BACKGROUND: Cancer-related pain comprises several mechanistically distinct syndromes. It can arise from tumor burden, treatment injury, neuropathy, visceral disease, bone involvement, postsurgical change, or pain that persists into survivorship. This distinction is central to spinal cord stimulation (SCS), which is most clinically defensible when the dominant pain generator is neuropathic, anatomically concordant, and sufficiently stable for trialing, programming, and maintenance. METHODS: We carried out a SANRA-guided structured narrative review. PubMed/MEDLINE and Scopus were searched on 21 May 2026 for literature on SCS and related neurostimulation in the settings of cancer, palliative or supportive care, neuropathic pain, polyneuropathy, plexopathy, radiculopathy, post-treatment pain, and survivorship. The search supported transparent literature mapping and narrative synthesis; it was not designed to produce a pooled effect estimate or a PRISMA-style study corpus. RESULTS: Direct evidence for SCS in cancer-related pain is sparse. The Cochrane review found no randomized trials, and most of the remaining literature consists of case reports, small series, retrospective cohorts, and scoping-level synthesis. The most plausible indications are refractory focal neuropathic pain, chemotherapy-induced painful polyneuropathy, plexopathy, radiculopathy, and neuropathic pain persisting into survivorship. The umbrella term “cancer pain” is too heterogeneous to justify broad efficacy claims. CONCLUSIONS: Spinal cord stimulation and related neurostimulation may be reasonable in selected patients with refractory cancer-related neuropathic pain when the mechanism is coherent, competing interventions have been considered, and the procedural and maintenance burden is proportionate. They should not be described as established treatments for cancer pain as a general category.
BACKGROUND: Cancer is a major cause of mortality in Saudi Arabia, increasing the demand for palliative and end-of-life care services. Accurate survival prediction in advanced cancer is essential for clinical decision-making and timely hospice referral. This study evaluated predictors of survival using the Palliative Performance Scale (PPS), Edmonton Symptom Assessment System (ESAS), and selected clinical parameters. METHODS: This retrospective cohort study included 417 adults with advanced cancer managed at a tertiary Saudi hospital between 2023 and 2024. Survival time was calculated from the last hospital admission to death. Clinical, laboratory, and treatment data were obtained from medical records. Prognostic assessments included PPS and ESAS. Kaplan–Meier survival analysis and multivariable Cox regression were used to identify independent predictors of survival. RESULTS: Mean overall survival was 36.9 days. Higher PPS scores were significantly associated with longer survival and clear separation of survival curves (log-rank p = 0.002). ESAS scores showed no significant association with survival. In multivariable Cox regression, increasing age (HR 1.007, 95% CI 1.000–1.013; p = 0.039) and hypoalbuminemia (HR 0.67, 95% CI 0.534–0.841; p < 0.001) independently predicted mortality. Patients with PPS scores of 40–60 had a significantly lower risk of death than those with PPS ≤ 30. CONCLUSIONS: Functional performance status was the strongest predictor of survival in advanced cancer patients. PPS, serum albumin, and age independently predicted mortality, supporting the integration of functional and biological indicators into prognostic assessment and end-of-life care planning.
BACKGROUND: Specialized palliative care (PC) services increased from nearly 5,000 in 2013 to 7,119 in 2025. However, it remains unclear whether countries are approaching the European Association for Palliative Care (EAPC) benchmark of two services per 100,000 inhabitants, and whether this growth has been evenly distributed. METHODS: Service density per 100,000 inhabitants was analyzed for 2013 and 2025. Relative changes (%) were calculated by country. Countries were grouped into United Nations subregions (Western Europe, Northern Europe, Eastern Europe, Southern Europe, Central Asia, and Western Asia), and median changes were compared. RESULTS: Average service density rose from 0.78 to 0.96 per 100,000 inhabitants. Few countries approached or exceeded the EAPC benchmark, including Austria (3.68), Lithuania (2.51), and Switzerland (2.10). Western Europe showed the highest median density (1.87), followed by Northern Europe (1.41). The largest relative increases occurred in Western Asia and Central Asia. Eastern Europe experienced substantial growth, with a median increase of 92.5%, particularly in Ukraine, the Czech Republic, Slovakia, Armenia, and Romania. CONCLUSIONS: Despite measurable growth in specialized PC services, expansion remains insufficient and uneven across regions. In several countries, large relative increases reflect low baseline levels rather than substantial improvements in service capacity.
BACKGROUND: Long-term oxygen therapy has not provided the expected survival benefits seen in randomized trials, nor the symptomatic benefits seen in meta-analyses. When long-term oxygen therapy (LTOT) is prescribed for people with symptomatic breathlessness, how do patients use it? The aim of this sub-study of a larger randomized controlled trial (RCT) was to describe self-reported patterns of LTOT use in people with severe/very severe breathlessness and optimally treated COPD, and compliance with physician-directed advice. METHODS: Participants in this cohort were asked: (a) whether they were prescribed LTOT and, if so, (b) what their oxygen use patterns were, and (c) whether this was the way in which the therapy was prescribed. RESULTS: Of 156 people randomized, 67 (43.2%) had LTOT available to them, of whom 17/67 (25.4%) had oxygen saturation < 90% at rest on room air. Oxygen was used continuously (35/67; 52.2%); only on exertion (13/67; 19.4%); only when needed (17/67; 25.4%); or rarely (2/67; 3%). Lower oxygen saturation was associated with a greater likelihood of continuous use. Almost all participants (63/67; 94%) indicated that the way they used LTOT was as directed by their prescribing physician. CONCLUSIONS: The use of oxygen varied widely. Research is needed to understand what prescribers said when LTOT was provided. A more detailed understanding of how LTOT is used, including why oxygen was commenced and ceased during episodic use, is needed.
BACKGROUND: Population aging has led to a sustained rise in gastrointestinal cancers among older adults, a group characterized by multimorbidity, frailty, and marked functional heterogeneity. In this setting, decisions based solely on chronological age or tumor stage risks resulting in both overtreatment and undertreatment. METHODS: We conducted a structured narrative review of the literature to synthesize current evidence on the role of comprehensive geriatric assessment (CGA) in clinical decision-making among older adults with gastrointestinal cancer. Relevant primary studies, systematic reviews, and clinical practice guidelines were identified through database searches and analyzed thematically. Findings were integrated with interdisciplinary clinical expertise to inform the development of an evidence-informed conceptual framework. RESULTS: The review synthesized evidence from clinical and observational studies, geriatric oncology research, and palliative care literature addressing decision-making in older adults with gastrointestinal cancer. CGA identifies clinically relevant vulnerabilities, stratifies the risk of treatment-related toxicity and functional decline, and guides optimization strategies before and during cancer treatment. Integrated with geriatric oncology and palliative care principles, CGA supports proportional, person-centered decisions that align with prognosis, symptom burden, and individual goals of care. CONCLUSIONS: We propose the palliative oncogeriatric assessment (POGA) as an evidence-informed, integrative conceptual framework that builds on CGA and is supported by a stepwise screening approach to facilitate implementation and strengthen individualized and proportionate decision-making for older adults with gastrointestinal cancer.
BACKGROUND: Sleep disturbances are highly prevalent among patients with cancer and significantly impair quality of life. Insomnia and depressive symptoms frequently co-occur in oncological populations; however, their relationship remains variably reported across different clinical settings. This study aimed to assess the prevalence and severity of insomnia among adult cancer inpatients in an Indian tertiary care hospital and to evaluate its association with depressive symptoms. METHODS: A hospital-based cross-sectional study was conducted among 108 adult cancer inpatients between October 2024 and October 2025. Insomnia was assessed using the Insomnia Severity Index (ISI), and depressive symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). Clinically significant insomnia was defined as ISI ≥ 15, and clinically significant depression as PHQ-9 ≥ 10. Descriptive statistics were used to summarize prevalence. The association between insomnia and depression was examined using the chi-square test and odds ratio (OR) with 95% confidence intervals (CI). Spearman’s rank correlation assessed the relationship between continuous scores. RESULTS: The mean age of participants was 51.05 ± 20.18 years; 50% were male. Clinically significant insomnia was observed in 32.4% of patients, while 29.6% had clinically significant depressive symptoms. Sub-threshold insomnia was present in 60.2% of the sample. No significant association was found between clinically significant insomnia and depression (χ² = 0.006, p = 0.94; OR = 1.13, 95% CI: 0.49–2.63). Spearman’s correlation between ISI and PHQ-9 scores revealed a very weak positive, non-significant relationship (ρ = 0.069, p = 0.476). Insomnia and depressive symptoms were not significantly associated with demographic or clinical variables. CONCLUSIONS: Insomnia is highly prevalent among hospitalized cancer patients and often occurs independently of depressive symptoms. Routine screening for insomnia using validated tools may facilitate early identification and targeted supportive interventions in oncology settings.
Przesłanie: rozpoznanie i leczenie nowotworów złośliwych prowadzić może do zaburzeń zdrowia psychicznego. Oceniono wpływ ekspozycji na immersyjną wirtualną rzeczywistość (IVR, ang. immersive virtual reality) w oparciu o innowacyjny autorski system NlightninVR™ – reagujący w czasie rzeczywistym na odczyty z sensorów – na poziom depresji, podstawowe parametry życiowe, odczyty z biosensorów (EEG, pulsometr) oraz subiektywną ocenę chorych onkologicznych, jako formę wsparcia chorych po leczeniu przeciwnowotworowym. Pacjenci i metody: sześciu chorym po leczeniu radykalnym (kobiety / mężczyźni = 5/1, mediana wieku: 52.5 lat, zakres: 43-73; mediana czasu od rozpoznania: 42.5, zakres 26-107 miesięcy) przedstawiano dwa autorskie scenariusze terapeutyczne w postaci fotorealistycznej interaktywnej animacji komputerowej „Morze od wschodu do zachodu słońca”. Wyniki: zaobserwowano statystycznie istotne obniżenie punktacji w teście Becka (zarówno mediana, jak i średnie wartości, p < 0.05) oraz Kwestionariuszu Zdrowia Pacjenta PHQ-9 (podobnie mediana i wartości średnie p < 0.05). Większość badanych oceniła sesje immersyjnej wirtualnej rzeczywistości jako zdarzenia wywierające duże wrażenie, powodujące całkowitą identyfikację z IVR, korzystnie wpływające na samopoczucie w dni między sesjami. Ekspozycja na IVR nie wiązała się z wystąpieniem objawów choroby symulatorowej oraz pozostała bez wpływu na średnie wartości skurczowego i rozkurczowego ciśnienia krwi oraz wartości akcji serca. Wskazano na pewne ograniczenia stosowanej procedury, głównie o charakterze technicznym. Podsumowanie: pilotażowe badanie wskazuje na przydatność kliniczną NlightninVR™ jako formę wsparcia chorych po leczeniu onkologicznym. Zastosowana procedura jest bezpieczna i dobrze odbierana przez chorych. Konieczna jest kontynuacja badania, aby potwierdzić wyniki w bardziej reprezentatywnej liczebnie grupie. Słowa kluczowe: immersyjna rzeczywistość wirtualna, depresja, rak, opieka wspierająca, biosensory Badania, których wyniki zaprezentowano w niniejszej pracy zostały przeprowadzone przez Nlightnin Production Sp. z o.o. w partnerstwie z Fundacją Hospicyjną w Gdańsku, w ramach projektu nr RPPM.01.01.01-22-0039/16 dofinansowanego ze środków UE.
The article presents the case of a 65-year-old woman with massive edema in the right arm region after radical treatment for breast cancer. Thanks to the use of three types of inelastic compression - multi-layer bandaging, adjustable compression wraps (ACW) with hook-and-loop fasteners, and a flat-knit compression sleeve - spectacular edema reduction and improvement in limb function were achieved. Palliat Med Pract 2026; 20: e01326041
Anti-resorptive drugs such as zoledronic acid and denosumab are used in the treatment of patients with bone metastases. These drugs inhibit bone resorption, improve quality of life, and prolong survival, but they can also cause a complication in the form of bisphosphonate-related osteonecrosis of the jaws. The authors present a case of a patient who required surgical treatment and draw attention to the increasingly frequent occurrence of this complication in patients treated with high doses of anti-resorptive drugs. Keywords: bisphosphonates, osteonecrosis of the jaws, bone metastases
Chylothorax is an uncommon clinical entity, most frequently associated with traumatic injury to the thoracic duct. It is less common in cancer patients, most typically related to lymphomas, and has a more favorable prognosis depending on the response to oncologic management. However, it may occur in advanced solid tumors, often signaling a poor prognosis and posing a significant challenge for the clinician. We report the case of a young woman with advanced metastatic osteosarcoma who developed bilateral malignant chylothorax. This case highlights the diagnostic challenges, therapeutic limitations, and the importance of multidisciplinary and palliative care approaches. Based on the literature review, available management strategies have been summarized.
BACKGROUND: Medically assisted dying (MAD), including euthanasia and physician-assisted suicide (PAS), is a highly controversial topic in healthcare, posing significant ethical dilemmas for health workers. This systematic review mapped evidence on health workers’ attitudes and perceptions toward MAD. METHODS: Guided by the Aromataris and Pearson (2014) framework and PRISMA-ScR checklist, a comprehensive search was conducted across seven databases (PubMed Central, PsycINFO, Scopus, JSTOR, Google Scholar, Web of Science, institutional repositories) for English, peer-reviewed studies published within the specified timeframe. Data were extracted using a standardized form and analyzed thematically. RESULTS: The initial search yielded 1,814 records, with 43 studies finally included after rigorous screening. All included studies were from outside Africa and nurses were the most frequently studied professional group (17 studies). Four major themes emerged for perceptions: (1) need for training, education and clear policies; (2) ethical and moral dilemmas; (3) lived experiences and professional meaning and (4) MAD as a way of facilitating good death and reducing suffering. Attitudes were categorized into: (1) supportive, (2) unfavorable, (3) supportive roles beyond direct provision, and (4) emotional and professional ambivalence. CONCLUSIONS: Health workers globally hold complex and diverse attitudes and perceptions toward MAD, influenced by ethical, moral, religious and professional considerations. While many support MAD, aligning with patient autonomy and suffering reduction, this is often tempered by profound ethical and moral dilemmas and emotional challenges. Findings highlight a critical need for enhanced training, clear policies and robust support systems to address professional uncertainties and emotional burdens, ensuring patient-centered care while upholding health worker well-being.
Background: Differences between the methods and content of palliative care teaching in various countries, centers, as well as within various medical disciplines, are noteworthy. Involving patients during the learning process is increasingly considered. Obtaining patients opinions and recognizing future professionals' knowledge and attitudes are important issues. This project had three aims: 1) descriptive analysis of university palliative curricula, 2) a cohort study based on medical, nursing and physiotherapy students' attitudes regarding palliative care before starting the training and after its completion, and 3) cross-sectional analysis of hospice patients' preferences according to practical bedside teaching. Methods: The structures of curricula were analyzed for knowledge and attitudes regarding care of seriously ill patients using 9-item Italian version of the Frommelt Attitude Toward the Care of the Dying (FATCOD-B) scale. The hospice patients' acceptance of bedside teaching was also addressed (authors' questionnaire). Results: Palliative undergraduate teaching differed among the examined domains in terms of content (practical or theoretical), quantity and trainers' professions. The attitudes both before and after the teaching were found to be moderate, but were slightly lower in the physiotherapy subgroup. The vast majority of the surveyed hospice patients accepted the general concept of bedside teaching, but they were less likely to consent to more intimate/invasive procedures. Conclusions: All efforts should be made to foster a compassionate and committed attitude towards future work in palliative care. Enhanced cooperation between universities and delivery of palliative care in in-patient units are needed. When planning bedside teaching, everything should be done to minimize the risk of affecting patients' autonomy and dignity. Palliat Med Pract 2026; 20: e01326030
BACKGROUND: When critical information about diagnosis or prognosis is partially or fully withheld from patients, a conspiracy of silence (COS) may occur. This scoping review aimed to map evidence on the reasons for, and consequences of, the COS in palliative care among patients, caregivers, and healthcare professionals (HCP). METHODS: Searches were conducted in MEDLINE, Web of Science, and Scopus for studies published between 2000 and April 2025 on COS involving patients with life-limiting illness, their caregivers, and HCP in palliative care settings. Evidence was synthesized narratively, with critical appraisal of included studies. The protocol was registered on the Open Science Framework. RESULTS: Twelve studies were included, mostly qualitative (66.67%), of moderate to high quality, predominantly European, and largely conducted in Spanish- and Portuguese-speaking contexts. Patients identified protection of family members as a major reason for COS, though their perspectives were underrepresented. Caregivers reported patient protection, cultural beliefs, expectations of recovery, and emotional overwhelm. HCP described similar motives, as well as prognostic uncertainty, limited communication skills, and fear of negative repercussions. Reported consequences included patients’ feelings of betrayal, isolation, loss of autonomy, and psychological distress; caregivers’ family conflict, complicated bereavement, and guilt; and HCP moral distress, communication barriers, and a sense of dehumanized care. CONCLUSIONS: Conspiracy of silence is a complex phenomenon that, despite good intentions, often causes harm. Compassionate, ethical communication is essential to protect autonomy and support families. Practice should strengthen HCP communication skills and disclosure policies, while research should develop interventions and expand evidence beyond cancer and high-income settings.
INTRODUCTION: This study mapped scientific evidence on nursing care for patients under palliative care in emergency and urgent care settings, in both national and international contexts. METHODS: This is a scoping review conducted following the methodology of the JBI Collaboration and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) extension. The search strategy included six databases and gray literature sources, encompassing publications without language or time restrictions. A total of 34 studies were analyzed qualitatively and quantitatively. RESULTS: The findings revealed that nursing practice in palliative care significantly improves patients’ quality of life, with positive outcomes in pain management, relief of physical symptoms, and reduction of anxiety and stress. The implementation of these practices, however, is hindered by the lack of specific protocols in emergency settings. A scarcity of national studies, particularly in Brazil, was noted regarding nurses’ experiences and the challenges faced in this context. Additionally, there is limited research on the impact of specific training for emergency nurses. CONCLUSIONS: Nursing care in palliative care within emergency and urgent care settings is essential but faces significant limitations due to the absence of specific protocols and training.
Background: Palliative care provides holistic care including symptom management and non-medical support for patients and their families. Rescue medicine takes action to save patients' lives in life-threatening emergencies. The aim of the study was to depict the course and effects of interventions undertaken by emergency medical service (EMS) called to cancer patients who stayed at home. Methods: The article presents five cases of cancer patients residing at home who called EMS. For each patient, the reason for calling, medical history, physical examination, selected vital signs, management and results of interventions have been presented. Results: EMS undertaking interventions in cancer patients staying at home comprised different actions and decisions depending on the clinical situation of the patients including clinical assessment, symptomatic treatment and support for patients and families at home and also referrals to hospital emergency units. Conclusions: Paramedics have a significant role in supplementing palliative care provision by home palliative care teams in the case of emergencies. Palliat Med Pract 2026; 20: e01326022
BACKGROUND: The study aimed to determine the relationship between pharmacological therapeutic adherence to pain treatment and quality of life in patients of a reference outpatient palliative unit in 2021. METHODS: Cross-sectional and observational research. In outpatients of a palliative referral unit in 2021, aged 18 years or older, with confirmed stage I, II, or III cancer of at least 6 months. The SF-36 questionnaire was used to assess quality of life and the therapeutic adherence scale. Authorization was obtained from the ethics committee and the statistical analysis was performed using Spearman’s Rho correlation test. RESULTS: The median age was 63 years, sex female (66.1%), level of secondary education (39.1%), and occupation of housewife (34.8%). The most frequent diagnoses were breast, prostate, and cervical cancer. The adherence to pharmacological therapy was good in 49.5%, fair in 30.4%, and poor in 20.1%. Quality of life was very low in 42.9% and relatively low in 23.9% of patients. Pharmacological therapeutic adherence (r = 0.68) and its dimensions: control over medication and food intake (r = 0.65), behavioral medical follow-up (r = 0.64), and self-efficacy (r = 0.69) were significantly related to quality of life (p < 0.001). CONCLUSIONS: Pharmacological therapeutic adherence is directly related to quality of life in the outpatient palliative care unit of a Peruvian hospital.
BACKGROUND: Palliative care (PC) in Saudi Arabia has advanced considerably in recent years, driven by the rising prevalence of chronic diseases, population ageing, and reforms to the national healthcare system. These developments have created a growing demand for patient-centered, holistic care. Despite rapid expansion, gaps remain in workforce capacity, geographic equity, community-based services, and culturally sensitive communication. As Saudi Arabia aligns its healthcare system with Vision 2030, regionally informed strategies that incorporate lessons from other Gulf Cooperation Council (GCC) countries are essential. This study synthesized current evidence from Saudi Arabia and the GCC to explore future directions for PC in health system development, workforce education and training, communication between healthcare professionals and patients/families, and the integration of PC across clinical disciplines. METHODS: A narrative review was conducted, identifying twenty references from Saudi Arabia and the GCC. Sources included workforce analyses, qualitative studies, national guidelines, service evaluations, and policy assessments. Findings were organized thematically in line with the review design. RESULTS: The review highlights persistent workforce limitations, with shortages of trained PC professionals and uneven distribution across regions. Communication and cultural barriers continue to hinder effective patient–family engagement and shared decision-making. Home-based services remain limited, underscoring the need for stronger community-based models. Integration of PC into broader health services and the establishment of a unified national strategy are critical to ensuring equitable and sustainable development. CONCLUSIONS: Advancing PC in Saudi Arabia requires coordinated national policies, workforce investment, and culturally attuned communication strategies. Strengthening integration across disciplines and expanding community-based services will be pivotal to achieving Vision 2030 goals of comprehensive, patient-centered healthcare.
Background: Futile therapy, defined as the maintenance of organ functions without patient benefit, has been the focus of growing ethical and medical debate. Recent initiatives in Poland, including new pro-tocols and the 2025 amendment to the Code of Medical Ethics, highlight the issue's relevance. Previous studies have primarily addressed healthcare professionals and end-of-life care, leaving the perspectives of the general population insufficiently studied. This study aimed to examine public attitudes toward futile therapy in Poland. Methods: An anonymous survey was conducted in Poland between March and September 2025. A total of 1,041 questionnaires were collected, of which 1,019 (97.9%) were complete and included in the final analysis. Eligibilitywas restricted to respondents aged 18 years or older. The mean age of participants was 31 years, 60% were female, and 47.3% lived in towns of 50,000-500,000 inhabitants. Most respondents had higher education (62.1%), and 54% were employed full-time. Results: While 84.2% of respondents identified futile therapy as the prolongation of vital functions with-out therapeutic benefit, detailed awareness of patients' rights and existing legal regulations was limited. One-fifth equated discontinuation of futile therapy with euthanasia. The majority (73.8%) agreed that futile therapy should not be applied if it prolongs suffering, and 58.4% supported family involvement in decision-making, while two-thirds disagreed that the decision should rest solely with physicians. Patient condition, prognosis, and will were cited as the most important factors in withdrawal decisions. The Internet and social media werethe predominant sources of knowledge. Significant differences in attitudes were observed across gender, religiosity, political orientation, education, age, and place of residence. Conclusions: Public awareness of the futile therapy issue in Poland remains limited, underscoring the need for educational initiatives.
