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.

This study aims to investigate the experiences of life in the initial period following a diagnosis of incurable cancer to inform early PC integration.

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.

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.

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. .

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.

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.

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.

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.

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.

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.

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.

Retrospective study of medical oncology outpatients with HGG at a tertiary hospital, analyzing first unscheduled hospitalizations. Primary variable: Overall Survival (OS) after admission.

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.

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.

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.

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.

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.

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.

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.

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.

Many urologic serious illnesses are treated with surgical procedures, which may put patients at a further risk of diminished quality of life.

To understand stakeholder perceptions on integrating perioperative Palliative Care (PC) for patients with serious urologic illness.

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.

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.

The study informs future interventions to improve the quality of surgical care by integrating PC with urology in a unified workflow.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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]).

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.

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.

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.

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.

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).

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.

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.

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.

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.

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).

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.

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.

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 versus telemedicine palliative care visits in real-world clinical practice and associated patient-centric factors.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

Pathway interventions specifically selected for our institution appeared to curtail ED visits and admissions in patients treated with exacting treatment regimens.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

To evaluate the extent to which changes in palliative care practices led to improvements in patient outcomes and cost of care.

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.

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.

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.

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.

Nurses play an important role in providing palliative care. However, few studies have evaluated the effectiveness of nurse-led primary palliative care.

To evaluate the effect of nurse-led enhanced supportive care as an early primary palliative care approach for advanced cancer patients.

Randomized controlled trial.

This study was conducted at Yonsei Cancer Center in Seoul, Korea.

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.

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.

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).

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.

Registered at ClinicalTrials.gov, NCT04407013, on May 29, 2020, https://www.

gov/ct2/show/study/NCT04407013. The protocol version is ESC 1.0.

The integration of nurse-led early primary palliative care into routine oncology practice for patients with advanced cancer is recommended.

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.

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.

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.

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.

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.

Most older adults having elective surgery are seriously ill. Pain, depression, function, and caregiving are targets for PC to improve post-surgical outcomes.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

ClinicalTrials.gov Identifier: NCT03306992.