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Baka, Sofia, Paul Lorigan, and Nick Thatcher. "Palliative treatment." Hematology/Oncology Clinics of North America 18, no. 2 (April 2004): 417–32. http://dx.doi.org/10.1016/j.hoc.2003.12.001.
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Bjordal, K. "Palliative medical treatment." Radiotherapy and Oncology 82 (February 2007): S16. http://dx.doi.org/10.1016/s0167-8140(07)80054-5.
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Kon, Alexander A., and Arthur R. Ablin. "It's not palliative care, it's palliative treatment." Lancet Oncology 10, no. 2 (February 2009): 106–7. http://dx.doi.org/10.1016/s1470-2045(09)70011-7.
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Patell, Rushad, David Johnson Einstein, Jennifer Halleck, and Mary K. Buss. "Patient perceptions of treatment benefit in advanced cancer." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e23163-e23163. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e23163.
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e23163 Background: Informed consent assumes accurate perceptions of potential benefits and risks of treatment, yet many patients receiving palliative cancer therapies misperceive the likelihood of cure. Our study aims to further explore patient perceptions of benefits and risks of palliative treatments and to examine this in the era of novel therapeutics. Methods: We surveyed patients with advanced solid cancers and their oncologists regarding benefits/risks of palliative therapies. We serially assessed patients’ perceptions of likelihood of tumor response, survival benefit, symptom palliation and side effects, as well as information-seeking behavior pre-treatment and decisional regret at the end of treatment. We also compared patients’ perceptions of benefits/risks to that of their oncologists. Results: Across four disease groups, 52 patients have enrolled (target accrual: 120). Median age is 64 years (range 20-84), 58% are male, and 60% had prior treatment. Treatments included chemotherapy (42%), targeted therapy (31%), and immunotherapy (27%). Misperceptions (patient-assessed likelihood minus oncologist-assessed likelihood) at the beginning of treatment across different domains are shown in the table. Conclusions: Compared with their oncologists, patients overestimate not only curability but also chance of tumor response, symptom palliation, and survival benefit, yet they accurately perceive chance of toxicity. Thus, efforts at improving communication should focus on the chances of treatment benefit and multiple types of benefits rather than treatment risks. In future analyses after full accrual, we will assess differences between domains, internal consistency of misperceptions, change in misperceptions over time on treatment, decisional regret at end of treatment, and association of misperceptions with information-seeking behavior and sources of education. [Table: see text]
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Mishreki, AP, E. Lim, P. Cranefield, S. Pascoe, S. Jackson, and DA Stell. "Low rate of active treatment of patients with hilar cholangiocarcinoma." Annals of The Royal College of Surgeons of England 95, no. 5 (July 2013): 349–52. http://dx.doi.org/10.1308/003588413x13629960046598.
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Introduction The results of surgical resection and palliative chemotherapy use in hilar cholangiocarcinoma (HC) have been well publicised but the proportion of patients able to undergo these treatments and the comparative outcomes in a population of patients with HC are less well known. Methods Patients with HC were identified by review of all patients undergoing percutaneous cholangiography over a nine-year period (2002–2010) in a tertiary facility. The treatment undertaken and outcomes were recorded. Results Overall, 68 patients were identified (37 female) with a median age of 70 years. Forty-five (66%) were treated solely by insertion of a metal stent (median survival 4.73 months) and nine (13%) also received palliative chemotherapy (median survival 13.7 months). Persisting jaundice after stent insertion was noted in 18 of 35 patients (51%) tested within one month of death. Fourteen patients (21%) underwent surgical resection (median survival 20.2 months). Conclusions Patients undergoing surgical resection had significantly longer survival than those receiving only a palliative stent but not compared with those also receiving palliative chemotherapy, with short-term follow-up. Only a third of patients, however, receive active treatment (surgery or chemotherapy) and improvements in long-term biliary palliation are needed.
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Patell, Rushad, David Johnson Einstein, Jennifer Halleck, Laura Dodge, and Mary K. Buss. "Patient perceptions of treatment benefit in advanced cancer." Journal of Clinical Oncology 37, no. 31_suppl (November 1, 2019): 25. http://dx.doi.org/10.1200/jco.2019.37.31_suppl.25.
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25 Background: Informed consent assumes accurate perceptions of potential treatment benefits and risks, yet many patients receiving palliative cancer therapies misperceive the likelihood of cure. Patients’ understanding of treatment benefits/risks beyond cure is unknown. We aimed to further explore patient perceptions of benefits/risks of palliative treatment in the era of novel therapeutics. Methods: We surveyed patients with advanced solid cancers and their oncologists regarding benefits/risks of palliative therapies. We assessed perceived likelihood of tumor response, survival benefit, symptom palliation and side effects, as well as information-seeking behavior. We used log binomial regression to estimate risk ratios (RR) and 95% confidence intervals (CI) of the association between misperception (patient perception minus physician’s perception) and various demographic, disease and treatment characteristics. Results: Of 119 patients enrolled: median age was 65 years (range 59–73), 55% male and 56% had prior treatment. Treatments included chemotherapy (60%), immunotherapy (25%) and targeted therapy (16%). Median misperceptions are shown in Table. Factors associated with decreased misperception included male gender (RR=0.70, 95% CI: 0.55–0.89), graduate level education (RR=0.63, 95% CI: 0.41–0.98) and targeted therapy (RR=0.54, 95% CI: 0.30–0.98). There was no correlation between misperceptions of tumor response and curability (r=0.13, P=0.15) or self-education (r=-0.04, P=0.69). Conclusions: Compared with their oncologists, patients’ overestimate not only curability but also chances of tumor response, symptom palliation and survival benefit; though they accurately perceive likelihood of toxicity. There is no correlation between perception of curability and other goals of therapy such as response rate and symptom palliation. Improvements in communication should focus on the likelihood of different treatment goals rather than treatment risks. [Table: see text]
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Porzsolt, F., and I. Tannock. "Goals of palliative cancer therapy." Journal of Clinical Oncology 11, no. 2 (February 1993): 378–81. http://dx.doi.org/10.1200/jco.1993.11.2.378.
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The major conclusions of the Workshop on Goals of Palliative Cancer Therapy are as follows: 1. The goals of any cancer therapy should be stated explicitly. 2. If the goal of treatment is palliation, this should be documented according to one of the established and validated methods for assessment of quality of life. Several validated methods are available, and although imperfect, have been shown to give reliable information. 3. The use of simple measures of quality of life (eg, symptom checklists, pain assessment cards) should become routine in oncology practice. The act of introducing such measures improves palliation. 4. Measures of cost-effectiveness should be used more widely in clinical decision making to ensure the appropriate deployment of resources. 5. There must be improved education of all health professionals with regard to the multiple methods for provision of palliative treatment to cancer patients and the assessment of palliation.
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Revannasiddaiah, Swaroop, RajeevK Seam, Manish Gupta, Madhup Rastogi, ManojK Gupta, and Priyanka Thakur. "When palliative treatment achieves more than palliation: Instances of long-term survival after palliative radiotherapy." Indian Journal of Palliative Care 18, no. 2 (2012): 117. http://dx.doi.org/10.4103/0973-1075.100829.
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Jeba, Jenifer, Ansu Mary Thankachan, Annie Jacob, Ramu Kandasamy, and D. N. Susithra. "COVID-19 – Initial Lockdown: Implications on Cancer Treatment among Palliative Care Outpatients." Indian Journal of Palliative Care 28 (March 16, 2022): 3–6. http://dx.doi.org/10.25259/ijpc_314_20.
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Objectives: The pandemic and the lockdown has challenged palliative care patients especially those on palliative oncological treatments. This study aims to understand the effect of COVID-19 and initial lockdown on palliative oncological treatments among palliative care patients. Materials and Methods: A retrospective chart review of patients who attended the palliative care outpatient clinic, between 21 April and 12 May 2020, was done. Sociodemographic and palliative oncological treatment details were reviewed. Results: Of the 107 patients included, 53.7% were between 40 and 60 years of age, and 58.3% were women. A large proportion (63%) was unemployed and 40.2% had to rent vehicles for hospital travel. During this period, palliative oncological treatment was interrupted or deferred in 20% and 3.5%, respectively. During this period, homecare services were also affected in about 12.2% of our patients. Conclusion: The COVID-19 pandemic and the lockdown have affected the palliative oncological treatment of palliative care outpatients with cancer. The implications of interrupted and deferred treatment on patient outcomes would be seen in the months and years to follow. Palliative care teams should enhance patient and caregiver support and promote non-abandonment and continuum of care during such unprecedented times.
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Volpe, Bruce T. "Palliative treatment for stroke." Neurologic Clinics 19, no. 4 (November 2001): 903–20. http://dx.doi.org/10.1016/s0733-8619(05)70053-0.
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Vuong, Brooke, Ahmed Dehal, Amanda N. Graff-Baker, Shu-Ching Chang, Leland Foshag, Anton Bilchik, and Melanie R. Goldfarb. "Effect of palliative surgery, chemotherapy, and radiation in stage IV pancreatic cancer." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e15707-e15707. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e15707.
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e15707 Background: Despite significant advances in multi-modality treatment for pancreatic adenocarcinoma (PC), prognosis for stage IV PC remains poor. While reducing suffering and optimizing quality of life are the primary goals of palliative therapies, these interventions may extend overall survival. We examined the impact on survival when aggressive palliative treatments including surgery, chemotherapy, or radiation were employed in end-of-life care. Methods: The 2004-2014 National Cancer Data Base (NCDB) was queried to identify patients with stage IV PC that did not undergo primary surgical resection. Univariate (Kaplan Meier and log-rank) and multivariable (Cox proportional hazard) analyses were used to assess the associations between patient characteristics, use of palliative therapies, and overall survival. Results: Of 72,736 patients identified with metastatic stage IV PC, 2,097 (3%) underwent surgical palliation (ST), 5,615 (8%) received palliative chemotherapy (CT), 940 (1%) received palliative radiation (RT), 1,163 (2%) received multimodality treatment (MMT), and 62,921 (87%) had no aggressive palliative intervention (NT). The choice of palliative therapy, if any, was influenced by all demographic and tumor variables except for gender (all p < 0.001). Median OS was greatest after CT (5.09 months, p < 0.001) compared to any other modality (NT: 3.45months, ST: 3.71months, RT: 3.25months, MMT: 4.47months). This remained true regardless of age, gender, race/ethnicity, insurance, and facility type. After adjusting for all demographic and tumor factors, use of CT decreased the annual risk of death by 20% (HR = 0.8; 95%CI [0.77, 0.82]) and MMT by 10% (HR = 0.9; 95%CI [0.84, 0.96]). Employment of RT increased risk of death by 9% (HR = 1.09; 95%CI [1.01, 1.17]) and ST did not affect OS (HR = 1.01; 95%CI [0.96,1.06]). Conclusions: Despite advances in palliative treatments, Stage IV PC arries a dismal prognosis. Palliative RT may shorten survival. Equivalent survival for ST versus NT suggests that this may be beneficial in the appropriate patient. Palliative CT independently improved survival by approximately 6 weeks and should be considered in patients that want to extend survival and can tolerate the toxicity.
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Vuong, Brooke, Ahmed Dehal, Amanda Graff-Baker, Shu-Ching Chang, Leland Jay Foshag, Anton Bilchik, and Melanie Goldfarb. "Effect of palliative surgery, chemotherapy, and radiation in stage IV pancreatic cancer." Journal of Clinical Oncology 35, no. 31_suppl (November 1, 2017): 233. http://dx.doi.org/10.1200/jco.2017.35.31_suppl.233.
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233 Background: Despite significant advances in multi-modality treatment for pancreatic adenocarcinoma (PC), prognosis for stage IV PC remains poor. While reducing suffering and optimizing quality of life are the primary goals of palliative therapies, these interventions may extend overall survival. We examined the impact on survival when aggressive palliative treatments including surgery, chemotherapy, or radiation were employed in end-of-life care. Methods: The 2004-2014 National Cancer Data Base (NCDB) was queried to identify patients with stage IV PC that did not undergo primary surgical resection. Univariate (Kaplan Meier and log-rank) and multivariable (Cox proportional hazard) analyses were used to assess the associations between patient characteristics, use of palliative therapies, and overall survival. Results: Of 72,736 patients identified with metastatic stage IV PC, 2,097 (3%) underwent surgical palliation (ST), 5,615 (8%) received palliative chemotherapy (CT), 940 (1%) received palliative radiation (RT), 1,163 (2%) received multimodality treatment (MMT), and 62,921 (87%) had no aggressive palliative intervention (NT). The choice of palliative therapy, if any, was influenced by all demographic and tumor variables except for gender (all p < 0.001). Median OS was greatest after CT (5.09 months, p < 0.001) compared to any other modality (NT: 3.45months, ST: 3.71months, RT: 3.25months, MMT: 4.47months). This remained true regardless of age, gender, race/ethnicity, insurance, and facility type. After adjusting for all demographic and tumor factors, use of CT decreased the annual risk of death by 20% (HR = 0.8; 95%CI [0.77, 0.82]) and MMT by 10% (HR = 0.9; 95%CI [0.84, 0.96]). Employment of RT increased risk of death by 9% (HR = 1.09; 95%CI [1.01, 1.17]) and ST did not affect OS (HR = 1.01; 95%CI [0.96,1.06]). Conclusions: Despite advances in palliative treatments, Stage IV PC arries a dismal prognosis. Palliative RT may shorten survival. Equivalent survival for ST versus NT suggests that this may be beneficial in the appropriate patient. Palliative CT independently improved survival by approximately 6 weeks and should be considered in patients that want to extend survival and can tolerate the toxicity.
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Patell, Rushad, David Einstein, Eric Miller, Laura Dodge, Jennifer Halleck, and Mary Buss. "Patient Perceptions of Treatment Benefit and Toxicity in Advanced Cancer: A Prospective Cross-Sectional Study." JCO Oncology Practice 17, no. 2 (February 2021): e119-e129. http://dx.doi.org/10.1200/op.20.00517.
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PURPOSE: Prior studies show that many patients receiving palliative cancer therapies misperceive likelihood of cure. Patients’ understanding of treatment benefits and risks beyond cure is unknown. We explore patient perceptions of palliative treatment in the novel therapeutic era. METHODS: We surveyed patients with advanced solid cancers and their oncologists regarding benefits and risks of palliative therapies. We assessed perceived likelihood of tumor response, survival benefit, symptom palliation, and side effects. We used generalized estimating equations to calculate least squares means of misperception (patient-assessed minus physician-assessed likelihood of benefit), accounting for clustering by physician, and compared the degree of misperception by participant characteristics. RESULTS: Of the 119 patients enrolled, median age was 65 years (range, 59-73 years), 55% were male, and 56% had prior treatment. Treatments included chemotherapy (60%), immunotherapy (24%), and targeted therapy (15%). Compared with their oncologists, patients overestimate curability (median misperception, 20%; interquartile range [IQR], 0 to 60), chances of tumor response (median, 20%; IQR, 0 to 40), symptom palliation (median, 10%; IQR, −10 to 30), and survival benefit (median, 20%; IQR, 0 to 40). Toxicity was relatively accurately estimated (median, 0.5%; IQR, −20 to 20). Immunotherapy was associated with higher risk of misperception of tumor response and toxicity. Misperceptions of tumor response and curability did not correlate (r = 0.13, P = .15). CONCLUSION: Compared with their oncologists, patients overestimated chances of tumor response, symptom palliation, and survival benefit, but accurately perceived likelihood of toxicity. There was no strong correlation between perception of curability and other goals of therapy. Communication focused on treatment goals alongside risks may reduce misperceptions and facilitate informed choices by patients.
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Fackrell, David Gareth, Muhammad Suhail Anwar, Indrajit Nalinika Fernando, Yvonne Doyle, and Ahmed El-Modir. "Palliative external-beam radiotherapy in recurrent ovarian carcinoma." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e15534-e15534. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e15534.
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e15534 Background: Up to 80% of patients with advanced ovarian cancer will recur following first-line platinum based chemotherapy. Palliation of focal lesions is often needed to alleviate symptoms. Response rate to second and third-line chemotherapy remain disappointing. The study aim was to characterise the patient population referred for palliative radiotherapy for advanced and recurrent ovarian carcinoma and to assess the effectiveness of radiotherapy in this population. Methods: We retrospectively reviewed the medical records of 94 patients with advanced recurrent ovarian carcinoma referred for palliative radiotherapy between March 1994 and July 2011. The median age of the patients was 62 years (range 33 to 85). One to 16 cycles of a platinum-based chemotherapy regimen were delivered before irradiation (median = 7 cycles). The indications for palliative treatment were: pain (n = 41), mass (n = 32), brain metastases (n = 19), vaginal bleeding (n = 9), rectal bleeding (n = 4), shortness of breath (n = 3), tenesmus (n = 2), skin ulceration (n = 2) and jaundice (n = 1). Some patients received treatment for more than one indication. Sites irradiated included the pelvis (n = 44), brain (n = 19), abdomen (n = 10), bone (n = 5), supraclavicular fossae (n = 4), groins (n = 3), chest (n = 3) and other (n = 6). The median radiotherapy dose was 20 Gy (range: 6 – 50 Gy). The median fraction size was 4 Gy (range: 1.8 – 8 Gy). Results: The overall response rate was 61.7%. Complete palliative response was achieved in 17% of the patients. 27.6% of patients suffered progressive disease during treatment. 10.7% had stable disease. The median duration of palliation was 6 months and closely approximated their survival. The treatment was very well tolerated. Grade 1 or 2 diarrhoea and nausea were the main side effects. Conclusions: External-beam radiotherapy can provide effective and durable palliation of symptoms in patients with recurrent platinum-resistant ovarian carcinoma. The results from palliative radiotherapy are comparable to the published series using second and third-line chemotherapy in the treatment of recurrent focally symptomatic ovarian cancer.
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Bernardo, Ma Jeanesse C., Mohd Firdaus Che Ani, Zhuang Chun, Abdullah Almayouf, Jee-sun Kim, Tae-Yong Kim, Seong-Ho Kong, Do-Joong Park, Han-Kwang Yang, and Hyuk-Joon Lee. "Laparoscopic Conversion Surgery After Three Years of Palliative Chemotherapy for Unresectable Advanced Gastric Cancer." Journal of Surgical Innovation and Education 1, no. 1 (June 30, 2024): 26–27. http://dx.doi.org/10.69474/jsie.2024.00073.
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Unresectable advanced gastric cancer remains a challenge in treatment, often requiring a multidisciplinary approach. Numerous studies have emphasized the role of palliative chemotherapy as the mainstay treatment for unresectable advanced gastric cancers. Some patients may still require conversion surgery to achieve survival gain and palliation. Several recent papers have shown the safety of laparoscopic gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer. However, there is a difference between neoadjuvant chemotherapy and palliative chemotherapy in terms of the duration of chemotherapy (about 3 months vs. more than 6 months) and the initial state of advanced gastric cancer (resectable vs. unresectable and/or metastatic). To date, the safety and efficacy of laparoscopic gastrectomy after long-term palliative chemotherapy has been rarely reported. This video aims to share our experience in performing laparoscopic distal gastrectomy with D2 lymph node dissection after 3 years of palliative chemotherapy for an unresectable advanced gastric cancer.
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Raunkiær, Mette, Jahan Shabnam, Kristoffer Marsaa, Geana Paula Kurita, Per Sjøgren, and Mai-Britt Guldin. "When and how to stop palliative antineoplastic treatment and to organise palliative care for patients with incurable cancer." International Journal of Palliative Nursing 29, no. 10 (October 2, 2023): 499–506. http://dx.doi.org/10.12968/ijpn.2023.29.10.499.
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Background: Improving the organisational aspects of the delivery of palliative care in order to support patients throughout their disease trajectory has received limited attention. Aim: To investigate the opportunities and barriers related to organising palliation for people with terminal cancer and their families. Methods: An explorative interview study was conducted among 31 nurses and three physicians concerning an intervention facilitating a fast transition from treatment at a cancer centre at a university hospital to palliation at home. A thematic analysis was conducted. Findings: This article presents three out of seven themes: 1) improvement in the cessation of antineoplastic treatment in palliation; 2) improvement in organisations delivering palliation; and 3) improvement in multidisciplinary and cross-sectoral collaboration. Conclusions: The results demonstrate the demand for flexible, family-centred and integrated palliation at all levels, from communication and the collaborative relationship between healthcare professionals and families to service sectors.
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Bingham, Brian Stewart, Tomas Dvorak, Christopher G. Morris, and Anamaria R. Yeung. "Thirty-day mortality rate in oncology patients treated with palliative radiotherapy." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 172. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.172.
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172 Background: Thirty-day mortality is a well-established metric for surgical specialties, but there are limited data available for 30-day mortality after radiation therapy. Our aim was to specifically identify the 30-day mortality of patients treated with palliative radiotherapy for the purposes of establishing a baseline to improve upon. Methods: We retrospectively reviewed the medical records of all patients treated with external-beam radiotherapy (EBRT) from January 1, 2012, to December 31, 2012, who died within 30 days of their last delivered radiation fraction. Patient age, sex, primary disease site, treatment site, fractions planned, and fractions delivered were recorded. Among all patients treated with palliative intent, age (> 70 and < 70 years) and sex were assessed for increased risk of 30-day mortality using a Fisher’s Exact test. Results: Of the 877 patients who received EBRT, 262 were treated palliatively and 615 were treated with curative intent. Of the 262 patients treated palliatively, 33 died within 30 days of the last delivered fraction, resulting in a palliative 30-day mortality rate of 12.6%. Of these 33 patients, the most common primary disease sites were lung (15%), pancreas (12%), and head/neck (12%), and the most common treatment sites were metastases to bone (37%) and brain (24%). In cases of palliative 30-day mortality, 10 or fewer fractions were prescribed 90% of the time and 83% of patients received more than half of their prescribed fractions. Among all patients treated with palliative intent, age (p = 0.0576) and sex (p = 0.5572) were not significantly associated with higher rates of 30-day mortality. Conclusions: We have established a baseline palliative radiation 30-day mortality rate at 12.6%, with the majority of patients receiving less than or equal to 10 radiation fractions and completing most if not all of their intended fractions. This analysis suggests institutional practices that are in line with other published patterns of care, and illustrates how clinical characteristics and 30-day mortality rate can be used to better understand palliative radiotherapy outcomes at a single treatment center.
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Kucharska, Ewa, Aleksandra Kucharska, Aleksander Sieroń, Mariusz Nowakowski, and Karolina Sieroń. "PALLIATIVE TREATMENT – STILL UNSOLVED PROBLEM." Wiadomości Lekarskie 72, no. 6 (2019): 1165–69. http://dx.doi.org/10.36740/wlek201906101.
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In a modern approach to palliative and hospice care, apart from pharmacological treatment, physio- and kinesiotherapy also play an important role. It affects the reduction of clinical symptoms, accompanying the basic disease and also significantly increase of the quality of life for palliative patients and their families. It becomes an inseparable element of treatment, both in outpatient care as well as in stationary care and home care. Thanks to modern forms of physio- and kinesiotherapy, it is possible to adapt therapeutic methods to the individual needs and clinical condition of the patient. Such individualization of treatment in physiotherapy is the main goal of the above methods in palliative and hospice treatment. Due to the dynamics onset of cancer in the group of geriatric patients there is a need for a broader analysis of the topic. The work presents available information of physiotherapy in palliative and hospice care. The problem of relative and absolute indications and contraindications for physiotherapy was discussed. Based analysis of the above topic can lead to the conclusion that there is a necessity undertaking further research on the impact of rehabilitation treatments on reducing patients complaints and improvement of patients life quality.
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Emby, D. J. "Palliative Treatment of Malignant Ascites." American Journal of Roentgenology 179, no. 2 (August 2002): 532. http://dx.doi.org/10.2214/ajr.179.2.1790532a.
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Unseld, Matthias. "Palliative treatment in daily practice." memo - Magazine of European Medical Oncology 14, no. 1 (March 2021): 5–6. http://dx.doi.org/10.1007/s12254-021-00682-9.
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Nielsen, Ole S. "Palliative Treatment of Bone Metastases." Acta Oncologica 35, sup5 (January 1996): 58–60. http://dx.doi.org/10.3109/02841869609083971.
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Ring, Alistair, and Peter Harper. "Palliative Treatment: What’s the Point?" American Journal of Clinical Oncology 25, no. 5 (October 2002): 537–39. http://dx.doi.org/10.1097/00000421-200210000-00024.
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VON WICHERT, Götz, Thomas SEUFFERLEIN, and Guido ADLER. "Palliative treatment of pancreatic cancer." Journal of Digestive Diseases 9, no. 1 (February 2008): 1–7. http://dx.doi.org/10.1111/j.1443-9573.2007.00314.x.
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Ahmad, Neelofur R., Eric B. Goosenberg, Harold Frucht, and Lawrence R. Coia. "Palliative treatment of esophageal cancer." Seminars in Radiation Oncology 4, no. 3 (July 1994): 202–14. http://dx.doi.org/10.1016/s1053-4296(05)80068-2.
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Ring, Alistair, and Peter Harper. "Palliative Treatment: What’s the Point?" American Journal of Clinical Oncology 25, no. 5 (October 2002): 537–39. http://dx.doi.org/10.1097/01.coc.0000023420.56046.d3.
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Bengmark, S. "Palliative treatment of hepatic tumours." British Journal of Surgery 76, no. 8 (August 1989): 771–73. http://dx.doi.org/10.1002/bjs.1800760802.
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Pohl, M., A. Reinacher-Schick, and W. Schmiegel. "Palliative endoscopic and chemotherapeutic treatment." European Surgery 42, no. 6 (December 2010): 287–98. http://dx.doi.org/10.1007/s10353-010-0571-9.
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McKinnon, J. Gregory. "Palliative treatment of neuroendocrine tumors." Seminars in Surgical Oncology 9, no. 5 (September 1993): 453–58. http://dx.doi.org/10.1002/ssu.2980090513.
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Tseimakh, Alexander E., Alexander F. Lazarev, and Yakov N. Shoykhet. "Palliative treatment of pancreatic cancer." Russian Journal of Oncology 27, no. 3 (October 14, 2023): 117–26. http://dx.doi.org/10.17816/onco115222.
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Pancreatic cancer is one of the most serious problems of modern oncology. In the Russian Federation, pancreatic cancer, along with a fairly small share in the structure of the incidence of malignant neoplasms 3%, ranks first in annual mortality (68.2%), and is also a nosology with the most unfavorable prognosis among tumors of the gastrointestinal tract. The current standard of first-line therapy is FOLFRINOX (FOLFIRINOX, a combination of 5-fluorouracil (5-FU), leucovorin, irinotecan, and oxaliplatin) or gemcitabine plus albumin-bound nab-paclitaxel.
One of the main obstacles to the action of chemotherapeutic drugs is the microenvironment of fibro-solid stromal tumors, which include pancreatic cancer. In order to potentiate the action of chemotherapy and combat the tumor microenvironment, at the present stage, drugs are being considered for influencing the programmed death 1 (PD-1) gene and cytotoxic T-lymphocyte antigen 4 (CTLA-4). Approximately 1015% of malignant neoplasms of the pancreas are believed to be associated with hereditary mutations, while all neoplasms have somatic mutations in different combinations of driver genes. One of the most common mutations are BRCA1/BRCA2 gene mutations. Poly-ADP-ribose polymerase inhibitors, like cisplatin, have shown promise as a treatment for tumors with BRCA mutations.
Another subtype of pancreatic cancer is characterized by microsatellite instability. Unlike the above mutations and phenotypes, which affect only a small proportion of patients with pancreatic cancer, mutations in KRAS (Kirsten homologous rat sarcoma viral oncogene) are found in 9095% of cases of pancreatic malignancy and may be a significant factor in pancreatic tumorigenesis. Another frequently mutating gene for a number of malignancies is ARID1A, which encodes a tumor suppressor protein, a subunit of the SWI/SNF chromatin remodeling complex.
The future of conservative therapy for pancreatic cancer is a complex treatment that includes both chemotherapy and targeted therapy and immunotherapy, the implementation of which is impossible without a deeper study of genetic mutations, molecular mechanisms of invasion and development of pancreatic malignant neoplasms, as well as extensive testing for genetic mutations in the clinical practice of specialized institutions.
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Suhag, Virender, B. S. Sunita, Pankaj Vats, Nilotpal Chakravarty, Mayuri Jain, and Rekha S. Vashisht. "Profile of patients undergoing palliative radiotherapy: A single-institute study from a tertiary care oncology center." South Asian Journal of Cancer 06, no. 04 (October 2017): 190–93. http://dx.doi.org/10.4103/sajc.sajc_149_17.
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Abstract Background: Palliative radiotherapy (PRT) plays a significant role in the palliation of symptoms in patients with cancer and constitutes nearly 50% of the workload in different settings. Aims: The aim is to study patient-, disease-, and treatment-related characteristics in locoregionally advanced and metastatic malignancies meriting palliative management. Setting and Design: This was a retrospective observational study in a tertiary care government institute with academic and research potential. Methodology: The electronic medical records, medical documents, and radiotherapy (RT) treatment charts were retrieved and studied. Observations: A total of 460 patients were included in the study over 2 years, forming 30% of the total number of patients treated during the study period. Three hundred and ninety-six patients received PRT to the metastatic sites, while 64 patients received extremely hypofractionated PRT to the primary for symptomatic relief. Totally 442 patients showed good symptomatic response to PRT. One hundred and thirty-eight patients underwent re-irradiation. Lung was the most common primary site seen in 155 cases. The most common indication for PRT was palliation of pain from painful metastases as seen in 240 cases, and the next common indication was palliative whole-brain RT for brain metastases as seen in 159 cases. Conclusion: PRT forms an integral and important aspect of palliative care to the vast number of patients harboring metastatic disease that warrants some form of treatment for symptomatic relief. Short course of PRT in outdoor setting is a preferred mode of treatment to improve the quality of life of these distressed patients.
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Wilson, Ana, Cecilia Grace Ethun, George A. Poultsides, Thuy Tran, Kamran Idrees, Chelsea A. Isom, Ryan C. Fields, et al. "Palliative treatment in extrahepatic biliary malignancies: A multi-institutional cohort." Journal of Clinical Oncology 34, no. 4_suppl (February 1, 2016): 456. http://dx.doi.org/10.1200/jco.2016.34.4_suppl.456.
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456 Background: Extrahepatic biliary malignancies (EBM) are often first diagnosed at advanced stages when the disease is no longer surgically resectable. While palliative resection may provide a more definitive solution for patients with jaundice, it also carries a higher risk of complications than endoscopic or percutaneous drainage. Herein, we analysed patients undergoing both methods of palliation to better delineate these risks. Methods: 172 patients who underwent palliative treatment for EBM between 2000 and 2014 were identified from 10 major hepato-biliary centers participating in the EBM Consortium. Clinicopathologic, operative and outcome data were collected and analyzed. We used propensity score matching to correct for confounding by indication. Results: 113 patients underwent surgery with palliative resection of their tumor (65.7%), while 59 underwent diagnostic surgery, but were treated with percutaneous or endoscopic biliary drainage instead of resection (34.3%). Patients who were not resected were more frequently jaundiced preoperatively (p = 0.001), and were more likely to undergo repeat drainage procedures (p < 0.001). After matching for functional status, age, and clinical jaundice, patients who underwent resection had significantly more complications (55.6% vs. 34.0%; p = 0.035), a higher median number of complications (1 vs. 0; p = 0.0149), a higher Clavien Dindo Grade (IIIa vs. II; p = 0.0261), a longer hospital stay (8 vs. 4 days; p < 0.001), and a notable trend towards higher perioperative mortality (10.9% vs. 1.96%; p = 0.069). Meanwhile the postoperative bilirubin level was equal among the resected (1.80 mg/dL (IQR, 0.60-8.90)) and drainage groups (2.45 (IQR 0.60-10.5))(p = 0.477), and both groups had a statistically significant drop after treatment (resection 8.30 mg/dL to 1.80 mg/dL, p < 0.001; drainage 8.4 to 2.45, p < 0.001). Conclusions: Both palliative resection and biliary drainage successfully treated EBM patients’ hyperbilirubinemia. However, in a propensity score matched group, palliative resection patients had more complications and a trend towards more perioperative mortality, urging caution in the selection of patients for these procedures.
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Fu, Qinghui, Ying Chen, and Xiaohan Liu. "The Choice of Palliative Treatment for Biliary and Duodenal Obstruction in Patients With Unresectable Pancreatic Cancer: Is Surgery Bypass Better?" International Surgery 101, no. 1-2 (January 1, 2016): 58–63. http://dx.doi.org/10.9738/intsurg-d-14-00247.1.
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This study aimed to investigate the clinical significance of palliative operation for carcinoma of pancreas between bypass surgery and interventional therapy. Most patients with locally advanced pancreatic cancer cannot undergo resection and show obstructive jaundice at presentation. Methods of palliation in these patients comprise biliary stent or surgical bypass. We retrospectively analyzed the clinical data of 53 patients who underwent palliative treatment with incurable locally advanced pancreatic ductal adenocarcinoma. This retrospective study compared morbidity, mortality, hospital stay, readmission rate, and survival in these patients. A total of 31 patients underwent biliary bypass surgery, and 22 had interventional therapy. There was no significant difference in the patients' basic condition before operation and in the 30-day mortality between surgical palliation and intervention. However, there were some differences in the early complications, survival time, successful biliary drainage, and recurrent jaundice. Through analysis of these clinical data and the published studies, we conclude that surgical bypass is a better effective palliative method for patients than biliary and duodenum stent with locally advanced pancreatic cancer. Patients need to be carefully selected in consideration of operative risk and perceived overall survival.
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Chernus, N. Yu, S. V. Sidorov, E. V. Babayants, and S. E. Krasilnikov. "Legal support of palliative care for cancer patients." Siberian journal of oncology 18, no. 2 (April 26, 2019): 65–69. http://dx.doi.org/10.21294/1814-4861-2019-18-2-65-69.
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Background. According to the novel approach to the treatment of patients as persons, the phenomenon of palliation distinguishes modern medicine from the traditional medical paternalism. it means that medical science and practice go beyond physical health, when treatment methods aimed to improving the quality of patient’ life are widely used. man as a phenomenon of culture becomes something much more than his physical body.The purpose of the study was to analyze the palliative care legislation.Results. The palliative care was shown not to be a type of medical care, but it refers to the terms used in clinical practice to determine the purposes of specialized treatment aimed at not curing the disease, but rather extending life and controlling symptoms. conclusion. it is necessary to include patients’ relatives and friends to the number of people in need of medical care. The development of the federal state educational standard of higher education in the specialty of a palliative care physician is also of great importance.
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Öhlén, J., G. Carlsson, A. Jepsen, I. Lindberg, and F. Friberg. "Enabling sense-making for patients receiving outpatient palliative treatment: A participatory action research driven model for person-centered communication." Palliative and Supportive Care 14, no. 3 (August 3, 2015): 212–24. http://dx.doi.org/10.1017/s1478951515000814.
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ABSTRACTObjectives:In clinical palliative cancer care, the diversity of patient concerns over time makes information provision a critical issue, the demands of information-seeking patients presenting a challenge to both the communicative and organizational skills of the health provider. This study puts forward a practice model for communication between patients, their family members, and professional health providers during ongoing palliative chemotherapy; a model which supports the providers in enabling person-centered communication.Method:A constant comparative analysis adapted to participatory action research was applied. The model was developed step-wise in three interrelated cycles, with results from previous studies from palliative cancer care processed in relation to professional health providers' experience-based clinical knowledge. In doing this, focus group discussions were carried out with providers and patients to develop and revise the model.Results:The Enabling Sense Making model for person-centered communication gave rise to three domains (which are also the major communicative actors in palliative care): the patient, the family, and the provider. These actors were placed in the context of a communicative arena. The three respective domains were built up in different layers discriminating between significant aspects of person-centered communication, from the manifest that is most usually explicated in dialogues, to the latent that tends to be implicitly mediated.Significance of results:The model intends to facilitate timely reorientation of care from curative treatment or rehabilitation to palliation, as well as the introduction of appropriate palliative interventions over time during palliative phases. In this way the model is to be regarded a frame for directing the awareness of the professionals, which focuses on how to communicate and how to consider the patient’s way of reasoning. The model could be used as a complement to other strategic initiatives for the advancement of palliative care communication. It needs to be further evaluated in regard to practice evidence.
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Bierle, Rebecca (Schuetz), Karen M. Vuckovic, and Catherine J. Ryan. "Integrating Palliative Care Into Heart Failure Management." Critical Care Nurse 41, no. 3 (June 1, 2021): e9-e18. http://dx.doi.org/10.4037/ccn2021877.
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Background The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families through the prevention and relief of suffering by assessment and treatment of physical, psychosocial, and spiritual problems. Any patient with chronic debilitating disease, including heart failure, is a candidate for interdisciplinary palliative care to manage their complex physical and psychosocial needs. Clinical Relevance The philosophy of palliative care has evolved to include a vision of holistic care extended to all individuals with serious illness and their families or caregivers that should be integrated throughout the continuum of care, including the acute phase. The critical care nurse will likely encounter patients with heart failure who are receiving or are eligible to receive palliative care at various time points during their illness. Critical care nurses therefore play a pivotal role in symptom palliation affecting the heart failure patient’s quality of life. Purpose To review the models of palliative care and the role that the critical care nurse plays in symptom palliation and preparation of the patient and their family for transition to other levels and settings of care. Content Covered This review addresses the principles and models of palliative care along with how to integrate these principles into all phases of the heart failure disease continuum. Also included are recommendations for palliation of symptoms specific to heart failure patients as well as a discussion of the role of the critical care nurse and the importance of shared decision-making.
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Wadiwala, Janvi, Mausam Patel, Chenghui Li, Sanjay Maraboyina, Ahmed Safar, and Thomas Kim. "Health care disparities and barriers to palliative care among metastatic renal cell carcinoma patients: An NCDB analysis." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 4545. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.4545.
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4545 Background: Palliative care improves quality of life for both patients and caregivers but may be underutilized due to socioeconomic barriers to access. An NCDB analysis was performed to analyze the effect of socioeconomics on palliative care receipt among patients with metastatic renal cell carcinoma. Methods: A retrospective hospital-based analysis was performed using the National Cancer Database to identify variables that significantly affect receipt of palliative care among patients diagnosed with metastatic renal cell carcinoma diagnosed between 2004 and 2016. Sub-cohort analysis was also performed among patients with the most severe disease. Multivariate binominal logistic regression was performed to determine the association of underlying socioeconomics with receipt of palliative care. The odds of receiving palliative care based on socioeconomic factors was reported as odds ratios (OR) with 95% CI. Results: There were 50405 patients meeting inclusion criteria with 40448 (80.2%) undergoing no palliation and 9957 (19.8%) undergoing palliative care. Both Black and Spanish/Hispanic patients had decreased odds of receiving palliative care (OR, 0.816, 95% CI, 0.753 to 0.885 and OR, 0.599, 95% CI, 0.540 to 0.665, respectively). Increasing age, papillary histology, increasing income, and increasing distance were also significantly associated with decreased odds of receiving palliation while treatment at an integrated network cancer program or comprehensive community cancer program and higher educational attainment were associated with increased odds of receiving palliative care. Similar findings were demonstrated among patients with the most severe disease. Limitations include the retrospective design and potential underlying selection biases of this study. Conclusions: Significant associations between receipt of palliative care and socioeconomic factors exist among patients with metastatic renal cell carcinoma. In this study among patients with metastatic renal cancer, we found associations between socioeconomics and palliative care access including age, race, Spanish/Hispanic origin, income, education, and other factors.
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Puckett, Lindsay, Lucille Lee, Petrina Zuvic, Isabella Bingchan Zhang, Louis Potters, and Beatrice Bloom. "Palliative treatment directives for bone metastases: A quality-directed approach to guiding institutional practice." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 188. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.188.
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188 Background: The efficacy of single fraction (fx) radiation treatment (RT) has proven to have equipoise for palliation of bone metastases when compared to courses of 10 fx or more. Despite these data, there has been a slow adoption of this practice in the US and worldwide. Examination of our multicenter practice from 2004 - 2016 showed that single fx RT utilization has remained at 17% and hypofractionationed (HFX) courses (1 or 5 fx) have remained at 71% since 2009. We hypothesized that evidence-based, treatment-guiding directives could improve HFX utilization in this population. Methods: Institutionally, palliative bone metastasis treatments are routinely tracked by a Quality Assurance committee. In 2/2016, two consensus-driven and evidence-based clinical directives were created within our electronic health system for use with either simple or complicated bone metastasis, irrespective of primary histology. The simple and complex directives had default prescriptions of 8 Gy/1fx or 20 Gy/5fx, respectively. The directives were reviewed with physician staff to improve compliance; directives were allowed to be edited at the physician’s discretion if an alternative fx was indicated. The chi-square test was used for analysis. Results: From 1/2009-5/2016, there were 1,781 treatment courses of palliative external beam RT. Following implementation in 2/2016, the new clinical directives were used for 96% of cases and were modified in 12 cases (n = 72). Single fx use increased from 17% to 36% among palliative bone metastasis treatments (p ≤ 0.001) and HFX (1 or 5 fx) utilization increased from 71% to 92% compared to other fractionation schemes (10 fx or other) (p = 0.001). Conclusions: The institution-wide adoption of evidence-based, treatment directives proved to be a straightforward and successful intervention which allowed for rapid adoption and increased utilization of the standard of care. Our early data suggests that this may be a useful approach in the setting of reticence to new treatment paradigms. Further examination of evidence based directives is warranted to address issues of overtreatment in palliation and in standardizing oncologic care.
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Jafry, Baqir, Munir Buhaya, and Syed Mohammad Ali Kazmi. "Comparison of palliative treatment modalities among patients with colon cancer: A review of NCDB Database." Journal of Clinical Oncology 42, no. 3_suppl (January 20, 2024): 220. http://dx.doi.org/10.1200/jco.2024.42.3_suppl.220.
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220 Background: Among colon cancer patients some patients present with significant symptom burden needing upfront palliation-directed therapies, aimed to improve the quality of life of patients with severe illnesses. These include palliation-directed surgery, chemotherapy, radiation, pain management, or a combination of these. The extent to which these palliation-directed therapies are utilized in colon cancer remains under-explored. This study's purpose was to understand the trends in utilization and factors associated with palliation-directed treatment modalities among patients with colon cancer. Methods: From the National Cancer Database, we identified patients with colon cancer who received first-line palliation-directed therapies from 2004 to 2016 without an intent to give definitive therapy. We evaluated the use of these treatments over time and compared frequencies of categorical variables using Chi square tests. A multivariate logistic regression was also used to evaluate patient characteristics associated with the use of these treatments. Results: We identified a total of 21,516 patients receiving palliation-directed therapy among patients with colon cancer – 19,506 received single palliation-directed therapy, 908 received a combination of palliation-directed treatments without pain management and 1102 received a combination of palliation-directed treatments with pain management. Of the 21,516 patients who received single palliation-directed treatments, 50.6% and 49.4% were male and female, respectively. The mean age was 67 years. Most patients had no existing comorbidities (68.7%), lived in metropolitan areas (81.6%), had grade 2 (59.4%) and AJCC Clinical stage 4 colon cancer (32.6%). Overall, most patients received chemotherapy (50.7%) as a palliative treatment, followed by surgery (25.2%), pain management (14.4%) and radiation (9.7%). The utilization of chemotherapy (39.6% in 2004 to 63.1% in 2016) and pain management (9.7% in 2004 to 12.7% in 2016) increased over time while the utilization of surgery (37.1% in 2004 to 16.9% in 2016), and radiation (13.6% in 2004 to 7.3% in 2016) decreased over time. The type of facility, readmission rates, and proportion of individuals who were whites, elder (age>50), resided in metropolitan areas and had insurance were significantly different between groups. Male patients, patients without existing comorbidities, and patients with grade 2 tumors had higher odds of receiving surgery, radiation, or chemotherapy as palliative therapy compared to pain management. Conclusions: Utilization of first-line palliation-directed chemotherapy has increased significantly from 2004 to 2016 whereas surgery and radiation therapy use has decreased in that period. Notably, patient characteristics such as gender, absence of existing comorbidities and grade 2 tumors influence the choice of therapy.
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Novotný, Rudolf, Zuzana Novotná, and Štefánia Andraščíková. "Inappropriate hemodialysis treatment and palliative care." Ethics & Bioethics 10, no. 1-2 (June 1, 2020): 48–58. http://dx.doi.org/10.2478/ebce-2020-0008.
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AbstractThe paper discusses inappropriate (futile) treatment by analyzing the casuistics of palliative patients in the terminal stage of illness who are hospitalized at the Department of Internal Medicine and Geriatrics of the Faculty hospital with policlinic (FNsP). Our research applies the principles of palliative care in the context of bioethics. The existing clinical conditions of healthcare in Slovakia are characteristic of making a taboo of the issues of inappropriate treatment of palliative patients. Inductive-deductive and normative clinical bioethics methods of palliative care and ethical strategy are applied for defining issues found in inappropriate hemodialysis treatment. An algorithm of hemodialysis treatment requires the definition of those lege artis criteria which, in the context of a patient’s autonomy and his/her decision, precondition the avoidance of the situation in which hemodialysis treatment is inappropriate (futile). Futile treatment in a terminal condition is ethically inappropriate medical treatment that extends the suffering of patients and their relatives. Its definition is determined by the relevant legislation and the methods of bioethics. An active palliative strategy is aimed at managing the process of incurable diseases in the patient’s bio-psycho-socio-spiritual continuity in the process of special bioethics. The global bioethical objective of general bioethics for palliative care is based on the paradigm of social harmony and solidarity in the context of an authentic modus of the patient’s existence as a constitutive principle for the phenomenon of the patient’s being to finite being (death).
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Buiting, Hilde M., Mirian Brink, Marleen N. Wijnhoven, Martine E. Lokker, Lydia GM van der Geest, Wim E. Terpstra, and Gabe S. Sonke. "Doctors’ reports about palliative systemic treatment: A medical record study." Palliative Medicine 31, no. 3 (August 19, 2016): 239–46. http://dx.doi.org/10.1177/0269216316661685.
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Background: Decisions about palliative systemic treatment are key elements of palliative and end-of-life care. Such decisions must often be made in complex, clinical situations. Aim: To explore the content of medical records of patients with advanced non-small cell lung cancer and pancreatic cancer with specific emphasis on doctors’ notes about decisions on palliative systemic treatment. Design: Medical record review (2009–2012) of 147 cancer patients containing 276 notes about palliative systemic treatment. We described the proportion of notes/medical records containing pre-specified items relevant to palliative systemic treatment. We selected patients using the nationwide Netherlands Cancer Registry. Setting: Hospital based. Results: About 75% of all notes reported doctors’ considerations to start/continue palliative systemic treatment, including information about the prognosis (47%), possible survival gain (22%), patients’ wish for palliative systemic treatment (33%), impact on quality of life (8%), and patient’s age (3%). Comorbidity (82%), smoking status (78%) and drinking behaviour (63%) were more often documented than patients’ performance status (16%). Conversations with the patient/family about palliative systemic treatment were reported in 49% of all notes. Response measurements and dose adaptations were documented in 75% and 71% of patients who received palliative systemic treatment respectively. Conclusion: Medical records provide insight into the decision-making process about palliative systemic treatment. The content and detail of doctors’ notes, however, widely varies especially concerning their palliative systemic treatment considerations. Registries that aim to measure the quality of (end-of-life) care must be aware of this outcome. Future research should further explore how medical records can best assist in evaluating the quality of the decision-making process in the patient’s final stage of life.
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Matoska, Thomas, Anjishnu Banerjee, Aditya Shreenivas, Lauren Jurkowski, Monica E. Shukla, Elizabeth M. Gore, Paul Linsky, et al. "Definitive Chemoradiation Associated with Improved Survival Outcomes in Patients with Synchronous Oligometastatic Esophageal Cancer." Cancers 15, no. 9 (April 28, 2023): 2523. http://dx.doi.org/10.3390/cancers15092523.
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Background: The study of oligometastatic esophageal cancer (EC) is relatively new. Preliminary data suggests that more aggressive treatment regimens in select patients may improve survival rates in oligometastatic EC. However, the consensus recommends palliative treatment. We hypothesized that oligometastatic esophageal cancer patients treated with a definitive approach (chemoradiotherapy [CRT]) would have improved overall survival (OS) compared to those treated with a purely palliative intent and historical controls. Methods: Patients diagnosed with synchronous oligometastatic (any histology, ≤5 metastatic foci) esophageal cancer treated in a single academic hospital were retrospectively analyzed and divided into definitive and palliative treatment groups. Definitive CRT was defined as radiation therapy to the primary site with ≥40 Gy and ≥2 cycles of chemotherapy. Results: Of 78 Stage IVB (AJCC 8th ed.) patients, 36 met the pre-specified oligometastatic definition. Of these, 19 received definitive CRT, and 17 received palliative treatment. With a median follow-up of 16.5 months (Range: 2.3–95.0 months), median OS for definitive CRT and palliative groups were 90.2 and 8.1 months (p < 0.01), translating into 5-year OS of 50.5% (95%CI: 32.0–79.8%) vs. 7.5% (95%CI: 1.7–48.9%), respectively. Conclusions: Oligometastatic EC patients treated with definitive CRT benefited from that approach with survival rates (50.5%) that vastly exceeded historical standards of 5% at 5 years for metastatic EC. Oligometastatic EC patients treated with definitive CRT had significantly improved OS compared to those treated with palliative-only intent within our cohort. Notably, definitively treated patients were generally younger and with better performance status versus those palliatively treated. Further prospective evaluation of definitive CRT for oligometastatic EC is warranted.
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ÖZTÜRK, Hüseyin Furkan, Gonca ALTINIŞIK İNAN, İpek Pınar ARAL, Suheyla AYTAÇ ARSLAN, Sedef GÖKHAN AÇIKGÖZ, Havva BEYAZ, and Yılmaz TEZCAN. "Clinical outcomes of palliative 3-dimensional conformal external beam gastric radiotherapy: single center experience." Journal of Medicine and Palliative Care 4, no. 1 (February 10, 2023): 46–50. http://dx.doi.org/10.47582/jompac.1184122.
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Aim: Patients diagnosed with locally advanced and/or metastatic gastric cancer and who cannot undergo surgery may need palliative treatment during their follow-up. There is scarce data about outcomes of palliative gastric radiotherapy (RT). In this study, we aimed to investigate the effect of 3-D external beam RT on oncological outcomes, as a non-invasive method.Material and Method: From 2013 to 2017, sixteen gastric cancer patients treated with palliative external RT in our institutional clinic were evaluated. Only patients who received palliative gastric radiotherapy for obstruction, pain and bleeding were analyzed, and patients who had previously received RT to the abdomen or who were given RT for adjuvant purposes were not included in the analysis. Results: Seven patients (43%) were not able to finish the planned palliative course. Thirty Gray with 10 fractions was the most planned RT schedule. Almost half of the patients (%56) received chemotherapy before RT. Overall survival was found to be median 2 months. Median survival was better in patients who were able to receive 28 Gy bioequivalent dose (4 vs 0.3 months, p≤0.00). Purpose of palliation also found to be a significant factor on survival. Patients who were referred for pain have found to be better survival rather than bleeding and obstruction (13 vs 0.7 months, p=0.03).Conclusion: External radiotherapy is an easily applicable and effective method for palliation in gastric cancer patients. Early referral for radiotherapy in patients who need palliation may increase oncological outcomes. It has been observed that the prognosis is worse in patients who received palliative radiotherapy due to gastric bleeding and obstruction.
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Ho, Samuel M. Y., and S. F. Leung. "Attitudes of Hong Kong Medical Students toward Different Modalities of Treatment for Cancer." Psychological Reports 76, no. 3_suppl (June 1995): 1291–96. http://dx.doi.org/10.2466/pr0.1995.76.3c.1291.
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140 medical undergraduates in a Hong Kong medical school rated the usefulness of different modalities of cancer treatment for curative, medically palliative, and psychologically palliative care, respectively. Factor analyses showed that respondents used a Chinese versus non-Chinese cultural framework in conceptualizing modalities of treatment outside the conventional Western medical model. The functions of unconventional modalities were mainly for psychologically palliative care according to the respondents, although they did not regard these modalities as adversive to curative and medically palliative treatments. Among the Western medical modalities, surgery was rated as more useful for curative treatment while chemotherapy and radiotherapy were rated as more useful for symptom control. The implications of the findings for cancer care and further research were discussed.
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Kucharska, Ewa, Aleksandra Kucharska, Aleksander Sieroń, Mariusz Nowakowski, and Karolina Sieroń. "MODERN METHODS OF TREATMENT IN PALLIATIVE CARE." Wiadomości Lekarskie 72, no. 7 (2019): 1229–35. http://dx.doi.org/10.36740/wlek201907101.
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The palliative care patient is definitely a unique type of patient. Due to the complexity of the symptoms requires a holistic therapeutic approach. Modern methods of treatment in palliative and hospice care underline an important role of physio, kinesiotherapy and pharmacological treatment coexistence. The rehabilitation reduces clinical symptoms, accompanying the basic disease and increases the quality of life of palliative patients and their families. It becomes an inseparable element of treatment, both in outpatient care as well as in stationary care and home care. Due to the high dynamics onset of cancer in the group of geriatric patients there is a need for a broader analysis of the topic. The goal of palliative care is to achieve the best possible quality of life for patients and their families.
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Dharmarajan, Kavita Vyas, Beryl McCormick, Chasity Walters, Christopher Monether, Tomer Levin, CarolAnn Milazzo, Robin Rawlins-Duell, and Gina Giannantoni-Ibelli. "Use of a video decision tool to improve informed decision making in hospitalized patients considering palliative radiation therapy." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 29. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.29.
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29 Background: Substantial evidence exists to suggest improved patient outcomes when oncologic patients are involved in making treatment decisions. Tools have been shown to facilitate the decision-making process for patients, yet aids to support decision making in radiation therapy (RT) are scarce. Given RT is one of the more difficult modalities for patients to conceptualize, there is a pressing need to develop and test decision aids, particularly in patients with incurable cancers. Methods: In this study, a video decision tool was developed and tested with 42 inpatients referred for palliative RT. Participants completed questionairres measuring their knowledge regarding palliative RT, treatment preferences and readiness, and decisional uncertainty before and after viewing the video. An additional 5-item tool was administered to participants after watching the video to assess their impression of the tool. Results: The mean percent of patients answering knowledge-assessing questions correctly increased 46.5% after viewing the video. Thirty-three percent (n=13) of patients rated their willingness to start palliative RT as 2 or greater (1= very ready; 10= not ready at all). Of these, 84.6% (n=11) showed improved scores in regard to their willingness to consent to palliative RT. Mean patient willingness scores improved 44% after watching the video. Decisional uncertainty scores changed minimally. Conclusions: Overall, participants' knowledge of palliative RT increased after viewing the video decision aid. With improved knowledge, there was a trend in increased willingness to begin RT. The next phase of this study will be a randomized trial to assess for differences in decisional uncertainty, knowledge of palliative RT, and treatment preferences for palliation. Clinical trial information: NCT01667965.
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Chu, Wei-Min, Wen-Yu Kuo, and Yu-Chi Tung. "Effects of different palliative care models on decedents with kidney failure receiving maintenance dialysis: a nationwide population-based retrospective observational study in Taiwan." BMJ Open 13, no. 7 (July 2023): e069835. http://dx.doi.org/10.1136/bmjopen-2022-069835.
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ObjectivesPatients with kidney failure receiving maintenance dialysis are a particularly important population and carry a heavy disease burden. However, evidence related to palliative care for patients with kidney failure receiving maintenance dialysis remains scarce, especially in regard to palliative care consultation services and palliative home care. This study aimed to evaluate the effects of different palliative care models on aggressive treatment among patients with kidney failure receiving maintenance dialysis during the end of life.DesignA population-based retrospective observational study.SettingThis study used a population database maintained by Taiwan’s Ministry of Health and Welfare in combination with Taiwan’s National Health Research Insurance Database.ParticipantsWe enrolled all decedents who were patients with kidney failure receiving maintenance dialysis from the period 1 January 2017 to 31 December 2017 in Taiwan.Main exposure measureHospice care during the 1-year period before death.Main outcome measuresEight aggressive treatments within 30 days before death, more than one emergency department visit, more than one admission, a longer than 14-day admission, admission to an intensive care unit, death in hospital, endotracheal tube use, ventilator use and need for cardiopulmonary resuscitation.ResultsA total of 10 083 patients were enrolled, including 1786 (17.7%) patients with kidney failure who received palliative care 1 year before death. Compared with patients without palliative care, patients with palliative care had significantly less aggressive treatments within 30 days before death (Estimates: −0.09, CI: −0.10 to −0.08). Patients with inpatient palliative care, palliative home care or a mixed model experienced significantly lower treatment aggressiveness within 30 days before death.ConclusionsPalliative care, particularly use of a mixed care model, inpatient palliative care and palliative home care in patients with kidney failure receiving dialysis, could all significantly reduce the aggressiveness of treatment within 30 days before death.
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Kinchen, Catherine Lee, Trent N. Taylor, Candice Aitken Johnstone, and Jared R. Robbins. "Stereotactic body radiation therapy for palliative treatment of bone metastases: Practice patterns and survival outcomes." Journal of Clinical Oncology 35, no. 31_suppl (November 1, 2017): 242. http://dx.doi.org/10.1200/jco.2017.35.31_suppl.242.
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242 Background: Stereotactic body radiation therapy (SBRT) is an emerging modality of treatment designed to deliver high radiation doses in few fractions. We examine practice trends in the use of SBRT for managing bone metastases in patients with breast, kidney, non-small-cell lung, melanoma, or prostate cancer. Methods: We selected patients from the National Cancer Database (2004-2013) diagnosed with bone metastases from breast, kidney, non-small-cell lung, melanoma, or prostate cancer. SBRT fractionation regimens were defined as 12-45 Gy in 1 fraction, 14-50 Gy in 2 fractions, 21-50 Gy in 3 fractions, 28-50 Gy in 4 fractions, and 30-60 Gy in 5 fractions. Standard palliative radiation fractionation regimens were defined as all other cases with 2-40 Gy in 20 fractions or fewer. Results: Patients receiving SBRT regimens made up 1454 of 57,556 total palliative cases. Bone metastases treated with SBRT primarily at the spine (65.5%), hip/pelvis (12.3%), and shoulder/extremity (11.4%). SBRT palliation regimens were used for only 2.5% of patients. Though standard palliative radiation fractionation regimens comprised the majority of treatments (97.5%), SBRT utilization is increasing, with a majority (68.4%) of SBRT cases occurring from 2009-2013. Treatment at an academic center and lack of comorbidities were positively associated with receiving SBRT regimens. Mean survival outcomes were higher for patients receiving SBRT (24.3 months) than patients receiving standard regimens (16.9 months). Conclusions: Though the vast majority of bone metastases were treated with standard palliative radiation fractionation, SBRT utilization increased from 2004-2013, with the greatest portion of SBRT cases occurring at academic institutions. Patients receiving SBRT exhibit better survival outcomes, likely as a result of patient selection practices.
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Jaruvongvanich, Veeravich, FNU Chesta, Anushka Baruah, Meher Oberoi, Daniel Adamo, Prabh G. Singh, Alyssa Meyer, Ryan J. Law, and Navtej Buttar. "Palliative treatment for malignant gastrointestinal obstruction with peritoneal carcinomatosis: enteral stenting versus surgery." Endoscopy International Open 08, no. 10 (October 2020): E1487—E1494. http://dx.doi.org/10.1055/a-1237-3956.
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Abstract Background and study aims Management of malignant gastrointestinal obstruction (MGIO) is more challenging in the presence of peritoneal carcinomatosis (PC). Outcomes data to guide the management of MGIO with PC are lacking. We aimed to compare the clinical outcomes and adverse events between endoscopic and surgical palliation and identify predictors of stent success in patients with MGIO with PC. Patients and methods Consecutive inpatients with MGIO with PC between 2000 and 2018 who underwent palliative surgery or enteral stenting were included. Clinical success was defined as relief of obstructive symptoms. Results Fifty-seven patients with enteral stenting and 40 with palliative surgery were compared. The two groups did not differ in rates of technical success, 30-day mortality, or recurrence. Clinical success from a single intervention (63.2 % versus 95 %), luminal patency duration (27 days vs. 145 days), and survival length (148 days vs. 336 days) favored palliative surgery (all P < 0.05) but the patients in the surgery group had a trend toward better Eastern Cooperative Oncology Group (ECOG) status. The rate of adverse events (AEs) (10.5 % vs. 50 %), the severity of AEs, and length of hospital stay (4.5 days vs. 9 days) favored enteral stenting (P < 0.05). The need for more than one stent was associated with a higher likelihood of stent failure. Conclusions Our study suggests that enteral stenting is safer and associated with a shorter hospital stay than palliative surgery, although unlike other MGIOs, clinical success is lower in MGIO with PC. Identification of the right candidates and potential predictors of clinical success in ECOG-matched large-scale studies is needed to validate these results.
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Thiong’o, Grace M., Susan S. Ferson, and A. Leland Albright. "Hydranencephaly treatments: retrospective case series and review of the literature." Journal of Neurosurgery: Pediatrics 26, no. 3 (September 2020): 228–31. http://dx.doi.org/10.3171/2020.3.peds19596.
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OBJECTIVEThe objective of this study was to review treatment options for infants with hydranencephaly and to consider the pros and cons of each treatment modality.METHODSThis paper is a review of hydranencephaly as well as a retrospective analysis evaluating the outcomes of 52 infants with hydranencephaly who were treated at the Kijabe Hospital, Kijabe, Kenya, in one of four ways: ventriculoperitoneal shunt (VPS) insertion, endoscopic choroid plexus coagulation (CPC), open choroid plexectomy (CPlx), and palliative care. The primary outcome measure was control of head size, with the aim of improving patient care. One-year mortality was a secondary outcome.RESULTSOf the 52 patients analyzed, 11 underwent VPS insertion, 17 CPC, 14 CPlx, and 10 were treated palliatively. Head size was controlled at the 3-month evaluation interval in 5 of 7 infants treated with VPS, 10 of 16 of those treated with CPC, 6 of 9 of those treated with CPlx, and 1 of 4 treated palliatively. The number of infants in each category with complete follow-up data that were needed to analyze change in head size was lower than the total number of patients included in each category. Mortality at 1 year of age was 9 of 11 in the VPS group, 14 of 17 in the CPC group, 6 of 14 in the CPlx group, and 7 of 10 in the palliative group.CONCLUSIONSHead size decreased by 1 cm or more in similar proportions (62%–71%) of infants with hydranencephaly who were treated by VPS insertion, CPC, and CPlx, and progressed in those who received palliative care. Mortality at 1 year of age was similar in infants treated by a VPS, CPC, and palliative care (70%–82%), but lower (43%) in those treated with CPlx.
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Datta, Rupak, and Manisha Juthani-Mehta. "Burden and Management of Multidrug-Resistant Organisms in Palliative Care." Palliative Care: Research and Treatment 10 (January 1, 2017): 117822421774923. http://dx.doi.org/10.1177/1178224217749233.
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Palliative care includes comprehensive strategies to optimize quality of life for patients and families confronting terminal illness. Infections are a common complication in terminal illness, and infections due to multidrug-resistant organisms (MDROs) are particularly challenging to manage in palliative care. Limited data suggest that palliative care patients often harbor MDRO. When MDROs are present, distinguishing colonization from infection is challenging due to cognitive impairment or metastatic disease limiting symptom assessment and the lack of common signs of infection. Multidrug-resistant organisms also add psychological burden through infection prevention measures including patient isolation and contact precautions which conflict with the goals of palliation. Moreover, if antimicrobial therapy is indicated per goals of care discussions, available treatment options are often limited, invasive, expensive, or associated with adverse effects that burden patients and families. These issues raise important ethical considerations for managing and containing MDROs in the palliative care setting.