Eduardo Bruera

Integration of Remote Monitoring Into Palliative Care for Patients With Advanced Cancer Undergoing Phase I Therapies: A Randomized Clinical Trial - PubMed Incorporating RM into SPC may improve symptoms and HRQOL beyond SPC alone for patients with moderate-to-high symptom burden. Our findings are considered preliminary and larger confirmatory trials are needed.

A pilot trial in advanced cancer found that adding weekly remote monitoring to monthly specialist palliative care led to greater early symptom relief and better 12-week quality of life than SPC alone. Results suggest RM may enhance SPC

pubmed.ncbi.nlm.nih.gov/40986798/

Existential suffering as an indication for palliative sedation: Identifying and addressing challenges - PubMed Existential suffering as an indication for palliative sedation: Identifying and addressing challenges

using existential suffering alone (e.g., psychological, spiritual distress) to justify palliative sedation at end of life raises serious ethical and practical problems. 
calls for careful assessment, criteria, and more research . 

pubmed.ncbi.nlm.nih.gov/38419195/

Illness trajectories of incurable solid cancers - PubMed Illness trajectories of incurable solid cancers

incurable solid cancers often follow variable courses — some patients decline slowly and steadily, others show temporary improvements or long-term responses — rather than a single predictable “steady-decline then death” trajectory.

pubmed.ncbi.nlm.nih.gov/38428972/

Telehealth Preferences Among Patients With Advanced Cancer in the Post COVID-19 Vaccine Era - PubMed Patients expressed strong preference for video over in-person visits in the outpatient palliative care setting.

Patients in a palliative care clinic largely preferred video visits post-vaccine, citing convenience, lower travel cost, and shorter waits. Preference for video was tech comfort, while Hispanic/Latino patients and those with dyspnea preferred in-person.

pubmed.ncbi.nlm.nih.gov/38467349/

Structured Personalized Oxygen and Supportive Therapies for Dyspnea in Oncology (SPOT-ON): A personalized randomized clinical trial protocol - PubMed Clinicaltrials.gov NCT06336642.

RCT testing SPOT-ON, a personalized RT-led 72h intervention using short trials of LFSO, HFNC, and NIV to tailor dyspnea therapy in hospitalized cancer patients. Compared with waitlist control, it measures dyspnea change at 24h and secondary symptom, safety

pubmed.ncbi.nlm.nih.gov/41329762/

The use of tramadol for cancer-associated pain-a systematic review - PubMed Relative to other analgesics, tramadol is neither superior nor inferior. There may exist a different safety profile and therefore an opportunity to provide individualized patient-centered treatment strategies focused on safety and quality of life.

Tramadol provides cancer-pain relief comparable to other analgesics, with few clear advantages or disadvantages. Across 11 studies, efficacy was mostly similar, while safety varied. Due to limited dosing up to 400 mg it may be best for opioid naive pts

pubmed.ncbi.nlm.nih.gov/41324745/

Twice-daily versus once-daily morphine sulphate controlled-release suppositories for the treatment of cancer pain. A randomized controlled trial - PubMed We evaluated the safety and efficacy of controlled-release morphine sulphate suppositories administered 12-hourly and once daily in patients with chronic cancer in a randomized double-blind crossover trial. Pain was assessed using a 100-mm VAS pain scale and a five-point ordinal pain scale. The VAS …

Custom made suppositories of morphine and methadone once or twice a day are excellent for cancer pain

pubmed.ncbi.nlm.nih.gov/10423055/

Capsules and suppositories of methadone for patients on high-dose opioids for cancer pain: clinical and economic considerations - PubMed The dose ratio, analgesic efficacy, toxicity and cost of methadone for cancer pain were evaluated in a retrospective review of 50 consecutive patients treated on a Palliative Care Unit. Patients were switched from hydromorphone 267.7 +/- 178.8 mg sc per day to custom-made capsules (24) or suppositor …

Methadone in 50 cancer patients, improving pain and costing far less. Useful for American pts, who are unprotected against massive drug cartels charges + insurance cartels denials.

pubmed.ncbi.nlm.nih.gov/8625339/

Neuropsychological effects of methylphenidate in patients receiving a continuous infusion of narcotics for cancer pain - PubMed Twenty consecutive patients with cancer pain receiving a continuous subcutaneous infusion of narcotics were admitted to a double-blind, crossover trial designed to assess the effects of methylphenidate on neuropsychological functions. After a baseline assessment, patients were randomized to receive …

Methylphenidate improved cognitive tests in pts with cancer on opioids
pubmed.ncbi.nlm.nih.gov/1589233/

Methylphenidate associated with narcotics for the treatment of cancer pain - PubMed Thirty-two patients with chronic pain due to advanced cancer were treated with methylphenidate (10 mg with breakfast and 5 mg with lunch) for 3 days, versus placebo, in a randomized, double-blind, cross-over study designed to evaluate the capacity of methylphenidate to potentiate the analgesic effec …

Methylphenidate improved sedation and analgesia in pts with cancer on opioids

pubmed.ncbi.nlm.nih.gov/3791269/

Physical Activity and Dexamethasone for Cancer-Related Fatigue: A Preliminary Placebo-Controlled, Randomized, Double-Blind Trial - PubMed gov identifier: NCT03583255.

PA plus dexamethasone or placebo was feasible, safe, and well-accepted for advanced cancer–related fatigue. Both improved fatigue, but PA+Dex produced greater, clinically meaningful gains by days 8 and 29. High adherence and satisfaction.

pubmed.ncbi.nlm.nih.gov/39773433/

Improvement of Fatigue Due to Placebo in Blinded and Open Labeled Cancer Fatigue Treatment Trials - PubMed In this study we found placebo response was not significantly different between patients receiving placebo in a blinded and open-labeled design in randomized controlled CRF clinical trials. In this study we found a significant association between placebo response and baseline CRF, gastrointestinal c …

Placebo response for cancer-related fatigue was similar in blinded and open-label trials. Greater placebo improvement was linked to worse baseline fatigue, gastrointestinal cancers, and higher ESAS pain, anxiety, and symptom distress. Further research is needed.

pubmed.ncbi.nlm.nih.gov/40659100/

Practices and perceptions regarding intravenous opioid infusion and cancer pain management - PubMed More than half the nurses working in the inpatient setting reported administering iv opioids too fast. ICU nurses administered opioids the fastest. Nurses who frequently used a timing device were less likely to infuse too fast. Further research is needed to standardize and improve the safe intermitt …

Over half of 731 oncology nurses reported infusing IV opioid boluses too quickly (<120 s), especially in ICU and ED. Frequent use of timing devices reduced fast infusions. Findings highlight need for standardized, safer IV opioid practices in cancer care.

pubmed.ncbi.nlm.nih.gov/31291011/

Challenging the Status Quo of Physician Attire in the Palliative Care Setting - PubMed Doctors' attire did not affect the perceptions of patients with cancer of physician's level of compassion and professionalism, nor did it influence the patients' preference for their doctor or their trust and confidence in the doctor's ability to provide care. There is a need for more studies in thi …

A randomized trial in 105 advanced-cancer patients found no differences in perceived compassion, professionalism, or physician preference between doctors wearing formal vs. casual attire. Attire did not influence trust or confidence in care.

pubmed.ncbi.nlm.nih.gov/32073181/

Home-Based Palliative Care for Patients With Non-Cancer Diagnoses: Clinical Characteristics, Symptom Burden, and Service Delivery - PubMed IntroductionPopulation aging has contributed to the increased prevalence of chronic non-communicable and disabling diseases, increasing the demand for home-based palliative care.ObjectiveTo describe the sociodemographic, clinical, and care profile of patients with non-cancer treated by a Home Care S …

Home-based palliative care for 248 non-cancer patients (mean age 81) showed high comorbidity and severe functional impairment (46% PPS ≤30). Median stay was 50 days with >1 MD/RN visit / day. All died at home, underscoring need to expand public palliative care.

pubmed.ncbi.nlm.nih.gov/40971993/

Integration of Remote Monitoring Into Palliative Care for Patients With Advanced Cancer Undergoing Phase I Therapies: A Randomized Clinical Trial - PubMed Incorporating RM into SPC may improve symptoms and HRQOL beyond SPC alone for patients with moderate-to-high symptom burden. Our findings are considered preliminary and larger confirmatory trials are needed.

Remote monitoring added to specialist palliative care led to greater early symptom and quality-of-life improvements than SPC alone in advanced cancer patients on phase I therapy. Benefits persisted to 12 weeks, suggesting RM may enhance SPC.

pubmed.ncbi.nlm.nih.gov/40986798/

Use of the Edmonton Injector for parenteral opioid management of cancer pain: a study of 100 consecutive patients - PubMed In this retrospective study, we reviewed the patterns of use of the Edmonton Injector (EI) in 100 consecutive cancer patients. Seventy-eight patients used the EI for an average of 23 +/- 27 days. The main reasons for starting the EI were nausea (37 patients) and severe pain (31 patients). The median …

The Edmonton injector is already middle age! And there are still too many pts with no access to parenteral opioids “ due to cost “

pubmed.ncbi.nlm.nih.gov/7525782/

cdn.ncbi.nlm.nih.gov/pmc/blobs/85...

Anyone can manufacture and use the Edmonton injector for SC meds. We made it for pts, not for profit!

A randomized double-blind crossover comparison of continuous and intermittent subcutaneous administration of opioid for cancer pain - PubMed ABSTRACT Although the preferred route of opioid administration is oral, patients with cancer often require an alternative route. Options include continuous subcutaneous infusion (CSCI) or regularly scheduled intermittent subcutaneous injections (ISCI). CSCI maintains steady drug levels, theoreticall …

Intermittent SC opioids q4h are as effective as continuous infusions, and much easier and cheaper!

pubmed.ncbi.nlm.nih.gov/18454609/

Systematic Screening of Advanced Cancer Patients' Curability Perception: A Longitudinal Analysis - PubMed Only one in three patients with advanced cancer had an accurate understanding of their curability, with limited improvement over time. Systematic screening may provide opportunities to improve illness understanding and coping support.

Among 432 patients with advanced cancer, only about one-third accurately understood their curability, with little improvement over time. Misperception was linked to Asian race and better reported well-being. Systematic screening may help identify needs

pubmed.ncbi.nlm.nih.gov/40992638/

Medical marijuana policies, opioid prescriptions, and adverse events among patients undergoing cancer resection surgery - PubMed MML policies may have affected the type of opioid prescribed and increased adverse hospital events among patients with cancer and resection surgery. Additional investigation of medical marijuana's impact on cancer pain management is warranted.

Medical marijuana legalization influenced postoperative cancer pain management. States with dispensaries saw fewer strong-opioid prescriptions but more adverse hospital events, while early MML stages increased weak-opioid use.

pubmed.ncbi.nlm.nih.gov/41031641/

Understanding challenges and barriers to quality end-of-life care for patients with hematologic malignancies: a GIMEMA survey - PubMed Patients with hematologic malignancies often receive aggressive end-of-life (EOL) care, which may be partly related to hematologists' discomfort with discontinuing aggressive treatments at EOL. It is therefore important to investigate how hematologists perceive EOL care and how this affects their cl …

hematologists generally accepted most EOL quality measures but face unrealistic patient expectations and discomfort with GOC/ACP discussions. Many feel unprepared for these conversations. They support earlier palliative care and better home-care access.

pubmed.ncbi.nlm.nih.gov/41068303/

Use of Nebulized Tranexamic acid (TA) in combination with nebulized recombinant coagulation factor VIIa to treat hemoptysis in pediatric patients with cancer at end-of-life (EOL) - PubMed Hemoptysis is a distressing symptom for both patients and families at end of life (EOL). In the acute care setting, this can be managed surgically or medically. However, research regarding interventions, such as nebulized tranexamic acid (TA) and nebulized factor VIIa, for palliative management of h …

In a pediatric palliative pts nebulised Tranexamic acid (TA) and nebulised Recombinant factor VIIa was used to manage haemoptysis near end-of-life. There was relief of bleeding and reduced distress, suggesting this combination may offer a palliative option.

pubmed.ncbi.nlm.nih.gov/41207344/

Personalized sedation goal for agitated delirium in patients with cancer: Balancing comfort and communication - PubMed In the last days of life, many patients with cancer develop delirium and become restless/agitated; this can be highly distressing. Caregivers and physicians alike are often concerned about the use of sedatives for agitated delirium and try to find a balance between maximizing comfort and maintaining …

Caregivers and nurses differed in preferred sedation goals for agitated delirium. Caregivers favored lighter sedation, nurses deeper. Patients were often undersedated. Vignettes showed deeper sedation preferred when communication impossible or prognosis short.

pubmed.ncbi.nlm.nih.gov/34432293/

Frequency of anxiety and depression and screening performance of the Edmonton Symptom Assessment Scale in a psycho-oncology clinic - PubMed Self-reported depression and anxiety are frequent symptoms among patients at a psychiatric oncology center for an initial visit. ESAS-A and ESAS-D have good sensitivity for anxiety and depression screening of cancer patients.

Depression (60%) and anxiety (51%) were common in 1,221 new psychiatric oncology outpatients. Age and gender correlated with anxiety. ESAS cutoffs ≥3 (depression) and ≥5 (anxiety) showed good sensitivity for detecting symptoms using PHQ-9 and GAD-7.

pubmed.ncbi.nlm.nih.gov/34546618/

The Edmonton injector: a simple device for patient-controlled subcutaneous analgesia - PubMed In a prospective open study we tested the Edmonton injector (EI), a device designed by our group for subcutaneous injection of narcotics. In 25 patients, the EI was used for patient-controlled analgesia (PCA); mean duration of treatment was 28 +/- 10 days. Mean equivalent daily dose of morphine was …

The Edmonton Injector for scheduled and PRN dosing. PRN wait times dropped from 18 to 3 minutes. The EI is safe, effective, inexpensive, great for resource-limited settings. After 35 years there is still no device to replace it, since ironically it is too cheap!

pubmed.ncbi.nlm.nih.gov/2052383/

Managing Cancer Pain in Hospitalized Patients with Comorbid Opioid Use Disorder with Buprenorphine: A Case Series - PubMed Data indicate that one in five patients with cancer might be at risk for nonmedical opioid use and its extreme form, opioid use disorder (OUD). Buprenorphine is one of the few medications available for the management of patients with co-occurring OUD and chronic pain. Care for these patients can be …

Three cancer patients with opioid use disorder (OUD) on buprenorphine were hospitalized for cancer pain. Primary clinicians managed complex needs, illustrating challenges and approaches to inpatient care for OUD in cancer.

pubmed.ncbi.nlm.nih.gov/39383025/

Letter to the Editor: Levetiracetam as an Alternative for Refractory Confusional Syndromes: A Case Series - PubMed Letter to the Editor: Levetiracetam as an Alternative for Refractory Confusional Syndromes: A Case Series

In this letter, the authors report on a small case-series using Levetiracetam for refractory confusional syndromes in palliative patients. They suggest it may offer a safe alternative when standard therapies fail, calling for further study.

pubmed.ncbi.nlm.nih.gov/39441578/

Case report: Poor prognosis or poor prognostication? - PubMed Physicians frequently overestimate or underestimate survival time which can be distressing to patients and families. There is need for further research to improve the accuracy of these tools for the sake of our patients and their families.

A patient with metastatic melanoma admitted to ICU and later to palliative care unexpectedly improved despite multiple death-predicting signs. The authors highlight that clinicians often misestimate survival, and call for better prognostic tools.

pubmed.ncbi.nlm.nih.gov/39478369/

Total suffering and will to live in persons with life-limiting diseases: Results from an Iberian multicenter study - PubMed Evidence-based understanding of WtL is critical to improving care for patients who experience suffering toward end-of-life and their families. Further research is needed to inform and refine interventions targeting total suffering.

A study of 107 palliative patients showed that will to live (WtL) varies widely over time and correlates with all ESAS symptoms. WtL had links to total, physical, and psychological burden. Findings highlight suffering’s complexity and need for targeted care

pubmed.ncbi.nlm.nih.gov/40739928/