Annals of palliative medicine最新文献

Radiofrequency ablation (RFA) is a neuromodulation technique that uses electrocautery to damage nerves with thermal energy and interrupt nociception and has primarily been used to treat patients with chronic back pain. While the use of RFA to modulate neuronal innervation of cervical and lumbar facet joints is well studied, research on the applications of RFA to target the thoracic spine is limited despite these facet joints accounting for pain in over 25% of patients with chronic mid-back and upper-back pain. The purpose of this paper is thus to describe RFA and its utilization in the thoracic spine for chronic back pain. A review of the literature on PubMed was conducted to identify primary evidence for RFA with a focus on only the thoracic spine. Nine papers were identified and reviewed in this article. Primary literature published on RFA-naive patients with thoracic facet joint pain has provided evidence in support of RFA for short-term and long-term pain relief in this spinal region. However, all but two of these studies utilized a cohort study design. Future studies with larger patient cohorts or that utilize a randomized control trial study design are crucial to better establish the effectiveness and long-term utility of this neuromodulation technique.

Background and objective: Breast cancer (BC) is the most prevalent cancer among women worldwide. With a growing number of BC survivors (BCSs), the number of survivors who require high-quality survivorship care is increasing. Various recommendations have been proposed for survivorship care plans (SCPs). However, globally, limited progress has been made to implement these recommendations consistently in cancer care centers. This review explores the gaps and challenges that exist in BC survivorship care (BCSC) and proposes future directions for improving survivorship care for patients and the healthcare system.

Methods: Current literature on BCSC was searched using PubMed and Google Scholar. The search strategy utilized a combination of keywords related to BCSC, gaps in survivorship care, and health promotion. Retrievable and English articles from January 2000 to March 2024 were included in the review.

Key content and findings: Despite the large number of guidelines and recommendations on best BCSC practices, only a small number of these have been translated into clinical practices that help streamline patient care. There are many gaps to the provision of high-quality survivorship care, all of which negatively affect patient outcomes. Some of these gaps include but are not limited to: the limited role of primary care providers (PCPs), lack of coordination of care, lack of evidence-based research, insufficient data on health promotion, and challenges implementing comprehensive care.

Conclusions: These findings indicate the need for a holistic and personalized approach to BCSC. The importance of implementing a multi-disciplinary and coordinated approach to survivorship care has been emphasized. This includes further involvement of PCPs, through increased training for PCPs in survivorship care. Despite available models of survivorship care, further research is needed to determine optimal BCSC that improves patient outcomes while decreasing the strain on the healthcare system. Additionally, technology can play a beneficial role in survivorship care, especially through telehealth and artificial intelligence (AI). Nonetheless, further research is needed on BCSC.

Background: Recognizing and appropriately treating symptoms of suffering in patients receiving palliative care is a means to enhance the quality of life for both the patient and their family. The objective of this study was to determine the proportion of pharmacological treatments for symptoms of suffering and prescribing patterns in hospitalized patients receiving palliative care at a tertiary care government general hospital.

Methods: This retrospective study was conducted at the Prachuapkhirikhan Hospital, Thailand. All patients over 18 years old who were admitted to the hospital and received palliative care were included. Data were collected from medical charts and analyzed using descriptive statistics.

Results: During the 3-year period of study, 296 admissions were included. Cancer, cardiovascular disease, and infectious disease were the top three primary diseases for which patients received palliative care. Dyspnea was the most reported symptom of suffering (81.08%), followed by fatigue, constipation, and pain (41.89%, 35.14%, and 25.34%, respectively). All cases experienced fatigue, depression, insomnia, and anxiety received pharmacological treatment. Dyspnea, pain, nausea/vomiting, delirium, and malignant bowel obstruction were treated in at least 80% of the cases experiencing suffering. Constipation, diarrhea, and anorexia/cachexia were treated in approximately 66.35%, 78.57%, and 67.86% of the cases, respectively. Strong opioids were the most commonly used medication for the treatment of dyspnea or pain.

Conclusions: Our study revealed that suffering symptoms were routinely identified in hospitalized palliative care patients. Pharmacological treatments were prescribed to manage most of these symptoms. However, there is a need to improve the quality of assessing suffering symptoms severity to enhance their effectiveness.

Hepatobiliary malignancies (HBMs), primarily hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), share the common traits of having a generally poor prognosis, late presentation, and high symptom burden related to both the disease process itself and underlying poor liver function. The incidences of both malignancies have been rising in recent decades for unclear reasons. Curative options remain limited given the general aggressive disease course despite advances in diagnosis, therapies, and surgery. Early integration of palliative care into the routine care of patients with HBMs is an essential, but underutilized, component of care to improve the functional and symptomatic quality of the lives of patients and their families. While formal guidelines for its integration are currently lacking, palliative care can and should be provided in parallel to disease specific care at any stage to address the physical, emotional, and spiritual needs of patients with HBMs. In this review, the special needs of this patient population are examined ranging from early symptom management at the time of diagnosis all the way through to end-of-life care. Key barriers that prevent the early provision of palliative care for patients with HBMs are identified and discussed and recommendations provided on how to improve early integration.

Background: Prolonged grief disorder (PGD) was added as a new disorder to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) in 2022. PGD is defined as an intense yearning or longing for the deceased and preoccupation with thoughts or memories of the deceased. The official diagnostic criteria for PGD do not include physical symptoms, but it is sometimes associated with somatic symptoms.

Case description: We present the case of a patient suffering from facsimile illness who lost her husband due to the deterioration of a brain tumor. She suffers from similar physical symptoms (severe headache reminiscent of a brain tumor, and hypertension) as her deceased husband. We focused on the dual process model in which grief exposure and behavioral activation began, ensuring an oscillation between loss-oriented grief (e.g., crying, feeling a continuing bond) and restoration-oriented grief (e.g., attending to life changes, new roles/identities/relationships). Outpatient psychotherapy based on the dual-process model of grief improved her physical symptoms.

Conclusions: This case report highlights the physical symptoms experienced by those bereaved by a deceased loved one. Exposure therapy and behavioral activation approaches based on the dual-process model of grief response were effective in reducing the physical symptoms of facsimile illness. Physical symptoms in deceased family members triggered by bereavement are often overlooked and need to be recognized.