Annals of palliative medicine最新文献

Background: Delirium is a common condition at the end of life and causes significant distress in patients and their loved ones. A precipitant factor can be found in less than half of the patients and the management interventions are limited.

Case description: A patient in his late sixties with low English proficiency with a metastatic neuroendocrine tumor was transferred to a palliative care unit on non-invasive bilevel ventilation. He appeared to become delirious and agitated, trying to remove the face mask, wriggling in bed, and tapping the bedrails. Haloperidol and lorazepam were required when non pharmacological interventions failed to calm him down. The following morning, the patient was able to explain that the positive-pressure facemask was suffocating him and that he could not breathe. So, he was transitioned to high-flow oxygen via nasal cannula, and within a few hours, his respiratory distress significantly improved, and he regained his previous self.

Conclusions: In this report, we highlight the challenges faced by clinical teams diagnosing and managing delirium, in particular when a language barrier is present. Non-invasive bilevel ventilation is generally avoided in patients at the end of life (unless it offers comfort and it is aligned with the patient's wishes), but if used should be considered as a cause of agitation and worsening shortness of breath, especially when it can be easily tested by removing the facemask.

Background: Although aggressive care at the end of life (ACEOL) for advanced gastrointestinal cancer can impose a significant burden on patients and healthcare systems, its prevalence and underlying determinants remain poorly understood. This study aimed to quantify the frequency of ACEOL and identify risk factors associated with such care in a Japanese population.

Methods: We retrospectively reviewed 275 patients with advanced gastrointestinal cancer who initiated first-line palliative chemotherapy at Osaka Medical and Pharmaceutical University between 2017 and 2022. ACEOL was defined according to established indicators, including prolonged hospitalization, multiple emergency department visits or hospital admissions, initiation of a new chemotherapy regimen, intensive care unit admission, and death in an acute care hospital during the last month of life. Logistic regression analyses were performed to explore factors predictive of ACEOL.

Results: Overall, 57.8% of patients (159/275) received at least one indicator of ACEOL. The most common factors were death in an acute hospital (38.5%) and prolonged hospitalization (>14 days; 33.8%). Patients receiving ACEOL had significantly shorter overall survival (OS) than those not receiving ACEOL (8.5 vs. 12.9 months, P=0.02). Younger age [odds ratio (OR) 2.01] and opioid use at the start of chemotherapy (OR 3.39) were identified as independent predictors.

Conclusions: More than half of these patients with advanced gastrointestinal cancer received ACEOL, partly driven by younger age and opioid use at baseline. These findings highlight the need for early identification of high-risk patients and proactive integration of palliative care services to decrease ACEOL.

Background: Patients with symptomatic bone metastases often require urgent palliative radiotherapy, yet conventional treatment planning workflows involving computed tomography (CT) simulation can delay the treatment planning. The purpose of this study is to utilize diagnostic CT for palliative radiotherapy treatment planning in patients with bone metastases in order to reduce the time between physician consultation and treatment planning.

Methods: We retrospectively collected data from 27 eligible patients treated for bone metastases at Mount Sinai Hospital between April 2020 and May 2023. From the original treatment plans, contours, beam arrangements, and administered monitor units (MUs) were transferred from the planning CT to the diagnostic CT for dose calculation. Plan quality was evaluated using target volume coverage metrics, including planning target volume (PTV) V95%, PTV mean dose, and global hotspots.

Results: Out of all the patients in our database, four patients were excluded due to absence of a prior diagnostic CT scan, and three patients were excluded since the entire target volume was not within the diagnostic CT field of view. In total, 26 treatment plans from 20 patients were compared with the original plans. The potential reduction in wait time was estimated by subtracting the average time from initial consult to CT simulation, which was approximately 6.5±1.2 days in this cohort. For all 26 diagnostic CT plans, the mean PTV V95% was 95.3%±0.2%. Compared to the original plans, mean V95% decreased by 1.3%±0.7% and global hotspots increased by 1.80%±0.004% in the diagnostic CT plans.

Conclusions: Our study demonstrated that treatment planning with diagnostic CT is feasible in the palliative radiotherapy setting for patients with bone metastases. This approach may reduce the time between physician consultation and treatment planning, thereby enabling timely relief for patients with symptomatic bone metastases.

Background and objective: The coronavirus disease 2019 (COVID-19) pandemic resulted in an historic disruption and transformation of the healthcare system, including the management of individuals with serious illness. Rehabilitation for patients facing serious or life-threatening illness is underutilized and poorly understood, resulting in unwarranted suffering, disability, and poorly coordinated care. This narrative review aims to describe the impact of the COVID-19 pandemic on the role and scope of rehabilitation within the context of serious illness and palliative care.

Methods: A focused review of the literature included selected articles identified from three databases published from January 2020 to January 2025. Findings were synthesized narratively, with a focus on identifying themes and gaps in the literature related to two main topics: (I) the evidence related to rehabilitation for those with serious or life-threatening COVID-19 during the pandemic and (II) how rehabilitation for patients with serious illness has been transformed after emerging from the pandemic (including non-COVID diagnoses such as cancer, neurologic conditions, etc.).

Key content and findings: The key themes identified during the COVID-19 pandemic emphasized the need for early rehabilitation, interdisciplinary care, and an emphasis on cardiopulmonary principles for rehabilitation. Themes identified during the pandemic also included the emerging role of telerehabilitation, and need for evidence and clinical guidelines for serious illnesses (including long COVID). Themes related to the transformative effect on palliative rehabilitation after the pandemic included an increased importance and focus on coordination of care and interdisciplinary care for those with serious illness and increased focus on mental health and social determinants of health (SDOH). Additionally, there appears to be increased infrastructure and activity related to research, advocacy, and awareness for palliative rehabilitation.

Conclusions: The COVID-19 global pandemic highlighted the need for high quality, coordinated palliative care, including rehabilitation services, for patients facing a serious or life-threatening illness. Due to the benefits to a person's quality of life (QoL), dignity, and comfort, there is increasing evidence of the importance of seamless, ongoing access to rehabilitation services for patients with serious illness.

Background and objective: Palliative care (PC) interventions have become essential in treating patients with acute myeloid leukemia (AML). Studies indicate that the early PC (EPC) integration during the entire disease course, from the diagnosis and the start of treatment until the end-of-life (EOL), especially regarding the decision-making process and the relief of symptom burden, can significantly impact the patient's quality of life (QoL) of AML patients and comprehensively address their physical and psychosocial needs. This narrative review synthesizes quantitative and qualitative research, including observational and randomized clinical studies, as well as review articles, to place issues of EPC within the context of AML.

Methods: This overview details our Medline English literature search from January 2010 to June 2025. A systematic search on PubMed was conducted in two phases: March-April 2025 and June 2025. We used several keywords, including AML, EOL care, EPC, PC, QoL, and symptom relief. Furthermore, we reviewed https://clinicaltrials.gov/ (last accessed June 30, 2025) and conducted manual searches of references to ensure the completeness of our findings. Additionally, we obtained expert insights through discussions with specialists in AML and PC.

Key content and findings: The key agendas of PC are symptom control, emotional support, and quality communication along the painful process of AML diagnosis and treatment. In this instance, patients who receive EPC experience a reduction in pain, anxiety, and depression compared to when patients are under standard care (SC), not supplemented with EPC. Additionally, integrating EPC is capable of enhancing patient-practitioner communication because it allows them to select the most appropriate treatment, ideally suited to the specific needs and experience of the patient.

Conclusions: The results of our review highlighted the evolving AML landscape, where novel therapies are now in practice, and numerous others are in development. Therefore, newer, reduced-intensity regimens can provide a duration of disease control but not remission. Thus, decision-making with treating physicians and initial treatment to control symptoms, together with psychological counseling, are integral parts of AML treatment, aiming to achieve greater satisfaction and better emotional well-being in patients and caregivers.

Cirrhosis continues to excel as one of the leading causes of death worldwide, characterized by an often tumultuous and unpredictable disease course with progressive decline accompanied by severe symptom burden, impacted quality of life (QOL), high healthcare expenditures, and caregiver burn out. This patient population often has concurrent concerns related to their underlying disease such as substance use disorders, mental health, or socioeconomic factors that may complicate their management. Palliative care (PC) and a multidisciplinary team approach can make substantial impacts through additional psychosocial support and symptom management for improved QOL. Barriers to timely PC intervention include lack of education and resources, poor health literacy, and social and health inequities. Lack of education and understanding from healthcare providers and healthcare systems as well as misunderstanding at individual, community, and societal levels are persistent problems that can perpetuate incorrect information and create confusion around PC involvement. Poor health literacy, considered a global public health concern, has become a priority in addressing chronic disease management. It is a known barrier to patient engagement in shared decision making and has been associated with poor health outcomes in PC; thus, contributing to health inequities in vulnerable and disadvantaged patient populations. Health literacy development that can lead to sustainable optimal health outcomes will require understanding the complex, multi-dimensionality of health literacy of each population with its strengths and limitations that reflect real-world settings and experiences. With this, the chronic liver disease (CLD) patient population faces unique challenges that will require a robust partnership between healthcare providers, healthcare systems, patients, local communities, stakeholders and leadership, in order to enhance our understanding of the challenges faced by these vulnerable populations and in turn address gaps and barriers to ensure comprehensive, holistic, and equitable health care models of patient-centered care.