Accepted: 02/21/2025] [Indexed: 03/24/2025]
Abstract
CONTEXT Many urologic serious illnesses are treated with surgical procedures, which may put patients at a further risk of diminished quality of life. OBJECTIVE To understand stakeholder perceptions on integrating perioperative Palliative Care (PC) for patients with serious urologic illness. METHODS We conducted semi-structured interviews and team-based thematic analysis to consensus with a dual review. Purposefully sampled urologists, palliative care physicians, and clinical team members at fourteen geographically distributed Veteran Health Administration sites were interviewed. RESULTS We identified one general overall theme, to "change culture" so that PC is not a "last resort," and three opportunities along the perioperative continuum for integrating urology and PC. Opportunity 1: Utilizing telehealth and team member role expansion when discussing the initial diagnosis, with surgery as a potential treatment option, allows for multiple conversations "so they're not rushed in 15 minutes to mentally deal with the new diagnosis." Opportunity 2: Creating a process to ensure goal of care conversations occur, since "urologic procedures can have complications that significantly impact quality of life," which "would require changing how our workflow is structured." Opportunity 3: During the preoperative visits, interdisciplinary input and evaluation of the patient prior to surgery allows the patient to "have a sort of joint meeting with us and the urologist." This represented the last point in time to de-escalate and offer nonsurgical options prior to surgery. CONCLUSIONS The study informs future interventions to improve the quality of surgical care by integrating PC with urology in a unified workflow.
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Affiliation(s)
- Bhagvat J Maheta
- VA Center for Innovation to Implementation (B.J.M), California Northstate University College of Medicine, Elk Grove, California, USA
| | - Nainwant K Singh
- VA Center for Innovation to Implementation (N.K.S), Department of Health Policy, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan Bergman
- VA Los Angeles Healthcare System (J.B.), Olive View UCLA Medical Center, Los Angeles, California, USA
| | - Cati G Brown-Johnson
- VA Center for Innovation to Implementation (C.G.B.J., K.A.L., K.F.G.), Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Alekhya Gunturi
- VA Center for Innovation to Implementation (A.G.), Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nickolas Interrante
- Veterans Health Administration, VA Center for Innovation to Implementation (N.I.), Menlo Park, California, USA
| | - John T Leppert
- VA Center for Innovation to Implementation (J.T.L.), Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Karl A Lorenz
- VA Center for Innovation to Implementation (C.G.B.J., K.A.L., K.F.G.), Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Isabella G Raspi
- VA Center for Innovation to Implementation (I.G.R.), Cornell University, The College of Arts and Sciences, Ithaca, New York, USA
| | - Karleen F Giannitrapani
- VA Center for Innovation to Implementation (C.G.B.J., K.A.L., K.F.G.), Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA.
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15
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Dock EL, Bowers C, Davis C, Sinha S. Using a Modified Surprise Question in the Intensive Care Unit for Early Palliative Care. Crit Care Nurse 2025; 45:41-46. [PMID: 40449927 DOI: 10.4037/ccn2025141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2025]
Abstract
BACKGROUND Patients with critical illness often seek meaningful relationships with members of their care teams. The patient experience can be enhanced through a goals-of-care conversation, an aspect of palliative care that focuses on the patient-clinician relationship. Despite recommendations for early palliative care interventions, no standardized time for generalists to initiate palliative care interventions in the acute care setting has been established. LOCAL PROBLEM An academic hospital identified a need for earlier palliative care interventions for patients admitted to the medical intensive care unit. The aim of this quality improvement project was to improve early palliative care interventions in the intensive care unit by increasing numbers of documented surrogate decision-makers and goals-of-care conversations. Newman's theory of health as expanding consciousness was used as a guide to improve the patient-clinician relationship through communication, early establishment of goals of care, and development of patient-centered care. METHODS Recently admitted patients were screened during interprofessional team huddles with a modified surprise question ("Would you be surprised if this patient died during this hospitalization?") to identify those who might benefit from an early goals-of-care conversation. The preimplementation group included all admitted patients and the postimplementation group included only patients with a "no" on the surprise question. RESULTS Analysis included 174 patients (139 before implementation, 35 after implementation). In the preimplementation group, 99 patients (71%) had documented surrogate decision-makers and 26 (19%) had documented goals-of-care conversations. In the postimplementation group, 34 patients (97%) had documented surrogate decision-makers and 14 (40%) had documented goals-of-care conversations. CONCLUSION Patients screened with the modified surprise question upon admission to the intensive care unit received earlier palliative care interventions, enhancing patient-centered care.
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Affiliation(s)
- Emily L Dock
- Emily L. Dock is an adult acute care nurse practitioner and the clinical manager for advanced practice providers for the palliative care service at Indiana University Health, Indianapolis
| | - Cynthia Bowers
- Cynthia Bowers is the interim associate dean, chief nurse administrator, and program coordinator for the Doctor of Nursing Practice program, University of Indianapolis
| | - Carmen Davis
- Carmen Davis is a clinical nurse specialist for the medical intensive care and progressive care units at University Hospital, Indianapolis, Indiana
| | - Shilpee Sinha
- Shilpee Sinha is an attending physician for the palliative care service at Indiana University Health and an associate professor, Adult Academic Health Center, Indiana University
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16
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Ahtiluoto SE, Carpén TP, Forsius PT, Nuutinen MSJ, Nåhls NSA, Kitti PM, Hammar TH, Finne-Soveri HU, Saarto TH. Impact of specialist palliative care on utilization of healthcare and social services at the end-of-life: a nationwide register-based cohort study. Eur J Public Health 2025:ckaf044. [PMID: 40434100 DOI: 10.1093/eurpub/ckaf044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2025] Open
Abstract
Non-malignant diseases cause 60% of non-communicable diseases requiring palliative care, yet specialist palliative care services primarily focus on cancer. We investigated end-of-life healthcare and social services utilization among cancer and non-malignant patients, and, secondarily, access to specialist palliative care and its effect on services utilization. This retrospective, nationwide register-based study included all adults (n = 38 540) who died from non-communicable life-limiting diseases in Finland in 2019, categorized into neurodegenerative (31%), other non-malignant (36%), and cancer (33%) groups. Hospital was the most common place of death (61%). Healthcare utilization substantially increased during the final weeks of life in all groups but remained highest in cancer patients. Social services utilization was highest in neurodegenerative diseases. Specialist palliative care contact was significantly (P < .001) higher in cancer (30.1%) compared to neurodegenerative (10.9%) and other non-malignant (7%) diseases. Early (>30 days before death) compared to late/no specialist palliative care contact significantly reduced emergency care contacts (47.8% vs. 52.2%) and hospitalizations in secondary hospitals (24.7% vs. 33.7%), and increased specialist palliative care ward (15.5% vs. 1.5%) and hospital-at-home (36.8% vs. 3.4%) utilization during the final month (P < .001). Healthcare utilization was high in all disease groups, highest among cancer patients. Hospital was the most common place of death. Specialist palliative care contact was rare in non-malignant diseases. Early contact with specialist palliative care associated with lower emergency care utilization and secondary hospital inpatient care during the last month of life. These results highlight the necessity for timely equitable specialist palliative care services for all.
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Affiliation(s)
- Satu E Ahtiluoto
- Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Timo P Carpén
- Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pirita T Forsius
- The Department of Healthcare and Social Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Nelli-Sofia A Nåhls
- Department of Oncology, Vaasa Central Hospital, The Wellbeing Services County of Ostrobothnia, Vaasa, Finland
| | - Pauliina M Kitti
- Department of Oncology, Comprehensive Cancer Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Teija H Hammar
- The Department of Healthcare and Social Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Harriet U Finne-Soveri
- The Department of Healthcare and Social Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tiina H Saarto
- Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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17
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Nattinger C, Nouri S, O'Riordan DL, Rabow MW. Disparities Among Asian and Black Patients with Cancer in Receipt of Palliative Care in a Single Urban Academic Cancer Center. J Palliat Med 2025. [PMID: 40425025 DOI: 10.1089/jpm.2024.0470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2025] Open
Abstract
Background: Research examining racial-ethnic disparities in palliative care (PC) receipt has produced mixed results. Objectives: To examine racial disparities in PC receipt with a large-scale study in a well-established outpatient cancer PC program. Design: We performed a multivariable analysis to test the association of race-ethnicity with PC receipt, adjusting for age, sex, stage, cancer, and insurance type. Exploratory analyses included association of race-ethnicity with reason for referral, functional status, and time to death. Setting/Subjects: Using a cancer registry in an urban academic medical center in the United States, we performed a retrospective cohort study of cancer decedents from May 2007 to December 2021. Results: Of 18,797 eligible patients, 7.9% (n = 1484) received PC. In adjusted analyses, compared with White patients, Asian patients had higher odds of PC receipt (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.21-1.66), but there were no significant differences for Latino/a or Black patients. Asian patients received PC significantly closer to death compared with White patients (9.6 vs. 12.08 months, p = 0.02). Compared with White patients, Black patients were more likely to be referred to PC for pain (OR, 1.81; 95% CI, 1.07-3.06). Conclusion: Asian patients had higher odds, yet a shorter duration of PC receipt, suggesting delayed referrals. Black patients were more likely to be referred to PC for pain. Development of structural changes to PC referrals and tailored pain interventions may help ensure more equitable PC access and care.
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Affiliation(s)
- Caroline Nattinger
- School of Medicine, University of California Berkeley, University of California San Francisco Joint Medical Program, San Francisco, California, USA
| | - Sarah Nouri
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - David L O'Riordan
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Michael W Rabow
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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18
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Castelli G, Cocconcelli E, Grimaudo G, Di Leo I, Bellani S, Fiorentù G, Giulianelli G, Bernardinello N, Balestro E, Spagnolo P. Interstitial Lung Diseases and Lung Cancer: A Review on Similarities, Common Pathogenesis and Therapeutic Approach. J Pers Med 2025; 15:213. [PMID: 40423084 DOI: 10.3390/jpm15050213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2025] [Revised: 05/12/2025] [Accepted: 05/20/2025] [Indexed: 05/28/2025] Open
Abstract
Interstitial lung disease (ILD) prevalence and survival are increasing due to improvement in scientific research together with clinical complications typical of advanced disease. Lung cancer (LC) is described as a possible event occurring in lung parenchyma in the context of fibrotic abnormalities that worsen patients' prognosis. This growth of malignant cells on a fibrotic background has also been called scar-cinoma. For this reason, not only an early diagnosis but also personalized decisions on the best treatment approach should be considered for each patient in a multidisciplinary discussion, since in some cases chemotherapy or surgery could be detrimental for patients with pulmonary fibrosis. LC and lung fibrosis may share common pathogenetic mechanisms like an altered healing process in response to repeated tissue damage from environmental exposure in genetically susceptible individuals. Smoking history and air pollution together with mutations in telomere and surfactant protein genes lead to the production of cytokines and nitro derivatives in the microenvironment that facilitate the carcinomatous transformation during fibrogenesis. The evolution of LC therapy and the implementation of immunotherapy acting on targetable immune checkpoints have raised interest in evaluating ILD-LC actionable mutations. The main pathogenetic mechanisms, clinical presentations and treatment implications are presented in this review.
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Affiliation(s)
- Gioele Castelli
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padua, Italy
| | - Elisabetta Cocconcelli
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padua, Italy
| | - Giuliana Grimaudo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padua, Italy
| | - Irene Di Leo
- Division of Respiratory Medicine, Department PROMISE, "Paolo Giaccone" University Hospital, University of Palermo, 90133 Palermo, Italy
| | - Serena Bellani
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padua, Italy
| | - Giordano Fiorentù
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padua, Italy
| | - Giacomo Giulianelli
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padua, Italy
| | - Nicol Bernardinello
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padua, Italy
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padua, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padua, Italy
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19
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Parajuli J, Chen ZJ, Smith RM, Hernandez LM, Norris S, Rutledge S, Williams G, Bakitas M, Hsiang S. Development and initial validation of a palliative care readiness (PALCARE) tool for older adults with cancer: Study protocol. PLoS One 2025; 20:e0323366. [PMID: 40397967 DOI: 10.1371/journal.pone.0323366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2025] [Accepted: 04/04/2025] [Indexed: 05/23/2025] Open
Abstract
INTRODUCTION Early palliative care (PC) has been recommended for older adults with cancer to address their cancer and treatment related high symptom burden and unmet needs. However, it is underutilized; older adults with cancer are 60% less likely to use PC compared to their younger counterparts. One approach to reduce existing barriers and improve utilization is to assess their readiness for PC. However, there are no gold-standard tools to measure older adults with cancer PC readiness. METHODS Informed by the 8 domains of PC recommended by National Consensus Project guidelines, Readiness to Change Framework, and principles of community engaged research, we will use a mixed methods approach, to develop and validate a Palliative Care Readiness (PALCARE) Tool through the following steps: 1) Identify items using semi-structured interviews with 20 diverse (race/ethnicity, rural/urban residence, cancer types) older adults with cancer; 2) Develop draft tool via expert panel surveys followed by focus group with PC experts, and 3) Determine item clarity and wording via cognitive interviews with 20 dyads of older adults with cancer and their family caregivers. DISCUSSION/CONCLUSION The PALCARE tool will be one of the first measures of PC readiness among a diverse sample of older adults with cancer. Once validated, PALCARE can enhance clinical practice by identifying those who are/are not ready for PC, providing targeted PC that is congruent with their readiness, and educating and supporting those who report being not yet ready for PC. The ultimate goal of this study is to improve PC early access and older adults' quality of life.
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Affiliation(s)
- Jyotsana Parajuli
- University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Zhuo Job Chen
- University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Regine M Smith
- University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Liliana M Hernandez
- University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Savannah Norris
- University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Sarah Rutledge
- Atrium Health, Charlotte, North Carolina, United States of America
| | - Grant Williams
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Marie Bakitas
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Simon Hsiang
- Atrium Health, Charlotte, North Carolina, United States of America
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20
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Hu X, Kwon Y, Jiang C, Fan Q, Shi KS, Zheng ZJ, Zhao J, Warren JL, Yabroff KR, Han X. Trend and Provider- and Organizational-Level Factors Associated With Early Palliative Care Billing Among Patients Diagnosed With Distant-Stage Cancers in 2010-2019 in the United States. J Clin Oncol 2025; 43:1789-1799. [PMID: 40053887 DOI: 10.1200/jco-24-01935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 01/19/2025] [Accepted: 01/28/2025] [Indexed: 03/09/2025] Open
Abstract
PURPOSE Early integration of specialized palliative care (PC) is recommended by clinical guidelines for advanced-stage cancers, but real-world evidence of its use is limited. We examined the recent trend of early PC billing among Medicare beneficiaries with distant-stage cancers and associated provider- and organization-level factors. METHODS Using SEER-Medicare data, we identified Medicare Fee-For-Service beneficiaries 65.5 years and older diagnosed with distant-stage female breast, colorectal, non-small cell lung, small cell lung, pancreatic, or prostate cancers in 2010-2019 with a survival of ≥6 months. Early PC billing was identified by diagnosis codes or hospice and palliative medicine (HPM) specialty codes on outpatient claims within first 3 months of cancer diagnosis or up to hospice admission date, whichever came first. Annual percentages of patients receiving early PC were assessed. We attributed treating physicians and organizations to patients and identified provider- and organization-level factors associated with early PC billing and the between-provider and between-organization variation in early PC billing using multivariable regressions. RESULTS Among 102,032 patients treated by 18,908 unique physicians, the percentage with early PC billing increased from 1.44% to 10.36% in 2010-2019 (P < .001). Treating physician's early PC referrals in the previous year and organizations' employment of any HPM specialist were associated with 3.01 percentage points (ppts, 95% CI, 2.50 to 3.52) and 4.54 ppts (95% CI, 3.65 to 5.42) higher likelihood of early PC billing. Between-provider variation in early PC was considerable but declined from 51.0% in 2010-2013 to 45.3% in 2017-2019. Similar patterns were found for between-organization variation. CONCLUSION Despite growth in early PC billing among patients with distant-stage cancers in 2010-2019, its level remained low. Provider and organizational characteristics such as referral patterns and availability of HPM specialists within the organization may be important drivers for early PC utilization.
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Affiliation(s)
- Xin Hu
- Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
- American Cancer Society, Atlanta, GA
| | - Youngmin Kwon
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Changchuan Jiang
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | | | | | | | | | | | | | - Xuesong Han
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
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21
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DiMartino L, Merrill V, Skinner CS, Hogan TP, Sadeghi N, Roche-Green A, Wang W, Hong AS. Early Integration of Outpatient Palliative Care Among Adults With Advanced Cancer in a Safety-Net Health System: A Patterns of Care Analysis. JCO Oncol Pract 2025:OP2400892. [PMID: 40378348 DOI: 10.1200/op-24-00892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 03/13/2025] [Accepted: 04/15/2025] [Indexed: 05/18/2025] Open
Abstract
PURPOSE Little is known about guideline-concordant, early integration of palliative care (PC) in the outpatient setting among patients with advanced cancer within a safety-net system. This study examined PC delivery patterns for patients seen in a large, urban safety-net system. METHODS Patients diagnosed with advanced-stage solid tumor and who had ≥1 outpatient oncology visit from January 2018 to July 2023 at Parkland Health were identified via electronic health record. Outcomes assessed included (1) receipt of PC referral ≤8 weeks after diagnosis, (2) receipt of any PC referral, and (3) PC visit completion. Multivariable logit models evaluated associations between key characteristics (age, race/ethnicity, gender, cancer type, preferred language, insurance, diagnosis year) and the outcomes. RESULTS Among 1,296 patients (44% female; 76% non-White), 55% received a referral. Of those referred, 46% patients were referred early (≤8 weeks). Two thirds of the referred patients completed a PC visit during the study period. In adjusted regression models, patients who were Black (v White; adjusted odds ratio [aOR], 0.52 [95% CI, 0.33 to 0.82]), Hispanic (aOR, 0.33 [95% CI, 0.18 to 0.59]), or had prostate cancer (v breast cancer; aOR, 0.27 [95% CI, 0.10 to 0.69]) had lower odds of receiving early referral. Ages 40-69 (v >80 years; lowest odds for 60 to <70, aOR, 0.41 [95% CI, 0.20 to 0.85]) and patients with gynecologic cancer (aOR, 0.14 [95% CI, 0.07 to 0.28]) had lower odds of receiving any PC referral. Females had higher odds of completing a PC visit (v males; aOR, 1.45 [95% CI, 1.01 to 2.08]). CONCLUSION Many patients did not receive an outpatient referral or received it late. Observed differences by race/ethnicity, cancer type, and age suggest the need for different interventions targeting PC delivery for underserved patients with cancer.
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Affiliation(s)
- Lisa DiMartino
- Peter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Vincent Merrill
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Celette Sugg Skinner
- Peter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Timothy P Hogan
- Peter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
| | - Navid Sadeghi
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Parkland Health, Dallas, TX
| | - Alva Roche-Green
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Parkland Health, Dallas, TX
| | - Winnie Wang
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Parkland Health, Dallas, TX
| | - Arthur S Hong
- Peter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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22
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Bohula EA, Landzberg MJ, Menon V, Alviar CL, Barsness GW, Crousillat DR, Jain N, Page R, Wells R, Damluji AA. Palliative and End-of-Life Care During Critical Cardiovascular Illness: A Scientific Statement From the American Heart Association. Circulation 2025. [PMID: 40371484 DOI: 10.1161/cir.0000000000001334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2025]
Abstract
Cardiac intensive care units are witnessing a demographic shift, characterized by patients with increasingly complex or end-stage cardiovascular disease with a greater burden of concomitant comorbid noncardiovascular disease. Despite technical advances in care that may be offered, many critically ill cardiovascular patients will nevertheless experience significant morbidity and mortality during the acute decompensation, including physical and psychological suffering. Palliative care, with its specialized focus on alleviating suffering, aligns treatments with patient and caregiver values and improves overall care planning. Integrating palliative care into cardiovascular disease management extends the therapeutic approach beyond life-sustaining measures to encompass life-enhancing goals, addressing the physical, emotional, psychosocial, and spiritual needs of critically ill patients. This American Heart Association scientific statement aims to explore the definitions and conceptual framework of palliative care and to suggest strategies to integrate palliative care principles into the management of patients with critical cardiovascular illness.
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23
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Garg SK, Kohli K, Garg IK, Garg YK, Nguyen LG, Nguyen IS, Feliciano EJG, Baez YA, Mahal BA, Iyengar P, Gomez DR, Lapen K, Dee EC. Disparities in receipt of palliative-intent treatment among disaggregated Hispanic populations with breast, lung, and prostate cancer in the United States. Cancer 2025; 131:e35903. [PMID: 40387172 DOI: 10.1002/cncr.35903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Revised: 03/16/2025] [Accepted: 04/15/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND Despite palliative-intent interventions' ability to improve the quality of life of patients, significant inequalities persist in uptake. Such disparities are characterized by racial, socioeconomic, and geographic factors. However, less is known among disaggregated Hispanic populations. This study examines disparities in the receipt of palliative-intent interventions among Hispanic subgroups with advanced lung, breast, and prostate cancer. METHODS Via the National Cancer Data Base, data were collected on the receipt of palliative-intent interventions among Hispanic subgroups diagnosed with American Joint Committee on Cancer analytic stage IV breast, lung, and prostate cancer between 2004 and 2021. Multivariate logistic regressions were conducted to quantify differences in the uptake of palliative-intent care among Hispanic subgroups. RESULTS Among 945,894 total patients, disaggregated analyses revealed reduced receipt of palliative-intent interventions for patients with lung, breast, and prostate cancer of Mexican descent (lung, p < .001; breast, p < .001; prostate, p = .03) compared to non-Hispanic White patients. Receipt for patients of South or Central American descent was reduced in comparison to non-Hispanic White patients for lung and breast cancer (lung, p < .001; breast, p < .001). Uptake of palliative interventions for metastatic lung and breast cancer was reduced for patients of Cuban descent (lung, p < .001; breast, p = .03), and was lower for patients of Dominican descent with breast cancer, compared to non-Hispanic White patients (p = .05). CONCLUSIONS These findings demonstrate disparities in the receipt of palliative-intent interventions among disaggregated Hispanic subgroups. This study highlights the need for disaggregated research to further characterize these disparities and their drivers. Community-level and patient-centric efforts may help to address these inequities.
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Affiliation(s)
| | - Khushi Kohli
- Harvard University, Cambridge, Massachusetts, USA
| | - Isha K Garg
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yash K Garg
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lilac G Nguyen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Isabella S Nguyen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erin Jay G Feliciano
- Department of Medicine, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mount Sinai, Queens, New York, USA
| | - Yefri A Baez
- Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Puneeth Iyengar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Bonnet J, Cernik C, Uno H, Xu L, Laurent CA, Fisher L, Cannizzaro N, Munneke J, Cooper RM, Lakin JR, Schwartz CM, Casperson M, Altschuler A, Kushi LH, Chao CR, Wiener L, Mack JW. Timing and Outcomes of Palliative Care Integration Into Care of Adolescents and Young Adults With Advanced Cancer. JCO Oncol Pract 2025:OP2400907. [PMID: 40359456 DOI: 10.1200/op-24-00907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 02/10/2025] [Accepted: 04/11/2025] [Indexed: 05/15/2025] Open
Abstract
PURPOSE Adolescent and young adult (AYA) patients with cancer frequently receive intensive measures at the end of life; many also express care goals that align with a palliative approach. We sought to understand the extent to which AYAs are referred to palliative care before death, the timing of referrals, and associations between referral timing and end-of-life care outcomes. METHODS Review of electronic health data and medical records for 1,918 AYAs age 12-39 years who died after receiving care at one of the three sites between 2003 and 2019. Patients who received palliative care but lacked documentation of referral timing were excluded. RESULTS Most included AYAs were White (61%); 12% were Asian, 8% Black, and 27% Hispanic. Nearly three quarters (73%) were referred to palliative care before death. Thirty-six percent of palliative care referrals took place before the last 90 days of life; 30% were in the last month of life. Palliative care referrals and their timing were associated with care received at the end of life, with earlier referrals associated with fewer intensive measures near death, including chemotherapy in the last 14 days of life (P = .001) as well as intensive care unit admissions, emergency room visits, and hospitalizations in the last month of life (P < .001 for all). Patients who were referred to palliative care were more likely to have symptoms assessed in the last 90 days of life, including pain, dyspnea, nausea, diarrhea, constipation, depression, and anxiety (P < .001 for all). CONCLUSION Although many AYAs receive intensive measures at the end of life, most are also referred to palliative care. Earlier referrals have potential to reduce care intensity and enhance attention to symptoms and quality of life near death.
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Affiliation(s)
| | - Colin Cernik
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Hajime Uno
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | | | - Cecile A Laurent
- Division of Research, Kaiser Permanente Northern California, Pleasanton, CA
| | - Lauren Fisher
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Nancy Cannizzaro
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Julie Munneke
- Division of Research, Kaiser Permanente Northern California, Pleasanton, CA
| | - Robert M Cooper
- Department of Pediatric Oncology, Kaiser Permanente Southern California, Pasadena, CA
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Corey M Schwartz
- Division of Medical Oncology, Kaiser Permanente Northern California, Pleasanton, CA
| | | | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Pleasanton, CA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Pleasanton, CA
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Lori Wiener
- Psychosocial Support and Research Program, National Cancer Institute, Bethesda, MD
| | - Jennifer W Mack
- Division of Population Sciences, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
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25
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Venditti A, Palmieri R, Maurillo L, Röllig C, Wierzbowska A, de Leeuw D, Efficace F, Curti A, Ngai LL, Tettero J, Adès L, Almeida A, Bullinger L, Dennis M, Esteve J, Ferrara F, Heuser M, Huls G, Lübbert M, Mehta P, Montesinos P, Pabst T, Récher C, Rossi G, Russell N, Sierra J, Stauder R, Vey N, Walter RB, Wang E, Nier S, Martins CG, Ossenkoppele G. Fitness assessment in acute myeloid leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet. Blood Adv 2025; 9:2207-2220. [PMID: 39913928 PMCID: PMC12083920 DOI: 10.1182/bloodadvances.2024013744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 01/26/2025] [Indexed: 04/30/2025] Open
Abstract
ABSTRACT Fitness assessment in patients with acute myeloid leukemia (AML) is critical to deliver the right therapy to the right patient. Although several scoring systems are available to aid in determining fitness, the absence of validation studies has resulted in the lack of universally accepted assessment procedures. This limitation, combined with the increasing availability of novel agents expanding the spectrum of less-intensive options, has introduced additional complexity to the fitness assessment process. In this evolving context, fitness should reflect eligibility for a specific treatment among the several available, rather than a generic binary classification of eligibility for intensive chemotherapy. Moreover, the growing emphasis on patient-centered care, further highlights the importance of integrating quality of life, patient preferences, patient self-reported physical and social functioning status, social support, and early integration of palliative care into the assessment framework. A modern interpretation of fitness assessment should incorporate a comprehensive evaluation that extends beyond traditional clinical and biological disease characteristics. Thus, fitness assessment in patients with AML represents only 1 piece of a larger puzzle, encompassing the patient's overall capacity to sustain and benefit from a specific therapeutic program.
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Affiliation(s)
- Adriano Venditti
- Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Rome, Italy
- Department of Onco-Hematology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Raffaele Palmieri
- Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Rome, Italy
| | - Luca Maurillo
- Department of Onco-Hematology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Christoph Röllig
- Medizinische Klinik und Poliklinik 1, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Agnieszka Wierzbowska
- Department of Hematology, Medical University of Lodz, Lodz, Poland
- Department of Hematology and Transplantology, Provincial Multispecialized Oncology and Trauma Center, Lodz, Poland
| | - David de Leeuw
- Department of Hematology, Amsterdam University Medical Center, Location Vrije University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto, Rome, Italy
| | - Antonio Curti
- Dipartimento delle “Malattie oncologiche ed ematologiche,” Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
| | - Lok Lam Ngai
- Department of Hematology, Amsterdam University Medical Center, Location Vrije University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jesse Tettero
- Department of Hematology, Amsterdam University Medical Center, Location Vrije University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Lionel Adès
- Service Hématologie Séniors, Hôpital Saint-Louis (Assistance Publique–Hôpitaux de Paris), Paris Cité University and INSERM U944, Paris, France
| | - Antonio Almeida
- Department of Hematology, Hospital da Luz, Lisbon, Portugal and Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Lars Bullinger
- Department of Hematology, Oncology and Cancer Immunology, Campus Virchow, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu, Berlin, Germany
| | - Mike Dennis
- Hematology, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Jordi Esteve
- Servicio de Hematología, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Gerwin Huls
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michael Lübbert
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Priyanka Mehta
- Hematology, University Hospitals of Bristol and Weston National Health Service Trust, Bristol, United Kingdom
| | - Pau Montesinos
- Hematology Department, Hospital Universitario i Politècnico la Fe, Valencia, Spain
| | - Thomas Pabst
- Department of Medical Oncology, Bern University Hospital, University of Bern, Inselspital, Bern, Switzerland
| | - Christian Récher
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Giuseppe Rossi
- Divisione di Ematologia, Ematologia, Azienda Socio Sanitaria Territoriale degli Spedali Civili, Brescia, Italy
| | - Nigel Russell
- Hematology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Reinhard Stauder
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology Tirol, The Tyrolean Private University, Hall in Tirol, Austria
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Norbert Vey
- Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Roland B. Walter
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Eunice Wang
- Leukemia Service, Roswell Park Comprehensive Cancer Center, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | | | | | - Gert Ossenkoppele
- Department of Hematology, Amsterdam University Medical Center, Location Vrije University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Kim MJ, Tang M, Taylor T, Chen M, Hui D, Reddy A, Narayanan S, Bruera E. Factors Associated With Cancer Patients' Preferences for Telemedicine or In-Person Palliative Care. J Pain Symptom Manage 2025:S0885-3924(25)00633-5. [PMID: 40355032 DOI: 10.1016/j.jpainsymman.2025.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Revised: 04/30/2025] [Accepted: 05/05/2025] [Indexed: 05/14/2025]
Abstract
BACKGROUND Prior studies demonstrate sociodemographic factors as barriers to telemedicine. Greater understanding of telemedicine preferences in cancer patients receiving palliative care and factors associated with their preferences could inform future care delivery in this vulnerable population. This study aimed to identify cancer patients' preferences for in-person vs. telemedicine palliative care visits in real-world clinical practice and associated patient-centric factors. MEASURES This was a retrospective study involving chart review of in-person or telemedicine palliative care visits between September 2021 and October 2021, during which patients' preferences for telemedicine or in-person visits and perceived difficulty coming in-person were routinely asked. Their answers were collected from the electronic chart. Associations between visit preference and sociodemographic and clinical factors were identified. OUTCOMES Of 400 patients, mean age was 59 years. 217 (54%) were female. 285 (71%) were White. Most had advanced cancer (344; 86%). 83% (n = 333) preferred telemedicine. 72% (n = 288) cited difficulty coming in-person. On univariate analysis, female gender (P = 0.03), college completion (P < 0.01), and perceived difficulty coming in-person (P < 0.01) were associated with preferring telemedicine. Positive Cut-Down, Annoyed, Guilty, Eye-Opener-Adapted to Include Drugs (CAGE-AID) score (P = 0.02) was associated with in-person preference. On multivariate analyses, perceived difficulty coming in-person was associated with telemedicine preference (OR: 16.81; 95% CI: 7.91-35.28; P < 0.01). A positive CAGE-AID score was associated with in-person preference (OR: 0.17; 95% CI: 0.05-0.59; P = 0.01). CONCLUSIONS Most patients having outpatient palliative care visits preferred telemedicine. Perceived difficulty coming in-person was associated with telemedicine preference. Patients with positive CAGE-AID scores were less likely to prefer telemedicine.
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Affiliation(s)
- Min Ji Kim
- Department of Palliative (M.J.K., M.T., D.H., A.R., S.N., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Michael Tang
- Department of Palliative (M.J.K., M.T., D.H., A.R., S.N., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Terry Taylor
- Department of Hospital Medicine (T.T.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Minxing Chen
- Department of Biostatistics (M.C.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Department of Palliative (M.J.K., M.T., D.H., A.R., S.N., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Akhila Reddy
- Department of Palliative (M.J.K., M.T., D.H., A.R., S.N., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Santhosshi Narayanan
- Department of Palliative (M.J.K., M.T., D.H., A.R., S.N., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative (M.J.K., M.T., D.H., A.R., S.N., E.B.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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27
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Vicenzini M, Di Lorenzo S, Venturini M. Early and simultaneous palliative care in cancer patients: an overview. Support Care Cancer 2025; 33:462. [PMID: 40346284 DOI: 10.1007/s00520-025-09501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 04/28/2025] [Indexed: 05/11/2025]
Abstract
PURPOSE The timing of access to palliative care is still a debated topic. We aim to investigate recent evidence on early and simultaneous palliative care to better understand what the most appropriate timing for integration and its impact on the quality of life of cancer patients and their carers might be. METHODS This is an overview of systematic reviews published between November 2020 and February 2024. Three search strings were launched on the PubMed, CINAHL, Cochrane Library and Scopus databases. Results were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. RESULTS A total of 17/1052 articles were selected. The following categories emerged and were described: need to define a timing for integration; definition of specific criteria for referral; access to palliative care; benefits of early and simultaneous palliative care; needs of patients and carers and their preferences. No specific timing for referral to palliative care emerged: one article suggested within 8 weeks of diagnosis, while another identified multiple time points. The term "supportive care" appears to facilitate early referral to palliative care services. CONCLUSION There is ample evidence that early and simultaneous access to palliative care ensures a better care pathway. Although it is not possible to standardise referral times, communication between professionals, patients and carers, shared and advance care planning are key elements in the identification of palliative care needs and their early integration. Much research is still needed to ensure equitable and appropriate access to palliative care.
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Affiliation(s)
- Mara Vicenzini
- Orthopaedics Department, Casa Di Cura San Giorgio, Pordenone, Italy
| | - Sara Di Lorenzo
- Home Care Nursing Department, Casa della Comunità Hub San Daniele, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy.
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28
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Ranganathan S, Hammond A, Jain U, Kohli K, Swami N, Patel TA, Feliciano EJG, Nguyen PL, Ng K, Dee EC, Jain B. Palliative treatment disparities in metastatic colon cancer: US retrospective cohort study with disaggregated ethnic groups. BMJ Support Palliat Care 2025:spcare-2025-005478. [PMID: 40345848 DOI: 10.1136/spcare-2025-005478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2025] [Accepted: 04/22/2025] [Indexed: 05/11/2025]
Abstract
BACKGROUND Palliative care is important in addressing the needs of patients and their caregivers holistically, particularly where patients are diagnosed with an advanced cancer such as metastatic colon cancer. Racial or ethnic disparities in the receipt of palliative treatment have not been well studied. METHODS Data from the National Cancer Database were used to identify patients with metastatic colon cancer. Patients were categorised into one of the following racial or ethnic groups: White, Black, Southeast Asian, East Asian, South Asian, Native Hawaiian or Other Pacific Islander (NHPI), other Asian and American Indian, Aleutian or Eskimo. The dependent variable was the receipt of palliative treatment, while the independent variable was the patients' racial or ethnic group. Multivariable logistic regressions were performed to derive the adjusted ORs (AOR) and p values. RESULTS Relative to White patients, patients who identified as Black, Southeast Asian or other Asian were less likely to receive palliative treatment (Black AOR=0.944, 95% CI 0.905 to 0.985, p=0.008; Southeast Asians AOR=0.678, 95% CI 0.553 to 0.830, p<0.001; other Asian AOR=0.781, 95% CI 0.637 to 0.957, p=0.017). However, NHPI patients had greater odds of receiving palliative treatment (NHPI AOR=1.696, 95% CI 1.267 to 2.271, p<0.001). CONCLUSIONS Black, Southeast Asian or other Asian patients had decreased odds of receiving palliative treatment, while NHPI patients had greater odds of receiving palliative treatment, compared with White patients. Further studies are needed to disaggregate reasons behind these disparities in the receipt of palliative treatment.
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Affiliation(s)
| | | | - Urvish Jain
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Khushi Kohli
- Harvard University, Cambridge, Massachusetts, USA
| | - Nishwant Swami
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tej A Patel
- Department of Healthcare Management & Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erin Jay G Feliciano
- Department of Medicine, NYC Health + Hospitals/Elmhurst, Elmhurst, New York, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kenrick Ng
- Department of Medical Oncology, St Bartholomew's Hospital, London, England, UK
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Bhav Jain
- Stanford University School of Medicine, Stanford University, Stanford, CA, USA
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29
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Bradley N, McConnell T, Blair C, O'Halloran P, Prue G, Lynn F, Roberts N, Wong G, Banks E, Reid J. Integrated palliative care and oncology: a realist synthesis. BMC Med 2025; 23:272. [PMID: 40346564 PMCID: PMC12065255 DOI: 10.1186/s12916-025-04083-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 04/16/2025] [Indexed: 05/11/2025] Open
Abstract
BACKGROUND Existing evidence demonstrates the benefits of integrated palliative care for people with cancer, for improved symptom burden, quality of life for patient and caregiver, and appropriate healthcare resource use. The integration of palliative care and oncology has the potential to reduce suffering and is recommended by international guidelines. However, it is not yet consistent practice. There are many approaches to integration, but it is unclear what works, for whom, and in what contexts, to achieve the best possible outcomes for patients, families, and healthcare systems. METHODS Realist review, conducted in accordance with RAMESES quality standards. Evidence was identified through systematic academic databases searches and stakeholder engagement. Data were extracted from included articles and synthesized using realist analysis to develop explanations of how and why integrated palliative care in oncology works, for whom, and in what contexts. RESULTS One hundred sixty-four papers were included in the review, from 33 countries, and involving a range of inpatient, outpatient, and home-based care settings. Integrated palliative care and oncology could improve patient outcomes, increase the goal-concordance of patient care, and support workforce wellbeing. Interventions towards integration should be tailored to the context in which they are delivered. Ensuring the timely delivery of palliative care for people with cancer requires integration that overcomes siloes between oncology, specialist palliative care, and primary and community care. The motivation to prioritise the integration of palliative care relies upon all stakeholders first understanding its value. Enriched interdisciplinary collaboration involves developing staff skills and confidence, facilitating coordination between care settings, and supporting communication within and between teams. Leadership is needed at all levels to attend to the structural and social norms of care. CONCLUSIONS The success of integration is influenced by the ways in which palliative care is understood, prioritised, operationalised, and measured within oncology. Through the synthesis of international evidence, this project draws on implementation science to contribute clarity on how integrated palliative care and cancer care can be achieved in practice.
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Affiliation(s)
- Natasha Bradley
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Tracey McConnell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Carolyn Blair
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Gillian Prue
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elspeth Banks
- Living With and Beyond Cancer, National Cancer Research Institute, London, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
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30
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Koprowski C, Subedi K, Jurkovitz CT, Sites K, Scott M, Petrelli N. Enhanced supportive care and communication in the initial treatment of curable cancer: Evaluation of the SCOOP (Supportive Care of Oncology Patients) pathway, a retrospective cohort study. Support Care Cancer 2025; 33:457. [PMID: 40335747 DOI: 10.1007/s00520-025-09477-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 04/17/2025] [Indexed: 05/09/2025]
Abstract
PURPOSE This study was designed to determine whether a series of interventions selected for our institution after systematic analysis of the cancer treatment process could decrease emergency room visits and hospital admissions in cancer patients treated with curative intent. A clinical pathway was devised with five key interventions designed to enhance supportive care, increase communication among providers, and quantify nurse navigator accountability. METHODS Patients with solid tumors treated with concurrent chemotherapy and radiation with curative intent were eligible for the study. They were identified in the multidisciplinary clinics of the Helen F. Graham Cancer Center of the Christian Care Health System (HFGCCRI). A total of 318 consecutive pathway patients were analyzed and compared to 455 historical controls. Pathway patients were selected from the beginning of the program in 2016 until 2019 and followed from the onset of radiotherapy until 1 month after the completion of radiotherapy. Emergency room (ED) visits and inpatient admissions were the primary outcomes of the study. The independent variables-including age, performance status, sex, race, insurance status, and diagnosis-were analyzed using regression-based adjustment for covariates. RESULTS The expected number of ED visits during the study period was 46% lower for SCOOP patients than for controls. Likewise, the expected number of hospitalizations was 50% lower for SCOOP patients. Both were statistically significant. Reanalysis after propensity score matching yielded similar results. CONCLUSION Pathway interventions specifically selected for our institution appeared to curtail ED visits and admissions in patients treated with exacting treatment regimens.
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Affiliation(s)
| | - Keshab Subedi
- Institute for Research on Equity and Community Health (iREACH)- Christiana Care Avenue North Campus, Suite NE2- 4000 Nexus Drive, Wilmington, DE, 19803, USA
| | - Claudine T Jurkovitz
- Institute for Research on Equity and Community Health (iREACH)- Christiana Care Avenue North Campus, Suite NE2- 4000 Nexus Drive, Wilmington, DE, 19803, USA
| | - Karen Sites
- Helen F Graham Cancer Center and Research Institute, Christiana Care Health System, 4701 Ogletown Stanton Rd, 115 Wynleigh Dr, Greenville, Newark, DE, 19713, USA
| | - Michael Scott
- Supportive and Palliative Care Department, Christiana Care Health System, 4755 Ogletown Stanton Rd, Newark, DE, 19718, USA
- Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Nicholas Petrelli
- Helen F Graham Cancer Center and Research Institute, Christiana Care Health System, 4701 Ogletown Stanton Rd, 115 Wynleigh Dr, Greenville, Newark, DE, 19713, USA
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31
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Barak R, Safadi E, Nikolaevski-Berlin A, Soback N, Wolf I, Waissengrin B. Systemic anticancer therapy at the end of life: real-world insights from a tertiary oncology center in Israel. Oncologist 2025; 30:oyaf066. [PMID: 40377438 DOI: 10.1093/oncolo/oyaf066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 02/02/2025] [Indexed: 05/18/2025] Open
Abstract
BACKGROUND Aggressive end-of-life (EOL) care, such as systemic anticancer therapy (SACT) for advanced cancer patients, represents a potential indicator of low-quality care that may deviate from the primary palliative objective of treatment. METHODS A retrospective study analyzed consecutive patients with advanced cancers treated at a tertiary oncology center in Israel from January 2019 to December 2022. Demographic and clinical data were examined, with a focus on intravenous (IV) oncologic treatment administration rates at 30 and 90 days before death. RESULTS The study included 1851 patients who received IV oncologic medications and died during 2019-2022. The median age at death was 69 years, with 51.3% (951) being men. Systemic anticancer therapy administration rates were 36% (666 patients) in the last 30 days and 67.6% (1252 patients) in the last 90 days prior to death. Chemotherapy was the most common EOL medication (58%). Higher EOL SACT rates were associated with younger age, better ECOG performance status, shorter disease duration, and specific tumor origins, particularly breast cancer. Conversely, gender, marital status, and ethnicity showed no significant correlation with EOL treatment use. DISCUSSION Our data provide insight into current practice adopted by healthcare professionals regarding EOL treatment administration in Israel. A positive EOL experience is a significant goal in the oncology clinic, yet our findings demonstrate high rates of aggressive EOL care and may highlight the necessity for regulatory and educational changes within the healthcare system.
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Affiliation(s)
- Renana Barak
- Oncology Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Esraa Safadi
- Oncology Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Noa Soback
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Oncology Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barliz Waissengrin
- Oncology Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hu X, Melson JW, Pan SS, Salei YV, Pai L, Parsons SK, Cao Y. Palliative and end-of-life care in Asian and White patients with metastatic lung cancer. Oncologist 2025; 30:oyaf065. [PMID: 40349132 PMCID: PMC12065943 DOI: 10.1093/oncolo/oyaf065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 02/24/2025] [Indexed: 05/14/2025] Open
Abstract
BACKGROUND Data on palliative and end-of-life care for Asian patients with metastatic lung cancer in the United States are limited, though this is the leading cause of cancer death in this group. Early palliative care improved quality of life and survival in patients with metastatic lung cancer treated with chemotherapy. We examined palliative and end-of-life care patterns in Asian and White patients with metastatic lung cancer in the era of novel therapy. METHODS Patients newly diagnosed with metastatic lung cancer from 2014 to 2019 were identified at our institution. Patient and disease characteristics and treatment information were compared between Asian and White patients by Mann-Whitney U test and Chi-square tests. Time-to-palliative care involvement was compared via log-rank test. RESULTS Both Asian (N = 89) and White (N = 197) patients had low rates of palliative care involvement (38.2% vs 37.6%), with median time from diagnosis to first encounter exceeding a year. The most given frontline systemic therapy was targeted therapy and chemotherapy in Asian and White patients, respectively. Of 22 Asian (24.7%) and 74 White (37.6%) patients who died, Asian patients more often died in-hospital (68.2% vs 32.4%, P = .004), and did not have documented code status discussions with their outpatient oncologists (0% vs 24.3%, P = .010) within 6 months preceding death. CONCLUSION Early palliative care appears challenging to implement for Asian and White patients newly diagnosed with metastatic lung cancer in a real-world setting. A more patient-centered approach to integrating palliative and end-of-life care communications and interventions alongside precision oncology warrants further study.
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Affiliation(s)
- Xiao Hu
- Division of Hematology-Oncology, Department of Medicine, Tufts Medical Center, Boston, MA, United States
| | - John W Melson
- Division of Hematology, Oncology and Palliative Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Stacey S Pan
- Division of Hematology-Oncology, Department of Medicine, Tufts Medical Center, Boston, MA, United States
| | - Yana V Salei
- Department of Medicine, Tufts Medical Center, Boston, MA, United States
| | - Lori Pai
- Division of Hematology-Oncology, Department of Medicine, Tufts Medical Center, Boston, MA, United States
| | - Susan K Parsons
- Division of Hematology-Oncology, Department of Medicine, Tufts Medical Center, Boston, MA, United States
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States
| | - Yu Cao
- Division of Hematology-Oncology, Department of Medicine, Tufts Medical Center, Boston, MA, United States
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Aglietta M, Rossana B, Biasco G, Bossi P, Gentili M, Giacomelli L, Lanzetta G, Marinangeli F, Tonini G, Vellucci R. Are we doing enough to treat cancer pain? The urgent need for action in oncology practice. Future Oncol 2025:1-3. [PMID: 40333362 DOI: 10.1080/14796694.2025.2501522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 04/30/2025] [Indexed: 05/09/2025] Open
Affiliation(s)
| | - Berardi Rossana
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Guido Biasco
- Medical Oncology, Alma Mater University of Bologna, Bologna, Italy
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marta Gentili
- Research Biology Private Practice, Milan, Milan, Italy
| | | | - Gaetano Lanzetta
- Department of Medical Oncology and Palliative Care, Casa di Cura INI, Grottaferrata, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Pain Treatment & Palliative Care, University of L'Aquila, L'Aquila, Italy
| | - Giuseppe Tonini
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Renato Vellucci
- Pain and Palliative Care Clinic, University of Florence, Florence, Italy
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Pask S, Murtagh FEM, Boland JW. Palliative care - what's the evidence? Clin Med (Lond) 2025:100320. [PMID: 40334942 DOI: 10.1016/j.clinme.2025.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2025] [Accepted: 04/26/2025] [Indexed: 05/09/2025]
Abstract
Palliative care is essential for people with an advanced life limiting illness. Most palliative care is delivered by healthcare professionals who do not specialise in palliative care ('non-specialists'). Multidisciplinary specialist palliative care services manage more complex problems, providing more comprehensive support when needed. Both 'non-specialist' and specialist palliative care improve patient and family outcomes and reduce formal healthcare costs. However, there are inconsistencies in delivery of and access to 'non-specialist' and specialist palliative care. These inconsistencies and inequities lead to unrecognised and unmet palliative care needs. There is also inconsistent referral to specialist palliative care services. Unless there are greater resources and training, these issues will be exacerbated by an increasing need for palliative care with changing population demographics.
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Affiliation(s)
- Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, HU6 7RX, United Kingdom
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, HU6 7RX, United Kingdom
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, HU6 7RX, United Kingdom..
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Rodriguez S, Goble SR, Leventhal TM. Terminal Hospitalizations in Liver Transplant Recipients: Reducing Costs and High-Intensity Care Through Palliative Care. Am J Hosp Palliat Care 2025:10499091251340685. [PMID: 40324789 DOI: 10.1177/10499091251340685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2025] Open
Abstract
IntroductionEnd-of-life care for liver transplant recipients is often characterized by high utilization of invasive procedures, prolonged hospital stays, and elevated health care costs. Despite evidence demonstrating that palliative care can reduce aggressive interventions, improve patient-centered outcomes, and lower costs, its integration into transplant care remains inconsistent.MethodsA retrospective analysis was conducted using the National Inpatient Sample database (2016-2021). Hospitalizations ending in death for liver transplant recipients were compared to non-recipients regarding invasive procedures, health care costs, and the impact of palliative care consultations. Assessed procedures included: mechanical ventilation, tracheostomy, enteral and parenteral nutrition support, red blood cell transfusion, renal replacement therapy, central line placement, and cardiopulmonary resuscitation. Multivariable regression models adjusted for demographic and clinical covariates were utilized.ResultsAmong 4,582,658 terminal hospitalizations, liver transplant recipients (n = 5995) were younger (mean age: 66.0 vs 70.9 years, P < 0.001), had higher comorbidity burdens, and were more likely to have undergone one or more of the assessed procedures (74.7% vs 58.4%, P < .001) compared to non-recipients. Hospitalization costs were increased in transplant recipients ($62,630 vs $46,930, P < .001). Palliative care consultations were associated with reduced procedure utilization (69.9% vs 83.7%, P < .001), shorter hospital stays, and lower costs ($46,930 vs $62,630, P < .001).DiscussionLiver transplant recipients face unique end-of-life care challenges, including greater reliance on high-intensity interventions and associated costs. Palliative care is associated with less invasive procedures and lower costs, highlighting the need for its integration into transplant care pathways.
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Affiliation(s)
| | - Spencer R Goble
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Thomas M Leventhal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Merkel EC, Meyer CL, Yusuf RA, Morrison CF, Kelly DL, Levine DR, LeBlanc TW, Ullrich CK, El-Jawahri A. What do pediatric transplant physicians think about palliative care? Results from a national survey study. Bone Marrow Transplant 2025:10.1038/s41409-025-02597-z. [PMID: 40319195 DOI: 10.1038/s41409-025-02597-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 03/26/2025] [Accepted: 04/07/2025] [Indexed: 05/07/2025]
Abstract
The benefits of palliative care (PC) for hematopoietic cell transplant (HCT) patients are well established, however, uptake in pediatric HCT remains limited. To understand pediatric transplant physicians' attitudes towards PC, we conducted a cross-sectional study with a 28-question survey. A composite score and regression model identified factors associated with positive attitudes towards subspecialty PC. Ninety-eight participants reported caring for pediatric patients. Most (81%) trust PC clinicians to care for their patients, yet 33% feel PC clinicians lack enough HCT knowledge to counsel patients. Nearly half (46%) see the name "PC" as a barrier to referral. Multivariable analysis showed that spiritual practice (β = 1.53, p = 0.029), <10 years of clinical practice (β = 2.23, p = 0.007), and perceived PC quality (β = 0.73, p < 0.001) were associated with a more positive attitude towards PC. More training in PC (β = -2.70, p = 0.003) and a higher sense of ownership over PC issues (β = -0.51, p = 0.001) were associated with a more negative attitude towards subspecialty PC. These findings highlight barriers to pediatric HCT and PC collaboration, including concerns about PC team knowledge of HCT and patient perceptions. While most pediatric transplant physicians trust PC to enhance patient care, interventions are needed to improve collaboration.
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Affiliation(s)
- Emily C Merkel
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
- Division of Pediatric Hematology, Oncology, Bone Marrow Transplant & Cellular Therapy, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | | | | | | | | | - Deena R Levine
- Division of Quality-of-life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Christina K Ullrich
- Harvard Medical School, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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Raihane AS, Nadeem MA, Raja AR, Bustillos AA, Awan AR, Quazi MA, Ikram J, Khan A, Ullah A, Khan M, Sheikh AB, Sohail AH. Shifting US location patterns in leukaemia mortality: retrospective analysis. BMJ Support Palliat Care 2025:spcare-2025-005520. [PMID: 40316426 DOI: 10.1136/spcare-2025-005520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2025] [Accepted: 04/23/2025] [Indexed: 05/04/2025]
Abstract
OBJECTIVES Leukaemia is a haematological malignancy with high mortality, yet end-of-life care patterns remain underexplored. This study analysed trends in the place of death among leukaemia decedents and assessed demographic disparities in end-of-life care. METHODS A retrospective observational study was conducted using the Centres for Disease Control and Prevention's WONDER and National Center for Health Statistics mortality databases (2008-2020). Leukaemia deaths were identified from death certificates, and place of death was categorised as hospice, home, inpatient, nursing home or outpatient/emergency room. Temporal trends were analysed using the Mann-Kendall test, and logistic regression assessed associations between place of death and demographics. RESULTS Among 295 057 leukaemia-related deaths, inpatient deaths declined from 51% to 37% (τ=-0.872, p<0.001), while home deaths increased from 26% to 40% (τ=0.897, p<0.001). Hospice deaths nearly doubled from 5% to 9% (τ=0.692, p=0.001), and nursing home deaths declined from 11% to 8% (τ=-0.795, p<0.001). No significant trend was observed for outpatient/emergency room deaths. Younger adults (20-34 years) had the highest inpatient death rate (74%), decreasing with age, while home and hospice deaths increased among older adults. Racial disparities were evident, with non-Hispanic black, Hispanic and Asian patients more likely to die in hospitals and less likely to use hospice care than non-Hispanic whites. CONCLUSIONS Leukaemia-related deaths have increasingly shifted from hospitals to home and hospice, reflecting broader palliative care trends. However, racial disparities persist, highlighting the need for targeted interventions to improve equitable access to hospice and home-based palliative care.
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Affiliation(s)
- Ahmed Sami Raihane
- Department of Internal Medicine, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Muhammad Ahmad Nadeem
- Department of Liver Transplant Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ahsan Raza Raja
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Arlin A Bustillos
- Department of Internal Medicine, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Abdul Rafeh Awan
- Department of Surgery, Nishtar Medical University, Multan, Pakistan
| | - Mohammed A Quazi
- Department of Family and Community Health, West Virginia University, Morgantown, West Virginia, USA
| | - Jibran Ikram
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abdullah Khan
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Asad Ullah
- Department of Pathology, Texas Technical University, Lubbock, Texas, USA
| | - Marjan Khan
- Department of Medicine, Marshfield Clinic Health System Inc, Marshfield, Wisconsin, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Amir Humza Sohail
- Surgical Oncology, Department of Surgery, The University of New Mexico, Albuquerque, New Mexico, USA
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Nishimura T, Nakamura M, Kako J, Fujimoto H. Palliative Care, Advance Care Planning, and Craftsmanship: What He Taught Me Through End-of-Life Care. J Palliat Med 2025; 28:689-690. [PMID: 39819045 DOI: 10.1089/jpm.2024.0512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2025] Open
Affiliation(s)
- Tadashi Nishimura
- Department of Pulmonary Medicine, Mie Chuo Medical Center, Tsu, Mie, Japan
| | - Megumi Nakamura
- Department of Nursing, Mie Chuo Medical Center, Tsu, Mie, Japan
| | - Jun Kako
- Department of Cancer Nursing, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hajime Fujimoto
- Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Boone-Sautter KM, Peterson MA, Vermeesch K, Ahmed A. Palliative care for stroke patients: Meeting the Quadruple Aim. J Stroke Cerebrovasc Dis 2025; 34:108263. [PMID: 39984147 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 02/03/2025] [Accepted: 02/17/2025] [Indexed: 02/23/2025] Open
Abstract
BACKGROUND Stroke patients present health care systems with complex clinical and care needs with high costs of care. Prior to 2022, Corewell Health lacked the palliative care infrastructure to reach and serve the diverse needs of this patient population. Corewell Health-West (CH-W) sought to improve end-of-life care for individuals with serious illness. OBJECTIVES To evaluate the extent to which changes in palliative care practices led to improvements in patient outcomes and cost of care. METHODS We conducted a retrospective review of palliative care referrals after hospitalization with primary diagnosis of stroke in the CH-W system from 2021 to 2023. Descriptive analysis was utilized to assess the impact and outcomes for patients pre- and post- system improvements. RESULTS The emergency department piloted consults directly to palliative which increased from six to seventy-four over a month's time. Stroke patients preferred in-home treatments such as Home Hospice. Fewer patients enrolled in inpatient treatment, such as skilled nursing facilities and inpatient rehab facilities, whose enrollment dropped from 25 % to 11.3 % and 18.3 % to 9.7 % respectively, from 2021 to 2023. Stroke patients enrolled in palliative care experienced lower utilization and costs. CONCLUSIONS After expanding resources and standardizing the referral and criteria process to palliative care, an increase in palliative care utilization was observed. This effort expanded care dispositions for palliative care services, allowing individuals more opportunities to receive palliative care treatment at home rather than inpatient.
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Affiliation(s)
| | | | | | - Aiesha Ahmed
- Corewell Health West, 333 Bridge Street NW, Grand Rapids, MI, USA
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Abasseri M, Hoque S, Caldwell K, Sheahan L, Kochovska S, Agar M, Zekry A. Exploring Misconceptions of Palliative Care Among Patients With Hepatocellular Carcinoma: A Pilot Study. Am J Hosp Palliat Care 2025; 42:467-476. [PMID: 39157978 PMCID: PMC11894838 DOI: 10.1177/10499091241268423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 08/20/2024] Open
Abstract
BackgroundHepatocellular carcinoma is a burdensome form of liver cancer with an increasing global prevalence. Emerging evidence has shown that early palliative care introduction at diagnosis of any life-limiting illness improves patient and carer outcomes. Despite this, patients with hepatocellular carcinoma usually receive palliative care late. These patients are important stakeholders in the provision of palliative care, but their perceived barriers regarding its delivery are poorly defined.AimThis pilot study aimed to identify the barriers perceived by patients to integrating palliative care into the hepatocellular carcinoma treatment algorithm.DesignPatients living with hepatocellular carcinoma undertook semi-structured interviews about their perceptions of palliative care. We compared these perceptions before and after providing a brief explanation of palliative care. Interview data was inductively coded in NVivo 12 (2018) and thematically analysed.ResultsTwenty-one patients were interviewed. 16 perceived palliative care to mean end-of-life therapy, and nine participants had no prior knowledge of palliative care. After hearing a definition of palliative care, 17 participants reported changed positive attitudes. Seven participants supported a name change, including four participants who continued to reject palliative care following the explanation due to the negative stigma associated with the term 'palliative care'.ConclusionThere is significant misperception about the purpose of palliative care among patients with hepatocellular carcinoma, constituting a barrier to early integration. This can be feasibly addressed with a two-folded educational and renaming initiative to dispel patient misconceptions regarding palliative care. Effective strategies to achieve this should be developed and tested with relevant stakeholders, particularly patients.
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Affiliation(s)
| | - Shakira Hoque
- Gastroenterology and Hepatology Department, St George Hospital, Sydney, NSW, Australia
| | - Kim Caldwell
- Palliative Medicine, Calvary Hospital Kogarah, Kogarah, NSW, Australia
- Palliative Medicine Department, St George Hospital, Sydney, NSW, Australia
| | - Linda Sheahan
- Clinical Ethics Service, South Eastern Sydney Local Health District, Randwick, NSW, Australia
- Sydney Health Ethics, The University of Sydney, Camperdown, NSW, Australia
- St George and Sutherland Clinical Campus, UNSW Medicine & Health, Sydney, NSW, Australia
- Palliative Medicine Department, St George Hospital, Sydney, NSW, Australia
| | - Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- IMPACCT, Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Meera Agar
- IMPACCT, Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Amany Zekry
- School of Medicine and Health, UNSW, Sydney, NSW, Australia
- Gastroenterology and Hepatology Department, St George Hospital, Sydney, NSW, Australia
- St George and Sutherland Clinical Campus, UNSW Medicine & Health, Sydney, NSW, Australia
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Valsecchi AA, Di Maio M. Association Between Health-Related Quality of Life Measures and Survival Endpoints in Oncology Clinical Trials and in Clinical Decision Making: A Narrative Review. Pharmaceut Med 2025; 39:171-182. [PMID: 40369361 DOI: 10.1007/s40290-025-00568-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2025] [Indexed: 05/16/2025]
Abstract
For decades, oncology research has primarily relied on survival-based endpoints, such as progression-free survival and overall survival, to evaluate treatment efficacy. However, recent studies and international guidelines underscore the importance of incorporating patient-reported outcomes through patient-reported outcomes measures (PROMs). PROMs provide a more comprehensive view of treatment effectiveness, integrating the concepts of 'living longer' and 'living better.' Health-related quality of life (HRQoL) improvements have an intrinsic value for the patient, with importance in the overall definition of treatment value. These findings have sparked discussions regarding the relationship between HRQoL and traditional survival endpoints, influencing both oncology clinical trials and their interpretation for decision-making processes in practice. To effectively integrate PROMs into research, the choice of study design, appropriate PROMs questionnaires, and timing of administration are critical. The clinician's ability to interpret HRQoL data with awareness is equally important to ensure good clinical decision making. A pivotal concept in this context is the minimum clinically important difference (MCID), which is essential to inform the interpretation of treatment effect size in terms of clinically relevant HRQoL changes. Incorporating PROMs fosters a patient-centered approach to cancer care, aligning treatment goals with individual preferences and values. By balancing survival outcomes with quality of life, and through empathetic communication, healthcare providers can deliver treatments that are not only effective but also resonate with patients' experiences and priorities.
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Affiliation(s)
- Anna Amela Valsecchi
- Department of Oncology, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Ospedale Molinette, Corso Bramante 88, 10126, Turin, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Ospedale Molinette, Corso Bramante 88, 10126, Turin, Italy.
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Kaufmann TL, Kearney M, Cortez D, Saxton JW, Goodfellow K, Smith C, Chang P, Sebastian K, Galaznik A, Scott J, Kvale EA, Kamal AH, Bennett AV, Stover AM, Henneghan AM, Pignone M, Rocque GB. Feasibility Study of Using Electronic Patient-Reported Outcomes to Screen Patients with Advanced Solid Cancers for Palliative Care Needs. J Palliat Med 2025; 28:580-591. [PMID: 40059654 DOI: 10.1089/jpm.2024.0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2025] Open
Abstract
Background: Palliative care delivery in oncology is challenging and referral practices vary widely. Standardized, needs-based screening and triage systems are essential to more effectively address patients' palliative care needs. Objective: Assess the feasibility, acceptability, and appropriateness among patients with advanced solid cancers of using electronic patient-reported outcomes (ePROs) to screen for palliative care needs. Design: We developed a 13-item ePRO palliative care survey to assess multidimensional palliative care needs and conducted a pilot study (n = 25) of a palliative care screening intervention using ePRO monitoring and presentation of ePRO reports to a multidisciplinary care team. Feasibility was assessed through enrollment, retention, and ePRO adherence rates. Acceptability and appropriateness were evaluated through exit surveys of all participants and semistructured interviews of a subset of participants (n = 10). Results: From May 2022 to April 2023, 68% (25/37) of eligible patients consented and enrolled on the ePRO platform. Overall, 96% (22/23; 2 censored for death/hospice) of participants completed the study and 96% of participants met predefined ePRO adherence thresholds. Overall, 84% (21/25) of patients reported a severe response during the study period, of whom 95% (20/21) received supportive services during the study period. Patients found the ePRO palliative survey acceptable and appropriate. Qualitative interviews found patient-identified barriers to the intervention and areas for improvement. Conclusions: Screening patients for unmet palliative needs using ePRO monitoring is feasible, acceptable, and appropriate among patients, but more work is needed to understand the perspectives of diverse patients and how to integrate ePRO palliative care screening into clinical workflows.
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Affiliation(s)
- Tara L Kaufmann
- Department of Medicine, Geisel School of Medicine, Lebanon, New Hampshire, USA
- Dartmouth Cancer Center, Lebanon, New Hampshire, USA
| | - Matthew Kearney
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dagoberto Cortez
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
- Department of Sociology, University of Texas at Austin, Austin, Texas, USA
| | - John W Saxton
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Katie Goodfellow
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Carolyn Smith
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Patrick Chang
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | | | | | - Julie Scott
- Carevive Systems Inc., Boston, Massachusetts, USA
| | | | - Arif H Kamal
- Duke Cancer Institute, Durham, North Carolina, USA
- American Cancer Society, Atlanta, Georgia, USA
| | - Antonia V Bennett
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angela M Stover
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Michael Pignone
- Duke Cancer Institute, Durham, North Carolina, USA
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Gabrielle Betty Rocque
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Choi YY, Hong B, Rha SY, Cho S, Lee HS, Lee J. The effect of nurse-led enhanced supportive care as an early primary palliative care approach for patients with advanced cancer: A randomized controlled trial. Int J Nurs Stud 2025; 168:105102. [PMID: 40378811 DOI: 10.1016/j.ijnurstu.2025.105102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 04/28/2025] [Accepted: 04/29/2025] [Indexed: 05/19/2025]
Abstract
BACKGROUND Nurses play an important role in providing palliative care. However, few studies have evaluated the effectiveness of nurse-led primary palliative care. OBJECTIVE To evaluate the effect of nurse-led enhanced supportive care as an early primary palliative care approach for advanced cancer patients. DESIGN Randomized controlled trial. SETTING(S) This study was conducted at Yonsei Cancer Center in Seoul, Korea. PARTICIPANTS Advanced cancer patients initiating palliative chemotherapy (N = 258) and their family caregivers (N = 120) were enrolled and completed 3-month (n = 182 patients, n = 79 caregivers) and 6-month (n = 141 patients, n = 60 caregivers) follow-up assessments. METHODS Participants were randomly assigned to the intervention or control group (1:1). The intervention group received nurse-led enhanced supportive care, which included symptom management and coping enhancement counseling before each chemotherapy cycle (baseline to 3 months) and was delivered by trained nurses. The control group received symptom monitoring. Family caregivers only participated in the evaluation. The primary outcomes were quality of life (EORTC-QLQ C30), symptoms (ESAS), and coping (Brief COPE) at 3 months. The secondary outcomes were quality of life, symptoms, and coping at 6 months. Self-efficacy for coping with cancer (CBI-3.0 K), and depression among cancer patients and family caregivers (HADS-D) at 3 and 6 months were also evaluated. The data were analyzed using linear mixed models. RESULTS The intervention group reported beneficial effects in the following outcomes: 1) Quality of life [role functioning domain at 3 months (1.01 ± 2.34 vs. -8.37 ± 2.07; p = .003 [-15.57, -3.18]; adjusted p = .044), 2) coping [active coping at 3 months (0.27 ± 0.16 vs. -0.34 ± 0.14; p = .006 [-1.04, -0.18]; adjusted p = .044), and self-distraction (0.22 ± 0.17 vs. -0.42 ± 0.15; p = .004 [-1.08, -0.20]; adjusted p = .044) at 3 months]; 3) self-efficacy in coping with cancer [maintaining activity and independence at 3 months (1.45 ± 0.47 vs. -0.31 ± 0.42; p = .006 [-2.99, -0.52]; adjusted p = .044)]. The intervention was not effective in reducing symptoms and depression of patients or depression of caregivers (adjusted p > .05). CONCLUSIONS Nurse-led enhanced supportive care as an early primary palliative care approach has demonstrated effectiveness in improving the role functioning domain of quality of life, use of coping strategies, and self-efficacy in maintaining activity and independence among advanced cancer patients. Nurse-led early primary palliative care should be delivered by trained nurses and incorporated into routine oncology practice. REGISTRATION Registered at ClinicalTrials.gov, NCT04407013, on May 29, 2020, https://www. CLINICALTRIALS gov/ct2/show/study/NCT04407013. The protocol version is ESC 1.0. TWEETABLE ABSTRACT The integration of nurse-led early primary palliative care into routine oncology practice for patients with advanced cancer is recommended.
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Affiliation(s)
- Yun Young Choi
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Bomi Hong
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Sun Young Rha
- College of Medicine and Yonsei Cancer Center, Yonsei University, Seoul, Republic of Korea
| | - Sungkun Cho
- Department of Psychology, Chungnam National University, Daejeon, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jiyeon Lee
- College of Nursing and Mo-Im Kim Research Institute, Yonsei University, Seoul, Republic of Korea.
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Ajibawo T, Okunowo O. Prevalence and Factors Associated With Palliative Care Utilization Among Hospitalized Patients With Gallbladder Cancer- A National Inpatient Sample Analysis. Am J Hosp Palliat Care 2025; 42:445-451. [PMID: 38881223 DOI: 10.1177/10499091241262968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
ObjectivesVarious factors have been associated with palliative utilization in different cancers. However, literature is still lacking on the prevalence and factors associated with palliative care use in gallbladder cancer (GBC). This study aims to determine the prevalence of palliative care utilization and examine the factors associated with palliative care utilization among patients with GBC.MethodsWe conducted a retrospective analysis using the National Inpatient Sample between 2016 and 2018. Descriptive statistics were used to characterize the study population. We explored factors associated with palliative care utilization among hospitalized GBC patients using logistic regression.ResultsOf the 20280 GBC hospitalizations, 18.0 % utilized palliative care. Multivariable analysis revealed that treatment at urban teaching hospitals, or treatment at urban nonteaching hospitals, Medicare insurance, other insurance coverage, transfer to a facility/discharge with home health, and death during hospital stay were associated with higher utilization of palliative care. In contrast, non-elective admissions were associated with decreased odds of palliative care utilization.ConclusionPalliative care use among GBC patients is still low at 18.0%. Palliative care use was associated with insurance disparities, discharge disposition, hospital location, and type of admission. Therefore, concerted efforts to address these disparities in palliative care utilization are needed to improve the quality of care for this population.
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Affiliation(s)
| | - Oluwatimilehin Okunowo
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute of City of Hope, Duarte, CA, USA
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Min JWS, Wang Y, Bollens-Lund E, Reich AJ, Dhanani H, Ankuda CK, Lipsitz S, Gray TF, Kim DH, Ritchie CS, Cooper Z. Long-term Changes in Pain, Depression, Function and Informal Caregiving after Major Elective Surgeries Among Seriously Ill Older Adults. Ann Surg 2025; 281:806-813. [PMID: 39720848 PMCID: PMC11987569 DOI: 10.1097/sla.0000000000006616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2024]
Abstract
OBJECTIVE To compare differences in pain, depression, function, and informal caregiving pre-major and post-major elective surgery among older adults with and without serious illness; and determine whether serious illness was independently associated with increasing pain, depression, assistance in activities of daily living (ADLs) and informal caregiving postsurgery. BACKGROUND The American College of Surgeons has endorsed the integration of palliative care (PC) into surgical care in adults with serious illness but targets for PC during surgical episodes such as pain, depression, function, and informal caregiving are understudied. METHODS We used Health and Retirement Study-linked Medicare data (2008 to 2018) to identify older (≥66 years) adults with and without serious illness who had major elective surgery. We performed difference-in-difference analysis to measure changes in pain, depression, function, and informal caregiving presurgery and postsurgery between groups. We tested associations between serious illness and changes in pain, depression, function, and informal caregiving using multivariable regression. RESULTS Among 1896 adults who had major surgery, 1139 (60%) were seriously ill. Compared with adults without serious illness, those with serious illness had greater baseline pain (43% vs 38%), depression (22% vs 13%), assistance with ADLs (12% vs 0%,) and informal caregiving (18% vs 4%); and, greater increases in assistance with ADLs presurgery and postsurgery (difference-in-difference: 6%, 95% CI: 3.7 to 8.3). Serious illness was independently associated with increasing pain [odds ratio (OR): 1.6, 95% CI: 1.1 to 2.2], depression (OR: 1.5, 95% CI: 1.1 to 2.2), assistance with ADLs (OR: 2.1, 95% CI: 1.3 to 3.4), and informal caregiving (OR: 2.1, 95% CI: 1.4 to 3.1) postsurgery. CONCLUSIONS Most older adults having elective surgery are seriously ill. Pain, depression, function, and caregiving are targets for PC to improve post-surgical outcomes.
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Affiliation(s)
- Jolene Wong Si Min
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, MA USA
- Department of Surgery, Brigham and Woman’s Hospital, Boston, MA USA
| | - Yihan Wang
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Evan Bollens-Lund
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Amanda J. Reich
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, MA USA
| | - Hiba Dhanani
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, MA USA
- Department of Surgery, Brigham and Woman’s Hospital, Boston, MA USA
| | - Claire K. Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Stuart Lipsitz
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, MA USA
| | - Tamryn F. Gray
- Department of Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, MA USA
- Department of Medicine, Brigham and Woman’s Hospital, Boston, MA USA
| | - Dae Hyun Kim
- Department of Medicine, Brigham and Woman’s Hospital, Boston, MA USA
- Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, MA USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Woman’s Hospital, Boston, MA USA
- Department of Surgery, Brigham and Woman’s Hospital, Boston, MA USA
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Rosen MR, Truong T, Gervais C, LeBlanc TW, Havrilesky LJ, Davidson BA. Quality for All: Clinical Trial Enrollment and End-of-Life Care in Solid and Hematologic Malignancies. Cancer Med 2025; 14:e70775. [PMID: 40287844 PMCID: PMC12034154 DOI: 10.1002/cam4.70775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 02/16/2025] [Accepted: 03/08/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND Patients with incurable cancer deserve quality end-of-life (EOL) care. Despite established EOL quality metrics, many patients receive aggressive EOL care with limited goals of care (GOC) documentation. Concurrently, clinical trials are critical for advancing cancer care. We aim to identify associations between trial enrollment in the last year of life (YOL) and EOL quality metrics for adults with cancer to identify opportunities to advance goal-concordant care. METHODS This is a retrospective review of adult patients with cancer at a single academic institution who died between January 2018 and October 2022. Outcomes included: initiation of a new anticancer therapy, intensive care unit (ICU) admission, hospitalization, or emergency department (ED) encounter in the last 30 days of life (DOL), reception of anti-cancer treatment in the last 14 DOL, referral to hospice, referral to palliative care, and GOC documentation. RESULTS Among 9817 patients, 577 (5.9%) enrolled in clinical trials in the last YOL. Patients enrolled in trials were more likely to initiate new anticancer treatments in the last 30 DOL (p = < 0.001), less likely to have a palliative care referral (p = < 0.001) or GOC documentation (p = < 0.001), but were less likely to have an ED encounter in the last 30 DOL (p = 0.04) or die in an acute care setting (p = 0.015). CONCLUSIONS Enrollment in clinical trials in the last YOL was associated with metrics of aggressive EOL care, with low rates of GOC documentation to determine if this care is goal-concordant. Low rates of palliative care and hospice engagement across the study population suggest opportunities for improvement for all patients, regardless of trial enrollment.
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Affiliation(s)
- Melissa R. Rosen
- Department of Gynecology and ObstetricsJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Tracy Truong
- Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Catherine Gervais
- Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Thomas W. LeBlanc
- Department of Hematologic MalignanciesDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Laura J. Havrilesky
- Department of Obstetrics and GynecologyDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Brittany A. Davidson
- Department of Obstetrics and GynecologyDuke University Medical CenterDurhamNorth CarolinaUSA
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Ulrich CM, Himbert C, Barnes CA, Boucher KM, Daniels B, Bandera VM, Ligibel JA, Wetter DW, Hess R, Kim J, Lundberg K, Mitzman B, Marcus R, Finlayson SRG, LaStayo PC, Varghese TK. Precision Exercise Effect on Fatigue and Function in Lung Cancer Surgery: A Randomized Clinical Trial. JAMA Surg 2025; 160:495-519. [PMID: 40072448 PMCID: PMC11904799 DOI: 10.1001/jamasurg.2025.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 12/30/2024] [Indexed: 03/15/2025]
Abstract
Importance Exercise intervention studies have shown benefits for patients with lung cancer undergoing surgery, yet most interventions to date have been resource intensive and have followed a one-size-fits-all approach. Objective To determine whether a personalized, clinic-aligned perioperative exercise program with remote monitoring and instructions can improve physical function and fatigue among patients undergoing surgery for lung cancer. Design, Setting, and Participants The Precision-Exercise-Prescription (PEP) randomized clinical trial is a single-center phase 3 trial. Adult patients with primary lung cancer (stages I-IIIa) or oligometastatic disease to the lung (where all disease could be removed) were assessed for eligibility and randomized to either an exercise intervention or standard care. Patients were enrolled between November 2017 and 2021, and the trial continued during the COVID-19 pandemic. Data were analyzed from November 2022 to December 2023. Interventions The structured exercise program, personalized based on mobility scores, was a home-based exercise intervention prescribed and monitored remotely by a licensed physical therapist. The program started approximately 2 weeks before surgery and continued after surgery. Standard care included use of incentive spirometer and encouragement to exercise without a formal program. Main Outcomes and Measures Physical function (6-minute walk test [6MWT]), the Short Physical Performance Battery, and cancer-related fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue) were assessed at baseline and 2 months after surgery. Results A total of 182 patients (92 receiving exercise intervention, 90 receiving standard care) were assessed in the intention-to-treat population. Patients had a mean (SD) age of 62.7 (13.8) years, 108 (59%) were female, and 89 (49%) had low mobility scores (Activity Measure for Post-Acute Care scores, 1-3). Physical function in the exercise group increased at 2 months after surgery (mean [SE] 6MWT at baseline, 467.9 [13.0] m; at 2 months, 482.2 [14.1] m), compared with a decrease in the standard-care group (mean [SE] 6MWT at baseline, 481.4 [11.1] m; at 2 months, 471.5 [14.0] m). Mean (SE) between-group changes in 6MWT distance for intent to treat from baseline to 2 months were 22.7 (12.7) m (P = .08), with greater effect sizes among women (mean [SE], 37.8 [17.3] m; P = .03). Similarly, women showed greater improvements in the Short Physical Performance Battery (mean [SE], 0.9 [0.4]; P = .04). Patients in the exercise group maintained stable fatigue scores at 2 months, whereas participants in the standard-care group deteriorated (mean [SD], 3.7 [1.4]; P = .009), with greater effect sizes among individuals who were younger, from rural areas, had overweight or obesity, and had primary lung cancer. Conclusions and Relevance The PEP intervention, a personalized, clinic-aligned, and remotely monitored perioperative exercise program for patients with lung cancer undergoing surgery demonstrated improvements in physical function for women and significant improvements in fatigue scores across all groups. Trial Registration ClinicalTrials.gov Identifier: NCT03306992.
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Affiliation(s)
- Cornelia M. Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Caroline Himbert
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Christopher A. Barnes
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City
| | - Kenneth M. Boucher
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Epidemiology, University of Utah, Salt Lake City
| | | | - Victoria M. Bandera
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Jennifer A. Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - David W. Wetter
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City
- Division of General Internal Medicine, University of Utah, Salt Lake City
| | - Jaewhan Kim
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City
| | - Kelly Lundberg
- Department of Psychiatry, University of Utah, Salt Lake City
| | - Brian Mitzman
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Surgery, University of Utah, Salt Lake City
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City
| | - Robin Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City
| | | | - Paul C. LaStayo
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City
| | - Thomas K. Varghese
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Surgery, University of Utah, Salt Lake City
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City
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Kuriakose J, Deodhar JK, Jain H, Sengar M, Shetty A, P P, Jayaseelan P. Palliative Care Needs in Adult Patients with Acute Leukemia: A Prospective Observational Study. J Palliat Med 2025; 28:648-654. [PMID: 39841522 DOI: 10.1089/jpm.2024.0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2025] Open
Abstract
Background: Acute leukemia (AL) affects patients' well-being and inflicts substantial symptom burden. We evaluated palliative care needs and symptom burden in adult patients with AL from diagnosis through fourth week of induction chemotherapy. Methods: Newly diagnosed adult patients with AL scheduled for curative-intent treatments, prospectively completed Functional Assessment of Cancer Therapy-Leukemia questionnaire at diagnosis and postinduction therapy. Subscale scores identified domains with major needs, with lower scores signifying higher needs, while Leu-subscale assessed leukemia-specific symptom burden. Results: One hundred patients were enrolled. Upon diagnosis and four weeks into induction phase, respectively, patients exhibited the lowest scores in physical (17 ± 8.75; 16 ± 11; p < 0.05), functional (16.5 ± 10.75; 11 ± 12.2; p < 0.05), and leukemia-specific (43 ± 16.75; 41.48 ± 11.68; p > 0.05) domains. Predominant symptoms were "getting tired easily" (91%) at diagnosis and "unable to do usual activities" (92.3%) after induction. Conclusion: Patients with AL demonstrated substantial physical, functional, and leukemia-specific symptom needs at diagnosis, which intensified postinduction, highlighting the necessity for palliative care integration from diagnosis.
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Affiliation(s)
- Jyothsna Kuriakose
- Department of Palliative Medicine, Christian Medical College, Vellore, India
| | - Jayita K Deodhar
- Department of Palliative Medicine, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
| | - Hasmukh Jain
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
| | - Alok Shetty
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
| | - Prasun P
- Department of Palliative Medicine, Advanced Centre for Treatment, Research and Education in Cancer, Homi Bhabha National Institute, Navi Mumbai, India
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Bustamante-Fermosel A, Díaz-Sánchez E, Pavón-Muñoz N, Hennekinne L, Gil-Gil F, Notario-Leo H, Sánchez-Pizarro A, Bustamante-Vega M, Torres-Macho J, Franco-Moreno A, on behalf of the COMPASS Research Group. External Validation of the NECPAL CCOMS-ICO Prognostic Tool for Early Palliative Care and Mortality Prediction in Patients with Advanced Chronic Conditions: A Prospective Observational Study Protocol. Methods Protoc 2025; 8:45. [PMID: 40407472 PMCID: PMC12101327 DOI: 10.3390/mps8030045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Revised: 04/23/2025] [Accepted: 04/25/2025] [Indexed: 05/26/2025] Open
Abstract
Early initiation of palliative care in patients with advanced chronic conditions significantly improves their quality of care; however, variability in disease trajectories complicates such interventions' timing. The NECPAL CCOMS-ICO prognostic tool was developed as a straightforward instrument to help healthcare providers in all clinical settings promptly identify patients with advanced chronic conditions who require palliative care, thereby enhancing service planning and delivery. Its latest version, 4.0, 2021, for the first time, incorporates a patient survival estimation. Nevertheless, validation is necessary. This study aims to validate the NECPAL version 4.0 tool in an independent cohort. It is an observational, prospective study involving outpatients and hospitalized non-randomized patients at Hospital Universitario Infanta Leonor-Virgen de la Torre in Madrid, Spain, all of whom have at least one advanced chronic condition. The study is scheduled to last 6 years, including a recruitment period of 30 months starting 1 February 2024, followed by a 12-month follow-up period for each patient. This is the first prospective study designed to validate the NECPAL version 4.0 instrument. Implementing this tool would allow the identification of patients with advanced chronic conditions and unmet palliative care needs and determine the more appropriate care pathway at the proper moment.
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Affiliation(s)
- Ana Bustamante-Fermosel
- Faculty of Medicine, Universidad Complutense de Madrid, 28233 Madrid, Spain
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
- Palliative Care, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
| | - Elena Díaz-Sánchez
- Faculty of Medicine, Universidad Complutense de Madrid, 28233 Madrid, Spain
| | | | - Laetitia Hennekinne
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
| | - Fuensanta Gil-Gil
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
- Palliative Care, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
| | - Helena Notario-Leo
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
- Palliative Care, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
| | - Alicia Sánchez-Pizarro
- Palliative Care, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
- Nursing Unit, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
| | - Marta Bustamante-Vega
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
| | - Juan Torres-Macho
- Faculty of Medicine, Universidad Complutense de Madrid, 28233 Madrid, Spain
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
| | - Anabel Franco-Moreno
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
- Department of Internal Medicine, Hospital Universitario Infanta Leonor-Virgen de la Torre, 28031 Madrid, Spain
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King S, Sinnarajah A, Ahmed S, Paolucci A, Shirt L, Slobogian V, Vig C, Hao D, Barbera LC, Kurien EC, Santana MJ, Pabani A, Biondo PD, Simon JE. Patient-Rated Acceptability of Automatic Palliative Care Referral: A Prospective Cohort Study. J Pain Symptom Manage 2025; 69:465-472. [PMID: 39914578 DOI: 10.1016/j.jpainsymman.2025.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 01/27/2025] [Accepted: 01/30/2025] [Indexed: 02/17/2025]
Abstract
CONTEXT Timely palliative care can alleviate distress after diagnosis of an incurable cancer. However, late referrals to palliative care continue, reflecting various provider and patient barriers. OBJECTIVES To determine patient/caregiver-reported acceptability of a phone call offering a supportive and palliative care (SPC) consultation without requiring oncologist referral. METHODS Two SPC nurses screened out-patient clinic lists at a tertiary cancer center weekly and called all eligible patients to offer an SPC consultation. Eligibility: >18 years, newly diagnosed/suspected stage IV nonsmall cell lung cancer, and completed first oncologist visit. Patients/caregivers were surveyed about the acceptability of the phone call offering SPC consultation, using Sekhon's Framework of Acceptability domains. RESULTS Among 113 patients screened, 81 patients/caregivers were contacted and offered an SPC consultation; 72% accepted the consultation. Of 48 patients/caregivers surveyed, 94% rated overall acceptability of the call somewhat/completely acceptable; 6% rated it neither acceptable nor unacceptable. Within specific acceptability domains, 95% were comfortable receiving the call; 92% understood why they received the call; 87% found the call valuable; 70% found the call helpful; 66% learned about SPC from the call; no one expressed concern that the SPC nurse had access to their contact/health information; 97% thought the call required little physical/emotional effort and were confident in their ability to participate (i.e., to ask questions/make decisions). CONCLUSION These unsolicited phone calls offering SPC consultation were highly acceptable to patients/caregivers, and most agreed to the consultation. Implementing routine calls offering SPC consultation may be a timely alternative to awaiting conventional oncologist referral.
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Affiliation(s)
- Seema King
- Department of Community Health Sciences (S.K., S.A., A.P., M.J.S., and J.E.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aynharan Sinnarajah
- Department of Oncology (A.S., D.H., L.C.B., E.C.K., P.D.B., and J.E.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine (A.S.), Queen's University, Kingston, Ontario, Canada
| | - Sadia Ahmed
- Department of Community Health Sciences (S.K., S.A., A.P., M.J.S., and J.E.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alessandra Paolucci
- Department of Community Health Sciences (S.K., S.A., A.P., M.J.S., and J.E.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lisa Shirt
- Palliative and End of Life Care (L.S., V.S., and C.V.), Alberta Health Services, Calgary, Alberta, Canada
| | - Vanessa Slobogian
- Palliative and End of Life Care (L.S., V.S., and C.V.), Alberta Health Services, Calgary, Alberta, Canada
| | - Chandra Vig
- Palliative and End of Life Care (L.S., V.S., and C.V.), Alberta Health Services, Calgary, Alberta, Canada
| | - Desiree Hao
- Department of Oncology (A.S., D.H., L.C.B., E.C.K., P.D.B., and J.E.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre (D.H., L.C.B., E.C.K., and A.P.), Calgary, Alberta, Canada
| | - Lisa C Barbera
- Department of Oncology (A.S., D.H., L.C.B., E.C.K., P.D.B., and J.E.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre (D.H., L.C.B., E.C.K., and A.P.), Calgary, Alberta, Canada
| | - Elizabeth C Kurien
- Department of Oncology (A.S., D.H., L.C.B., E.C.K., P.D.B., and J.E.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre (D.H., L.C.B., E.C.K., and A.P.), Calgary, Alberta, Canada
| | - Maria J Santana
- Department of Community Health Sciences (S.K., S.A., A.P., M.J.S., and J.E.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aliyah Pabani
- Department of Oncology (A.S., D.H., L.C.B., E.C.K., P.D.B., and J.E.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre (D.H., L.C.B., E.C.K., and A.P.), Calgary, Alberta, Canada
| | - Patricia D Biondo
- Department of Oncology (A.S., D.H., L.C.B., E.C.K., P.D.B., and J.E.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jessica E Simon
- Department of Community Health Sciences (S.K., S.A., A.P., M.J.S., and J.E.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Oncology (A.S., D.H., L.C.B., E.C.K., P.D.B., and J.E.S.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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