Cancer Research and Treatment

Special Article

Psychological Aspects of Care in Cancer Patients in the Last Weeks/Days of Life: Sujin Ann-Yi, Eduardo Bruera; Cancer Res Treat. 2022;54(3):651-660. Published online June 28, 2022; DOI: https://doi.org/10.4143/crt.2022.116

Palliative care is comprised of an interdisciplinary team (IDT) approach with members from different disciplines who collaboratively work together to reduce multidimensional components of pain and suffering and improve quality of life for patients coping with a terminal illness. Psychosocial team members are integral to the palliative care IDT and provide expertise in assessment and empirically validated interventions to address psychological distress. The following paper will provide a review of different facets of psychological distress experienced by advanced cancer patients such as psychological disorders, existential distress, spiritual distress, caregiver distress, parental distress, and grief. Finally, an overview of commonly used screening and assessment tools as well as psychological interventions relevant for the palliative care population is presented.

Citations

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Review Article

Prognostication of the Last Days of Life: Masanori Mori, Tatsuya Morita, Eduardo Bruera, David Hui; Cancer Res Treat. 2022;54(3):631-643. Published online March 30, 2022; DOI: https://doi.org/10.4143/crt.2021.1573

Abstract PDF PubReader ePub

Accurate prediction of impending death (i.e., last few days of life) is essential for terminally-ill cancer patients and their families. International guidelines state that clinicians should identify patients with impending death, communicate the prognosis with patients and families, help them with their end-of-life decision-making, and provide sufficient symptom palliation. Over the past decade, several national and international studies have been conducted that systematically investigated signs and symptoms of impending death as well as how to communicate such a prognosis effectively with patients and families. In this article, we summarize the current evidence on prognostication and communication regarding the last days of life of patients with cancer, and future directions of clinical research.

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Days spent with healthcare contact by patients with metastatic castrate resistant prostate cancer in the last year of life
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Acta Oncologica.2022; 61(12): 1435. CrossRef

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17 Web of Science
19 Crossref

Original Article

Frequency and Outcome of Neuroleptic Rotation in the Management of Delirium in Patients with Advanced Cancer: Seong Hoon Shin, David Hui, Gary Chisholm, Jung Hun Kang, Julio Allo, Janet Williams, Eduardo Bruera; Cancer Res Treat. 2015;47(3):399-405. Published online November 24, 2014; DOI: https://doi.org/10.4143/crt.2013.229

Abstract PDF PubReader ePub

Purpose
The response to haloperidol as a first-line neuroleptic and the pattern of neuroleptic rotation after haloperidol failure have not been well defined in palliative care. The purpose of this study was to determine the efficacy of haloperidol as a first-line neuroleptic and the predictors associated with the need to rotate to a second neuroleptic. Materials and Methods We conducted a retrospective review of the charts of advanced cancer patients admitted to our acute palliative care unit between January 2012 and March 2013. Inclusion criteria were a diagnosis of delirium and first-line treatment with haloperidol. Results Among 167 patients with delirium, 128 (77%) received only haloperidol and 39 (23%) received a second neuroleptic. Ninety-one patients (71%) who received haloperidol alone improved and were discharged alive. The median initial haloperidol dose was 5 mg (interquartile ranges [IQR], 3 to 7 mg) and the median duration was 5 days (IQR, 3 to 7 days). The median final haloperidol dose was 6 mg (IQR, 5 to 7 mg). A lack of treatment efficacy was the most common reason for neuroleptic rotation (87%). Significant factors associated with neuroleptic rotation were inpatient mortality (59% vs. 29%, p=0.001), and being Caucasian (87% vs. 62%, p=0.014). Chlorpromazine was administered to 37 patients (95%) who were not treated successfully by haloperidol. The median initial chlorpromazine dose was 150 mg (IQR, 100 to 150 mg) and the median duration was 3 days (IQR, 2 to 6 days). Thirteen patients (33%) showed reduced symptoms after the second neuroleptic. Conclusion Neuroleptic rotation from haloperidol was only required in 23% of patients with delirium and was associated with inpatient mortality and white race.

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