Annals of palliative medicine最新文献

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.

Background: Late-stage and recurrent disease patients with a prognosis of 6-24 months should receive specialty palliative care, yet only 30% of eligible patients are referred. We aimed to characterize outpatient palliative care referral sources, timeliness, and completion rates across our cancer center at The University of Kansas Medical Center.

Methods: We conducted a single institution retrospective quality improvement study of patients in oncology subspecialties with the most palliative care referrals from 2019-2022 at our institution. Data collected included demographics, referral sources, and utilization metrics. The primary outcome was referral completion rates, and secondary outcomes included time from referral to first palliative care visit, hospice enrollment, and/or death. We performed descriptive statistics using chi-square and one-way analysis of variance (ANOVA) tests to compare oncologic subspecialty cohorts regarding these outcomes.

Results: There were 1,674 outpatient specialty palliative care referrals. Medical oncologists initiated 57%, whereas surgical oncologists initiated only 14%. Seventy-four percent of patients referred were ultimately seen by outpatient palliative care. Gynecologic and breast cancer patients had the highest rates of being scheduled. The median time from referral to appointment was 20 days, ranging from 19-23 days. The most common reason patients did not utilize palliative care was patient choice (41%). Eighty-five percent of patients were enrolled in hospice at the time of death; gynecologic cancer patients had the highest rate of enrollment. The median time from referral to hospice was 66 days and the median time from palliative care referral to death was 92 days. Gynecologic cancer patients had the longest median times for both metrics.

Conclusions: At our cancer center, most patients referred to outpatient specialty palliative care were seen within 30 days, which represents timely initiation of palliative care after referral placement. However, the uptake of outpatient specialty palliative care and the timing of outpatient specialty palliative care referral relative to end-of-life transitions varied across oncologic subspecialties. Relevant goals for quality improvement interventions include increasing palliative care referrals among surgical oncologists, referring patients earlier in the disease process, and reframing palliative care as a beneficial resource for all patients.

Breast cancer, a heterogeneous malignancy with a significant global burden, necessitates evolving therapeutic strategies. With nearly two million new cases diagnosed annually, metastatic dissemination remains a critical clinical challenge despite advancements in surgery, radiotherapy, and cytotoxic chemotherapy. The emergence of targeted therapies, including monoclonal antibodies, small-molecule inhibitors, and antibody-drug conjugates (ADCs), has revolutionized breast cancer management by selectively modulating oncogenic signaling pathways to inhibit tumor proliferation and spread. This approach offers a more focused treatment strategy with the potential for reduced systemic toxicities. Targeted therapies have demonstrated significant clinical efficacy across breast cancer subtypes. For instance, agents such as trastuzumab, pertuzumab, and trastuzumab emtansine (T-DM1) improved survival in human epidermal growth factor receptor 2 (HER2)-positive disease. Similarly, cyclin dependent kinase 4/6 (CDK4/6) and poly (ADP-ribose) polymerase (PARP) inhibitors have yielded substantial benefits in hormone receptor-positive and breast cancer gene (BRCA)-mutated breast cancers, respectively, by modulating endocrine resistance and DNA repair pathways. Furthermore, phosphoinositide 3-kinase (PI3K) inhibitors for PIK3CA-mutant tumors and immune checkpoint inhibitors for triple-negative breast cancer (TNBC) have expanded the available therapeutic measures. However, despite these advancements, challenges such as acquired resistance, often driven by pathway reactivation or gene mutations, continue to limit optimal patient outcomes. Additionally, treatment-related toxicities demand rigorous management, therefore ongoing identification of robust predictive biomarkers to refine patient selection and treatment strategies remains a critical focus of research. This mini-review provides a comprehensive overview of current targeted therapies in breast cancer, detailing their mechanisms of action, clinical efficacy, and associated toxicities. It addresses relevant challenges such as resistance pathways, financial toxicity, and gaps in biomarker research, while emphasizing the importance of patient-centered decision-making and multidisciplinary care. Future directions include the development of next-generation sequencing, refined drug designs, and the integration of immunotherapies to further improve patient outcomes and quality of life, ultimately striving towards personalized cancer care.

Background and objective: Palliative care aims to improve quality of life and reduce suffering among patients facing serious illnesses and their families. Patients with surgical conditions have various palliative care needs, although the incorporation of palliative care principles in perioperative care may be suboptimal. The aims of this narrative review are to define and delineate the surgeon's role in integrating palliative care in surgical practice, through highlighting strategies and opportunities for surgeons to engage with patients, families, and interdisciplinary palliative care providers.

Methods: We searched PubMed and EMBASE databases for English-language publications dated between January 2010 to May 2024, according to the search terms: "palliative care", "surgery", and "surgeon". Inclusion criteria were: (I) studies involving adult patients (given differing considerations in pediatric populations); (II) original quantitative or qualitative research (i.e., those with primary data), including case reports and series; and (III) a primary focus on palliative care in the context of surgical conditions. A total of 713 manuscripts were initially identified to be potentially relevant and a total of 43 articles were included for this review. In addition, we describe an illustrative case involving a patient with a surgical condition facing critical illness to highlight opportunities for surgeons to engage in serious illness communication and palliative care.

Key content and findings: We emphasize the surgeon's roles in both perioperative communication and shared decision-making with patients and families regarding surgical interventions, along with potential strategies for improved communication and enhanced primary palliative care skills. In addition, we describe valuable opportunities for surgeons to collaborate with interdisciplinary palliative care teams in the care of patients with surgical conditions.

Conclusions: Opportunities for surgeons to utilize palliative care approaches and engage with palliative care specialists in surgical and perioperative care exist, which may improve the patient and family experience.