Aim of the study This study investigated the frequency and intensity of emergency service interventions in palliative care patients and the appropriateness of treatment. Methods Evaluation of emergency service interventions in palliative care during 6 months period after discharge. Protocols were analysed for inappropriate measures.Results 26 of 105 patients (24.8%) were consulted by an emergency medical service at least once during the follow-up period. The most common reasons were dyspnoea (25,8%) and pain (16,1%). Inappropriate treatment was found in one third of all patients. Conclusion In patients in palliative care situations, inappropriate medical interventions, including overtreatment, are a frequently observed.

BACKGROUND:Carcinomas of the stomach and esophagogastric junction (EGJ) are the fifth leading cause of cancer-related deaths worldwide. In Germany, gastric cancer ranks tenth in incidence across both sexes. The new German national guideline aims to provide the most relevant evidence-based recommendations on diagnosis and treatment of gastric and EGJ adenocarcinomas and has been comprehensively updated by an interdisciplinary panel of experts from national medical societies. SUMMARY:The updated S3 guideline reflects the latest advances in diagnostics, improved palliative therapies, and supportive care. The objectives are to improve the quality of individual and broad care and to ensure consistent, evidence-based treatment strategies. KEY MESSAGES:New recommendations introduce preventive strategies, including management of familial risk due to microsatellite instability (MSI) and H. pylori eradication. The biomarkers HER2, PD-L1, MSI, and Claudin 18.2 enable the use of targeted therapies that improve long-term outcomes in advanced disease. Combinations of chemotherapy with immunotherapy nivolumab, pembrolizumab, or tislelizumab significantly prolong survival compared with chemotherapy alone (e.g., nivolumab 14.4 vs. 11.1 months, HR 0.71; pembrolizumab 13.0 vs. 11.4 months, HR 0.75; tislelizumab 17.2 vs. 12.6 months, HR 0.74) with 5-year survival rates up to 16%. In patients with high Claudin 18.2 expression, zolbetuximab plus chemotherapy improved median survival to 16.4 vs. 13.4 months (HR 0.77). For patients in good general condition, subsequent lines of therapy including biomarker-driven approaches (trastuzumab deruxtecan, pembrolizumab) or third-line therapies (e.g., trifluridine tipiracil) and advanced molecular diagnostics are recommended after treatment failure.

Introduction Current or former smokers with 20-pack year history between ages 50-80 years old are eligible for lung cancer screening (LCS) under current guidelines. Despite age restrictions for screening, older patients remain at risk for lung cancer and without screening are diagnosed with advanced stage disease that limits curative treatment options.Treatment for early-stage lung cancer has improved with minimally invasive surgical techniques and reduced toxicity with stereotactic body radiation therapy (SBRT). Robust older patients can tolerate surgical resection or SBRT with similar rates of recovery to younger peers. Given the advancements in treatment and improved tools to identify frailty, chronologic age should not be a gatekeeper for lung cancer screening. Methods A taskforce within the International Society of Geriatric Oncology was created to address challenges of LCS within older patients. Taskforce members represented 5 different specialties with clinical expertise in lung cancer and/or the care of older adults. Results For patients >80 years old that qualify for LCS, we recommend performing geriatric assessment (GA) to assess functional status and age-related vulnerabilities. Robust patients determined by GA should be eligible for screening and discuss their health care priorities in shared decision-making conversations. GA should be performed every 2 years while enrolled in LCS to determine the appropriateness of continued screening efforts. Conclusions Age should not be an exclusion criteria for lung cancer screening. Patients over 80 years old should be thoughtfully co-managed by geriatric and lung cancer specialists to determine which older patients would benefit from screening efforts.

PURPOSE:Diagnosis with UICC stage IV colorectal cancer often indicates palliative treatment to alleviate symptoms. Data on pain in these patients are still scarce but can help improve symptom management. This study therefore aimed to describe patient-reported pain and quality of life. METHODS:147 palliatively treated stage IV colorectal cancer patients diagnosed between 2018 and 2023 completed the EORTC QLQ-C30 and QLQ-CR29 before and 12 months after treatment initiation within the EDIUM study. Descriptive results for pain and quality of life were examined and compared to reference values. A logistic regression analysis investigated the relationship between quality of life and pain and 1-year survival. RESULTS:The mean (SD) for the "overall pain" score was 26 (32) (T0) and 35 (32) (T1) for rectal cancer patients and 34 (33) (T0) and 35 (32) (T1) for colon cancer patients. This is higher than the reference value (24 (30)) and indicates high average pain levels. The "overall quality of life" score showed means below the reference value (61 (23)), indicating poorer quality of life (colon: 51 (25) (T0), 56 (22) (T1); rectum: 52 (24) (T0), 51 (22) (T1)). Higher pain levels persisted at both time points, with no patients reporting absence of pain. The logistic regression results suggest a small relationship between pain and quality of life and 1-year survival. DISCUSSION:This study reveals high levels of pain among palliatively treated colorectal cancer patients, impacting their quality of life. Effective pain management and close monitoring are necessary to improve the quality of life for these patients. TRAIL NUMBER:DRKS00008724.

Objective To analyse the relationship between functional status and occupational therapy measuresMethods Over a period of three months, occupational therapy interventions and the time spent per patient were recorded prospectively and in a standardised manner in a palliative care unit. The measures were assigned to the individual functional status and evaluated in terms of frequency and distribution.Results A total of 333 contacts with 1.752 interventions were documented for 57 patients. On average, there were 5,8 contacts per patient, during which an average of 5,2 interventions were carried out. The focus of the measures varied according to functional status: higher values were characterised by ADL walking and functional training, medium values by psychological stabilisation and lower values by positioning measures.Conclusion The results show that occupational therapy is is utilised across all levels of functional status and thus significantly supports the multidisciplinary approach to palliative care.

Mit dieser Studie wurden die Häufigkeit und Intensität von Rettungsdiensteinsätzen bei Palliativpatienten sowie die Angemessenheit der Behandlung untersucht. Bewertung von Interventionen des Rettungsdienstes bei einem palliativen Ansatz während 6 Monaten nach Entlassung. Rettungsdienstprotokolle wurden in Hinblick auf unangemessene Maßnahmen analysiert. 26 von 105 Patienten (24,8%) wurden während der Nachbeobachtung mindestens einmal von einem Rettungsdienst konsultiert. Die häufigsten Gründe waren Dyspnoe (25,8%) und Schmerzen (16,1%). Eine unangemessene Behandlung wurde bei einem Drittel aller Patienten festgestellt. Bei Patienten in palliativen Behandlungssituationen sind unangemessene medizinische Interventionen, einschließlich Übertherapie, ein häufig zu beobachtendes Phänomen. Maßnahmen der vorausschauenden Versorgungsplanung (Advance Care Planning, ACP) sowie standardisierte Notfalldokumente können dazu beitragen, in akuten Situationen nicht indizierte oder patientenwillenswidrige Therapien zu vermeiden.

In der ambulanten Palliativversorgung (PV) von Patient:innen mit onkologischen Erkrankungen haben sich über die Jahre hinweg unterschiedliche Versorgungsmodelle etabliert. Ein wichtiges Anliegen der ambulanten PV ist die Reduktion von Verordnungsraten (VO-Raten) potenziell inadäquater Medikation (PIM). Es stellt sich die Frage, inwiefern dies in den verschiedenen Formen der ambulanten PV erfolgreich umgesetzt wird. In der retrospektiven Kohortenstudie wurden Routinedaten von 158.035 zwischen 2016 und 2021 verstorbenen GKV-Versicherten (VS im Gesetzlichen Krankenversicherungssystem) mit onkologischer Erkrankung analysiert. Für diese VS wurde anhand dokumentierter ATC-Codes (nach Anatomisch-Therapeutisch-Chemischem Klassifikationssystem der WHO) die Verordnung von Protonenpumpeninhibitoren (PPI), Vitaminen und Mineralstoffen, Statinen, Acetylsalicylsäure (ASS) sowie Osteologika ermittelt. Wir überprüften den Zusammenhang derartiger Verordnungen mit der Form ambulanter Palliativversorgung in logistischen Regressionsanalysen. Dabei wurden drei Gruppen unterschieden: VS ohne ambulante PV, mit allgemeiner ambulanter PV oder besonders qualifizierter und koordinierter PV (AAPV/BQKPmV) sowie mit spezialisierter ambulanter PV (SAPV). Mehr als ein Viertel der ambulant palliativversorgten VS hatte im letzten Lebensmonat eine PPI-VO, insbesondere VS mit SAPV (29,4

Die zunehmende Alterung unserer Gesellschaft bedingt, dass immer mehr ältere und älteste Menschen an einer chronischen Niereninsuffizienz leiden und auch dialysepflichtig werden können. Da Menschen an der Dialyse aufgrund von Komplikationen (kardiovaskulär, Infektionen) eine schlechtere Prognose haben als manche Tumorpatienten, ist es nicht immer ratsam, eine solche Dialysetherapie zu beginnen. Vielmehr kann es sinnvoll sein, bei zunehmender Verschlechterung der Gesamtsituation diese dann auch zu beenden. Für dieses relativ neue Gebiet unseres Faches wurde der Begriff „palliative Nephrologie“ geprägt. Ärztliches Handeln allgemein, aber insbesondere bei der Betreuung von Sterbenden setzt einen ethisch reflektierten moralischen Kompass voraus. Leider wird dieser Aspekt im Medizinstudium, aber auch in der Weiterbildung zum Facharzt sträflich vernachlässigt. Deshalb findet sich in diesem Beitrag eine kurze Übersicht über ethische Aspekte der angemessenen Betreuung von Sterbenden. Die Betreuung schwerstkranker und sterbender Menschen gehört zu den „vornehmsten“ Aufgaben ärztlichen Handelns und ärztlicher Kunst. Jeder Arzt sollte sich vor Augen halten, dass Sterbende uns nur vorausgehen und wir alle irgendwann das gleiche Schicksal haben werden. Allein schon deshalb sollten wir die zukünftige Generation von Kollegen und Kolleginnen, die dann uns in der Sterbephase begleiten werden, fachlich, ethisch, psychologisch und menschlich gut aus- und weiterbilden.

Abstract Background There are hardly any data on the extent to which nursing home residents are provided with palliative homecare. We want to add evidence by comparing nursing home residents (who had been living in a nursing home for at least one year) and nursing-care-dependent community dwellers in terms of utilization and quality of palliative homecare. Methods We conducted a population-based study with nationwide claims data from deceased beneficiaries of a large German health insurance provider. First, we compared utilization rates of primary palliative care [PPC], specialized palliative homecare [SPHC], and no palliative care [noPC] between nursing home residents and community dwellers, both descriptively and adjusted for covariates. Second, we analyzed the (adjusted) relationship between PPC-only and SPHC (both: starting ≥ 30 days before death), and noPC with healthcare indicators (death in hospital, hospitalization, emergencies, intensive care treatment within the last 30 days of life), and compared these relationships between nursing home residents and community dwellers. Analyses were conducted using simple and multiple logistic regression. Data were standardized by age and gender. Results From 117,436 decedents in 2019, 71,803‬ could be included in the first, 55,367‬ in the second analysis. The rate of decedents with noPC was higher in nursing home residents (61.3%) compared to community dwellers (56.6%). Nursing home residents received less SPHC (10.7% vs. 23.2%) but more PPC (30.3% vs. 27.0%) than community dwellers, and achieved better outcomes across all end-of-life healthcare indicators. Adjusted for covariates, both types of palliative homecare were associated with beneficial outcomes, in nursing home residents as well as in community dwellers, with generally better outcomes for SPHC than PPC-only. For most outcomes, the associations with palliative homecare were equal or smaller in nursing home residents than in community dwellers. Conclusions The overall better performance in quality of end-of-life care in nursing home residents than in community dwellers may be due to the institutionally provided nursing and general practitioner care within nursing homes. This may also explain higher rates of PPC and lower rates of SPHC in nursing home residents, and why the relationship with both PPC and SPHC are smaller in nursing home residents. Trial registration German Clinical Trials Register (DRKS): [DRKS00024133, Date of registration: 28.06.2021].

ObjectiveQuality of life (QoL) has become a relevant outcome criterion in oncology in general and in palliative care in particular. The aims of this study were to compare the QoL of cancer patients receiving palliative care with groups of mixed cancer patients and with the general population, and to test whether response shift effects influence the assessment of QoL.MethodsThis study included data from several cross-sectional investigations: one sample of 152 cancer patients receiving palliative care, two samples of patients with mixed cancer diagnoses (n > 500), and two samples of the general population (n > 1,000). QoL was assessed with the EORTC QLQ-C30 and with two anchoring vignettes for identifying response shift.ResultsQoL was highest in the general population (EORTC QLQ-C30 mean sum score M = 87.4), followed by the mixed cancer patients (M = 70.9) and the palliative care group (M = 58.2). Both groups of cancer patients rated the anchoring vignette, which presented a subject with mainly physical problems, as being healthier than the general population did.ConclusionThe results show in which specific dimensions advanced cancer patients report strong detriments in QoL. The different assessments of the vignettes indicate a response shift effect so that the cancer patients have changed their frames of reference for assessing QoL in such a way that they indicate less severe restrictions. This means that the reductions in QoL in cancer patients, as measured with standard questionnaires, tend to underestimate the true detriments.

Palliativmedizin zielt darauf ab, die Lebensqualität von Patient*innen mit potenziell lebensbedrohlichen Erkrankungen und deren Angehörigen zu verbessern, indem Leiden und Symptome in körperlicher, psychosozialer und spiritueller Hinsicht frühzeitig erkannt und behandelt werden. Die vorliegende Studie untersucht die Auswirkungen der am 01.04.2025 in Kraft getretenen Krankenhausstrukturreform in Nordrhein-Westfalen (NRW) auf die Erreichbarkeit von Einrichtungen mit spezialisierter stationärer palliativmedizinischer Versorgung. Krankenhäuser mit spezialisierter stationärer Palliativversorgung wurden über das Palliativregister und die §136b Daten an den Gemeinsamen Bundesausschuss identifiziert. Mittlere gewichtete Fahrzeiten zu diesen Einrichtungen wurden ermittelt und mit den Standorten verglichen, die im Rahmen der Krankenhausstrukturreform NRW in der Leistungsgruppe 29 „Palliativmedizin“ vorgesehen sind. Die Erreichbarkeit wurde mit der sozioökonomischen Deprivation (German Index of Socioeconomic Deprivation, GISD) auf Gemeindeebene korreliert. Insgesamt wurden 162 Kliniken in NRW identifiziert, die spezialisierte palliativmedizinische Versorgung anbieten. Im Jahr 2022 betrug die mittlere gewichtete Fahrzeit zu diesen Kliniken 11,4 min, wobei 53% der Bevölkerung eine Klinik innerhalb von 10 Minuten und 97% in 30 min erreichen konnten. Es zeigte sich keine signifikante Korrelation zwischen der Erreichbarkeit spezialisierter stationärer palliativmedizinischer Einrichtungen und der sozioökonomischen Deprivation. Im Rahmen der Krankenhausstrukturreform wird die mittlere Fahrzeit auf 12,2 min ansteigen. 48% der Bevölkerung werden eine Klinik mit Palliativmedizin innerhalb von knapp 10 min und 96% in 30 min erreichen. Die Ergebnisse legen nahe, dass die geplante Reform nur einen marginalen Einfluss auf die Erreichbarkeit spezialisierter palliativmedizinischer Versorgung in NRW haben wird. Obwohl die durchschnittlichen Fahrzeiten geringfügig ansteigen, bleibt der Zugang für die Mehrheit der Bevölkerung weiterhin innerhalb kurzer Zeit realisierbar.

Hintergrund Ergebnisqualität und Kosteneffektivität regionaler Hospiz- und Palliativversorgung (PV) variieren stark. Die Studie untersucht den Zusammenhang der regional unterschiedlich ausgestalteten ambulanten PV-Formen mit diesen beiden Dimensionen. Methoden Die retrospektive Analyse basiert auf der Studienpopulation von 145.372 in 2016 bis 2019 verstorbenen BARMER-Versicherten, die im letzten Lebensjahr PV erhielten. Der Zusammenhang von Allgemeiner Ambulanter PV (AAPV), Besonders Qualifizierter und Koordinierter Palliativmedizinischer Versorgung (BQKPmV) sowie Spezialisierter Ambulanter PV (SAPV) mit den ergebnisqualitäts- und kostenbezogenen Zielgrößen wurde in multiplen Regressionsanalysen unter Berücksichtigung regionaler Variabilität dieser Zusammenhänge und Kontrolle um jeweils andere PV-Formen sowie Patienten- und Wohnkreismerkmale ermittelt. Ergebnisse Am Bundesmittel gemessen überdurchschnittliche Ergebnisqualität erreicht AAPV in Rheinland-Pfalz, BQKPmV in Thüringen und SAPV in Sachsen-Anhalt und Berlin. Die Gesamtversorgungskosten exkl. ambulanter PV-Kosten werden durch AAPV reduziert. Bei der SAPV übersteigen anfallende PV-Kosten die möglichen Kosteneinsparungen, insbesondere in Nordrhein; Gegenbeispiele sind Berlin und Westfalen-Lippe. Während sich Westfalen-Lippe auf ein solides wirksames, integriertes, kostengünstiges AAPV-SAPV-Modell stützt, das vielen Menschen zugutekommt, steht Berlin für ein hochwirksames, kostengünstiges SAPV-Modell, das jedoch weniger Menschen erreicht. Schlussfolgerung Neue Hinweise auf Good-Practice-Regionen bieten Ansatzpunkte, die Herausforderung einer lebensqualitätsorientierten, ressourceneffizienten PV für eine demografiebedingt wachsende Zahl Bedürftiger zu bewältigen. Wege, die weniger Versorgte und Kostenerhöhungen bedeuten und allenfalls Versorgungsqualität für wenige Menschen erhöhen, sollten kritisch hinterfragt werden.

BACKGROUND:The quality of outcomes and cost-effectiveness of regional hospice and palliative care (PC) services vary greatly. This study examines the relationship between the different regional outpatient forms of PC and these two dimensions. METHODS:The retrospective analysis is based on the study population of 145,372 persons who were insured with the BARMER health insurance fund, who died between 2016 and 2019 and received PC in the last year of their life. The association of primary palliative care (AAPV), specially qualified and coordinated PC (BQKPmV), and specialist palliative homecare (SAPV) with quality- and cost-related outcomes was determined through multiple regression analyses, taking into account regional variability of these associations and controlling for other forms of PC as well as patient and residential district characteristics. RESULTS:AAPV in Rhineland-Palatinate, BQKPmV in Thuringia, and SAPV in Saxony-Anhalt and Berlin achieve an above-average impact on the quality of outcomes compared to the national average. The total costs of care in the last three months of life (except for the costs of ambulatory palliative care) are significantly reduced by AAPV. For SAPV, costs usually exceed potential savings, especially in North Rhine-Westphalia, with Berlin and Westphalia-Lippe being counter-examples. Whilst Westphalia-Lippe relies on a solidly effective, integrated, low-cost AAPV-SAPV model that benefits many people, Berlin represents a highly effective, low-cost SAPV model which, however, reaches fewer people. CONCLUSION:New evidence of good practice regions offers starting points for tackling the challenge of quality-of-life-oriented, resource-efficient palliative care for a demographically growing number of people in need. Approaches that result in fewer people receiving care and higher costs and at best increase the quality of care for a few, should be critically scrutinized.

From 13th to 17th of September 2024, the annual meeting of the European Society for Medical Oncology (ESMO) took place in Barcelona. The ESMO Congress provided a valuable opportunity to learn about new therapeutic approaches, current study results, and the results of basic research across all entities in the entire field of internal oncology. In addition to the standard sessions, sorted by cancer entities, there were also sessions for oncology nurses, Women for Oncology (W4O), and Young Oncologists (YO). Our report presents the highlights from the perspective of the Geriatric Oncology Research Group and covers secondary areas of geriatric oncology as well, such as supportive and palliative care. Many presentations, particularly those in the keynote sessions, focused on younger and physically fitter patients. Geriatric oncology as an independent topic has been underrepresented and not adequately addressed in comparison to the prevalent advanced aged patients treated in real-world settings.