Palliative and Supportive Care in Oncology: An Update

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: closed (10 February 2022) | Viewed by 69547

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Guest Editor
Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, FC, Italy
Interests: early palliative care; prognosis; palliative sedation
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Special Issue Information

Dear Colleagues,

Palliative care (PC) is an essential component of modern oncology. It is included in the treatment path in a progressive and integrated way, based on the needs of the patients and, in part, on their prognosis. PC can be further distinguished as early palliative care and end-of-life palliative care. Research in PC is essential to provide scientific evidence for what procedures should be adopted in clinical practice. The purpose of this monographic issue of Cancers is to present updates on classic themes or presentations of innovative themes on some topics. The papers, original studies or reviews, can concern organizational (early palliative care, integration between PC and radiotherapy) or clinical (delirium, PROMs, palliative sedation, PC in lung cancer) aspects or be focused on innovative topics (prognosis, philosophy of Cicely Saunders, new drugs in PC, neonatal comfort care, PC in cancer survivors).

Prof. Marco Cesare Maltoni
Guest Editor

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Keywords

  • palliative care
  • symptom management
  • prognostic factors
  • cancer pain
  • delirium
  • palliative sedation
  • PROM

Published Papers (20 papers)

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Research

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15 pages, 1041 KiB  
Article
A Retrospective, Single-Center Analysis of Specialized Palliative Care Services for Patients with Advanced Small-Cell Lung Cancer
by Claudia Wachter, Klaus Hackner, Iris Groissenberger, Franziska Jutz, Lisa Tschurlovich, Nguyen-Son Le and Gudrun Kreye
Cancers 2022, 14(20), 4988; https://doi.org/10.3390/cancers14204988 - 12 Oct 2022
Cited by 2 | Viewed by 1649
Abstract
Timely integration of specialized palliative care (SPC) has been shown to improve cancer patients’ quality of life (QoL) and reduced the use of medical services. To evaluate the level of integration of SPC services for patients with advanced small-cell lung cancer (SCLC), we [...] Read more.
Timely integration of specialized palliative care (SPC) has been shown to improve cancer patients’ quality of life (QoL) and reduced the use of medical services. To evaluate the level of integration of SPC services for patients with advanced small-cell lung cancer (SCLC), we retrospectively analyzed medical records of patients from 2019 to 2021. Regarding the timing of referral to SPC services, we defined four cutoffs for early referral according to the current literature: (a) SPC provided ≤ 60 days after diagnosis; (b) SPC provided ≥ 60 days before death; (c) SPC provided ≥ 30 days before death; and (d) SPC provided ≥ 130 days before death. One hundred and forty-three patients (94.1%) were found to have locally advanced (stage III) or metastatic (stage IV) disease. Sixty-eight were not referred to SPC services (47.6%), whereas 75 patients received SPC (52.4%). We found a significantly higher number of referrals to SPC services for patients with higher ECOG (Eastern Cooperative Oncology Group) (i.e., ECOG ≥ 2) (p = 0.010) and patients with stage IV disease (p ≤ 0.001). The median overall survival (OS) for SCLC stage III/IV patients (n = 143) who did not receive SPC treatment was 17 months (95% CI 8.5–25.5), while those who did receive SPC treatment had a median OS of 8 months (95% CI 6.2–9.8) (p = 0.014). However, when we evaluated patients receiving SPC treatment in a timely manner before death as suggested by the different cutoffs indicated in the literature, they lived significantly longer when referred at a minimum of ≥60 or ≥130 days before death. Based on our findings, we suggest that patients with advanced SCLC should participate in a consultation with a SPC team in a timely manner to ensure a benefit of SPC for this patient group. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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17 pages, 2674 KiB  
Article
Genome-Wide Association Study Identifies Candidate Loci Associated with Opioid Analgesic Requirements in the Treatment of Cancer Pain
by Daisuke Nishizawa, Takeshi Terui, Kunihiko Ishitani, Shinya Kasai, Junko Hasegawa, Kyoko Nakayama, Yuko Ebata and Kazutaka Ikeda
Cancers 2022, 14(19), 4692; https://doi.org/10.3390/cancers14194692 - 27 Sep 2022
Cited by 3 | Viewed by 1593
Abstract
Considerable individual differences have been widely observed in the sensitivity to opioids. We conducted a genome-wide association study (GWAS) in patients with cancer pain to identify potential candidate single-nucleotide polymorphisms (SNPs) that contribute to individual differences in opioid analgesic requirements in pain treatment [...] Read more.
Considerable individual differences have been widely observed in the sensitivity to opioids. We conducted a genome-wide association study (GWAS) in patients with cancer pain to identify potential candidate single-nucleotide polymorphisms (SNPs) that contribute to individual differences in opioid analgesic requirements in pain treatment by utilizing whole-genome genotyping arrays with more than 650,000 markers. The subjects in the GWAS were 428 patients who provided written informed consent and underwent treatment for pain with opioid analgesics in a palliative care unit at Higashi-Sapporo Hospital. The GWAS showed two intronic SNPs, rs1283671 and rs1283720, in the ANGPT1 gene that encodes a secreted glycoprotein that belongs to the angiopoietin family. These two SNPs were strongly associated with average daily opioid requirements for the treatment of pain in both the additive and recessive models (p < 5.0000 × 10−8). Several other SNPs were also significantly associated with the phenotype. In the gene-based analysis, the association was significant for the SLC2A14 gene in the additive model. These results indicate that these SNPs could serve as markers that predict the efficacy of opioid analgesics in cancer pain treatment. Our findings may provide valuable information for achieving satisfactory pain control and open new avenues for personalized pain treatment. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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16 pages, 1895 KiB  
Article
Simultaneous Care in Oncology: A 7-Year Experience at ESMO Designated Centre at Veneto Institute of Oncology, Italy
by Antonella Brunello, Antonella Galiano, Stefania Schiavon, Mariateresa Nardi, Alessandra Feltrin, Ardi Pambuku, Chiara De Toni, Alice Dal Col, Evelina Lamberti, Chiara Pittarello, Francesca Bergamo, Umberto Basso, Marco Maruzzo, Silvia Finotto, Maital Bolshinsky, Silvia Stragliotto, Letizia Procaccio, Mario Domenico Rizzato, Fabio Formaglio, Giuseppe Lombardi, Sara Lonardi and Vittorina Zagoneladd Show full author list remove Hide full author list
Cancers 2022, 14(10), 2568; https://doi.org/10.3390/cancers14102568 - 23 May 2022
Cited by 6 | Viewed by 1871
Abstract
Benefits of early palliative care referral in oncology are well-validated. At the Veneto Institute of Oncology-IRCCS, a simultaneous-care outpatient clinic (SCOC) has been active since 2014, where patients with advanced cancer are evaluated by an oncologist together with a palliative care team. We [...] Read more.
Benefits of early palliative care referral in oncology are well-validated. At the Veneto Institute of Oncology-IRCCS, a simultaneous-care outpatient clinic (SCOC) has been active since 2014, where patients with advanced cancer are evaluated by an oncologist together with a palliative care team. We prospectively assessed SCOC patients’ characteristics and SCOC outcomes through internal procedure indicators. Data were retrieved from the SCOC prospectively maintained database. There were 753 eligible patients. The median age was 68 years; primary tumor sites were gastrointestinal (75.2%), genitourinary (15.0%) and other sites (9.8%). Predominant symptoms were psychological issues (69.4%), appetite loss (67.5%) and pain (65.9%). Dyspnea was reported in 53 patients (7%) in the referral form, while it was detected in 226 patients (34.2%) during SCOC visits (p < 0.0001). Median survival of patients after the SCOC visit was 7.3 months. Survival estimates by the referring oncologist were significantly different from the actual survival. Psychological intervention was deemed necessary and undertaken in 34.6% of patients, and nutritional support was undertaken in 37.9% of patients. Activation of palliative care services was prompted for 77.7% of patients. Out of 357 patients whose place of death is known, 69.2% died at home, in hospice or residential care. With regard to indicators’ assessment, the threshold was reached for 9 out of 11 parameters (81.8%) requested by the procedure. This study confirmed the importance of close collaboration between oncologists and palliative care teams in responding properly to cancer patients’ needs. The introduction of a procedure with indicators allowed punctual assessment of a team’s performance. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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15 pages, 2099 KiB  
Article
Development and Validation of the PaP Score Nomogram for Terminally Ill Cancer Patients
by Emanuela Scarpi, Oriana Nanni and Marco Maltoni
Cancers 2022, 14(10), 2510; https://doi.org/10.3390/cancers14102510 - 19 May 2022
Cited by 7 | Viewed by 1263
Abstract
The validated Palliative Prognostic (PaP) score predicts survival in terminally ill cancer patients, assigning patients to three different risk groups according to a 30-day survival probability: group A, >70%; group B, 30–70%; and group C, <30%. We aimed to develop and validate a [...] Read more.
The validated Palliative Prognostic (PaP) score predicts survival in terminally ill cancer patients, assigning patients to three different risk groups according to a 30-day survival probability: group A, >70%; group B, 30–70%; and group C, <30%. We aimed to develop and validate a PaP nomogram to provide individualized prediction of survival at 15, 30 and 60 days. Three cohorts of consecutive terminally ill cancer patients were used: one (n = 519) for nomogram development and internal validation, and a second (n = 451) and third (n = 549) for external validation. Multivariate analyses included dyspnea, anorexia, Karnofsky performance status, clinical prediction of survival, total white blood count and lymphocyte percentage. The predictive accuracy of the nomogram was determined by Harrell’s concordance index (95% CI), and calibration plots were generated. The nomogram had a concordance index of 0.74 (0.72–0.75) and showed good calibration. The internal validation showed no departures from ideal prediction. The accuracy of the nomogram at 15, 30 and 60 days was 74% (70–77), 89% (85–92) and 72% (68–76) in the external validation cohorts, respectively. The PaP nomogram predicts the individualized estimate of survival and could greatly facilitate clinical care decision-making at the end of life. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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11 pages, 460 KiB  
Article
Aromatherapy in Palliative Care: A Single-Institute Retrospective Analysis Evaluating the Effect of Lemon Oil Pads against Nausea and Vomiting in Advanced Cancer Patients
by Gudrun Kreye, Manuela Wasl, Andrea Dietz, Daniela Klaffel, Andrea Groselji-Strele, Katharina Eberhard and Anna Glechner
Cancers 2022, 14(9), 2131; https://doi.org/10.3390/cancers14092131 - 24 Apr 2022
Cited by 3 | Viewed by 4493
Abstract
Aromatherapy is regularly used in the University Hospital Krems’s palliative care unit. In a retrospective analysis, we investigated whether there were improvements in nausea and vomiting in patients with advanced cancers over a time span of 24 months. Data collection used the medical [...] Read more.
Aromatherapy is regularly used in the University Hospital Krems’s palliative care unit. In a retrospective analysis, we investigated whether there were improvements in nausea and vomiting in patients with advanced cancers over a time span of 24 months. Data collection used the medical records of patients who were institutionally approved to receive routine aroma applications for alleviating nausea and vomiting. The efficacy of using lemon oil pads was tested with one-dimensional chi-squared tests. Sixty-six patients received 222 applications of lemon oil on cotton pads; no data were available for 17 applications. The adequate relief of nausea and vomiting was reported for 149 (73%) applications, whereas no symptom control was seen for 56 (27%) applications. For the 56 applications without symptom control, first- and second-line rescue medications were successful in 53 and 3 cases, respectively. The use of aromatherapy with lemon oil pads against nausea and vomiting was feasible for 73% of all applications. All patients who did not benefit from aromatherapy had effective symptom control with a rescue medication. Large randomized prospective trials are necessary to evaluate the benefit of the use of lemon oil pads against nausea and vomiting in patients with advanced cancer. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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12 pages, 1517 KiB  
Article
Effectiveness of Naldemedine Compared with Magnesium Oxide in Preventing Opioid-Induced Constipation: A Randomized Controlled Trial
by Anna Ozaki, Takaomi Kessoku, Kosuke Tanaka, Atsushi Yamamoto, Kota Takahashi, Yuma Takeda, Yuki Kasai, Michihiro Iwaki, Takashi Kobayashi, Tsutomu Yoshihara, Takayuki Kato, Akihiro Suzuki, Yasushi Honda, Yuji Ogawa, Akiko Fuyuki, Kento Imajo, Takuma Higurashi, Masato Yoneda, Masataka Taguri, Hiroto Ishiki, Noritoshi Kobayashi, Satoru Saito, Yasushi Ichikawa and Atsushi Nakajimaadd Show full author list remove Hide full author list
Cancers 2022, 14(9), 2112; https://doi.org/10.3390/cancers14092112 - 24 Apr 2022
Cited by 12 | Viewed by 2897
Abstract
Opioid-induced constipation (OIC) may occur in patients receiving opioid treatment, decreasing their quality of life (QOL). We compared the effectiveness of magnesium oxide (MgO) with that of naldemedine (NAL) in preventing OIC. This proof-of-concept, randomized controlled trial (registration number UMIN000031891) involved 120 patients [...] Read more.
Opioid-induced constipation (OIC) may occur in patients receiving opioid treatment, decreasing their quality of life (QOL). We compared the effectiveness of magnesium oxide (MgO) with that of naldemedine (NAL) in preventing OIC. This proof-of-concept, randomized controlled trial (registration number UMIN000031891) involved 120 patients with cancer scheduled to receive opioid therapy. The patients were randomly assigned and stratified by age and sex to receive MgO (500 mg, thrice daily) or NAL (0.2 mg, once daily) for 12 weeks. The change in the average Japanese version of Patient Assessment of Constipation QOL (JPAC-QOL) from baseline to 2 weeks was assessed as the primary endpoint. The other endpoints were spontaneous bowel movements (SBMs) and complete SBMs (CSBMs). Deterioration in the mean JPAC-QOL was significantly lower in the NAL group than in the MgO group after 2 weeks. There were fewer adverse events in the NAL group than in the MgO group. Neither significant differences in the change in SBMs between the groups nor serious adverse events/deaths were observed. The CSBM rate was higher in the NAL group than in the MgO group at 2 and 12 weeks. In conclusion, NAL significantly prevented deterioration in constipation-specific QOL and CSBM rate compared with MgO. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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13 pages, 305 KiB  
Article
Symptom Prevalence in Spanish and Colombian Oncology Patients Measured with the MSAS
by Inés Llamas-Ramos, Rocío Llamas-Ramos, Gloria Mabel Carrillo-González, Jennifer Sepúlveda-Ramírez and Elizabeth Vargas-Rosero
Cancers 2022, 14(7), 1624; https://doi.org/10.3390/cancers14071624 - 23 Mar 2022
Cited by 3 | Viewed by 1488
Abstract
Cancer patients experience several symptoms throughout their illness and the treatments they receive. While this pathology represents a worldwide health problem, knowing the symptom prevalence in oncology patients remains a challenge; validated tools to obtain this information are essential. Furthermore, this prevalence information [...] Read more.
Cancer patients experience several symptoms throughout their illness and the treatments they receive. While this pathology represents a worldwide health problem, knowing the symptom prevalence in oncology patients remains a challenge; validated tools to obtain this information are essential. Furthermore, this prevalence information would help health professionals to establish appropriate treatments. The objective of this study was to ascertain the symptom prevalence in cancer patients from Spain and Colombia to improve future approaches. The frequency, severity, and distress of 32 symptoms from a validated scale experienced by cancer patients from Spain and Colombia were measured. Two hundred and forty-six patients (49.7%) who attended the Day University Hospital of Salamanca (Spain) and two hundred and forty-nine outpatients (50.3%) of the San Diego Cancer Center (Colombia) between 2016 and 2019 participated in the study. All patients filled in the Assessment Scale only once. Four hundred and ninety-five patients (333 women (67.3%) and 162 men (32.7%)) completed the Memorial Symptom Assessment Scale (Spanish version). The most frequent symptom for both samples (Spanish and Colombian) was “lack of energy” (38.4% and 13.7%, respectively). The most severe symptoms for the Spanish and Colombian samples were “problems with sexual interest or activity” (38.4%) and “dry mouth” (13.7%), respectively, and both samples agreed on the most distressing symptom: “hair loss” (Spanish, 38%; Colombian, 10.1%). The Spanish version of the MSAS has proven to be a valid and reliable tool in Spanish-speaking countries to obtain the most prevalent, severe, and distressing symptoms in Spanish and Colombian oncology patients. The prevalence of symptoms was demonstrated to be similar across both countries, and the results will help to design and adapt treatments for cancer patients, targeting these symptoms to reduce or avoid them and thus improving their quality of life. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
13 pages, 432 KiB  
Article
Antibiotic Therapy in Integrated Oncology and Palliative Cancer Care: An Observational Study
by Martine Kjølberg Moen, Erik Torbjørn Løhre, Gunnhild Jakobsen, Morten Thronæs and Pål Klepstad
Cancers 2022, 14(7), 1602; https://doi.org/10.3390/cancers14071602 - 22 Mar 2022
Cited by 1 | Viewed by 1807
Abstract
Decision-making for antibiotic therapy in palliative cancer care implies avoiding futile interventions and to identify patients who benefit from treatment. We evaluated patient-reported outcome-measures (PROMs), physiological findings, and survival in palliative cancer care patients hospitalized with an infection. All acute admissions during one [...] Read more.
Decision-making for antibiotic therapy in palliative cancer care implies avoiding futile interventions and to identify patients who benefit from treatment. We evaluated patient-reported outcome-measures (PROMs), physiological findings, and survival in palliative cancer care patients hospitalized with an infection. All acute admissions during one year, directly to a University Hospital unit that provided integrated services, were included. Serious infection was defined as a need to start intravenous antibiotics. PROMs, clinical and paraclinical variables, and survival were obtained. Sixty-two of 257 patients received intravenous antibiotic treatment. PROMs were generally similar in the infection group and the non-infection group, both in respect to intensities at admission and improvements during the stay. There were more physiological and paraclinical deviations at admission in patients in the infection group. These deviations improved during the stay. Survival was not poorer in the infection group compared to the non-infection group. Patients in integrated cancer care were as likely to be put on intravenous antibiotics but had longer survival. In integrated oncology and palliative cancer services, patients with an infection had similar outcomes as those without an infection. This argues that the use of intravenous antibiotics is appropriate in many patients admitted to palliative care. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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9 pages, 277 KiB  
Article
The Impact of Frailty Screening on Radiation Treatment Modification
by Encarnación Fernández-Camacho, Carlos Ferrer-Ramos, Virginia Morilllo-Macías, Marta Rodríguez-Cordón, Ángel Sánchez-Iglesias, Inmaculada Beato-Tortajada, Alicia Francés-Muñoz, Rodrigo Muelas-Soria, Teresa Piquer-Camañes, Ana Isabel Santafé-Jiménez, Vanessa Aznar-Tortonda and Carlos Ferrer-Albiach
Cancers 2022, 14(4), 1072; https://doi.org/10.3390/cancers14041072 - 21 Feb 2022
Cited by 1 | Viewed by 1792
Abstract
Background: Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs) in oncology settings. We analyzed if screening tools modified radiotherapy in oncogeriatric patients. Methods: Patients ≥ 65 years, irradiated between December 2020 and March 2021 at the Hospital Provincial de Castellón, [...] Read more.
Background: Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs) in oncology settings. We analyzed if screening tools modified radiotherapy in oncogeriatric patients. Methods: Patients ≥ 65 years, irradiated between December 2020 and March 2021 at the Hospital Provincial de Castellón, completed the frailty G8 and estimated survival Charlson questionnaires. The cohort was stratified between G8 score ≤ 14 (fragile) or >14 (robust); the cutoff point for the Charlson index was established at five. Results: Of 161 patients; 69.4% were male, the median age was 75 years (range 65–91), and the prevailing performance status (PS) was 0–1 (83.1%). Overall, 28.7% of the cohort were frail based on G8 scores, while the estimated survival at 10 years was 2.25% based on the Charlson test. The treatment administered changed up to 21% after frailty analysis. The therapies prescribed were 5.8 times more likely to be modified in frail patients based on the G8 test. In addition, patients ≥ 85 years (p = 0.01), a PS ≥ 2 (p = 0.008), and limited mobility (p = 0.024) were also associated with a potential change. Conclusions: CGAs remain the optimal assessment tool in oncogeriatry. However, we found that the G8 fragility screening test, which is easier to integrate into patient consultations, is a reliable and efficient aid to rapid decision making. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
13 pages, 1638 KiB  
Article
Sex Differences in the Effect of Vitamin D on Fatigue in Palliative Cancer Care—A Post Hoc Analysis of the Randomized, Controlled Trial ‘Palliative-D’
by Caritha Klasson, Maria Helde Frankling, Anna Warnqvist, Carina Sandberg, Marie Nordström, Carina Lundh-Hagelin and Linda Björkhem-Bergman
Cancers 2022, 14(3), 746; https://doi.org/10.3390/cancers14030746 - 31 Jan 2022
Cited by 4 | Viewed by 4082
Abstract
In the randomized, placebo-controlled, double-blind trial ‘Palliative-D’, vitamin D treatment of 4000 IE/day for 12 weeks reduced opioid use and fatigue in vitamin-D-deficient cancer patients. In screening data from this trial, lower levels of vitamin D were associated with more fatigue in men [...] Read more.
In the randomized, placebo-controlled, double-blind trial ‘Palliative-D’, vitamin D treatment of 4000 IE/day for 12 weeks reduced opioid use and fatigue in vitamin-D-deficient cancer patients. In screening data from this trial, lower levels of vitamin D were associated with more fatigue in men but not in women. The aim of the present study was to investigate possible sex differences in the effect of vitamin D in patients with advanced cancer, with a specific focus on fatigue. A post hoc analysis of sex differences in patients completing the Palliative-D study (n = 150) was performed. Fatigue assessed with the Edmonton Symptom Assessment Scale (ESAS) was reduced in vitamin-D-treated men; −1.50 ESAS points (95%CI −2.57 to −0.43; p = 0.007) but not in women; −0.75 (95%CI −1.85 to 0.36; p = 0.18). Fatigue measured with EORTC QLQ-C15-PAL had a borderline significant effect in men (−0.33 (95%CI −0.67 to 0.03; p = 0.05)) but not in women (p = 0.55). The effect on fatigue measured with ESAS in men remained the same after adjustment for opioid doses (p = 0.01). In conclusion, the positive effect of the correction of vitamin D deficiency on fatigue may be more pronounced in men than in women. However, studies focused on analyzing sex differences in this context must be performed before firm conclusions can be drawn. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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Review

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13 pages, 888 KiB  
Review
Effect of Opioids on Survival in Patients with Cancer
by Jason W. Boland
Cancers 2022, 14(22), 5720; https://doi.org/10.3390/cancers14225720 - 21 Nov 2022
Cited by 8 | Viewed by 1796
Abstract
Opioids are commonly used for pain management in patients with cancer. They have a range of unwanted effects, including some that potentially influence cancer growth. This article reviews the data assessing the effects of opioids on survival in patients with cancer. Many studies [...] Read more.
Opioids are commonly used for pain management in patients with cancer. They have a range of unwanted effects, including some that potentially influence cancer growth. This article reviews the data assessing the effects of opioids on survival in patients with cancer. Many studies assessing this show an association between opioids and decreased survival. This effect is present even at very low doses of opioids. These studies do not assess causality, so it is not known if it is a direct effect of opioids on survival. As the control groups are not matched to the opioid group it might be that opioids are being used to control pain and patients receiving opioids have more aggressive cancers and it is the underlying cancer which is causing the decreased survival. Furthermore, although some studies allude to different opioids having different effects on survival, often all opioids are pooled in analysis. Future work needs to try to ascertain causality and differentiate between different opioids, pain, and cancer-mediated effects on survival in specific cancer types. Until then, opioids should continue to be used in patients with cancer as part of measures to optimise comfort and quality of life. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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16 pages, 1418 KiB  
Review
Chronic Cancer Pain: Opioids within Tumor Microenvironment Affect Neuroinflammation, Tumor and Pain Evolution
by Angela Santoni, Matteo Santoni and Edoardo Arcuri
Cancers 2022, 14(9), 2253; https://doi.org/10.3390/cancers14092253 - 30 Apr 2022
Cited by 18 | Viewed by 3310
Abstract
Pain can be a devastating experience for cancer patients, resulting in decreased quality of life. In the last two decades, immunological and pain research have demonstrated that pain persistence is primarily caused by neuroinflammation leading to central sensitization with brain neuroplastic alterations and [...] Read more.
Pain can be a devastating experience for cancer patients, resulting in decreased quality of life. In the last two decades, immunological and pain research have demonstrated that pain persistence is primarily caused by neuroinflammation leading to central sensitization with brain neuroplastic alterations and changes in pain responsiveness (hyperalgesia, and pain behavior). Cancer pain is markedly affected by the tumor microenvironment (TME), a complex ecosystem consisting of different cell types (cancer cells, endothelial and stromal cells, leukocytes, fibroblasts and neurons) that release soluble mediators triggering neuroinflammation. The TME cellular components express opioid receptors (i.e., MOR) that upon engagement by endogenous or exogenous opioids such as morphine, initiate signaling events leading to neuroinflammation. MOR engagement does not only affect pain features and quality, but also influences directly and/or indirectly tumor growth and metastasis. The opioid effects on chronic cancer pain are also clinically characterized by altered opioid responsiveness (tolerance and hyperalgesia), a hallmark of the problematic long-term treatment of non-cancer pain. The significant progress made in understanding the immune-mediated development of chronic pain suggests its exploitation for novel alternative immunotherapeutic approaches. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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13 pages, 681 KiB  
Review
Treatment of Neuropathic Pain Directly Due to Cancer: An Update
by Morena Shkodra and Augusto Caraceni
Cancers 2022, 14(8), 1992; https://doi.org/10.3390/cancers14081992 - 14 Apr 2022
Cited by 11 | Viewed by 4218
Abstract
Neuropathic pain can be defined as pain related to abnormal somatosensory processing in either the peripheral or central nervous system. In this review article, with neuropathic cancer pain (NCP), we refer to pain due to nervous tissue lesions caused by the tumor or [...] Read more.
Neuropathic pain can be defined as pain related to abnormal somatosensory processing in either the peripheral or central nervous system. In this review article, with neuropathic cancer pain (NCP), we refer to pain due to nervous tissue lesions caused by the tumor or its metastases. Nervous tissue damage is the cause of cancer pain in approximately 40% of those experiencing cancer pain. Recognizing a neuropathic pathophysiology in these cases may be difficult and requires specific criteria that are not homogenously applied in clinical practice. The management of this type of pain can be challenging, requiring the use of specific non-opioid adjuvant drugs. The majority of the criteria for NCP diagnosis and management have been based mainly on results from the noncancer population, risking the failure of addressing the specific needs of this population of patients. In this review, we summarize current management options available for NCP and provide some insights on new promising treatments. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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15 pages, 294 KiB  
Review
Pediatric Palliative Care in Oncology: Basic Principles
by Franca Benini, Irene Avagnina, Luca Giacomelli, Simonetta Papa, Anna Mercante and Giorgio Perilongo
Cancers 2022, 14(8), 1972; https://doi.org/10.3390/cancers14081972 - 13 Apr 2022
Cited by 6 | Viewed by 5091
Abstract
About 4 million children with an oncological disease worldwide require pediatric palliative care (PPC) due to the nature of their condition. PPC is not limited to end-of-life care; it is a general approach continuing over the entire disease trajectory, regardless of whether the [...] Read more.
About 4 million children with an oncological disease worldwide require pediatric palliative care (PPC) due to the nature of their condition. PPC is not limited to end-of-life care; it is a general approach continuing over the entire disease trajectory, regardless of whether the patient receives any oncological treatment. This review addresses the value of integrating PPC in treating children with cancer, focusing on the basic principles of PPC and its application in pediatric oncology. Moreover, models for PPC implementation in oncology, end-of-life care, and advanced care planning are discussed. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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11 pages, 450 KiB  
Review
Telemedicine and Its Past, Present, and Future Roles in Providing Palliative Care to Advanced Cancer Patients
by Michael Tang and Akhila Reddy
Cancers 2022, 14(8), 1884; https://doi.org/10.3390/cancers14081884 - 8 Apr 2022
Cited by 18 | Viewed by 3286
Abstract
The landscape of healthcare delivery has considerably changed due to the emergence of coronavirus disease 2019 (COVID-19). This is nowhere more evident than in the care of advanced cancer patients receiving palliative care. This population is susceptible to the severe complications of COVID-19, [...] Read more.
The landscape of healthcare delivery has considerably changed due to the emergence of coronavirus disease 2019 (COVID-19). This is nowhere more evident than in the care of advanced cancer patients receiving palliative care. This population is susceptible to the severe complications of COVID-19, and immediate measures had to be taken to ensure their safety. Thus, the adoption of telemedicine as a health care delivery model emerged. This model provides many benefits, such as improved access to care while maintaining social distancing; however, there exist challenges to this model, including health care disparities, reimbursement, and monitoring of opioids in high-risk populations. This narrative review provides an overview of the unique benefits and barriers of telemedicine in palliative care patients. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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14 pages, 852 KiB  
Review
Timely Palliative Care: Personalizing the Process of Referral
by David Hui, Yvonne Heung and Eduardo Bruera
Cancers 2022, 14(4), 1047; https://doi.org/10.3390/cancers14041047 - 18 Feb 2022
Cited by 51 | Viewed by 9888
Abstract
Timely palliative care is a systematic process to identify patients with high supportive care needs and to refer these individuals to specialist palliative care in a timely manner based on standardized referral criteria. It requires four components: (1) routine screening of supportive care [...] Read more.
Timely palliative care is a systematic process to identify patients with high supportive care needs and to refer these individuals to specialist palliative care in a timely manner based on standardized referral criteria. It requires four components: (1) routine screening of supportive care needs at oncology clinics, (2) establishment of institution-specific consensual criteria for referral, (3) a system in place to trigger a referral when patients meet criteria, and (4) availability of outpatient palliative care resources to deliver personalized, timely patient-centered care aimed at improving patient and caregiver outcomes. In this review, we discuss the conceptual underpinnings, rationale, barriers and facilitators for timely palliative care referral. Timely palliative care provides a more rational use of the scarce palliative care resource and maximizes the impact on patients who are offered the intervention. Several sets of referral criteria have been proposed to date for outpatient palliative care referral. Studies examining the use of these referral criteria consistently found that timely palliative care can lead to a greater number of referrals and earlier palliative care access than routine referral. Implementation of timely palliative care at each institution requires oncology leadership support, adequate palliative care infrastructure, integration of electronic health record and customization of referral criteria. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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11 pages, 660 KiB  
Review
Delirium in Palliative Care
by Patricia Bramati and Eduardo Bruera
Cancers 2021, 13(23), 5893; https://doi.org/10.3390/cancers13235893 - 23 Nov 2021
Cited by 15 | Viewed by 7979
Abstract
Delirium, a widespread neuropsychiatric disorder in patients with terminal diseases, is associated with increased morbidity and mortality, profoundly impacting patients, their families, and caregivers. Although frequently missed, the effective recognition of delirium demands attention and commitment. Reversibility is frequently not achievable. Non-pharmacological and [...] Read more.
Delirium, a widespread neuropsychiatric disorder in patients with terminal diseases, is associated with increased morbidity and mortality, profoundly impacting patients, their families, and caregivers. Although frequently missed, the effective recognition of delirium demands attention and commitment. Reversibility is frequently not achievable. Non-pharmacological and pharmacological interventions are commonly used but largely unproven. Palliative sedation, although controversial, should be considered for refractory delirium. Psychological assistance should be available to patients and their families at all times. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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14 pages, 547 KiB  
Review
Cancer-Related Alopecia: From Etiologies to Global Management
by Stanislas Quesada, Alexandre Guichard and Frédéric Fiteni
Cancers 2021, 13(21), 5556; https://doi.org/10.3390/cancers13215556 - 5 Nov 2021
Cited by 6 | Viewed by 3623
Abstract
Alopecia represents a multifaceted challenge with distinct etiologies and consequences. Transposed to the world of oncology, different types of alopecia and molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. In patients with cancer, alopecia can be iatrogenic (i.e., [...] Read more.
Alopecia represents a multifaceted challenge with distinct etiologies and consequences. Transposed to the world of oncology, different types of alopecia and molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. In patients with cancer, alopecia can be iatrogenic (i.e., due to conventional chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy and surgery) or a direct consequence of the disease itself (e.g., malnutrition, scalp metastases and paraneoplastic syndromes). Identification of the actual incriminated mechanism(s) is therefore essential in order to deliver appropriate supportive care, whether preventive or curative. On the preventive side, the last few years have seen the advent of the automated cooling cap, a prophylactic approach supported by several randomized clinical trials. On the curative side, although the treatments currently available are limited, several promising therapeutic approaches are under development. Appropriate alopecia management is essential, particularly regarding its psychological repercussions with significant consequences on the quality of life of patients and their family and with a potential impact on treatment compliance. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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20 pages, 2379 KiB  
Systematic Review
Predictors of Mortality in Patients with Advanced Cancer—A Systematic Review and Meta-Analysis
by Catherine Owusuaa, Simone A. Dijkland, Daan Nieboer, Agnes van der Heide and Carin C. D. van der Rijt
Cancers 2022, 14(2), 328; https://doi.org/10.3390/cancers14020328 - 11 Jan 2022
Cited by 14 | Viewed by 2543
Abstract
To timely initiate advance care planning in patients with advanced cancer, physicians should identify patients with limited life expectancy. We aimed to identify predictors of mortality. To identify the relevant literature, we searched Embase, MEDLINE, Cochrane Central, Web of Science, and PubMed databases [...] Read more.
To timely initiate advance care planning in patients with advanced cancer, physicians should identify patients with limited life expectancy. We aimed to identify predictors of mortality. To identify the relevant literature, we searched Embase, MEDLINE, Cochrane Central, Web of Science, and PubMed databases between January 2000–April 2020. Identified studies were assessed on risk-of-bias with a modified QUIPS tool. The main outcomes were predictors and prediction models of mortality within a period of 3–24 months. We included predictors that were studied in ≥2 cancer types in a meta-analysis using a fixed or random-effects model and summarized the discriminative ability of models. We included 68 studies (ranging from 42 to 66,112 patients), of which 24 were low risk-of-bias, and 39 were included in the meta-analysis. Using a fixed-effects model, the predictors of mortality were: the surprise question, performance status, cognitive impairment, (sub)cutaneous metastases, body mass index, comorbidity, serum albumin, and hemoglobin. Using a random-effects model, predictors were: disease stage IV (hazard ratio [HR] 7.58; 95% confidence interval [CI] 4.00–14.36), lung cancer (HR 2.51; 95% CI 1.24–5.06), ECOG performance status 1+ (HR 2.03; 95% CI 1.44–2.86) and 2+ (HR 4.06; 95% CI 2.36–6.98), age (HR 1.20; 95% CI 1.05–1.38), male sex (HR 1.24; 95% CI 1.14–1.36), and Charlson comorbidity score 3+ (HR 1.60; 95% CI 1.11–2.32). Thirteen studies reported on prediction models consisting of different sets of predictors with mostly moderate discriminative ability. To conclude, we identified reasonably accurate non-tumor specific predictors of mortality. Those predictors could guide in developing a more accurate prediction model and in selecting patients for advance care planning. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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9 pages, 600 KiB  
Systematic Review
The Decision-Making Process for Palliative Sedation for Patients with Advanced Cancer–Analysis from a Systematic Review of Prospective Studies
by Alazne Belar, Maria Arantzamendi, Johan Menten, Sheila Payne, Jeroen Hasselaar and Carlos Centeno
Cancers 2022, 14(2), 301; https://doi.org/10.3390/cancers14020301 - 8 Jan 2022
Cited by 7 | Viewed by 3059
Abstract
Background. The involvement of patients in decision making about their healthcare plans is being emphasized. In the context of palliative sedation, it is unclear how these decisions are made and who are involved in. The aim of the study is to understand how [...] Read more.
Background. The involvement of patients in decision making about their healthcare plans is being emphasized. In the context of palliative sedation, it is unclear how these decisions are made and who are involved in. The aim of the study is to understand how this decision-making is taken. Method. Information from a systematic review on clinical aspects of palliative sedation prospective studies were included. PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE were searched (January 2014–December 2019). Data extraction and analysis regarded: (a) When and by whom the decision-making process is initiated; (b) patient involvement; (c) family involvement and (d) healthcare involvement. Results. Data about decision making were reported in 8/10 included articles. Palliative sedation was reported in 1137 patients (only 16 of them were non-cancer). Palliative sedation was introduced by the palliative care team during the disease process, at admission, or when patients experienced refractory symptoms. Only two studies explicitly mentioned the involvement of patients in decision making. Co-decision between families and the regular health care professionals was usual, and the health care professionals involved had been working in palliative care services. Conclusion. Patient participation in decision making appeared to be compromised by limited physical or cognitive capacity and family participation is described. The possibility of palliative sedation should be discussed earlier in the disease process. Full article
(This article belongs to the Special Issue Palliative and Supportive Care in Oncology: An Update)
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