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Advances in Supportive and Palliative Care in Cancer

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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 (29 February 2024) | Viewed by 4869

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Prof. Dr. Sriram Yennurajalingam

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Guest Editor

Palliative, Rehabilitation & Integrative Medicine The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX 77030, USA
Interests: palliative care

Special Issue Information

Dear Colleagues,

Patients with advanced cancer often experience severe physical and psychological distress resulting in a significant impact on the patients’ quality of life. Palliative and supportive care focuses on improving patients’ quality of life. Since the inclusion of palliative and supportive care as a subspeciality in the American Board of Medical Specialties (2006), the field has seen an incremental growth with significant advances in symptom management of the most distressing symptoms, including pain, fatigue, sleep disturbances, and delirium. Another very important area of significant growth is the improvement of access to and delivery of palliative care. In this Special Issue, we aim to discuss the advances in the field of supportive and palliative care in cancer, with a focus on cancer-related symptoms and access to palliative and supportive care. Additionally, in the articles of this Special Issue, we will focus on the current challenges in the management of these palliative care issues and discuss strategies to overcome these challenges through education and research.

Prof. Dr. Sriram Yennurajalingam
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (6 papers)

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Research

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9 pages, 737 KiB

Open AccessArticle

Outpatient Palliative Care Program: Impact on Home Death Rate in Brazil

by Sarah Ananda Gomes, Danielle Nunes Moura Silva, Flavia Sorice, Alexandra Arantes, Rafaela Peixoto, Renata Ferrari, Matheus Martins, Alexandre Jácome, Cristiane Bergerot, Andreia Cristina de Melo and Bruno Ferrari

Cancers 2024, 16(7), 1380; https://doi.org/10.3390/cancers16071380 - 31 Mar 2024

Viewed by 624

Abstract

While the positive impact of early palliative care on the quality of life of cancer patients is well established, there is a noticeable research gap in developing countries. This study sought to determine the impact of an outpatient palliative care (OPC) program on the location of death among patients in Brazil. This was a retrospective study including patients with cancer who died between January 2022 and December 2022 in 32 private cancer centers in Brazil. Data were collected from medical records, encompassing demographics, cancer characteristics, and participation in the OPC program. The study involved 1980 patients, of which 32.3% were in the OPC program. OPC patients were predominantly younger (average age at death of 66.8 vs. 68.0 years old, p = 0.039) and composed of women (59.4% vs. 51.3%, p = 0.019) compared to the no-OPC patients. OPC patients had more home/hospice deaths (19.6% vs. 10.4%, p < 0.001), and participation in the outpatient palliative care program strongly predicted home death (OR: 2.02, 95% CI: 1.54–2.64). Our findings suggest a significant impact of the OPC program on increasing home and hospice deaths among patients with cancer in our sample. These findings emphasize the potential of specialized OPC programs to enhance end-of-life care, particularly in low-resource countries facing challenges related to social and cultural dimensions of care and healthcare access. Full article

(This article belongs to the Special Issue Advances in Supportive and Palliative Care in Cancer)

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10 pages, 502 KiB

Open AccessArticle

Sonographic Measurements of Rectus Femoris Muscle Thickness Strongly Predict Neutropenia in Cancer Patients Receiving Chemotherapy

by Gürkan Güner, Levent Özçakar, Yusuf Baytar, Mehmet Ruhi Onur, Metin Demir, Burak Yasin Aktaş, Oktay Halit Aktepe, Deniz Can Güven, Hakan Taban, Hasan Çağrı Yıldırım, Serkan Akın, Sercan Aksoy, Murat Kara and Ömer Dizdar

Cancers 2024, 16(5), 1061; https://doi.org/10.3390/cancers16051061 - 5 Mar 2024

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Abstract

The objective of this study was to explore the possible association between low skeletal muscle mass (SMM)—assessed by computed tomography (CT) and ultrasound (US)—and hematologic toxicity in cancer patients. A prospective cohort study was conducted in cancer patients who received anthracycline-based chemotherapy between 2018 and 2020 and who had baseline abdominal CT including L3 level for measuring SMM. Regional muscle measurements were carried out using US. A total of 65 patients (14 males, 51 females) were included. ROC (receiver operating characteristic) analysis identified threshold values of 18.0 mm [AUC (area under the curve) = 0.765] for females and 20.0 mm (AUC = 0.813) for males, predicting severe neutropenia. Using these cut-offs, females with low rectus femoris (RF) thickness (<18.0 mm) had a significantly higher incidence of grade ≥3 neutropenia (50.0% vs. 10.8%, p = 0.005), and males with low RF values (<20.0 mm) had a higher incidence (80.0% vs. 22.2%, p = 0.063). A regression analysis, irrespective of age, gender, and body mass index, revealed that only low RF muscle thickness increased the risk of grade 3–4 neutropenia by 9.210 times (95% CI = 2.401–35.326, p = 0.001). Utilizing US to measure RF muscle thickness aids in identifying cancer patients at an elevated risk of developing neutropenia. Needless to say, US can serve as a convenient and easily accessible tool for assessing low SMM, providing repeat point-of-care evaluations in clinical practice. Full article

(This article belongs to the Special Issue Advances in Supportive and Palliative Care in Cancer)

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9 pages, 241 KiB

Open AccessArticle

Tertiary Inpatient Palliative Care within Region-Wide Services: A Retrospective Examination of Psychosocial and Medical Demographics at Admissions

by Andrea Feldstain, Lauren Buote, Janet M. de Groot, Jennifer Hughes and Aynharan Sinnarajah

Cancers 2023, 15(23), 5578; https://doi.org/10.3390/cancers15235578 - 25 Nov 2023

Viewed by 555

Abstract

Palliative care offers symptom relief and improved quality of life. Tertiary palliative care units (TPCUs) focus on complex suffering under the care of specialist palliative physicians and interdisciplinary teams. The Intensive Palliative Care Unit (IPCU) is a TPCU integrated in well-developed region-wide palliative services in Calgary, Canada. We compared the population accessing the IPCU to published data from other Canadian sites. Methods: A retrospective chart review was conducted using 8 sample months over a 2-year period. We gleaned psychosocial and medical demographics alongside the self-reported symptom burden on the Edmonton Symptom Assessment System. Descriptive statistics were calculated. Results: Adults (n = 117) with cancer admitted to the IPCU were 5–10 years younger, had later-stage cancer, and had higher discharges to preferred locations than other published Canadian TPCUs. Up to two months before admission, most commonly reported symptoms were consistent with the outpatient literature although with higher reported intensity. Discussion: With more advanced disease, younger age, and elevated symptom burden before admission, the IPCU still discharged patients to preferred locations at higher rates than other sites. This may be due to integration in the region’s organized palliative care services. Conclusion: With proper integration, a TPCU may be able to improve quality of life and reduce deaths in hospitals. Full article

(This article belongs to the Special Issue Advances in Supportive and Palliative Care in Cancer)

11 pages, 8043 KiB

Open AccessArticle

Complications of Central Venous Access Devices Used in Palliative Care Settings for Terminally Ill Cancer Patients: A Systematic Review and Meta-Analysis

by Clement Chun-Him Wong, Horace Cheuk-Wai Choi and Victor Ho-Fun Lee

Cancers 2023, 15(19), 4712; https://doi.org/10.3390/cancers15194712 - 25 Sep 2023

Cited by 1 | Viewed by 1129

Abstract

(1) Background: Central venous access devices (CVADs) have been commonly employed during various courses of anticancer treatment. Currently, there are a few types of clinically available CVADs, which are associated with short-term and long-term complications. However, little is known about the complication rates when CVADs are used only in palliative care settings. We therefore performed a systematic review and meta-analysis of all the published literature to evaluate the complication rates of CVADs in this clinical setting. (2) Methods: A systematic review and meta-analysis were conducted to identify publications from PubMed/MEDLINE, Embase (Ovid), Scopus, Cochrane Library, CINAHL, Google Scholar, and trial registries. Publications reporting the complication rates of PICCs, central lines, and PORTs in palliative settings for terminally ill cancer patients were included, while those on the use of systemic anticancer therapy and peripheral venous catheters were excluded. The outcome measures included overall complication rate, rate of catheter-related bloodstream infection (CRBSI), and rate of thromboembolism (TE). This systematic review was registered with PROSPERO (CRD42023404489). (3) Results: Five publications with 327 patients were analyzed, including four studies on PICCs and one study on central lines. No studies on PORTs were eligible for analysis. The overall complication rate for PICCs (pooled estimate 7.02%, 95% CI 0.27–19.10) was higher than that for central lines (1.44%, 95% CI 0.30–4.14, p = 0.002). The risk of CRBSI with PICCs (2.03%, 95% CI 0.00–9.62) was also higher than that with central lines (0.96%, 95% CI 0.12–3.41, p = 0.046). PICCs also had a trend of a higher risk of TE (2.10%, 95% CI 0.00–12.22) compared to central lines (0.48%, 95% CI 0.01–2.64, p = 0.061). (4) Conclusions: PICCs for palliative cancer care were found to have greater complications than central lines. This might aid in the formulation of future recommendation guidelines on the choice of CVAD in this setting. Full article

(This article belongs to the Special Issue Advances in Supportive and Palliative Care in Cancer)

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Review

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22 pages, 2049 KiB

Open AccessReview

Updates in Cancer Cachexia: Clinical Management and Pharmacologic Interventions

by Sudeep Pandey, Lauren Bradley and Egidio Del Fabbro

Cancers 2024, 16(9), 1696; https://doi.org/10.3390/cancers16091696 - 27 Apr 2024

Viewed by 592

Abstract

Despite a better understanding of the mechanisms causing cancer cachexia (CC) and development of promising pharmacologic and supportive care interventions, CC persists as an underdiagnosed and undertreated condition. CC contributes to fatigue, poor quality of life, functional impairment, increases treatment related toxicity, and reduces survival. The core elements of CC such as weight loss and poor appetite should be identified early. Currently, addressing contributing conditions (hypothyroidism, hypogonadism, and adrenal insufficiency), managing nutrition impact symptoms leading to decreased oral intake (nausea, constipation, dysgeusia, stomatitis, mucositis, pain, fatigue, depressed mood, or anxiety), and the addition of pharmacologic agents when appropriate (progesterone analog, corticosteroids, and olanzapine) is recommended. In Japan, the clinical practice has changed based on the availability of Anamorelin, a ghrelin receptor agonist that improved lean body mass, weight, and appetite-related quality of life (QoL) compared to a placebo, in phase III trials. Other promising therapeutic agents currently in trials include Espindolol, a non-selective β blocker and a monoclonal antibody to GDF-15. In the future, a single therapeutic agent or perhaps multiple medications targeting the various mechanisms of CC may prove to be an effective strategy. Ideally, these medications should be incorporated into a multimodal interdisciplinary approach that includes exercise and nutrition. Full article

(This article belongs to the Special Issue Advances in Supportive and Palliative Care in Cancer)

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13 pages, 592 KiB

Open AccessReview

Review of the Use of Medicinal Cannabis Products in Palliative Care

by James Troyer and Kimberson Tanco

Cancers 2024, 16(7), 1412; https://doi.org/10.3390/cancers16071412 - 4 Apr 2024

Viewed by 833

Abstract

In this review, we discuss the potential role of cannabis and cannabinoids in the management of cancer-related symptoms. There is limited evidence demonstrating the effectiveness of cannabis-based products in treating cancer-related pain and gastrointestinal symptoms such as nausea, vomiting, and loss of appetite. Regarding the role of cannabis-based products in the treatment of insomnia and mood disorders, most studies looked at these symptoms as secondary outcomes with mixed results. Cannabis-based products have adverse effects, ranging from neuropsychiatric to systemic effects to potential drug interactions. Full article

(This article belongs to the Special Issue Advances in Supportive and Palliative Care in Cancer)

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