Oligoprogression in prostate cancer is increasingly recognized as a clinically meaningful state with increased incidence due to effective systemic therapies and more sensitive molecular imaging, particularly prostate-specific membrane antigen positron emission tomography (PET). Broadly, oligoprogressive prostate cancer is defined as progression at a limited number of metastatic sites, commonly three to five or fewer, while the remainder of disease remains stable on ongoing therapy. In prostate cancer, however, this concept spans biologically and clinically distinct states, including repeat oligorecurrence off systemic therapy, new oligometastasis at the time of castration-resistance, and oligoprogression in castration-resistant disease. These differences are important because the goals of metastasis-directed therapy (MDT) differ across settings. In castration-sensitive disease, local therapy is often used to delay initiation or re-initiation of androgen deprivation therapy (ADT) and preserve quality of life. In castration-resistant disease, the goal is more often to ablate resistant clones, prolong the benefit of otherwise effective systemic therapy, and defer next-line treatment. Prospective randomized phase II data in oligometastatic castration-sensitive prostate cancer (CSPC) support MDT as an ADT-sparing strategy, and emerging studies suggest that repeat courses of stereotactic body radiotherapy (SBRT) may remain feasible in selected patients with serial limited-site recurrence. In metastatic castration-resistant prostate cancer (mCRPC), two randomized phase II trials and multiple prospective and retrospective series support the addition of MDT in carefully selected men. Across both disease states, local control rates are high and grade 3 or higher toxicity is uncommon. Nevertheless, major questions remain regarding optimal patient selection, imaging definitions, integration with systemic intensification, and the role of biomarkers in distinguishing durable oligoprogression from impending polyprogression. This review summarizes the biologic rationale, clinical evidence, and future directions for MDT in oligoprogressive prostate cancer.
BACKGROUND:Delirium is common and distressing in palliative care, particularly near death, but evidence linking difficulty in accepting the dying process to terminal hyperactive delirium is limited. This study aimed to examine the association between difficulty in accepting the dying process and hyperactive delirium in patients receiving palliative care, while accounting for other clinical risk factors. METHODS:We performed a subanalysis of a large multicenter cohort study conducted in 23 palliative care units in Japan. Variables were selected from previous studies and extracted from the present data set. The acceptance of the dying process was assessed by the attending palliative care physician. Hyperactive delirium was defined as Memorial Delirium Assessment Scale (MDAS) item 9 of ≥2. Multivariate analysis was performed to identify associations with hyperactive delirium within the last 3 days before death. RESULTS:A total of 1,045 patients were included (mean age was 71.5 years, 49.9% were female). Hyperactive delirium was present in 17.8% of patients. A total of 8.3% of patients had been assessed as having difficulty in accepting the dying process. Factors associated with hyperactive delirium in the last 3 days before death were: difficulty in accepting the dying process [odds ratio (OR): 2.64, 95% confidence interval (CI): 1.60-4.30, P<0.001], Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≤2 (OR: 2.11, 95% CI: 1.21-3.62, P=0.009), ECOG PS =3 (OR: 1.46, 95% CI: 1.02-2.10, P=0.041), no drowsiness (OR: 1.62, 1.03-2.64, P=0.04), oral morphine equivalent daily dose (OMEDD) ≥60 mg (OR: 1.53, 1.01-2.30, P=0.043), and males (1.46, 1.04-2.05, P=0.03). CONCLUSIONS:Difficulty in accepting the dying process was associated with hyperactive delirium within the last 3 days of life. These exploratory findings do not establish causality; prospective studies are warranted to determine whether supportive interventions around the dying process could mitigate terminal delirium.
Prolonged grief disorder (PGD) is a recognized distinct mental health disorder in the DSM-5-TR and ICD-11, characterized by core symptoms such as longing for and preoccupation with the deceased that persist and worsen over time. Family members and caregivers of patients that receive end-of-life care are confronted with imminent bereavement, which emphasizes the importance of bereavement care as a preventive measure and the need for continued support after death beyond the hospital setting. This review discusses bereaved family members' and caregivers' risk factors of developing PGD, screening and assessment tools (i.e., pre-death measures, measures of bereavement risk, and prolonged bereavement measures) for family members and caregivers of patients during end-of-life care to assess anticipatory loss, after the loss to assess grief reaction, and 6 months after the loss to assess prolonged grief. Implications for accurate and timely interventions during end-of-life care and after the patient's death are presented. Furthermore, limitations of current assessment methods and interventions, and barriers to and facilitators of guideline implementation are addressed. Early detection of elevated grief symptoms and potential PGD through ecological methods of studying daily life (e.g., Experience-Sampling Method, Electronically Activated Recorder, Mobile Sensing Methods, wearables) and digital, just-in-time interventions personalized to an individual's needs (i.e., Just-In-Time Adaptive Interventions) present an innovative digital approach for bereavement care in the future.
BACKGROUND:Healthcare professionals face stressful situations, especially in palliative care settings, where they are exposed to ethical dilemmas. This study aims to assess the association between moral distress and burnout syndrome among working at a Palliative Care Unit. METHODS:This is a cross-sectional analytical observational study conducted in a specialized Palliative Care Unit in Brazil. Between June and November 2024, a questionnaire was applied to healthcare professionals, collecting sociodemographic data, the Measure of Moral Distress for Healthcare Professionals-Brazilian version (MMD-HP BR) and the OLdenburg Burnout Inventory (OLBI) scales. RESULTS:A total of 100 healthcare professionals were included, with a mean age of 39.79±10.23 years. The majority were female (82%), physicians (24%), had no palliative care formation (79%) and worked for less than 11 years (75%). The MMD-HP BR scale ranged from 0 to 309 (median =98), while the OLBI scale ranged from 36 to 65 (median =49). Burnout was associated with age (coefficient β=-0.11, P=0.02) and the intention to leave the job (coefficient β=2.81, P=0.01); however, there was no statistically significant association between burnout and moral distress. CONCLUSIONS:There was no association between moral distress and burnout in our study. This may be due to the interdisciplinary nature of palliative care helping mitigate this impact. Nevertheless, the association between Burnout, professionals' age, and the desire to leave their jobs highlights workforce overload. Broader studies are needed to enhance understanding and help to prevent and control these phenomena.
BACKGROUND AND OBJECTIVE:Hypnosis has been explored for its therapeutic effects in bleeding disorders since the 1960s, yet this relationship remains inadequately characterized in contemporary medical literature. This study aimed to provide a narrative review examining the relationship between hypnosis and bleeding disorders, with emphasis on hemophilia, and identify evidence gaps. METHODS:A literature search was conducted using PubMed (1946-October 2025) with keywords "Hypno*" AND "Bleed*" without restrictions on article origin, language, or study design. KEY CONTENT AND FINDINGS:Of 527 articles identified, 37 were retained, predominantly case reports and small trials. Twenty-five articles (68%) focused on hemophilia. Four randomized controlled trials were identified (total n=90). Publications concentrated in 1960-1980 (40.5%), with declining frequency thereafter. Evidence on bleeding reduction is mixed: historical studies suggested reduced bleeding frequency and factor use, while recent trials showed non-significant trends. Contemporary research focuses on quality of life, with hypnosis demonstrating significant improvements in pain interference with daily activities and health-related quality of life, despite not reducing absolute pain intensity. Effects persisted at three-month follow-up. Hypnosis showed good feasibility and safety, with 90-100% retention rates and no adverse events. Additional evidence supports hypnotic interventions in surgical bleeding, menstrual disorders, gastrointestinal hemorrhage, epistaxis, and hematuria. CONCLUSIONS:Hypnosis demonstrates promise as an adjunctive intervention in bleeding disorders, particularly for improving quality of life in people with hemophilia. Contemporary protocols focus on relaxation and anxiety reduction rather than direct bleeding control, reflecting understanding of stress-mediated effects on hemostasis. Future adequately powered trials should elucidate mechanisms and identify patient populations most likely to benefit. Given consistent evidence for improved health-related quality of life and safety, hypnosis warrants consideration as a component of comprehensive care for bleeding disorders.
BACKGROUND:Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality, yet palliative care (PC) remains underutilized. Critically, the extent of this underutilization has not been rigorously quantified among patients who ultimately die during hospitalization. Characterizing PC utilization and its predictors in this terminal cohort is essential to identify disparities and improve end-of-life care quality. This study aimed to quantify PC utilization among terminal ACLF hospitalizations in the United States and identify demographic, clinical, and hospital-level factors associated with its use. METHODS:The National Inpatient Sample Database (2016-2022) was used to identify adult terminal ACLF hospitalizations. Patients were divided into two groups, stratified by PC utilization. Data were obtained on patient demographics, underlying liver disease, liver-related decompensations, comorbidities, and clinical outcomes. Multivariate logistic and linear regression analyses were used to identify predictors of PC utilization in patients with ACLF and to assess the impact of PC on resource utilization. RESULTS:Of the total 163,060 terminal ACLF hospitalizations ending in in-hospital mortality, only 75,365 (46.2%) received PC. Among those who received PC, the majority were male (60.9%), White (67.3%), and had Medicare insurance (42.7%). Compared to Whites, Black/African Americans and Hispanics had 29% and 34% lower odds of receiving PC, respectively. There was an incremental increase in PC use across income quartiles, with patients in the highest quartiles having 32% higher odds of receiving PC than those in the lowest quartile. Patients who had a history of liver transplantation were less likely to receive PC (adjusted odds ratio, 0.51; P=0.001). There were no significant differences in the length of stay; however, the use of PC was associated with lower total hospitalization charges (adjusted coefficient, -$7,942.93; 95% CI: -$14,065.26 to -$1,820.59; P=0.01). CONCLUSIONS:Our study highlights significant racial, regional, socioeconomic, and clinical disparities in PC utilization with respect to in-hospital mortalities with terminal ACLF hospitalizations. These findings suggest that PC resources are not being equitably provided, underscoring the need for targeted interventions to address these gaps.
BACKGROUND:Patients receiving palliative or hospice care and their caregivers frequently experience depression, anxiety, hopelessness, and fear of death. While previous reviews sought to clarify the impact of psychotherapy interventions for individuals receiving palliative and hospice care, none focused on the impact of psychotherapeutic interventions delivered by mental health professionals with formal psychotherapy training to all populations impacted. The aim of the present study was to systematically review the literature evaluating the efficacy of various psychotherapeutic interventions administered by mental health professionals, delivered to patients, their caregivers, and patient-caregiver dyads targeting a diverse set of outcomes. METHODS:We conducted a systematic review of the literature to examine specific forms of psychotherapy support delivered by mental health professionals with formal psychotherapy training, assessed by validated quantitative instruments, offered to patients receiving palliative or hospice care, their caregivers, and patient-caregiver dyads. Risk of bias was assessed by either the Cochrane risk of bias assessment for randomized-controlled trials (RCTs), or the Newcastle-Ottawa Quality Assessment Form for Cohort studies for pilot/feasibility studies. RESULTS:Twenty-seven studies met the criteria for inclusion in our final review after title/abstract and full-text screening. A wide variety of psychotherapeutic modalities and clinical outcomes were captured. Existential-phenomenological and life review/memory specificity therapy had the strongest current evidence base. Studies of cognitive behavioral therapy and dignity therapy (DT) almost uniformly found no significance in outcomes. CONCLUSIONS:While often well-tolerated and appreciated, psychotherapy administered by mental health professionals with formal psychotherapy training inconsistently improves objective outcomes for patients receiving palliative care, their caregivers, and patient-caregiver dyads-a demographic uniquely impacted by advanced disease states and subsequent existential distress. Studies that utilized mixed-effect model intention-to-treat analyses to account for loss to follow-up and blinding approaches like delayed intervention for control groups were rated as high quality.
Opioids may impair the ability to drive especially when prescribed for the first time or when the dose is increased. Because driving is closely associated with independence and quality of life, discussions regarding driving safety should be an integral part of prescribing opioids. However, little is known about the frequency with which palliative care specialists address this issue in clinical practice. In this pilot study, an anonymous survey was conducted among palliative care specialists to evaluate whether driving safety is discussed when prescribing opioids. The survey was distributed to advanced practice providers and physicians from a palliative care service of a tertiary cancer center, and 61 of 72 (85%) completed it. Fifty-seven (93%) respondents considered assessing patients' driving status to be important, and 58 (95%) agreed that driving is an important part of the quality of life of the patients. However, only 28 (46%) reported that they often discuss driving safety in general, and responses were lower when patients were on chronic opioids: 24 (39%) when the morphine equivalent daily dose (MEDD) was ≥100 mg whereas only 13 (21%) did so when the MEDD was ≤50 mg. In addition, just 20 (33%) frequently discuss driving safety when the dose is increased, and only 13 (21%) were familiar with local driving regulations regarding opioid prescribing. Despite recognizing the importance of driving safety, palliative care specialists infrequently address driving safety and opioids with their patients. Educational interventions, increased awareness of local regulations, and standardized preprinted information for patients may improve counseling and promote safer opioid prescribing practices.
BACKGROUND AND OBJECTIVE:The management of metastatic cancer is shifting from a strict division between curative local therapy and palliative systemic treatment toward a biology-driven continuum. In this setting, stereotactic body radiotherapy (SBRT), or stereotactic ablative radiotherapy (SABR), has emerged as an effective consolidative approach for patients with limited metastatic burden. Its role is now being explored beyond the classical oligometastatic paradigm, including oligoprogressive and selected polymetastatic disease. This narrative review summarizes the evidence supporting SBRT/SABR in patients with metastatic burden exceeding the traditional definition (≤3-5 metastases), focusing on emerging clinical scenarios. METHODS:A structured PubMed/MEDLINE search identified studies published between January 2000 and December 2025 using MeSH and free-text terms related to stereotactic radiotherapy and metastatic disease states. Randomized trials, prospective cohorts, and retrospective studies evaluating SBRT/SABR in oligoprogressive and other non-classical settings were included. Reviews, case reports, and preclinical studies were excluded. Due to heterogeneity in definitions and study designs, findings were synthesized narratively. KEY CONTENT AND FINDINGS:Prospective and observational data show that SBRT/SABR achieves high local control with acceptable toxicity in oligometastatic disease and is increasingly investigated in patients with higher metastatic burden. The conventional cutoff of ≤3-5 metastases appears arbitrary, with ongoing trials assessing broader indications. Clinical benefit is strongly influenced by tumor biology, with more favorable outcomes in prostate and renal cell carcinoma than in other malignancies. SBRT/SABR is also used in oligoprogressive disease to prolong systemic therapy efficacy and for local symptom control. Patient-reported outcomes suggest disease progression, rather than treatment toxicity, is the main driver of quality-of-life decline. CONCLUSIONS:SBRT/SABR may extend beyond the oligometastatic paradigm, but lesion count alone is insufficient for patient selection. Optimal use requires individualized, biology-driven strategies. Future research should refine selection criteria, incorporate biomarkers, and clarify integration with systemic therapies.
BACKGROUND AND OBJECTIVE:Solid organ transplant has increased within the last 50 years, particularly as surgical procedures, transplant outcomes, brain death criteria, and immunosuppressive therapies are improving. While transplant programs have specific criteria to help identify ideal transplant candidates, some programs are recognizing the emotional and physical burden that transplant candidates have leading up to the transplant decision; as such, a multidisciplinary approach to candidate evaluation which involves social work, psychiatry, nursing, and other disciplines is necessary for transplant success. Due to the complex nature of medical illnesses that lead to solid organ transplant, and the significant impact on quality of life, palliative care involvement both pre-transplant and post-transplant has been identified as a helpful support for patients. This narrative review summarizes relevant literature on the involvement of palliative care in transplant and provides a conversation guide for supporting patients through the transplant process from a palliative lens. METHODS:Authors ran a narrative review search in the National Library of Medicine (NLM) PubMed database. The search was restricted to English language articles, and publication date filters limited the results from January 1, 2015 to the day the search was run on April 2, 2026. An effort was made to exclude animal studies. Search terms included Medical Subject Headings (MeSH) terms as well as keywords, including terms for palliative care, palliative medicine, transplantation, solid organ transplant, conversation guide, heart transplant, liver transplant, lung transplant, kidney transplant, attitudes, perspectives, trajectory, utilization, outpatient, inpatient, early palliative care, referral, cost-savings, and their synonyms. KEY CONTENT AND FINDINGS:While palliative care involvement in transplantation has been well studied, only certain transplant groups, particularly heart and liver, have formally updated guidelines to reflect this. Palliative care providers should continue to partner with transplant teams in order to better support patients and caregivers throughout all stages of end-stage disease, particularly pre- and post-transplant. CONCLUSIONS:Further consideration should be given to healthcare outcomes with palliative team involvement in transplant populations. More research is needed to determine optimal timing, setting, and resource availability of palliative teams.
BACKGROUND:Code status is infrequently addressed in surgical disciplines unless there is a specific triggering event. Consistency and quality of code status discussions at a rural teaching hospital were evaluated, focusing on surgical residents' performance. METHODS:Study was conducted at Bassett Medical Center in Cooperstown, New York, a rural teaching, tertiary hospital. Bassett Healthcare Network has affiliations with Columbia University. A retrospective analysis of emergency department (ED) to inpatient surgical admissions from 1/1/2022 to 12/31/2023 was conducted of surgical patients (n=716) 18 years or older, excluding trauma, multiple admissions, and patients without a surgical procedure. Patient age, sex, race, insurance status, American Society of Anesthesiologists (ASA) class, discharge disposition, procedure, and service team requesting the procedure were collected. Code status orders were reviewed to assess whether Medical Orders for Life-Sustaining Treatment (MOLST) were on file, code status was discussed by the admitting clinician, and a new or revised MOLST was completed. RESULTS:About 94% of patients were documented as having no MOLST form, nor explicit discussion of code status resulting in completion of a MOLST form. 24.44% of patients had advance care planning documents in their electronic health record. 91.43% of these patients also had "NO" to all three MOLST questions in their admission orders. Majority of patients were ASA class 3 (60%) and most common surgeries were laparotomy (11.31%), laparoscopic cholecystectomy (11.17%), laparoscopic appendectomy (6.56%), and esophagogastroduodenoscopy (3.77%). CONCLUSIONS:Discussing code status with surgical patients is critical to providing complete surgical care, yet our results add to evidence of inconsistency in doing so. Rural areas face additional challenges, such as resource scarcity and older, comorbid populations. To bridge these gaps in surgical care, there is necessity for additional programming, such as rural surgical training programs, to ensure appropriate, informed, and patient-centered code status management for every surgical patient, regardless of geography.
BACKGROUND:Though especially in the last decade, much work has been done on various aspects of palliative sedation, little attention has been given to the role played by religious beliefs and traditions. Since the attitudes and decisions of patients, family members, and caregivers can be deeply influenced by religion when faced with severe suffering at the end of life, it is important to know the views of these traditions regarding palliative sedation. This study discusses and compares normative views in Christian denominations (Anglicanism, Catholicism, Eastern Orthodoxy, Protestantism) and Indian religions (Hinduism, Buddhism, Sikhism). METHODS:This study used a scoping study method to analyse religious normative perspectives on palliative sedation. Comprehensive database and grey literature searches were conducted to gather relevant sources from Christian denominations and Indian religions, followed by snowballing and expert consultation. The systematic mapping of views and arguments was followed by a grounded theory analysis of the mapped information and a comparative analysis between the Christian and Indian religious traditions. This manuscript is written following the Scoping Reviews PRISMA-ScR checklist. RESULTS:Christian traditions generally view palliative sedation as a morally acceptable means to relieve suffering, grounded in charity and dignity, but in doing so stress the importance of intent and a clear distinction from euthanasia. Concerns persist regarding the impact of lowered consciousness on the spiritual preparation for death, especially in Eastern Orthodox traditions; Protestant perspectives add the issue of autonomy and personal agency. Indian religions lack robust explicit authoritative statements but commonly value consciousness at the moment of death for spiritual reasons related to rebirth and karma. Palliative sedation could be an option, but Indian religious traditions also emphasize spiritual practices, such as prayer and meditation, to alleviate end-of-life suffering. CONCLUSIONS:Religious traditions significantly influence views and practices concerning palliative sedation, shaping both professional and patient decisions in advanced disease care. The major Christian denominations permit palliative sedation with safeguards, while Indian religions generally recommend spiritual awareness at life's end but accept palliative sedation as an option. Recognizing these beliefs deepens understanding of diverse end-of-life values and enhances culturally and religiously sensitive care in palliative settings.
BACKGROUND:Palliative surgery aims to alleviate symptoms and enhance health-related quality of life (HRQL) for patients with incurable cancer. Standardized patient-reported outcome measures (PROMs) are needed to assess effects of interventions, including HRQL from patient perspectives. A previously published systematic review (Wong et al., 2025) identified studies of palliative cancer surgery; the present study is a secondary scoping review to identify and characterize patient-reported measures of HRQL in these studies. METHODS:We searched PubMed, EMBASE, and CINAHL databases to identify English-language publications (August 1, 2005-December 31, 2023) reporting palliative thoraco-abdominal procedures for cancer patients. Of these, studies reporting patient-reported HRQL outcomes were secondarily analyzed using descriptive and thematic analysis. RESULTS:Screening of 1,915 unique studies yielded 92 studies of which 16 (17.4%) included a patient-reported HRQL outcome, 11 of which used a total of 13 unique validated PROMs. Five studies which used investigator-developed (non-validated) questionnaires were included to comprehensively map HRQL measures and to identify whether investigator-developed questionnaires captured domains not represented by existing PROMs. Twelve of the identified PROMs were developed or subsequently validated for cancer populations. Items from each PROM were extracted and coded, identifying 62 sub-themes further organized into 6 top-level themes. Content analysis of 242 PROM items across 6 main themes revealed that physical symptoms (76 items, 31.4%) and functional status (50 items, 20.7%) dominate existing measures, while social and structural domains are underrepresented. Fatigue was the most frequently measured sub-theme (11 items), and change in stools, affecting personal relationships, activities of daily living and financial stress were measured by 10 items each. Investigator-developed questionnaires largely overlapped with sub-themes of existing PROMs, identifying only two new sub-themes. CONCLUSIONS:Despite improved HRQL being the primary goal of palliative surgery, only 16 of 92 studies measured HRQL outcomes, and amidst these studies, significant heterogeneity exists in measurement approaches, with 11 studies using 13 unique PROMs. High heterogeneity in both PROMs used and subthemes measured demonstrates lack of standardization and highlights need for a validated, surgery-specific PROM that captures relevant priorities across HRQL domains.
BACKGROUND:The optimal drainage volume for paracentesis in malignant ascites (MA) has not been established, and identifying risk factors for paracentesis may serve as a guideline for clinical decisions regarding drainage volume in MA patients. Therefore, the aim of this study is to compare the safety of small-volume drainage (SVD) versus large-volume drainage (LVD) in MA patients and to identify risk factors for adverse events (AEs). METHODS:This single-center retrospective study analyzed gastrointestinal cancer patients who underwent paracentesis between 2014 and 2023. Patients were categorized into SVD (<3,000 mL) and LVD (≥3,000 mL) groups. The primary endpoint was the incidence of paracentesis-related AEs, including hypotension, infection, renal dysfunction, and hyponatremia. Multivariate logistic regression was used to identify independent risk factors for AEs. RESULTS:Among 89 eligible patients, 58 received SVD and 31 received LVD. The incidence of AEs was significantly higher in the LVD group compared to the SVD group (41.9% vs. 20.7%, P=0.04), particularly for hypotension (12.9% vs. 1.7%, P=0.04). In multivariate analysis, serum albumin <2.5 g/dL [odds ratio (OR) 3.20; 95% confidence interval (CI): 1.06-9.64] and LVD (OR 3.45; 95% CI: 1.20-9.93) were identified as independent risk factors for AEs. There was no significant difference in overall survival (OS; P=0.86) or the interval to subsequent paracentesis (P=0.21) between the groups. CONCLUSIONS:Large-volume paracentesis was associated with a higher risk of AEs without additional efficacy in terms of symptom control. SVD appears to be a safer and equally effective option, especially for patients with low serum albumin. These findings support a conservative and individualized approach to fluid removal in patients with MA.
BACKGROUND:Metastatic brachial plexopathy (MBP) is a rare but debilitating complication of advanced malignancies, most commonly associated with lung and breast carcinomas. Distinguishing MBP from radiation-induced brachial plexopathy (RIBP) represents a significant clinical challenge due to their overlapping clinical presentations and similar appearances on structural imaging. While magnetic resonance imaging (MRI) is considered the gold standard for evaluating the brachial plexus (BP), it often lacks the sensitivity required to definitively differentiate between malignant infiltration and post-radiation fibrosis. CASE DESCRIPTION:A 75-year-old male with a history of cT4N3M1c squamous cell lung carcinoma was treated with chemo-immunotherapy followed by consolidating radiotherapy (46.75 Gy in 17 fractions). After 2 years of maintenance pembrolizumab and achieving a complete response, the patient presented with progressive right arm paralysis and neuropathic pain. Initial electromyography and MRI were inconclusive, with the latter suggesting RIBP as a potential etiology. However, a subsequent [18F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) revealed intense hypermetabolic uptake along the C4-C5 nerve roots extending into the right BP, confirming a diagnosis of MBP. The patient subsequently underwent palliative radiotherapy (30 Gy in 10 fractions) targeted at the [18F]FDG-avid lesion. This intervention resulted in substantial pain relief, although the motor deficits remained persistent. CONCLUSIONS:This case highlights an atypical presentation of MBP that closely mimicked RIBP through its slowly progressive nature. It underscores the pivotal role of [18F]FDG-PET/CT in establishing the correct diagnosis and guiding palliative management.
BACKGROUND:Singapore's Home Ventilation and Respiratory Support Service (HVRSS) provides care for patients with chronic respiratory failure needing long-term home ventilation. Currently, data on the distribution of places of death (PODs) among these patients is lacking. We examined the distribution of POD among deceased HVRSS patients over a 10-year period and explored clinical factors potentially associated with specific death locations. Additionally, we assessed the agreement between patients' preferred POD (PPOD), as documented in Advance Care Planning (ACP), and their actual POD. METHODS:We conducted a retrospective cohort study of patients with at least one HVRSS encounter and who had died by 2019. Death-related information was obtained from an administrative dataset and linked with socio-demographic, clinical, and ACP data from other sources. Logistic regression was used to identify clinical factors associated with specific POD. Agreement analysis between actual POD and PPOD was performed among decedents with valid ACP documentation. RESULTS:Among 118 patients studied, 44% died at home, 53% in hospitals, and 3% elsewhere. ACP documentation was available for 52 patients (44.1%), with 73.1% of those preferring home as their POD. Clinical factors associated with home as POD included diagnosis of motor neuron disease (MND) [odds ratio (OR) =5.6; 95% confidence interval (CI): 1.2-25.0; P=0.02], ventilation status at death (OR =14.9; 95% CI: 3.8-58.3; P<0.001), and feeding type at death (OR =3.8; 95% CI: 1.0-14.0; P=0.044). The percentage agreement between actual POD and PPOD was 57.1% (95% CI: 43-72%; P<0.001) with a Gwet's AC1 coefficient of 0.49 (95% CI: 0.31-0.66; P<0.001), indicating moderate agreement. CONCLUSIONS:This is the first study in Singapore to characterise POD patterns and associated factors among home ventilation patients, as well as to evaluate alignment between preferred and actual POD. These findings may inform policy and end-of-life care practices to better support HVRSS patients, particularly at their chosen POD.
BACKGROUND AND OBJECTIVE:Due to the importance of religion for 70% of adults in the United States, the prevalence of religious beliefs, and the impact of religious beliefs on health behaviors and health outcomes, palliative care teams must pay attention to the religious dimension of the lives of patients at end-of-life (EOL). We will review the content of some religious beliefs associated with EOL as well as the impact religious beliefs may have on EOL medical care and decision-making. We will also discuss potential pathways for palliative care teams to address the religious beliefs of patients and their loved ones at EOL which promote culturally sensitive and patient-centered care. METHODS:This is a narrative review. We carried out an electronic PubMed search from 2010 to 2025 utilizing the subsequent words: religious beliefs; end-of-life; palliative care; adult 19+ years. We also integrated a hypothetical case study as well as the experience and proficiency of the authors. KEY CONTENT AND FINDINGS:Many adult patients at EOL hold religious beliefs which can be facilitated through religious behaviors and belonging. The religious beliefs of patients at EOL have a strong potential to impact their medical care decision-making and outcomes as well as their quality of life. Yet, treatment teams insufficiently address the religious beliefs of patients at EOL. CONCLUSIONS:Religious beliefs are often present and can impact EOL medical care. Best practice dictates that an interdisciplinary palliative care team approach should address the religious beliefs and values of patients at EOL through a generalist and specialist spiritual care model. When palliative care teams are willing to engage the religious beliefs and values of patients at EOL, this has the potential to help patients find acceptance and peace in the dying process.
