Updates on Palliative Medicine

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 12912

Special Issue Editor

Special Issue Information

Dear Colleagues,

In modern society, palliative medicine represents an important advancement in the health care system, so much so that some countries have promulgated laws obliging the national health care systems to provide appropriate care to terminal patients and their families. Life expectancy is now increasingly longer, and chronic pathologies are more diffused, with patients requiring support even if affected by hopeless diseases. Palliative Medicine is a medical specialty dedicated to providing relief from the stress, burden, and symptoms of an illness. Its ultimate goal is to provide patients with better management, reduce their suffering, and increase their quality of life. In addition, palliative care should support patients’ families, relieving their psychological and physical burden to assist a terminal patient, with all the associated consequences that this entails.

Palliative support of terminal patients may be provided both at home and in dedicated and organized care facilities, named hospices. The organization of palliative care depends on many local aspects but is also strictly correlated with the patient's health condition, the social conditions of the family, the organization of the health care system, etc. In general, palliative support is granted by a dedicated team able to interact and implement the care already provided to patients’ other doctors. In fact, palliative medicine should be based on patients’ needs, and not on their prognoses. Moreover, palliative support should be provided along with curative therapy when possible and where necessary. In essence, palliative care teams are not focused on the disease itself but rather on the symptoms affecting the quality of life of terminal patients, and on cooperating with their relatives in order to reduce stress in their lives.

The large majority of palliative care patients are affected by cancer, but the number of chronic patients requiring palliative care is increasing, especially in the area of heart diseases, such as congestive heart failure (CHF), chronic obstructive pulmonary diseases (COPD), and chronic renal insufficiency, as well as many neurodegenerative diseases, such as amyotrophic lateral sclerosis (ALS), Alzheimer’s disease, and Parkinson’s disease. The result has been an increase in interest of clinical medicine toward this medical specialty, the main goal of which is to provide the best possible quality of life for patients and their families and to relieve their suffering.

The most frequent symptoms to care for are pain, fatigue, breathing difficulties, gastrointestinal problems (loss of appetite, nausea, vomiting, constipation), and/or psychiatric and psychological alterations (difficulty sleeping, anxiety, depression). The palliative care teams should always help terminal patients and their families to gain the strength to cope with daily life. Many studies have clearly shown that palliative care may increase the life expectancy of terminal patients and increase their quality of life.

For these reasons, a Special Issue of the Journal of Clinical Medicine dedicated to updates in palliative medicine is timely. We hope that the readers of the journal will enjoy the topic as well, and that we will receive a high number of submissions, especially focused on a modern vision for this new medical specialty. Let us work together for better medicine and a more humanistic approach to the patients’ life.

Dr. Giustino Varrassi
Guest Editor

Manuscript Submission Information

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Keywords

  • cancer pain
  • fatigue
  • hospice and palliative care nursing
  • nausea and vomiting
  • palliative care
  • palliative care medicine
  • palliative care nursing
  • terminal patient management

Published Papers (4 papers)

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Editorial

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4 pages, 197 KiB  
Editorial
Updates on Palliative Medicine in the COVID-19 Era
by Giustino Varrassi and Martina Rekatsina
J. Clin. Med. 2022, 11(2), 315; https://doi.org/10.3390/jcm11020315 - 9 Jan 2022
Cited by 4 | Viewed by 2042
Abstract
The advances in knowledge in the field of pain medicine in the last half century have recently been reported from both the scientific and the social points of view [...] Full article
(This article belongs to the Special Issue Updates on Palliative Medicine)

Research

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13 pages, 1001 KiB  
Article
Effectiveness of Therapeutic Exercise and Patient Education on Cancer-Related Fatigue in Breast Cancer Survivors: A Randomised, Single-Blind, Controlled Trial with a 6-Month Follow-Up
by Virginia Prieto-Gómez, María José Yuste-Sánchez, Javier Bailón-Cerezo, Helena Romay-Barrero, Irene de la Rosa-Díaz, Cristina Lirio-Romero and María Torres-Lacomba
J. Clin. Med. 2022, 11(1), 269; https://doi.org/10.3390/jcm11010269 - 5 Jan 2022
Cited by 7 | Viewed by 3828
Abstract
This study aimed to determine the effectiveness of therapeutic exercise plus patient therapeutic education on perceived fatigue, functional capacity and pain in breast cancer survivors with cancer-related fatigue. A randomised, single-blind, clinical trial was conducted with a total of 80 breast cancer survivors [...] Read more.
This study aimed to determine the effectiveness of therapeutic exercise plus patient therapeutic education on perceived fatigue, functional capacity and pain in breast cancer survivors with cancer-related fatigue. A randomised, single-blind, clinical trial was conducted with a total of 80 breast cancer survivors who presented cancer-related fatigue. Women were randomised into a supervised therapeutic exercise group (STE-G) (n = 40) or an unsupervised exercise group (UE-G) (n = 40). Both interventions included patient therapeutic education and were delivered in three sessions per week over eight weeks. The main outcome was perceived fatigue as assessed by the Spanish version of the Functional Assessment of Chronic Illness Therapy-Fatigue subscale (FACIT-F). Other evaluated outcomes were pain measured on a visual analogue scale, and distance measured using the 6-Minute Walk Test. Data were collected at baseline, immediately post-intervention, and at three and six months after baseline. Significantly greater improvements across all variables were observed in the STE-G throughout the entire follow-up period with the exception of pain. Conclusions: A supervised therapeutic exercise program plus patient therapeutic education significantly reduce perceived fatigue and increase functional capacity in breast cancer survivors suffering from cancer-related fatigue compared to an unsupervised physical exercise program based on individual preferences with patient therapeutic education. Full article
(This article belongs to the Special Issue Updates on Palliative Medicine)
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13 pages, 4820 KiB  
Article
Influence of Physical Activity on Pain, Depression and Quality of Life of Patients in Palliative Care: A Proof-of-Concept Study
by Dariusz Myrcik, Wojciech Statowski, Magdalena Trzepizur, Antonella Paladini, Oscar Corli and Giustino Varrassi
J. Clin. Med. 2021, 10(5), 1012; https://doi.org/10.3390/jcm10051012 - 2 Mar 2021
Cited by 4 | Viewed by 2961
Abstract
Introduction: Palliative care not only focuses on physical ailments associated with the disease, but also considers the psychological, social and spiritual needs of the patients. The aim of this study is to assess the impact of physical activity on palliative care patients, with [...] Read more.
Introduction: Palliative care not only focuses on physical ailments associated with the disease, but also considers the psychological, social and spiritual needs of the patients. The aim of this study is to assess the impact of physical activity on palliative care patients, with special regard to the subjective assessment of severity of total pain and quality of life. Materials and methods: The study was conducted on 92 palliative care patients either in a hospice or at home. The tool used to assess the patients was an original questionnaire focusing on the area of their independence and motor abilities. The study attempted to understand whether an appropriate physical activity and the instruction of palliative care patients and their families in the field of independence would improve the quality of life and reduce the intensity of total pain in the patients. Results: All of the patients were at an advanced stage of cancer. The survey at time “0”, conducted before the start of the instructions for patients and their relatives, showed that a majority of patients (47, 51.09%) often experienced limitations during the performance of daily activities. In the fourth visit, conducted one week after the fourth educational session, there was a significant increase in patients who did not experience any limitations in performing their daily activities or experienced them just sometimes. Conclusions: The ultimate effect of the proposed educational program on physical activity was an increase in the quality of life, a reduction in pain and a mood improvement. These results would need confirmation with more extensive studies. Full article
(This article belongs to the Special Issue Updates on Palliative Medicine)
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Review

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19 pages, 4509 KiB  
Review
Balneotherapy for Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis
by Chun-Feng Cao, Kun-Long Ma, Qian-Lu Li, Fu-Jun Luan, Qun-Bo Wang, Ming-Hua Zhang, Omar Viswanath, Dariusz Myrcik, Giustino Varrassi and Hai-Qiang Wang
J. Clin. Med. 2021, 10(7), 1493; https://doi.org/10.3390/jcm10071493 - 3 Apr 2021
Cited by 8 | Viewed by 2921
Abstract
(1) Background: The efficiency of balneotherapy (BT) for fibromyalgia syndrome (FMS) remains elusive. (2) Methods: Cochrane Library, EMBASE, MEDLINE, PubMed, Clinicaltrials.gov, and PsycINFO were searched from inception to 31 May 2020. Randomized controlled trials (RCTs) with at least one indicator were included, i.e., [...] Read more.
(1) Background: The efficiency of balneotherapy (BT) for fibromyalgia syndrome (FMS) remains elusive. (2) Methods: Cochrane Library, EMBASE, MEDLINE, PubMed, Clinicaltrials.gov, and PsycINFO were searched from inception to 31 May 2020. Randomized controlled trials (RCTs) with at least one indicator were included, i.e., pain, Fibromyalgia Impact Questionnaire (FIQ), Tender Points Count (TPC), and Beck’s Depression Index (BDI). The outcome was reported as a standardized mean difference (SMD), 95% confidence intervals (CIs), and I2 for heterogeneity at three observational time points. GRADE was used to evaluate the strength of evidence. (3) Results: Amongst 884 citations, 11 RCTs were included (n = 672). Various BT regimens were reported (water types, duration, temperature, and ingredients). BT can benefit FMS with statistically significant improvement at different time points (pain of two weeks, three and six months: SMD = −0.92, −0.45, −0.70; 95% CI (−1.31 to −0.53, −0.73 to −0.16, −1.34 to −0.05); I2 = 54%, 51%, 87%; GRADE: very low, moderate, low; FIQ: SMD = −1.04, −0.64, −0.94; 95% CI (−1.51 to −0.57, −0.95 to −0.33, −1.55 to −0.34); I2 = 76%, 62%, 85%; GRADE: low, low, very low; TPC at two weeks and three months: SMD = −0.94, −0.47; 95% CI (−1.69 to −0.18, −0.71 to −0.22); I2 = 81%, 0; GRADE: very low, moderate; BDI at six months: SMD = −0.45; 95% CI (−0.73 to −0.17); I2 = 0; GRADE: moderate). There was no statistically significant effect for the TPC and BDI at the remaining time points (TPC at six months: SMD = −0.89; 95% CI (−1.85 to 0.07); I2 = 91%; GRADE: very low; BDI at two weeks and three months: SMD = −0.35, −0.23; 95% CI (−0.73 to 0.04, −0.64 to 0.17); I2 = 24%, 60%; GRADE: moderate, low). (4) Conclusions: Very low to moderate evidence indicates that BT can benefit FMS in pain and quality-of-life improvement, whereas tenderness and depression improvement varies at time phases. Established BT regimens with a large sample size and longer observation are needed. Full article
(This article belongs to the Special Issue Updates on Palliative Medicine)
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