Psychological Aspects of Care in Cancer Patients in the Last Weeks/Days of Life

Transforming End-of-Life Care: Impact of the "Melhor em Casa" Home-Based Palliative Care Program in Brazil

Background: Palliative care (PC) is essential for managing symptoms and improving the quality of life for cancer patients. In Brazil, the "Melhor em Casa" ("Better at Home") program offers interdisciplinary home-based care. The SAD-Caratinga Program (SAD-CP) in Minas Gerais has provided care to patients with cancer since 2013. Objectives: This study aimed to evaluate the SAD-CP, focusing on sociodemographic and clinical data of cancer patients, symptoms, survival, number of hospitalizations, and place of death. Methods: A retrospective, cross-sectional, quantitative analysis was conducted on data from 471 consecutive oncology patients who died while under the program's care between 2013 and 2023. Demographic, clinical, and service data were analyzed using descriptive statistics, Kaplan-Meier survival estimates, chi-square, and Kruskal-Wallis tests. Results: The median age was 70 years, with 52.9% male patients and stage IV (57.8%). Pain was the most reported symptom (94.7%), followed by dyspnea (77.1%) and hypersomnolence (69.2%). Median survival was 48 days, with significant variation by cancer type. Notably, 468/471 (99.4%) patients died at home. The program demonstrated effective symptom management, as only three patients (0.6%) patients were hospitalized, and there were minimal emergency visits (0.08 visits/day). Conclusion: This interdisciplinary intensive home-based PC program improved patient symptom control and dramatically reduced hospital deaths. Future research should explore scalability and long-term outcomes in diverse populations.

The Experience of Reflexive Hospice Care for Patients With Advanced Cancer: A Qualitative Study

BACKGROUND

Hospice care for patients with advanced cancer mainly takes the family members and healthcare professionals as the main body and the patients as the object. There is a lack of relevant research on reflexive hospice care that considers patients as subjects.

AIM

To explore the experience of reflexive hospice care for patients with advanced cancer.

DESIGN

An empirical phenomenological approach to research was conducted.

METHODS

Data were collected using face-to-face semi-structured interviews between April 3, 2024 and May 27, 2024 in the oncology wards of two comprehensive hospitals. Purposive sampling was used to recruit 18 patients with advanced cancer receiving hospice care. Colaizzi's phenomenological analysis method was used to analyse the data. We followed the consolidated criteria for reporting qualitative research (COREQ).

RESULTS

Four themes were identified as being relevant to the experience of reflexive hospice care for patients with advanced cancer: the absence of prior awareness, reconciling with self and others, care and concern for others, and pursuing the meaning of life.

CONCLUSION

This study provides new insights into hospice care for patients with advanced cancer. It emphasises the importance of patients' participation as subjects in hospice care. In reflexive hospice care, patients can actively participate and express their care for others and their understanding of life, thus gaining more respect and care in the end-of-life stage. Therefore, placing patients as the subjects of hospice care and fully respecting and listening to their wishes and needs is one of the most important ways to promote the development of hospice care quality.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Diagnostic and therapeutic strategies in pancreatic adenosquamous carcinoma: Molecular and clinical insights in managing metastatic disease

Adenosquamous carcinoma of the pancreas (ASCP) is a rare and aggressive variant of pancreatic cancer, characterized by both adenocarcinoma and squamous cell carcinoma components. It presents significant diagnostic and therapeutic challenges due to its atypical histology and poor prognosis. A 72-year-old male presented with abdominal pain, lighter-colored stools, and intermittent nausea. Initial imaging revealed a complex mass in the distal pancreatic body and tail. Elevated lipase levels and subsequent endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) suggested an atypical pancreatic lesion with keratinizing squamous cells. Further investigation through fiberoptic bronchoscopy and EBUS-guided transbronchial needle aspiration (TBNA) confirmed carcinoma with squamous differentiation. Genetic testing identified KRAS G12D and PIK3CA mutations. The multidisciplinary tumor board recommended systemic chemotherapy with mFOLFIRINOX and G-CSF support. The patient underwent twelve cycles of mFOLFIRINOX with dose adjustments for thrombocytopenia and effective management of chemotherapy-related side effects. Restaging CT scans showed a decrease in tumor size and stable metastatic nodes. The patient showed a partial biochemical response with decreasing CA 19-9 levels and disease stabilization on imaging. This case demonstrates the critical role of a multidisciplinary approach in managing rare pancreatic malignancies. ASCP requires a comprehensive diagnostic and therapeutic strategy involving advanced imaging, histopathological confirmation, and personalized chemotherapy. Integrating advanced diagnostic techniques, molecular profiling, and a multidisciplinary approach is essential for improving patient outcomes and providing comprehensive care for this challenging malignancy. Addressing the psychological aspects and offering compassionate care are vital for supporting patients through their treatment journey.

Perceived Shame and Stigma, and Other Psychosocial Predictors of Psychological Distress Among Cancer Patients in Malaysia

BACKGROUND

Patients' sociodemographic factors, clinical characteristics, distress factors, perceived shame and stigma may give rise to psychological distress in cancer patients that bring about further psychosocial impact.

AIMS

(1) to determine the degrees of shame and stigma towards cancer and psychological distress among cancer patients in Malaysia and (2) to examine the clinical and psychosocial predictors of psychological distress.

METHODS

This cross-sectional study recruited a total of 217 cancer patients. The participants were administered the sociodemographic and clinical characteristics questionnaires, the Malay version of the Shame and Stigma Scale (SSS-M) to assess for the degree of cancer shame and stigma, and the Malay version of the Distress Thermometer and Problem List to assess for presence of psychological distress and identify its sources.

RESULTS

There was a significant level of shame and stigma among cancer patients with the total mean SSS-M score of 12.08 (SD = 6.09). Anger (adjusted odds ratio [AOR] = 11.97, 95% confidence interval [CI] = 2.96-86.8, p = 0.001), loss of interest or enjoyment (AOR = 14.84, 95% CI = 2.93-75.20, p = 0.001), loneliness (AOR = 8.10, 95% CI = 1.13-58.02, p = 0.001), feeling of worthlessness or being a burden (AOR = 6.24, 95% CI = 1.32-29.59, p = 0.021), fear (AOR = 4.52, 95% CI = 1.79-11.43, p = 0.001), pain (AOR = 4.07, 95% CI = 1.53-10.82, p = 0.005), financial constraint (AOR = 2.95, 95% CI = 1.22-7.13, p = 0.016), and having regret (AOR = 1.89, 95% CI = 1.03-3.79, p = 0.039) increased the odds of developing psychological distress.

CONCLUSION

Treating clinicians should monitor for and provide psychosocial interventions for the biopsychosocial factors which may worsen psychological distress among cancer patients.

Psychosocial Distress Screening Among Interprofessional Palliative Care Teams: A Narrative Review

With increased need for palliative care and limited staffing resources, non-social workers are increasingly responsible for screening for urgent psychosocial distress. The National Consensus Project guidelines call for all palliative care team members to be competent in screening across domains. Yet, in contrast to an abundance of evidence-informed tools for palliative social work assessments, standardization for interprofessional psychosocial screening is lacking. This lack of standardized practice may lead to harmful disparities in care delivery. The purpose of this narrative review is to examine current literature on evidence-informed practices for psychosocial screening within palliative care. Google Scholar, a university Summon library search engine, and prominent palliative care journals were searched using the same phrases to locate articles for inclusion. Each article was reviewed and synthesized across common themes. Although an abundance of validated screening tools exists for outpatient oncology-specific settings, there is minimal guidance on psychosocial screening tools intended for specialty palliative care. The most oft-cited tools have been met with concern for validity across diverse palliative care populations and settings. Additional research is needed to operationalize and measure brief psychosocial screening tools that can be validated for use by interprofessional palliative care teams, a stepping-stone for increased equity in palliative care practice.

Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review

BACKGROUND

People with an advanced progressive illness and their caregivers frequently experience anxiety, uncertainty and anticipatory grief. Traditional approaches to address psychological concerns aim to modify dysfunctional thinking; however, this is limited in palliative care, as often concerns area valid and thought modification is unrealistic. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy aimed at promoting acceptance and valued living even in difficult circumstances. Evidence on its value in palliative care is emerging.

AIMS

To scope the evidence regarding Acceptance and Commitment Therapy for people with advanced progressive illness, their caregivers and staff involved in their care.

DESIGN

Systematic scoping review using four databases (Medline, PsychInfo, CINAHL and AMED), with relevant MeSH terms and keywords from January 1999 to May 2023.

RESULTS

1,373 papers were identified and 26 were eligible for inclusion. These involved people with advanced progressive illness (n = 14), informal caregivers (n = 4), palliative care staff (n = 3), bereaved carers (n = 3), and mixed groups (n = 2). Intervention studies (n = 15) showed that Acceptance and Commitment Therapy is acceptable and may have positive effects on anxiety, depression, distress, and sleep in palliative care populations. Observational studies (n = 11) revealed positive relationships between acceptance and adjustment to loss and physical function.

CONCLUSION

Acceptance and Commitment Therapy is acceptable and feasible in palliative care, and may improve anxiety, depression, and distress. Full scale mixed-method evaluation studies are now needed to demonstrate effectiveness and cost-effectiveness amongst patients; while further intervention development and feasibility studies are warranted to explore its value for bereaved carers and staff.

Effectiveness of precise and quantitative rapid pulmonary rehabilitation nursing program for elderly patients with lung cancer during the perioperative period: A randomized controlled trial

Objective

Preoperative rehabilitation should improve the functional condition of patients. Improvements in metabolism, lung mechanics, cardiovascular function, and muscle-function can be achieved by pulmonary rehabilitation. Hence, we focused on elderly patients with lung cancer undergoing surgery, and assessed the effectiveness of a rapid and precise pulmonary rehabilitation nursing program during the perioperative period.

Methods

This randomized controlled trial at the department of thoracic surgery; Shanghai pulmonary hospital, China during 2021 was conducted amongst 218 elderly patients with lung cancer treated by surgical operation into either a precision quantitative nursing model nursing group (experimental group) or a perioperative routine nursing group (control group). After individual planning of the pulmonary rehabilitation nursing outpatient clinic, nurses distributed breathing trainers, instructed the patients in breathing training, and supervised the patients after the operation. For our evaluation we considered pulmonary function tests, postoperative thoracic drainage tube indwelling times, postoperative hospital stays, postoperative complication rates, and postoperative quality of life results.

Result

The experimental group showed better pulmonary function, length of hospital stay, and quality of life outcomes than the control group, but the differences were not statistically significant. However, we found a significantly higher postoperative complications rate in the control group (11.9%) than in the experimental group (3.7%; p=0.02).

Conclusion

Strengthening pulmonary rehabilitation nursing interventions for elderly patients with lung cancer during the perioperative period can reduce their postoperative complications and promote their rapid recovery. Clinical Trial: Registration Number - ChiCTR2100042916.].