Annals of palliative medicine最新文献

People with life-threatening illness frequently experience progressive functional decline and shifting priorities that require a flexible, individualized approach to rehabilitation. However, rehabilitation services within palliative care remain underutilized and are often poorly understood. This clinical practice review describes the importance of integrating relationship-centered care principles into palliative rehabilitation to enhance communication, shared decision-making, and alignment of care with patient values. A data-driven case vignette of a hospitalized patient illustrates the complexities and missed opportunities that can occur when rehabilitation care is not guided by relationship-centered principles. A review of the literature was conducted using PubMed, CINAHL, and Google Scholar from 2015 through 2025. Search terms included "palliative rehabilitation, relationship-centered care, shared decision making, communication, person-centered care, interdisciplinary rehabilitation, and advanced illness". Reference lists of key articles and reviews were also examined. Articles were included if they addressed communication, decision-making, or relational aspects of care within rehabilitation or palliative contexts. Both empirical and conceptual papers were reviewed, along with consensus documents from professional and governmental agencies and clinical summaries from authoritative book chapters. Only English-language publications focusing on adult populations were included. The literature indicates that palliative rehabilitation differs from conventional models by emphasizing adaptation to changing patient goals, unpredictable disease trajectories, and the psychosocial realities of serious illness. Relationship-centered care appreciates that rehabilitation care takes place within systemic and relational structures of care such as reimbursement requirements, time pressures, trustworthy relationships and power imbalances. The case vignette demonstrates how collaborative, values-based decision-making is challenging but essential to improve to better align with one's medical circumstances and patient and professional priorities. Literature reviews and our clinical experiences underscore the importance of flexible communication strategies, interdisciplinary collaboration, and an appreciation of the relational dimensions inherent in therapeutic encounters. Palliative rehabilitation represents a critical intersection of physical restoration, emotional support, and relational care. Although these challenges are often most evident during hospitalization, integrating relationship-centered principles into any rehabilitation setting can optimize quality of life, preserve dignity, and improve alignment of care with patient goals. These insights have implications for clinical training, interdisciplinary practice models, and policy initiatives aimed at expanding access to rehabilitation for individuals with advanced disease.

Background and objective: The increasing legalization of medical marijuana in the United States (US) has spurred ongoing interest in its clinical application for the management of cancer-related pain. Although medical marijuana is legal in 40 states and the District of Columbia, its effect on pain pathways and variability in patient responses remain key areas of investigation. The purpose of this narrative review was to examine the prevalence and efficacy of marijuana use in the treatment of cancer-related pain.

Methods: A research librarian conducted a literature search in PubMed and EMBASE for articles published between January 01, 2018 and August 2025. Search terms included but were not exclusive to cancer Cannabis AND cancer pain; Marijuana AND cancer pain management; Cannabinoids AND cancer-related pain; Medical cannabis AND oncology pain; THC CBD AND cancer pain relief. Twenty articles were identified and three database reviewers (A.M.M., A.N., and L.R.K.) independently screened titles and abstracts for relevance. Full-text articles were then reviewed with full consensus for final inclusion.

Key content and findings: This narrative review examines the current understanding of the mechanisms of action and clinical efficacy of medical marijuana for cancer pain. We explore the pharmacological mechanisms underlying its analgesic properties, including its interaction with cannabinoid receptors and modulation of pain-related pathways. We also review and synthesize existing clinical evidence on the effectiveness of medical marijuana in reducing pain, improving quality of life, and minimizing opioid use in cancer patients.

Conclusions: Overall, there continues to be limited evidence to support the use of medical cannabis for treatment of cancer-related pain. While significant progress has been made in this domain of pain management research, current federal regulations classifying marijuana as a Schedule I substance continue to limit large research studies. As the legal landscape evolves, an emphasis on future randomized controlled trial studies focused on the challenges related to medical marijuana dosing, side effects, and long-term safety will help advance the field and future cancer patients.

Non-small cell lung cancer (NSCLC) remains the leading cause of cancer mortality in the UK, with most patients presenting with locally advanced or metastatic disease. While palliative radiotherapy has historically aimed to alleviate symptoms, rapid advances in imaging, planning, and delivery-particularly stereotactic ablative body radiotherapy (SABR)-have expanded its role toward disease control. This review summarises the evolving evidence for external beam radiotherapy (EBRT) and SABR in advanced NSCLC. Low-dose thoracic EBRT remains effective for symptom relief, though higher-dose regimens may offer improved control in selected patients. Growing data support the use of local consolidative therapy, particularly SABR, to improve disease control in oligometastatic NSCLC. Trials such as SABR-COMET and that by Gomez et al. demonstrate substantial improvements in progression-free and overall survival with local consolidative therapy, though results are tempered by small sample sizes and heterogeneous populations. Multiple large-scale phase III trials are currently underway to further assess benefits of SABR in oligometastatic cancer and better define dose regimens. Systemic therapies have also rapidly evolved with significant advancements in targeted therapies, immunotherapy, and combination regimens. These are often used alongside radiation therapy, leading to concerns over increased toxicity. Large contemporary randomised trials are underway to update the evidence base in the context of modern systemic therapies. Ultimately, palliative radiotherapy remains central to advanced NSCLC management, with its role expanding from symptom control toward modifying disease progression and improving survival outcome.

Acute-on-chronic liver failure (ACLF) represents a rapidly progressive deterioration in chronic liver disease (CLD) marked by multi-organ dysfunction and high short-term mortality. Although consensus on a single definition remains elusive, the clinical phenotype is increasingly recognized across diverse populations, with regional differences in underlying liver disease and precipitants influencing diagnostic criteria and reported incidence. Bacterial infections, alcohol-associated hepatitis (AH), viral hepatitis flares, and drug-induced liver injury (DILI) are among the most common intrahepatic and extrahepatic triggers. The pathophysiology of ACLF reflects immune dysregulation and circulatory collapse, leading to organ failure (OF). This complex interplay may vary according to the number and type of failing organs, the severity of the underlying liver disease, and the nature of the precipitating event. Short-term mortality in ACLF remains high and increases in proportion to the number of OFs. Therapeutic options remain largely supportive, as no disease-modifying therapies have yet been established clinical benefit. Emerging therapies, such as liver support systems, have yet to demonstrate a clear long-term survival advantage. Liver transplantation (LT) remains the sole curative option with demonstrated survival benefit in carefully selected candidates. Due to the high risk of mortality in ACLF, early engagement of palliative care (PC) alongside evaluation for transplant is essential. Early recognition and timely triage remain central to improving outcomes in this high-risk population. This review explores the definitions, prognosis and clinical course of ACLF, emphasizing the importance of early recognition and intervention.

Metastatic breast cancer (MBC) remains incurable, but as survival improves, individuals are living longer and experience complex, evolving needs that span medical, psychosocial, and existential domains. These needs are often inadequately addressed by existing care models. Survivorship programs frequently exclude those with incurable disease, while palliative care is commonly delayed due to stigma, misperceptions, and systemic barriers. This paper explores the critical intersection of survivorship and palliative care in the context of MBC, advocating for an integrated, person-centered model that combines the strengths of both approaches. A blended model offers a comprehensive framework that prioritizes quality of life, enhances care coordination, and ensures timely, values-aligned interventions across the full course of illness. Key components of this approach include interprofessional collaboration, proactive needs assessment, caregiver inclusion, and culturally responsive support. Successful implementation depends on clear role definition among providers, sustainable system-level investment, and the active involvement of patients and caregivers in designing flexible and inclusive care pathways. This model reframes MBC as a long-term condition that requires sustained, holistic support rather than being seen solely as a terminal diagnosis. By doing so, it enables individuals to receive the care they need to live with dignity, purpose, and consistent support throughout their journey.