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Integrating Palliative Care in Oncology

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 13226

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Dr. Albert Tuca-Rodríguez

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Cancer Supportive and Palliative Care Unit, Department of Medical Oncology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain
Interests: supportive care in cancer; palliative care; medical oncology; palliative medicine

Special Issue Information

Dear Colleagues,

The World Health Organization (WHO) calls for health services to be designed so that early palliative care is integrated into existing health services in a shared care model to provide appropriate support to those who need it.

Many randomised clinical trials have shown that early palliative care (EPC) in patients with advanced cancer improves symptom control, psychological distress, quality of life, and patient and family satisfaction. Some trials have also shown that EPC reduces the use of futile chemotherapy at the end of life and improves healthcare resource use and survival.

Based on consistent scientific evidence, many international scientific societies and expert commissions (American Society of Clinical Oncology, European Society of Medical Oncology, National Comprehensive Cancer Network, and The Lancet Commission) recommend that patients with advanced cancer should be managed by multidisciplinary teams specialising in EPC, parallelly with their cancer treatment.

Referral to early palliative care teams and the intensity of shared care with oncology not only depend on the extent of patients' disease and prognosis, but also on the individual complexity of their care needs. A key component of improving the care of patients with advanced cancer is increasing our knowledge in this area. That is why we are seeking your opinion and contribution (through narrative or systematic reviews, original research, etc.).

The aim of this Special Issue is to review the integration of early palliative care in oncology. The main topics for the Special Issue may include, but are not limited to: the integration of palliative care in oncology; complexity of palliative care needs; organisational models of shared care between oncology and palliative care; cancer pain; symptom control; end of life in cancer patients; advanced care planning, etc.

Dr. Albert Tuca-Rodríguez
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

early palliative care
advanced cancer
complexity of care needs
integration of palliative care in oncology
cancer pain
symptom control
end-of-life
advance care planning

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Published Papers (9 papers)

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Research

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11 pages, 228 KiB

Open AccessArticle

The Impact of Advanced Care Planning on Hospice Utilization in Patients with Cancer: A Nationwide Analysis in Korea

by Woorim Kim, Boram Kim, Minju Kim and Jin Young Choi

Cancers 2025, 17(9), 1471; https://doi.org/10.3390/cancers17091471 - 27 Apr 2025

Viewed by 135

Abstract

Background: Hospice and palliative care play key roles in facilitating goals-of-care discussions and managing symptoms in end-of-life (EOL) care for cancer patients. In this study, the association between completion of advance care planning (ACP), which refers to decisions regarding life-sustaining treatment, and hospice utilization in patients with cancer is examined. Methods: Data from the Korea-Clinical Data Utilization Network for Research Excellence were used. The study population included individuals diagnosed with one of the five leading causes of cancer-related deaths in South Korea. The association between the completion of ACP and hospice utilization was analyzed using multivariable logistic regression analysis. Results: The study population included 50,574 patients with terminal cancer, of whom 10,530 (20.8%) had received hospice care. Self-determined ACP was completed by 9271 (18.3%) participants and non-self-determined ACP by 8654 (17.1%). Patients with ACP were more likely to receive hospice care, with the self-determined group (OR, 5.46; 95% CI: 5.13–5.81) showing a stronger association than the non-self-determined group (OR, 1.27; 95% CI: 1.18–1.37). Conclusions: Patients with cancer who completed ACP were more likely to use hospice care services. These findings indicate the potential importance of ACP decisions in providing EOL care. Full article

(This article belongs to the Special Issue Integrating Palliative Care in Oncology)

12 pages, 674 KiB

Open AccessArticle

The ‘Surprise’ Question in Haemato-Oncology: The Estimating Physician and Time to Death Reduce the Prognostic Uncertainty—An Observational Study

by Christina Gerlach, Martin Weber and Irene Schmidtmann

Cancers 2025, 17(8), 1326; https://doi.org/10.3390/cancers17081326 - 15 Apr 2025

Viewed by 191

Abstract

Background/Objectives: Patients with haematological malignancies less frequently receive specialist palliative care, although they may have unmet needs for symptom control and alleviating psychosocial and existential burdens. The ‘Surprise’ Question, ‘Would you be surprised if this patient died in the next 12 months?’, helps physicians to identify patients who may benefit from palliative care. We tested the influencing factors of the feasibility of the ‘Surprise’ Question in haemato-oncology outpatients. Methods: We performed a prospective cohort study comparing patients with solid tumours and haematological malignancies. All the patients in the haemato-oncology outpatient clinics of a German university hospital were screened by haemato-oncologists using the ‘Surprise’ Question. Results: A survival analysis was performed on 672 patients (76% with haematological malignancies) at 3 and 12 months. Within one year, 110 patients (16%) died. Of these, 30/52 (58%) were patients with solid tumours, but only 12/53 (23%) patients with haematological malignancies were identified in advance by the ‘Surprise’ Question, which reflects ambiguous test sensitivity. A substantial part of the haematology patients in their last year of life were not identified (77%). The match between the survival estimates and actual outcomes was fair (Cohen’s kappa 0.37). The proximity from prediction to event and the estimating physician rather than patient characteristics influenced the accuracy of the instrument. Conclusions: For the first time, the feasibility of the ‘Surprise’ Question in haematology outpatients was proven. Factors that would improve haemato-oncologists’ clinical intuition should be further explored to facilitate timely conversations about issues important to patients nearing the end of life. Full article

(This article belongs to the Special Issue Integrating Palliative Care in Oncology)

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12 pages, 282 KiB

Open AccessArticle

Evaluation of Emotional Distress in Oncology Palliative Patients: Edmonton Symptom Assessment System (ESAS) and Palliative Outcome Scale (POS)—A Portuguese Cross-Sectional Study

by Florbela Gonçalves, Margarida Gaudêncio, Ivo Paiva, Francisca Rego and Rui Nunes

Cancers 2024, 16(24), 4232; https://doi.org/10.3390/cancers16244232 - 19 Dec 2024

Viewed by 1086

Abstract

Introduction: Cancer patients in palliative care frequently experience psychological distress, encompassing cognitive, behavioral, and emotional dimensions. This distress can significantly affect their capacity to accept the inevitability of death. Commonly, such distress manifests as sadness, depression, anxiety, and fear, which may culminate in an existential crisis. Objectives: The purpose of this study was to analyze the psychometric properties of the Edmonton Symptom Assessment System (ESAS) and the Palliative Outcome Scale (POS) among hospitalized cancer patients receiving palliative care in a Portuguese palliative care unit. Methods: Data were collected from psychological screening instruments (ESAS and POS) used in oncology patients admitted to an oncology palliative service. The study period spanned from January 2021 to March 2021. Results: The study included a convenience sample of 60 patients diagnosed with advanced cancer who were sequentially admitted to a palliative care unit. The most frequently reported primary oncological diagnoses were gastrointestinal (41.7%) and head/neck (20%) tumors. The majority of the patients were male (n = 37; 61.7%), with a median age of 72 years (range: 43–94 years). Key findings from the analysis indicated the following associations: anxiety and self-reported symptoms (higher levels of patient anxiety related to illness or treatment were strongly correlated with increased self-reported anxiety (p < 0.01)); emotional sharing and perceived meaning of life (patients who shared their feelings less frequently with family and friends were significantly less likely to find meaning in life (p < 0.01) and were more likely to report a poorer self-perception (p < 0.05)); understanding the importance of life and self-perception (a diminished understanding of the importance of life was associated with worsened self-perception (p < 0.01)); anxiety and depressive symptoms (greater anxiety related to the disease or its treatment correlated with an increased severity of depressive symptoms (p < 0.01)). Discussion and conclusion: There are numerous validated instruments available for measuring emotional distress. Among these, the ESAS and POS complement each other as practical and easy-to-use tools for evaluating emotional distress in patients admitted to palliative care settings. Findings revealed that anxiety and concerns related to the disease and its treatment, as measured by the POS, served as predictors of the risk for self-reported anxiety and depression identified by the ESAS. Furthermore, the items within the POS that evaluate the emotional component demonstrated strong internal correlation, supporting their combined use for a comprehensive assessment of this dimension. Full article

(This article belongs to the Special Issue Integrating Palliative Care in Oncology)

22 pages, 12351 KiB

Open AccessArticle

The Efficacy of Cannabis in Oncology Patient Care and Its Anti-Tumor Effects

by Walid Shalata, Omar Abu Saleh, Lena Tourkey, Sondos Shalata, Ala Eddin Neime, Ali Abu Juma’a, Arina Soklakova, Lama Tourkey, Ashraf Abu Jama and Alexander Yakobson

Cancers 2024, 16(16), 2909; https://doi.org/10.3390/cancers16162909 - 21 Aug 2024

Cited by 2 | Viewed by 3191

Abstract

As the legalization of medical cannabis expands across several countries, interest in its potential advantages among cancer patients and caregivers is burgeoning. However, patients seeking to integrate cannabis into their treatment often encounter frustration when their oncologists lack adequate information to offer guidance. This knowledge gap is exacerbated by the scarcity of published literature on the benefits of medical cannabis, leaving oncologists reliant on evidence-based data disheartened. This comprehensive narrative article, tailored for both clinicians and patients, endeavors to bridge these informational voids. It synthesizes cannabis history, pharmacology, and physiology and focuses on addressing various symptoms prevalent in cancer care, including insomnia, nausea and vomiting, appetite issues, pain management, and potential anti-cancer effects. Furthermore, by delving into the potential mechanisms of action and exploring their relevance in cancer treatment, this article aims to shed light on the potential benefits and effects of cannabis in oncology. Full article

(This article belongs to the Special Issue Integrating Palliative Care in Oncology)

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10 pages, 526 KiB

Open AccessArticle

How Do Quality of Life (QoL) and Symptom Burden Evolve in Inpatient Palliative Care (PC) Patients following One Week of Care in a Specialized Palliative Care Unit (PCU)? A Comparison of Two Groups, with One Receiving Specialized Outpatient Palliative Care Prior to Admission

by Hanna Salm, Florian Doberschütz, Franziska Hallmann, Philipp Munzert, Johannes Rahm, Sarah Uhlig and Daniel Pink

Cancers 2024, 16(8), 1612; https://doi.org/10.3390/cancers16081612 - 22 Apr 2024

Cited by 1 | Viewed by 1612

Abstract

Purpose: This study sought to investigate changes in quality of life (QoL) and symptom burden among palliative care patients undergoing one week of inpatient care in a specialized palliative care unit (PCU). The patient population was stratified into two groups, with one group pretreated from pre-admission palliative care (PC) provided by an outpatient multidisciplinary PC team, while the other group did not receive such support prior to admission. Although the average duration of treatment at a PCU in Germany is 1–2 weeks, the question also arises as to whether a significant improvement in symptom burden and QoL can be expected after just one week of PC in a PCU. Methods: PC patients with various cancer entities were prospectively included in a non-randomized study. Patients in group 1 received outpatient specialized PC prior to admission, while patients in group 2 did not. Over an 8-month period, we gathered data from one academic cancer center, utilizing the EORTC QLQ-C30, one of the most widely used patient-reported outcome (PRO) instruments to assess health-related QoL in cancer patients. Patients completed the QLQ-C30 at T0 (admission or one day later) and T1 (one week later), enabling the assessment of potential changes in their QoL and symptom burden over time. Results: A total of 103 patients (51.5% male) were enrolled (group 1: 42%, group 2: 58%). At T0, there were no significant differences regarding QLQ-C30 scores between groups 1 and 2, except from global health/QoL (group 1 mean 20.7, group 2 mean 25.6, p = 0.026). Over the course of one week several significant and clinically relevant changes were found: Emotional functioning demonstrated an uplift in both groups (group 1: mean 41.5 IQR 33 vs. 53.1 IQR 50, p = 0.014, group 2: mean 48.2 IQR 46 vs. 56.8 IQR 58, p = 0.029), as did the global health status (group 1: M 20.7 IQR 17 vs. 36.2 IQR 33, p < 0.001, group 2: M 25.6 IQR 25 vs. 35.3 IQR 33, p < 0.001). Nausea and vomiting showed a reduction (group 1: M 29.9 IQR 17 vs. 6.8 IQR 0, p < 0.001, group 2: M 22.6 IQR 17 vs. 8.2 IQR 0, p < 0.001), along with a notable decline in pain (group 1: M 67.4 IQR 67 vs. 25.3 IQR 17, p < 0.001, group 2: M 73.1 IQR 83 vs. 29.7 IQR 17, p < 0.001). A decrease was observed in insomnia (group 1: M 63.6 IQR 67 vs. 27.6 IQR 33, p < 0.001, group 2: M 60.1 IQR 67 vs. 27.6 IQR 33, p < 0.001). There were no significant differences between groups 1 and 2 in the extent of improvement in the various symptom scales from T0 to T1. Conclusion: The findings of our study demonstrate that QoL and several symptoms prevalent in cancer patients cared for in the PCU experienced significant enhancement over the span of just one week. Both groups, patients receiving specialized outpatient PC prior to admission and those without, equally benefited from inpatient PC. All mentioned changes from T0 to T1 are considered not only significant but clinically relevant. Full article

(This article belongs to the Special Issue Integrating Palliative Care in Oncology)

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11 pages, 468 KiB

Open AccessEditor’s ChoiceArticle

Fear of Recurrence in Advanced Cancer Patients: Sociodemographic, Clinical, and Psychological Correlates

by Caterina Calderon, Marina Gustems, Rocio Galán-Moral, Maria M. Muñoz-Sánchez, Lorena Ostios-García and Paula Jiménez-Fonseca

Cancers 2024, 16(5), 909; https://doi.org/10.3390/cancers16050909 - 23 Feb 2024

Cited by 8 | Viewed by 2698

Abstract

Fear of cancer recurrence significantly impacts advanced cancer patients, prompting emotional distress and increased healthcare utilization. This present study aims to analyze the fear of recurrence among patients with advanced cancer undergoing systemic treatment and its relationship with sociodemographic, clinical, and psychological factors. A multicenter cross-sectional study was conducted in 15 oncology departments across Spain, involving patients with locally advanced, unresectable, or metastatic cancer eligible for systemic treatment. Participants provided demographic information and completed instruments such as the Cancer Worry Scale, Brief Symptom Inventory, Mishel Uncertainty in Illness Scale, and the Duke–UNC-11 Functional Social Support Questionnaire (DUFSSQ). A total of 1195 participants participated: median age 66, 56% male, mostly metastatic cancers (80%), and common tumor sites. Two fear groups emerged: 28% low and 72% high levels of fear. High fear was associated with being female, being younger, lower levels of education, and worse survival estimates. High fear correlated with more depression, anxiety, somatic symptoms, uncertainty, and stronger social support. Multivariate analyses indicated that younger patients, those with shorter survival estimates, higher depression and anxiety scores, more uncertainty, and stronger social support had a greater likelihood of experiencing fear of recurrence, while the opposite was true for older patients. This study underscores distinct fear of recurrence profiles in advanced cancer patients, emphasizing the need for targeted interventions and support. Future research should delve deeper into understanding their repercussions for improving patient care and well-being. Full article

(This article belongs to the Special Issue Integrating Palliative Care in Oncology)

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16 pages, 2133 KiB

Open AccessArticle

Validation Study of the PALCOM Scale of Complexity of Palliative Care Needs: A Cohort Study in Advanced Cancer Patients

by Margarita Viladot, Jose-Luís Gallardo-Martínez, Fany Hernandez-Rodríguez, Jessica Izcara-Cobo, Josep Majó-LLopart, Marta Peguera-Carré, Giselle Russinyol-Fonte, Katia Saavedra-Cruz, Carmen Barrera, Manoli Chicote, Tanny-Daniela Barreto, Gemma Carrera, Jackeline Cimerman, Elena Font, Ignacio Grafia, Lucia Llavata, Javier Marco-Hernandez, Joan Padrosa, Anais Pascual, Dolors Quera, Carles Zamora-Martínez, Ana-Maria Bozzone, Carme Font and Albert Tuca Show full author list Hide full author list

Cancers 2023, 15(16), 4182; https://doi.org/10.3390/cancers15164182 - 20 Aug 2023

Cited by 7 | Viewed by 2547

Abstract

Background: In a patient-centred model of care, referral to early palliative care (EPC) depends on both the prognosis and the complexity of care needs. The PALCOM scale is a 5-domain multidimensional assessment tool developed to identify the level of complexity of palliative care needs of cancer patients. The aim of this study was to validate the PALCOM scale. Patient and methods: We conducted a prospective cohort study of cancer patients to compare the PALCOM scale and expert empirical assessment (EA) of the complexity of palliative care needs. The EA had to categorise patients according to their complexity, considering that medium to high levels required priority attention from specialist EPC teams, while those with low levels could be managed by non-specialist teams. Systematically collected multidimensional variables were recorded in an electronic report form and stratified by level of complexity and rating system (PALCOM scale versus EA). The correlation rank (Kendall’s tau test) and accuracy test (F1-score) between the two rating systems were analysed. ROC curve analysis was used to determine the predictive power of the PALCOM scale. Results: A total of 283 advanced cancer patients were included. There were no significant differences in the frequency of the levels of complexity between the EA and the PALCOM scale (low 22.3–23.7%; medium 57.2–59.0%; high 20.5–17.3%). The prevalence of high symptom burden, severe pain, functional impairment, socio-familial risk, existential/spiritual problems, 6-month mortality and in-hospital death was significantly higher (p < 0.001) at the high complexity levels in both scoring systems. Comparative analysis showed a high correlation rank and accuracy between the two scoring systems (Kendall’s tau test 0.81, F1 score 0.84). The predictive ability of the PALCOM scale was confirmed by an area under the curve in the ROC analysis of 0.907 for high and 0.902 for low complexity. Conclusions: In a patient-centred care model, the identification of complexity is a key point to appropriate referral and management of shared care with EPC teams. The PALCOM scale is a high precision tool for determining the level of complexity of palliative care needs. Full article

(This article belongs to the Special Issue Integrating Palliative Care in Oncology)

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Review

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23 pages, 1915 KiB

Open AccessReview

A Systematic Review and Meta-Analysis on Opioid Management of Dyspnea in Cancer Patients

by Elena Chitoran, Vlad Rotaru, Giuseppe Gullo, Daniela Viorica Mosoiu and Laurentiu Simion

Cancers 2025, 17(8), 1368; https://doi.org/10.3390/cancers17081368 - 19 Apr 2025

Viewed by 220

Abstract

Background/Objectives: Dyspnea accompanies end-of-life in many cancer patients, with around 50% experiencing moderate/severe dyspnea, and is an independent factor for poor prognosis and declining quality of life. Managing dyspnea becomes a key component of palliative treatment and end-of-life support for cancer patients. Opioids seem to be the obvious choice in cancer patients as they also address the pain component (often important in such patients). Evidence-based conclusions on the effectiveness/safety of opioids in dyspnea management are scarce, and the results are still controversial. We aim to address this knowledge gap. Methods: In order to achieve the objective of this paper, we conducted a comprehensive search of international databases (PubMed, Medline, Embase, and Cochrane Library) for randomized controlled trials on the use of opioids to treat refractory dyspnea in adult cancer patients, and we performed a pooled meta-analysis of the results. Results: The effect of opioids on the relief of dyspnea was significant (SMD −0.44, 95% CI [−0.75,−0.12], p = 0.007). The significance of the opioid effect is maintained only for morphine administration (SMD −078, 95% CI [−1.45,−0.10], p = 0.02) and only for exertional dyspnea (SMD −1.00, 95% CI [−1.98, −0.03], p = 0.04). No correlation was noted between fentanyl/hydromorphone and dyspnea relief or opioids administered for dyspnea at rest. The subcutaneous route seems to be significantly correlated with dyspnea relief (SMD −0.73, 95% CI [−1.27, −0.19], p = 0.008), while the other administration modalities lack such an effect. No significant correlation was present between the usage of morphine/fentanyl and increased odds of severe adverse effects (OR 1.48, 95% CI [0.57,3.86], p = 0.42); however, fentanyl seems to be associated with increased somnolence. Although we aimed to evaluate how opioids impact the quality of life of cancer patients with dyspnea, we were unable to obtain such results due to the absolute lack of the literature available discussing QoL. Conclusions: Although we managed to provide some insights into the efficiency and safety of opioids usage for dyspnea management in cancer patients, the evidence based on the available literature is low grade. There is a marked need to address this knowledge gap with future high-quality studies with large sample sizes and standardized protocols. Full article

(This article belongs to the Special Issue Integrating Palliative Care in Oncology)

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Other

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23 pages, 976 KiB

Open AccessSystematic Review

The Experiences of Adolescents and Young Adults with Digital Supportive Care Interventions for Cancer: A Systematic Review of Qualitative Studies

by Mashiad Mostafa, Y. Sarah Chae, Kelcey A. Bland and Helen McTaggart-Cowan

Cancers 2025, 17(5), 736; https://doi.org/10.3390/cancers17050736 - 21 Feb 2025

Viewed by 488

Abstract

Background: Evidence suggests the importance of cancer supportive care for adolescents and young adults (AYAs), and digital technology may provide tailored care that is flexible, affordable and accessible. However, AYAs’ experiences with these digital cancer supportive care interventions are currently unclear. Objective: The aim of this review is to systematically identify and explore potential intervention facilitators, barriers and areas of improvement. Methods: We conducted a comprehensive search of MEDLINE (Ovid), EMBASE, PsycINFO and CINAHL for mixed methods and qualitative studies, published between 2000 and 2023, focusing on the experiences of AYAs between the ages of 15 and 39 years using digital supportive care interventions for cancer. Studies involving only pediatric and older populations were excluded. The identified studies were critically appraised and thematically analyzed. Results: Twenty-three digital interventions were identified. They varied in modality and addressed different aspects of supportive care (e.g., physical activity, psychological well-being and symptom management). Participants’ experiences with the intervention attributes (e.g., appropriate content, flexible choices, seamless technology and inclusive environment) influenced their physical and psychological health, connections and communication skills, and autonomy. Conclusions: Overall, AYAs reported favorable experiences with digital interventions when provided with tailored supportive care for cancer. Digital interventions may help to increase reach and access to supportive care for cancer; however, barriers to delivery, such as faulty technology or cumbersome intervention features, can negatively impact participant experiences and may reduce engagement. Full article

(This article belongs to the Special Issue Integrating Palliative Care in Oncology)

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