Annals of palliative medicine最新文献

Existential distress is commonly experienced by patients diagnosed with a life-threatening illness. This condition has been shown to adversely impact quality of life and is correlated with increased suicidal ideation and requests for hastened death. While palliative care teams are experienced in treating depression and anxiety, existential distress is a distinct clinical condition for which traditional medications and psychotherapy approaches demonstrate limited efficacy or duration of effect. Psychedelic drugs, including psilocybin and lysergic acid diethylamide (LSD), in conjunction with psychotherapy have been shown to produce rapid and sustained reductions in existential and psychiatric distress and may be a promising treatment for patients facing existential distress in palliative care settings. In this narrative review article, we describe the history of psychedelic medicine including early studies and the modern wave of research over the past 20 years, which includes high quality clinical trial data. This review outlines specific considerations for therapeutic application of psilocybin including pharmacokinetics, patient selection, dosing, protocol designs, and safeguards to reduce potential adverse effects to help guide future psychedelic practitioners. With growing public interest and evolving state level policy reforms allowing access to psychedelic treatments, it is critical for palliative care providers to gain familiarity with the current state of science and the potential of psilocybin assisted psychotherapy in the treatment of existential distress.

Background: Integration of palliative care has been shown to be beneficial and is therefore recommended. However, the specific methods for arranging such care remain unclear. Systematic referral and regular visits with a multi-professional palliative care team have appeared most beneficial. This study aimed to study how integrated palliative care is currently carried out in relation to which patients are referred to an integrated visit and what occurs during the visit, along with lifespan after the first integrated visit.

Methods: A retrospective chart review of all patients with an incurable cancer receiving integrated palliative care with ongoing oncologic therapy, who were treated in Tampere University Hospital, Finland, between January 1, 2018 and June 30, 2021.

Results: Altogether 207 patients were referred to an integrated palliative care visit, which covers 4% of the incurable cancer patients in the department of oncology at the same time. The most common reasons for referral were symptom burden and limited anti-cancer treatment possibilities. The need for advance care planning was seldom identified. During the first year after the integrated visit, 99 (48%) patients died. Approximately one-third of the patients received anti-cancer treatment in the last month of their life.

Conclusions: Based on the results of the study, the need for palliative care might be unmet, since so few patients are referred to integrated palliative care visits. Emphasis should be placed on identification of palliative care needs and advance care planning. The follow-up models of outpatient clinics should be examined and developed to better meet the needs of the patients.

Background: 2.4 million neonatal deaths and 2.6 million stillbirths occur each year. Over 98% of perinatal loss occurs in low- and middle-income countries. Despite the global burden of perinatal loss, access to relevant perinatal palliative and psychosocial care is poor and understudied.

Methods: In this review, we synthesize perinatal palliative care literature from low- and middle-income countries. We focus on the clinical practice of perinatal palliative care and educational models being used in resource-constrained settings. We used a systematic scoping review approach, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. The PubMed, Scopus, Embase, Cochrane, CINAHL, and Global Health (embsco) databases were searched. There were no date or language restrictions placed during the search. Study selection was conducted using Covidence to facilitate a staged review process.

Results: A total of 10,145 articles remained after removing duplicate studies. Following the three-staged review, 81 studies were included in our analysis. The largest portion of published perinatal palliative care literature focused on clinical care (n=44). Nine studies focused on provider training in perinatal palliative care and 28 studies addressed parent or family experience. Of the included studies, 84.9% had a first or last author from a low- or middle-income country and 91.8% included an author from the country of focus in the manuscript. The findings presented in this scoping review reveal that healthcare workers and families desire improved guidelines about perinatal palliative care that reflect the realities of local culture and resources. Additionally, providers need enhanced training in perinatal palliative care techniques and management approaches that can be applied in a range of clinical settings.

Conclusions: Global perinatal palliative care strategies must encompass compassionate communication with families, psychosocial support after stillbirth or neonatal death, and emotional and mental health support for healthcare workers who provide perinatal palliative care.

Background: Palliative radiotherapy (RT) is commonly used for malignancy-associated hemoptysis. This study aims to determine RT control probability, durability, and influencing factors.

Methods: This single-institution prospective observational study included patients ≥18 years old with any lung malignancy and active hemoptysis. Hemoptysis severity was captured and monitored via Common Terminology Criteria for Adverse Events (CTCAE) and an in-house developed Patient-Reported Outcome Measure (PROM) tool. Patients were interviewed at enrollment, 2 weeks, 3 months, and 6 months post-treatment. Descriptive statistics, the Kaplan-Meier (KM) method, the Wilcoxon signed-rank test, and Cox regression models were used.

Results: From April 2016 to November 2018, 41 patients were enrolled. One patient withdrew consent and was excluded. The median age was 68 years. Most patients were male (67%) with stage 4 (87.5%), lung primary (85%) disease, and Eastern Cooperative Oncology Group (ECOG) performance status ≥2 (55%). The most common fractionation scheme (72.5%) was 2,000 cGy in 5 fractions. Eight patients (20%) passed away before 2-week assessment. Median follow-up was 6.1 months (range, 0.9-6.2 months). The 6-month overall survival (OS) rate was 26% [95% confidence interval (CI): 13-41%]. The 6-month bleeding-related survival (BRS) was 95% (95% CI: 80-99%), and the 6-month freedom from hemoptysis rate was 37% (95% CI: 18-57%). No patient received re-irradiation for their hemoptysis. On univariate analysis, ECOG status (P=0.01) and prior radiation (P=0.006) were strongly associated with freedom from hemoptysis survival.

Conclusions: Hemostatic RT remains an effective modality for controlling hemoptysis. The short interval high mortality rate post-RT challenges whether fractionated palliative RT should be used for this patient population. Conducting a large clinical trial with a hemoptysis PROM tool is necessary to identify hemostatic durability and influencing factors properly.

Background: The rapid expansion of synchronous telephone and video virtual care options allowed the Veterans Health Administration (VHA) to adapt to the coronavirus disease 2019 (COVID-19) pandemic and provided a unique opportunity to assess the potential for integration and utility of virtual care in VHA systems. The objective of this study was to highlight the perspectives of VHA providers caring for intensive care unit (ICU) patients during the COVID-19 pandemic and their views on the use of virtual care and communication for palliative and end-of-life patients.

Methods: Forty-eight semi-structured qualitative interviews were conducted with providers between April 2021 and March 2022 and were analyzed using steps informed by thematic content analysis. Participants were eligible if they delivered ICU care to surgical patients at VHA hospitals. Participants were recruited from 14 VHA facilities across the United States. Participants were asked questions about their experiences as providers working with ICU patients, including about the impacts of the COVID-19 pandemic and ways in which virtual care was adapted to deal with emerging challenges.

Results: When asked about their experiences with ICU patient care during the COVID-19 pandemic, participant experiences showed: (I) disruption of staff roles and responsibilities, (II) reduced opportunities for communication and rapport building with family members, and (III) increased patient isolation. In each case, virtual options were adapted to overcome these emerging barriers, but limitations for the utility of those options for palliative and end-of-life care patients remain.

Conclusions: Virtual options were an important adaptation for providers during the COVID-19 pandemic, but their use can be limited in palliative and end-of-life care settings. However, when visitation is limited, virtual options can support communication between providers, family members, and caregivers.

Background and objective: Breast cancer is the most prevalent cancer among women worldwide, with 45% of them over 65 years old. Older breast cancer patients tend to be underrepresented and understudied in major clinical trials. This narrative review provides a comprehensive overview of the current evidence regarding treatment decision-making, treatment toxicities, and proposed survivorship management recommendations for geriatric cancer patients.

Methods: A literature search was conducted on PubMed and Google Scholar. The search strategy included a combination of keywords related to clinical management and treatment toxicities of older cancer breast cancer patients. English articles published between May 1990 to May 2024 were included.

Key content and findings: Older breast cancer patients represent a heterogeneous group with specific needs and treatment considerations. Treatment decisions for geriatric cancer patients should be based on a comprehensive geriatric assessment (CGA), which considers the patient's functional status, comorbidities, and preferences, rather than relying solely on chronological age. Breast cancer surgery is generally well tolerated in older patients, with a low rate of systemic complications and 30-day post-surgery mortality. In selected elderly patients, axillary surgery may be omitted to minimize side effects. The choice of endocrine therapy should take into account the side effect profile, patient's comorbidities, concomitant medications, and preferences. While aromatase inhibitors provide better efficacy, musculoskeletal side effects and osteoporosis may be a concern for older patients. CDK4/6 inhibitors have a similar efficacy in elderly patients as younger patients, but the incidence of neutropenia and dose modifications or interruptions are more frequent. Reported radiotherapy side effects are similar across age groups, although the occurrence of radiation-induced pulmonary toxicities was found to be associated with old age. Chemotherapy is reserved for triple-negative and HER2-positive disease in elderly patients due to known side effects. such as neutropenia, cardiotoxicity, and cognitive impairment. Data on the efficacy and safety of immunotherapy use in older patients are limited.

Conclusions: Physicians should make additional efforts to evaluate age-specific treatment efficacy and treatment-induced toxicities. Further efforts to enhance the representation of older patients in breast cancer trials are warranted.