Annals of palliative medicine最新文献

Background and objective: Young women with breast cancer (YWBC) face unique survivorship challenges due to being diagnosed at a more vulnerable stage in life and receiving gonadotoxic and/or antiestrogen therapy during their reproductive years. The purpose of this article is to elaborate on these challenges and demonstrate how specialized supportive care programs tailored specifically for YWBC, can greatly facilitate the provision of interventions to address these challenges.

Methods: The databases used were PubMed and Medline. Articles included those that involve young women with breast cancer and survivorship care needs.

Key content and findings: Compared to older breast cancer patients, YWBC generally require more aggressive treatments and are more likely to have a hereditary basis for their disease. Common challenges include childbearing concerns, premature menopause, body image issues, excessive fear of cancer recurrence, difficulties with intimate relationships, and financial toxicity. A possible solution to addressing these needs are longitudinal care in a specialized supportive care program, such as the PYNK Program for Young Women with Breast Cancer in Toronto, Ontario, Canada. Examples of such interventions include fast-tracking fertility preservation, aggressive management of symptoms of iatrogenic menopause, peer support groups, as well as individualized psycho-social support for the patient and her family.

Conclusions: By addressing the unique needs of this population, supportive care programs can play a crucial role in empowering young women with breast cancer to cope with the physical, emotional, and practical challenges they may face during and after treatment. The limitation lies in resource availability and funding for sustainability. Ongoing research is required to better understand the needs of YWBC patients in survivorship and ensure the sustainability of programs designed to address these challenges.

Background: Bone metastasis is the most common cause of cancer-related pain. Radiation therapy (RT) can provide successful palliation but there is currently no consensus for surveillance after palliative radiation. This study aimed to assess the feasibility of surveillance after RT for painful bone metastases.

Methods: The study took place in an academic cancer center. Patient feasibility measures included % of calls answered, ease of recruitment and study retention. Clinician measures included % of calls made within 3 days, call time and qualitative feedback. Patients were identified with a painful bone metastasis treated with RT. The bone metastasis had a worst pain score of at least 4 (0-10 scale), with pain localized to a radiographically confirmed lesion. Patients were called at weeks 1, 4 and 8 following RT. Pain response and opioid use were assessed. Quality of life was assessed using a validated questionnaire. Descriptive statistics were used to assess if these metrics were met for patients and clinicians over 8 weeks post-RT.

Results: Twenty patients were consented: 14 participants completed treatment and were not hospitalized or deceased prior to week 1. The patients were 50% male and 50% female. Recruitment was completed quickly, with no patients withdrawing. Response rate was week 1: 85% week 4: 83% and week 8: 83%. Six patients were referred back to their provider for pain management. Calls were made to patients within 3 days a median of 63% of the time (range, 40-82%), with a median call time of 16 (range, 8-42) minutes. Call lengths were longer for patients who required interpretation. Nurse feedback highlighted length of call and nursing time available as limitations.

Conclusions: All patient feasibility measures were met. Six patients required further pain management, highlighting a need for improved follow up post-RT for bone metastases. Staffing challenges for this intervention must be overcome.

Background and objective: Male breast cancer (MBC) accounts for nearly one percent of all diagnosed breast cancer (BC). In the United States alone, there were 2,670 MBC reported cases and 500 fatalities in 2019. In addition to the general challenges faced by patients to diagnose and treat cancer, MBC patients experience stigma from the medical community and their own feelings of embarrassment. The presence of stigma has a negative impact on the quality of life and psychological outcomes of MBC patients. This narrative review investigates current research on the presence of stigma in the diagnosis and care of MBC patients, and the role of stigma as a barrier to care.

Methods: Current literature on MBC and stigma was found through a search of PubMed and Google Scholar. The search strategy consisted of keywords related to "male breast cancer, stigma, awareness, experiences, and social support". Studies published from January 2005 to April 2024, that were retrievable and written in English, were included in this review.

Key content and findings: Several studies have supported that MBC patients experience stigma due to the lack of awareness in the medical community, and feelings of embarrassment felt by the patients. This stigma is seen through insufficient guidelines on MBC diagnosis and treatment and a lack of male-specific information for BC. These topics of stigma act as barriers to care, as they lead to psychological distress (e.g., anxiety and depression) and delayed diagnoses. Current studies suggest addressing the lack of information and awareness of MBC and implementing screening procedures to mitigate the negative impact of stigma.

Conclusions: This review highlights the presence of stigma in the care of MBC patients and its distressing effects on patients. There is a need for increased awareness among the medical community to improve diagnosis and treatment of MBC patients, to allow for more equitable care. Future therapies should focus on the viability of routine screening programs for male patients and addressing the gap of male-specific information.

Background and objective: Due to advances in early detection and treatment options, non-central nervous system (non-CNS) cancer survivors are living longer, even those with metastatic disease. Many of these survivors will experience enduring symptoms of breast cancer, such as cancer-related cognitive impairment (CRCI). Although CRCI is bothersome and, in some cases, potentially debilitating, little research has been done to address this symptom. Thus, the overarching goal of this narrative review is to provide both an overview of the problem of CRCI and its impact and focus on the latest research aimed at addressing CRCI in non-CNS cancer survivors.

Methods: A MEDLINE database (PubMed) search was conducted for terms related to non-CNS cancer, cognition, impacts of CRCI, and interventions. The English-language articles published until April 8th, 2024, were included in the search.

Key content and findings: CRCI includes self-reported cognitive complaints and/or impaired performance in multiple cognitive domains, including memory, processing speed, attention, and executive function. CRCI, in turn, can have a significant impact on everyday functioning, work ability, work engagement and productivity, and overall quality of life (QoL) of cancer survivors. While some researchers have examined pharmacological approaches, the vast majority of the interventional studies to date to address CRCI has focused on non-pharmacological approaches. Three of the most common non-pharmacological approaches are physical activity or exercise, mind-body approaches [e.g., mindfulness-based stress reduction (MBSR)], and cognitive rehabilitative approaches [e.g., cognitive training (CT) and cognitive behavioral therapy (CBT)].

Conclusions: Addressing the cognitive health of cancer survivors is imperative but has only recently been the focus of interventional research. More research in larger and more diverse samples of non-CNS cancer survivors is needed to identify effective ways to manage CRCI for all cancer survivors. Overall, maintaining cognitive health, especially in cancer survivors who are at increased risk for deficits, is a national health care priority that should not be ignored.

Background: Concurrent palliative care for patients with advanced cancer has been shown to reduce physical and psychological symptoms, and improve the quality of life of patients with advanced cancer. Underutilization of palliative care services, especially among African American patients with advanced cancer, remains an important public health problem. To address this gap, we developed a community health worker (CHW) palliative care intervention for African American patients with advanced cancer, which is being formally assessed through an ongoing effectiveness-implementation trial (NCT05407844). As part of the preparatory phase of this study, we conducted qualitative interviews with African American patients with advanced cancer and their caregivers. The objective of this analysis was to explore patient and caregiver attitudes and perceptions of the CHW palliative care intervention to support African American patients with advanced cancer in accessing palliative care.

Methods: We used purposive sampling to identify African American patients with advanced cancer and their informal caregivers from clinic lists and through referring oncologists. We conducted six individual and group semi-structured interviews with patients and caregivers between November 2022 and April 2023 at three enrollment sites: Johns Hopkins Hospital, TidalHealth Peninsula Regional, and University of Alabama at Birmingham Hospital. The interview guide was informed by the Consolidated Framework for Implementation Research, with a focus on the Innovation and Inner Setting domains. We used the framework method for thematic analysis.

Results: Overall, there was a lack of awareness and understanding of palliative care, due primarily to limited experiences with palliative care services among study participants. Despite this lack of familiarity, participants recognized the potential benefits of palliative care for patients with advanced cancer. All study participants were enthusiastic about the concept of patient navigation and the CHW palliative care intervention, with CHWs as lay patient navigators in palliative care. When reflecting on their own experiences, patients and their caregivers identified several areas where CHWs may have supported their cancer care, such as care coordination. Study participants viewed the CHW palliative care intervention as fulfilling a need within the African American community. Participants also made intervention delivery recommendations related to CHW characteristics, training and integration, and communication.

Conclusions: This study provides evidence for the acceptability of a CHW palliative care intervention for African American patients with advanced cancer and their caregivers. The findings of this study have led to intervention refinement, which will enhance implementation, delivery, and sustainability of the intervention.

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.

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.

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: Childhood cancer persists as a prominent public health concern in low- and middle-income countries (LMICs), with only a 20% survival rate. In Bangladesh, 67% of healthcare expenses are out of pocket. Since 2012, World Child Cancer-UK (WCC-UK) has collaborated with Bangabandhu Sheikh Mujib Medical University (BSMMU) to address this issue. This evaluation aimed to assess the project's purpose and impact, delivering insights to donors regarding their contributions, best practices, lessons learned, potential challenges encountered, and recommendations for future project development or refinement.

Methods: This study employed a qualitative method to evaluate the WCC-UK project objectives from May to June 2017. It involved seven document reviews and nine key informant interviews (KIIs) with project leadership, collaborating partners at the Hub and Satellites, management staff, and Twinning Partners. Besides, two in-depth interviews (IDIs) were carried out with certain beneficiaries, particularly parents of children with cancer. Thematic data analysis was performed to emanate the findings.

Results: Despite facing challenges such as an unclear management structure, ambiguous patient eligibility criteria, personnel issues, and communication gaps, the project made strides in several areas. BSMMU provided essential space and leadership, while Satellite Centers supported the project with continuing medical education (CME) and data entry. The project offered subsidies to poor patients and improved cancer awareness among healthcare providers and service seekers. Despite some parents receiving health and nutrition education during their hospital stays, developing a long-lasting system to educate them about long-term cancer care for their children was found to be formidable. The analysis also highlighted staffing shortages, a hierarchical gap between physicians and nurses, and a predominantly male leadership structure.

Conclusions: While the project has made progress toward its goals, there are critical areas that require attention to fully realize its objectives. Specifically, it is recommended that the project clarify its management structure, establish clear patient eligibility criteria, address staffing and communication issues, and work towards a more inclusive leadership. These improvements are essential for the project's long-term success and sustainability.