Background There is growing interest in poetry as a healing modality within healthcare.[1,2] Poetic Medicine is a therapeutic process offering a defined and structured format in which participants listen to and write poetry in community.[3] Although widely practiced, few poetry-based interventions have been systematically evaluated for bereaved populations. This pilot aimed to address that gap by developing and studying a standardized Poetic Medicine model designed for grief support.[3] Objective To evaluate the feasibility, acceptability, and psychological impact of a virtual Poetic Medicine intervention for bereaved individuals. Methods Developed by an interprofessional team with expertise in palliative medicine and Poetic Medicine, the pilot included three cohorts of bereaved individuals from diverse communities. Participants attended three 60-minute virtual sessions following a structured format of listening, reflecting, and writing poetry, with the option to share aloud. All facilitators were trained by the UCSF MERI Center to ensure a consistent, supportive approach. Participants provided pre-intervention demographics, post-session Likert evaluations, and pre-/post-intervention validated scales assessing depression, anxiety, grief, loneliness, hope, resilience, and spiritual well-being. Paired analyses compared pre- and post-scores using two-tailed tests; qualitative feedback was reviewed for thematic insights. Results Forty-eight participants engaged; 41 completed post-evaluations and 37 completed pre-post scales. Ninety-seven percent were somewhat or extremely likely to recommend the workshops, and over 70% reported the sessions helped them cope with grief. Pre-post testing showed significant decreases in depression (PHQ-8, p=0.009) and anxiety (GAD-7, p=0.03), and increases in resilience (BRCS, p=0.005) and spiritual well-being (FACIT-Sp meaning p=0.04; peace p=0.02). Qualitative themes emphasized connection, shared humanity, and safe expression of emotion. Conclusions Poetic Medicine is a feasible, scalable, accessible, and creative intervention that meaningfully supports bereaved individuals from diverse settings and backgrounds. Findings demonstrate high satisfaction and measurable improvements in psychosocial outcomes, advancing evidence-based approaches to addressing grief and emotional suffering in palliative care.

INTRODUCTION:Cancer diagnoses are associated with considerable psychological distress and increased incidence of new mental health disorders (MHDs). Our aim was to identify patterns and differences in the emergence of new MHDs within the first year following a cancer diagnosis, using data from a diverse, multi-institutional cancer cohort including more than half a million patients within a statewide academic health system. METHODS:The University of California Data Discovery Platform was used, which aggregates data of all patients at University of California-affiliated hospitals. We identified a cohort consisting of all adult patients with a cancer diagnosis and no documented MHDs before cancer diagnosis between 2013 and 2023. Multivariable adjusted time-partitioned hazard ratios for overall all-cause mortality were constructed using epochs of 12 through 35, 36 through 59, and 60 through 120 months. RESULTS:A total of 371,897 patients (mean age, 62.1 years) did not have a diagnosis. Following an incident cancer diagnosis, 39,687 patients (10.6%) developed a new MHD within a year. Of these, 13,904 (35.0%) were newly prescribed one or more oral psychotropic medications. After adjusting for covariates, early MHD was found to be linked to increased all-cause mortality in the initial 12 through 35 months (hazard ratio, 1.51; 95% CI, 1.47-1.56), which diminished over time, observed as 1.17 (95% CI, 1.11-1.24) for 36 through 59 months and 0.95 (95% CI, 0.89-1.01) for 60 through 120 months. CONCLUSIONS:Patients with cancer who experience a mental health condition are at an increased risk of all-cause mortality. This reinforces and emphasizes existing recommendations for prompt screening and management of distress and mental health following a cancer diagnosis.

BACKGROUND:Radiation therapy (RT) plays a crucial role in managing cancer-related symptoms. This study characterized symptom documentation, especially pain, preceding bone metastasis diagnosis and initiation of RT for bone metastasis using natural language processing approaches. METHODS:A deidentified cohort of patients who received RT for bone metastasis at a single tertiary-care institution (2013-2023) was created. Clinical data, notes, and metadata were computationally extracted. A previously validated natural language processing pipeline based on Apache clinical Text Analysis and Knowledge Extraction System was used to extract Common Terminology Criteria for Adverse Events-encoded symptoms from all notes in the 30 days preceding bone metastasis diagnosis and each course of RT for bone metastasis. Logistic regression analyses examined the association between clinical and demographic variables and pain documentation. RESULTS:In all, 1061 patients (median [IQR] age, 64 [54-72] years; 582 [54.9%] men) received 1718 courses of RT for bone metastases. The most common documented symptoms before bone metastasis diagnosis and first RT for bone metastasis, respectively, were bone metastasis-related pain (52.5% vs 91.6%, P < .001), nausea (20.8% vs 48.9%, P < .001), and constipation (12.8% vs 34.2%, P < .001). Before bone metastasis diagnosis, multiracial or a race other than Asian, Black, or White (odds ratio = 0.61, 95% confidence interval = 0.38 to 0.99]; P = .045) was associated with decreased pain documentation compared with White race. Before RT for bone metastases, women (odds ratio = 1.48, 95% confidence interval = 1.02 to 2.15, P = .04) had increased pain documentation compared with men. CONCLUSIONS:Women and patients who identified as multiracial or a race other than Asian, Black, or White experienced a relative increase in pain documentation from bone metastasis diagnosis to RT for bone metastases. This finding may reflect differential decision-making for which patients are offered RT for bone metastases sooner in the symptom trajectory. Interventions are needed to increase equitable distribution of RT.

For patients with serious illnesses, goals of care conversations improve quality of life and patient and family satisfaction and may reduce healthcare costs. However, these conversations often happen late in a serious illness or not at all. To better integrate goals of care into routine clinical practice, health systems across the country have implemented initiatives to increase and document these conversations. In this article, we describe the landscape of goals of care initiatives across eight large health systems in the U.S. and identify core elements for effective programs: 1) Defining the purpose of the initiative; 2) identifying the target patient population using patient diagnoses, artificial intelligence algorithms, or length of stay; 3) engaging key stakeholders, including patient, caregiver, frontline provider, and leadership; 4) encouraging the conversation through clinician and patient education and electronic health record (EHR) prompts; 5) documenting conversations within the EHR; 6) measuring data by building EHR and information technology infrastructure; and 7) planning for sustainability and scalability through leadership and funding support. These core elements can help inform how health systems plan goals of care initiatives, build infrastructure, and garner support to successfully implement these initiatives.

Background/Rationale Patients with advanced cancer face high physical and psychological symptom burden, yet access to palliative care (PC) and psycho-oncology (PO) remains limited (1,2). Group medical visits (GMVs) may enhance access, efficiency, interdisciplinary collaboration, and patient experience by combining clinical care, education, and peer support (3). Few studies have examined GMVs as a health service delivery model in palliative care. Objectives/Purpose To develop, refine, and pilot an integrative PC/PO GMV; assess feasibility and acceptability; explore changes in patient-reported outcomes (PROs); and evaluate clinical efficiency and financial viability within an outpatient oncology setting. Methods/Approach In this single-center pilot, adults with stage III–IV solid tumor cancers participated in four weekly two-hour telehealth GMV sessions co-facilitated by a PC physician and psychologist. Sessions included mind-body practices, symptom management education, group discussion, and individual check-ins. Intervention content was iteratively refined through patient feedback. Feasibility thresholds were ≥50% enrollment (% eligible and approached patients consenting to participate), ≥70% retention (% completing pre and post questionnaires), and ≥70% adherence (% completing two or more sessions). Acceptability was defined as mean satisfaction ≥7/10 on satisfaction questions. PROs were measured pre- and post-intervention using validated scales. Exploratory analyses assessed patients seen per session and relative value units (RVUs) and as indicators of clinical efficiency and financial sustainability. Results Thirty-eight patients enrolled (33% of those approached); retention and adherence were 81% and 87%, respectively. Mean satisfaction scores exceeded 7/10 across all questions. Sleep disturbance (p = 0.007) and depression (p = 0.02) significantly improved. GMVs demonstrated clinical efficiency for both co-facilitators and financial viability for the physician. Conclusions/Implications An integrative PC/PO GMV model is a feasible and acceptable health service delivery approach that may improve patient access, sleep, and mood while enhancing efficiency. Larger studies are warranted to evaluate scalability and integration into standard oncology and palliative care workflows.

Importance:Patients with cancer frequently experience unplanned acute care with emergency department visits and hospitalization due to disease or treatment complications, which impacts outcomes, quality of life, and health care costs. There remains a knowledge gap in understanding patterns of symptoms that precede acute care events. Natural language processing (NLP) may enable greater understanding of the symptoms and identify differences across patient and cancer characteristics. Objective:To characterize symptoms preceding acute care in patients with cancer and quantify differences in symptom documentation across sociodemographic and cancer histologic subgroups. Design, Setting, and Participants:A cohort study in a single tertiary-care institution, including all acute care (emergency department and hospitalization) encounters for patients aged 18 years or older with a primary cancer diagnosis identified between January 1, 2013, and December 31, 2023. Main Outcomes and Measures:Natural language processing was used to identify routine clinical documentation to characterize symptoms documented in the 30 days preceding acute care. Logistic regression analyses was used to examine the possible association between sex, age, race and ethnicity, insurance coverage, cancer histologic characteristics, and reported symptoms. Results:Overall, 28 708 patients with cancer had 70 606 acute care visits with 854 830 associated preceding documented symptoms. Median age was 61 (IQR, 48-70) years. Men (37 861 encounters [53.62%]) and patients of White race (39 989 encounters [56.64%]) accounted for most acute care encounters. Pain (7.54% of documented symptoms), nausea (6.74%), and vomiting (5.79%) were the most frequently documented symptoms. Acute care encounters with patients who were female (adjusted odds ratio [AOR], 1.14; 95% CI, 1.10-1.18; P < .001), Asian (AOR, 1.22; 1.17-1.28; P < .001), Black (AOR, 1.17; 95% CI, 1.10-1.25; P < .001), American Indian or Alaska Native (AOR, 1.21; 95% CI, 1.01-1.44; P = .04), or Medicaid-insured (AOR, 1.10; 95% CI, 1.05-1.14; P < .001) were associated with a high documented symptom burden (>10 unique symptoms) preceding acute care visits. Patients aged 65 years or older (AOR, 0.96; 95% CI, 0.92-1.00; P = .04) or uninsured (AOR, 0.58; 95% CI, 0.45-0.76; P < .001) were less likely to have a high symptom burden documented before acute care events. Conclusions and Relevance:The findings of this study highlight common symptoms preceding acute care as well as the need for further research on interventions to reduce patient burden, improve quality of life, and reduce the use of acute care in patients with cancer.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain provide recommendations for the comprehensive management of pain in patients with cancer. This article will focus on methods for screening for pain, safe and appropriate prescription of opioid and miscellaneous analgesics, and the optimization of nonpharmacologic interventions including integrative and interventional strategies for treatment of cancer-related pain. Additionally, the NCCN Guidelines discuss methods for the safe reduction of opioids when appropriate, as well as techniques for encouraging the judicious use of opioids. The complete version of the NCCN Guidelines for Adult Cancer Pain addresses additional issues that are not covered here, including management of pain during a pain crisis, management of procedure-related pain and anxiety, pain management for cancer survivors, and the use of nonopioid and adjuvant analgesics for cancer-related pain.

Background: Research examining racial-ethnic disparities in palliative care (PC) receipt has produced mixed results. Objectives: To examine racial disparities in PC receipt with a large-scale study in a well-established outpatient cancer PC program. Design: We performed a multivariable analysis to test the association of race-ethnicity with PC receipt, adjusting for age, sex, stage, cancer, and insurance type. Exploratory analyses included association of race-ethnicity with reason for referral, functional status, and time to death. Setting/Subjects: Using a cancer registry in an urban academic medical center in the United States, we performed a retrospective cohort study of cancer decedents from May 2007 to December 2021. Results: Of 18,797 eligible patients, 7.9% (n = 1484) received PC. In adjusted analyses, compared with White patients, Asian patients had higher odds of PC receipt (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.21-1.66), but there were no significant differences for Latino/a or Black patients. Asian patients received PC significantly closer to death compared with White patients (9.6 vs. 12.08 months, p = 0.02). Compared with White patients, Black patients were more likely to be referred to PC for pain (OR, 1.81; 95% CI, 1.07-3.06). Conclusion: Asian patients had higher odds, yet a shorter duration of PC receipt, suggesting delayed referrals. Black patients were more likely to be referred to PC for pain. Development of structural changes to PC referrals and tailored pain interventions may help ensure more equitable PC access and care.

OBJECTIVE:Describe a pilot system that 1) proactively identifies palliative care (PC) needs in a gynecology oncology population and 2) efficiently connects patients with targeted primary and specialty PC services. METHODS:Outpatients with stage 3 or 4 gynecologic malignancies received electronic surveys assessing PC needs in domains of physical symptoms, emotional or spiritual distress, care coordination, practical concerns, and advance care planning (ACP). Referrals to support groups, social work (SW), ACP websites/workshops, and specialty PC consultation were offered accordingly. RESULTS:Overall, 129 (45 %) of 287 patients participated. Sixty-three (49 %) reported significant physical symptoms, 58 (45 %) significant emotional symptoms, 9 (7 %) spiritual distress, 19 (14.7 %) a care coordination challenge, 30 (23 %) a practical issue, and 86 (67 %) no ACP documentation. Thirty-seven (59 %) patients with physical symptoms not already followed by PC were offered a PC consultation; 18 (49 %) accepted. Of 58 patients with emotional symptoms 18 (31 %) accepted a SW consultation, 19 (32 %) a support group and 21 (36 %) a resiliency class. Fifteen (50 %) patients with practical concerns were not already connected with SW and offered SW consultation; 10 (33 %) accepted. Forty (47 %) patients with ACP needs accepted an interactive ACP website, 23 (27 %) an ACP workshop, and 31 (36 %) an advance directive worksheet via mail. CONCLUSIONS:We describe how to routinely screen and proactively connect patients to a wide range of PC services. PC needs were common and many could be addressed through non-specialty PC services. Acceptance of the services offered was incomplete, however, and warrants further investigation.

113 Background: Pain management is essential to quality cancer care. Prior studies suggest gaps in pain reporting and management, though variability across regions and institutions is less described. This study examines pain reporting, surveillance, and management by sociodemographic characteristics in patients with cancer at two demographically distinct academic cancer centers. Methods: This retrospective cohort study examines electronic health records of patients receiving radiotherapy between 2013-2022/21 at two hospital systems: A, B. Linear and logistic regression analyses assessed inpatient pain level reporting, frequency of pain scores, and receipt of opioid and IV analgesics across sex, language preference, and race at each institution. Results: 8797 patients were treated at A and 3270 at B. Most were male (A 54.8%, B 50.6%). Patient-reported race differed by site (White, A 59.6%, B 71.4%; Black, A 6.5%, B 16%; Asian, A 18.6%, B 6%). English language preference was common (ELP; A 86.6%, B 87.2%). Patients were younger at A (median 56 years [IQR, 38-66]) than B (64 [56-71]). Median pain scores were higher at B (4 [IQR 0-6]) than A (2 [0-5]). Women had higher pain scores than men (A β 0.32, p < 0.001; B 0.34; p < 0.001). ELP patients reported greater pain compared to non-ELP (NELP) patients (A β 0.78, p < 0.001; B 0.84; p < 0.001). Compared to White patients, Black (A β 0.88, p < 0.001; B 0.32; p < 0.001) and Native American (A β 0.59, p < 0.001; B 1.06, p < 0.001) patients reported greater pain and Asian patients reported lower pain (A β -0.72, p < 0.001; B -1.03; p < 0.001). Time between pain assessment was similar across sites (A 2.08 hours [1.00-3.79], B 2.64 [1.23–5.59], longer for NELP patients (A β 0.02, p < 0.001; B 0.02, p < 0.001), but highly variable by sex and race across institutions. Controlling for pain score, treatment varied by demographic group. On a per admission basis, women received fewer opioids (A OR 0.79, p < 0.001; B 0.84, p = 0.002), but variable IV medication (A 0.94 p = 0.02; B 0.98, p = 0.65). NELP was associated with fewer opioids at A (0.76, p < 0.001) but not B (1.10, p = 0.27). NELP was associated with less IV medication at B (0.87, p = 0.04) but not at A (0.98, p = 0.51). Opioid receipt and IV medication also differed among racial groups between the institutions. Conclusions: This study highlights sociodemographic differences in pain reporting and management as well as variability across institutions, suggesting regional, cultural, and institutional differences.

12011 Background: Patients (pts) with high HCT-Comorbidity Index scores (HCT-CI of ≥3), older age (≥65 years), and/or who are frail per gait speed (<0.8 meters/second) have increased morbidity and mortality after allo-HCT compared to younger and healthier counterparts. We report the phase II analysis (PIIA) and interim phase III primary outcome analysis (PIIIA) of a seamless phase II/III prospective, randomized clinical trial conducted at 11 transplant centers to test new approaches to improve quality of life (QOL) in this population. Methods: Phase II compared specialist-administered supportive and palliative care (SPC), patient-administered management of comorbidities (MC, e.g. physical exercise, stress reduction, etc), both (SPC+MC), and usual care (UC) for change in Functional Assessment of Cancer Therapy – Bone Marrow Transplantation (FACT-BMT) QOL scores from baseline to day 90 (D90). Pts deceased prior to D90 were assigned FACT-BMT score=0. The winning phase II arm moved forward versus UC in phase III. Results: PIIA was done after enrolling 35 pts to each of the 4 study arms. Calculating the difference between FACT-BMT scores on D90 minus baseline, excluding missing data, indicated that only SPC resulted in a small improvement in QOL compared to either MC or SPC+MC (Table); hence SPC was the winning phase II arm. The PIIIA was conducted after enrolling 158 SPC pts and 153 UC pts. The SPC and UC arms were well balanced with median age (both 68 years), HCT-CI ≥3 (49% vs 55%), frailty per gait speed (13% vs 12%), female sex (41% vs 34%), non-white race (9.5% vs 11.5%), and Hispanic or unreported ethnicity (7.7% vs 5.7%), respectively. After median follow-up of 362 days, 45 pts had died in each arm. The mean QOL difference between D90 and baseline was 2.83 for SPC and 4.27 for UC (difference of differences, -1.44, 95% CI of difference, -5.03 to 2.14, p=0.43). Fitting a generalized linear model that included baseline, D30, and D90 values and testing the null hypothesis that the slope of scores differs between SPC and UC resulted in p=0.85. Using the Kaplan Meier method, no difference in survival was observed across arms (HR 1.13 [0.75-1.73]). Conclusions: Specialist-administered palliative care showed no meaningful improvement in QOL, nor a survival advantage, compared to usual care in frail, older and comorbid allo-HCT recipients, resulting in the cessation of this Phase II/III trial. Analysis of the whole patient population for primary and secondary outcomes is in progress. Clinical trial information: NCT03870750 . Change in FACT-BMT (D90 value minus baseline value) comparing the 4 arms of phase II. Group Mean difference (sd) Median difference (range) SPC (n=28) -2.93 (28.52) 0.25 (-102 to 38.22) CM (n=18) -18.37 (33.80) -9.50 (-98.33 to 11) SPC+CM (n=27) -15.76 (32.69) -7.67 (-90 to 32)

BACKGROUND:Cancer-related pain is common and debilitating. Patients frequently use integrative medicine therapies to manage this, though safety and efficacy evidence is incomplete. This scoping review aims to characterize the state of integrative cancer pain therapy (ICPT) and identify priorities for future research. METHODS:Following PRISMA guidelines, we searched PubMed, Embase, Web of Science, PsycINFO, CINAHL, and Cochrane for ICPT studies published between January 1, 1975 and May 26, 2022. Study findings were extracted and analyzed using descriptive statistics and thematic analysis. Interventions were categorized as follows: Whole Systems of Medicine (WSM); Mind-body Medicine (MBM); Botanicals and Supplements (BAS); and Manual Therapies (MT). Quality appraisal was performed using the Downs and Black checklist. Efficacy was "positive" if there were statistically significant differences between study arms (p < 0.05) favoring ICPT. RESULTS:Among 1246 studies reviewed, 151 met inclusion criteria; 63.5% were excellent or good quality, and 68.9% were RCTs; 122 studies (80.7%) were published since 2010. Studies occurred in 24 countries, in variable settings, among participants with a wide range of cancers, disease status, and age ranges. Studies investigating WSM and MBM interventions were most frequent (35.7% for each), MT (20.59%), and BAS (7.9%). Overall, of the included studies, 127 (84.1%) found that the ICPT intervention reduced pain. CONCLUSIONS:Studies on ICPT are increasingly common, and the majority of ICPT interventions demonstrated a positive impact on cancer pain. Future rigorous research should compare efficacy across integrative and biomedical interventions and explore how to incorporate evidence-based ICPT into standard cancer treatment.

INTRODUCTION While prognostic understanding (PU) is important for all patients (pts) considering hematopoietic stem cell transplantation (HCT), it may be particularly important for older (>65 years), medically infirm, and/or frail pts deciding whether to undergo allogeneic HCT (allo-HCT). This abstract reports on PU and concordance with transplant physician (hereafter MD) PU for pts participating in an ongoing seamless, phase II-III randomized clinical trial (ACE-BMT) comparing 4-arms: a pt-administered comorbidity management intervention (CM), specialist-administered palliative care (PC), a combined arm of CM and PC to standard of care. Here we report preliminary data on the concordance between pt and MD PU on the chance of cure 1-year (yr) post allo-HCT. METHODS Pt PU was compared to MD PU (gold standard) to determine concordance. MD and pt answers were compared on a single validated question asked at enrollment to the study (typically 2 weeks prior to HCT). Both pts and MD's estimated the chance of cure 1 yr after allo-HCT by selecting one of six possible response options: very good (more than 90%), good (75-90%), better than 50% (50-74%), worse than 50% (25-49%), bad (10-24%) or very bad (less than 10%). PU was “concordant” or “accurate” if MD and pt selected the same response option. Pts with discordant PU were labeled “pessimistic” if the pt selected a response option with a lower chance of cure than the MD (and “optimistic” if a higher chance). Response options were further simplified to greater than or less than 50% chance of cure and MD and pt PU were compared again. Descriptive statistics, chi-square for categorical and t-tests for continuous variables were used. Logistic regression was used to determine the association between pt prognostic concordance and pt socio-demographic and clinical characteristics. RESULTS All pts consented to date were included (n=358), except those who did not answer the prognosis question (n=61). 54.2% (n=194) had HCT-Comorbidity Index (HCT-CI) of ≥3, 67.9% (n=243) were older than 65 yrs and 4.5% (n=16) were frail, defined by walk speed <0.8 m/s. Median age was 68 yrs (range 20-80). 39.7% (n=141) were female. 89.9% (n=322) identified as White, 4.2% (n=15) Asian, and 1% each as Black/African American and Native Hawaiian/Other Pacific Islander. 5.3% (n=19) identified Hispanic. 11.5% (n=44) had high school education or less. 54.1% (n=183) made less than $100,000/yr. 40.1% (n=136) had acute myelogenous leukemia, 25.4% (n=86) had high-risk myelodysplastic syndrome and 10.6% (n=36) had a myeloproliferative cancer. 72.1% (n=245) had matched, 82.5% (n=283) unrelated and 95.0% (n=36) peripheral blood allo-HCT. 9% (n=31) had KPS of 100%, 35% (n=121) KPS 90%, and 47.5% (n=147) KPS 80%. Pts reported having a very good, good, better than 50%, worse than 50% and bad/very bad chance of cure 1 yr post allo-HCTL 34.4% (n=123), 30.7% (n=110), 26.0% (n=93), 7.3% (n=26) and 1.7% (n=6), respectively. 91.1% (n=326) of pts felt they had a >50% chance of being cured 1 yr post allo-HCT. MD answers were missing for 159/358 (44.4%) pts. MDs reported pt had a very good, good, better than 50%, worse than 50% and bad/very bad chance of being cured 1 yr post allo-HCT, 3.0% (n=6), 6.5% (n=13), 52.8% (n=105), 35.7% (n=71) and 2% (n=4) respectively. 62.3% (n=124) of MDs felt the pt had a >50% chance of being cured 1 yr post allo-HCT. For the subset of pts with MD prognostic data (n=199), pt's PU was concordant 20.6% (n=41) of the time when compared across all 6 response options. Overall, 71.9% (n=143) of pts erred toward optimism, while 7.5% (n=15) of pts were pessimistic. 60.8% of MD and pts agreed on prognosis when dichotomized to better or worse than 50% chance of being cured 1 yr post allo-HCT. Prognostic concordance was not significantly associated with any pt socio-demographic factors, HCT-CI or KPS via descriptive statistics or regression analysis. CONCLUSIONS In this prospective randomized trial focusing on a population of older, medically infirm, and/or frail pts receiving allo-HCT, pts' PU was not concordant with MD prognosis approximately 80% of the time. While some pts were pessimistic, the majority overestimated the likelihood they would be cured of disease compared to MD estimates. Future studies should investigate the true accuracy of both MD and pt prognosis, as well as how to improve communication about prognosis and pt PU (if inaccurate based on best available information) prior to HCT.

Patient sexuality and intimacy comprise important dimensions of quality of life (QOL), making them essential topics for palliative care (PC) clinicians to address. Created with interprofessional input from PC, urology, gynecology, sexual health, oncology, psychiatry, psychology, nursing, and social work, this article offers 10 high-yield, evidence-based tips to better equip PC clinicians to address sexuality and intimacy for patients with serious illness. These tips highlight skills such as opening discussions, assessing concerns through a biopsychosocial model, and thinking through appropriate interventions to improve QOL.

Context. Dignity therapy (DT) is a well -researched psychotherapeutic intervention but it remains unclear whether symptom burden or religious/spiritual (R/S) struggles moderate DT outcomes. Objective. To explore the effects of symptom burden and R/S struggles on DT outcomes. Methods. This analysis was the secondary aim of a randomized controlled trial that employed a stepped -wedge design and included 579 participants with cancer, recruited from six sites across the United States. Participants were ages 55 years and older, 59% female, 22% race other than White, and receiving outpatient specialty palliative care. Outcome measures included the seven -item dignity impact scale (DIS), and QUAL-E subscales (preparation for death; life completion); distress measures were the Edmonton Symptom Assessment Scale (ESAS-r) (symptom burden), and the Religious Spiritual Struggle Scale (RSS14; R/S). Results. DT effects on DIS were significant for patients with both low (P = 0.03) and moderate/high symptom burden (P = 0.001). They were significant for patients with low (P = 0.004) but not high R/S struggle (P = 0.10). Moderation effects of symptom burden (P = 0.054) and R/S struggle (P = 0.52) on DIS were not significant. DT effects on preparation and completion were not significant, neither were the moderation effects of the two distress measures. Conclusion. Neither baseline symptom burden nor R/S struggle significantly moderated the effect of DT on DIS in this sample. Further study is warranted including exploration of other moderation models and development of measures sensitive to effects of DT and other end -of -life psychotherapeutic interventions. J Pain Symptom Manage 2024;67:e333-e340. (c) 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

PURPOSE:To provide evidence-based guidance to oncology clinicians, patients, nonprofessional caregivers, and palliative care clinicians to update the 2016 ASCO guideline on the integration of palliative care into standard oncology for all patients diagnosed with cancer. METHODS:ASCO convened an Expert Panel of medical, radiation, hematology-oncology, oncology nursing, palliative care, social work, ethics, advocacy, and psycho-oncology experts. The Panel conducted a literature search, including systematic reviews, meta-analyses, and randomized controlled trials published from 2015-2023. Outcomes of interest included quality of life (QOL), patient satisfaction, physical and psychological symptoms, survival, and caregiver burden. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS:The literature search identified 52 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS:Evidence-based recommendations address the integration of palliative care in oncology. Oncology clinicians should refer patients with advanced solid tumors and hematologic malignancies to specialized interdisciplinary palliative care teams that provide outpatient and inpatient care beginning early in the course of the disease, alongside active treatment of their cancer. For patients with cancer with unaddressed physical, psychosocial, or spiritual distress, cancer care programs should provide dedicated specialist palliative care services complementing existing or emerging supportive care interventions. Oncology clinicians from across the interdisciplinary cancer care team may refer the caregivers (eg, family, chosen family, and friends) of patients with cancer to palliative care teams for additional support. The Expert Panel suggests early palliative care involvement, especially for patients with uncontrolled symptoms and QOL concerns. Clinicians caring for patients with solid tumors on phase I cancer trials may also refer them to specialist palliative care.Additional information is available at www.asco.org/supportive-care-guidelines.

Background: The End of Life Option Act (EOLOA) legalized medical aid in dying (MAID) in California in 2015. University of California, San Francisco Health initially implemented a policy requiring a mandatory mental health assessment of all patients seeking MAID, though this was not required by the EOLOA. State-level statistics on EOLOA are available, but less is known about outcomes at individual institutions and how institutional policy affects outcomes for patients seeking MAID. Objectives: Investigators examined the factors contributing to patients' decisions to request MAID and how the mandatory mental health assessment impacted determinations of decisional capacity and access to MAID. Methods: Retrospective chart review was conducted on a sample of patients who had pursued MAID or been prescribed MAID medications between June 2016 and May 2020 obtained by a combination of purposive sampling (n = 78) and systematic electronic health record sampling (n = 22). Descriptive statistics were used to examine demographic factors, neuropsychiatric diagnoses and rating scales, factors contributing to patients' decision to request MAID, and outcomes of the psychiatric evaluation process. Results: Of the 78 patients in the purposive sample who had initiated EOLOA requests, 67% had MAID medications prescribed. No patient was found to lack decisional capacity due to a current psychiatric condition. Many patient records were missing relevant data including neuropsychiatric rating scale scores and factors contributing to patients' decision to request MAID. The neuropsychiatric rating scale scores and diagnoses that were present did not suggest a high prevalence of severe psychiatric illness in the sample. Conclusions: The findings from this study suggest that mandatory mental health assessments for all patients requesting MAID at a single academic medical center did not identify patients who lacked decisional capacity to pursue MAID, and potentially created access barriers to seriously ill patients seeking this intervention. Generalizability of findings may be limited by the fact that mental illness burden was low in the studied sample. Results from this study contributed to changes in EOLOA institutional policy at University of California, San Francisco, including elimination of the mandatory mental health assessment for EOLOA candidates in favor of a conditional mental health assessment based on certain clinical criteria.

Importance Numerous studies show that early palliative care improves quality of life and other key outcomes in patients with advanced cancer and their caregivers, although most lack access to this evidence-based model of care. Objective To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non–small cell lung cancer (NSCLC). Design, Setting, and Participants Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers. Intervention Participants were randomized to meet with a specialty-trained palliative care clinician every 4 weeks either via video visit or in person in the outpatient clinic from the time of enrollment and throughout the course of disease. The video visit group had an initial in-person visit to establish rapport, followed by subsequent virtual visits. Main Outcomes and Measures Equivalence of the effect of video visit vs in-person early palliative care on quality of life at week 24 per the Functional Assessment of Cancer Therapy-Lung questionnaire (equivalence margin of ±4 points; score range: 0-136, with higher scores indicating better quality of life). Participants completed study questionnaires at enrollment and at weeks 12, 24, 36, and 48. Results By 24 weeks, participants (mean age, 65.5 years; 54.0% women; 82.7% White) had a mean of 4.7 (video) and 4.9 (in-person) early palliative care encounters. Patient-reported quality-of-life scores were equivalent between groups (video mean, 99.7 vs in-person mean, 97.7; difference, 2.0 [90% CI, 0.1-3.9]; P = .04 for equivalence). Rate of caregiver participation in visits was lower for video vs in-person early palliative care (36.6% vs 49.7%; P &lt; .001). Study groups did not differ in caregiver quality of life, patient coping, or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions. Conclusions and Relevance The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC, underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery. Trial Registration ClinicalTrials.gov Identifier: NCT03375489