Eduardo Bruera

Just-in-Time Decision Making: Preliminary Findings of a Goals of Care Rapid Response Team - PubMed GOC RRT consultations were feasible and associated with care limitation. Adherence to core team participation was fair.

A GOC Rapid Response Team at a cancer center proved feasible during COVID-19, completing 85% of requested consults. Core team participation was 64%, and care limitation occurred in 74% of cases, showing effectiveness in promoting goal-concordant care.

pubmed.ncbi.nlm.nih.gov/36496112/

Comparison of Health Care Providers Attitudes and Beliefs Regarding Medical Marijuana and Cannabidiol in the Management of Pain and Other Symptoms in Cancer Patients - PubMed <span><b><i>Background:</i></b> Medical marijuana (MM) and cannabidiol (CBD) have received increasing attention to manage pain and other symptoms even with limited scientific evidence. <b><i>Objective...

Survey of clinicians from four specialties found few preferred medical marijuana (9%) or CBD (13%) over opioids for cancer pain; some supported combining them with opioids. MM and CBD were not favored over standard treatments for pain or other symptoms.

pubmed.ncbi.nlm.nih.gov/36576904/

Meta-Analysis of Pharmacological, Nutraceutical and Phytopharmaceutical Interventions for the Treatment of Cancer Related Fatigue - PubMed Purpose: In this study we aimed to estimate the effectiveness of pharmacological, nutraceutical, and phytopharmaceutical treatments on CRF. Methods: Ovid MEDLINE, Ovid Embase, Ovid Psych info, CINHAHL...

Meta-analysis of 32 RCTs (4896 patients) found that pharmacological, phytopharmaceutical treatments significantly reduced cancer-related fatigue (pooled effect −0.29). Only corticosteroids showed significant benefit (effect −0.94); other agents were not effective.

pubmed.ncbi.nlm.nih.gov/36612088/

Levorphanol as a Second Line Opioid in Cancer Patients Presenting to an Outpatient Supportive Care Center: An Open-label Study - PubMed This study provided preliminary data that cancer patients could be successfully rotated to levorphanol using an ORR of 8.5. Levorphanol was associated with improved pain and symptom control and was we...

A very nice synthetic opioid agonist. Unfortunately American Pharma and Insurance cartels make access impossible for American patients with cancer pain.

pubmed.ncbi.nlm.nih.gov/36720398/

Knowledge, attitudes, and beliefs of oncology trainees on function and cancer rehabilitation medicine - PubMed This study demonstrates that oncology trainees believe that function is important. They also believe that access to CRM would improve treatment tolerance and survival, but most report that they rarely...

Oncology trainees value function and believe CRM improves treatment tolerance and survival, yet most rarely refer patients to CRM. Prior PM&R exposure increases referrals. Most trainees support adding CRM education to oncology training.

pubmed.ncbi.nlm.nih.gov/36762725/

Please request your FREE copy of the new edition to : cmartinez9@mdanderson.org

Treating Radiation Anxiety With Systematic Desensitization: Head and Neck Cancer Case Reports - PubMed <span><b><i>Introduction:</i></b> Head and neck cancer patients have high rates of psychological distress, which may be exacerbated by the treatments they receive. Many patients who undergo radiation ...

Head and neck cancer patients often experience severe anxiety from radiation masks. Two claustrophobic patients received early supportive desensitization, enabling successful treatment completion. Early psychological support may improve adherence and outcomes.

pubmed.ncbi.nlm.nih.gov/36730789/

Palliative and Supportive Care Consultation for Patients With Malignant Gastrointestinal Obstruction is Associated With Broad Interdisciplinary Management - PubMed PC consultation benefits patients with malignant GIO by facilitating comprehensive interdisciplinary care, ACP discussions, and transition to hospice care, where appropriate. Diagnosis of malignant GI...

Malignant GIO carries a poor prognosis. In this study, palliative care consultation improved advance care planning, DNR orders, hospice transitions, and interdisciplinary involvement, suggesting malignant GIO should automatically trigger palliative care referral.

pubmed.ncbi.nlm.nih.gov/36745760/

Decision-Making Preferences among Advanced Cancer Patients in a Palliative Setting in Jordan - PubMed Understanding patients' decision-making preferences is crucial for enhancing patients' outcomes. The current study aims to identify Jordanian advanced cancer patients' preferred decision-making and to...

In a survey of 200 Jordanian advanced cancer patients, 40.5% preferred passive decision-making, while 35% preferred shared and 24.5% active control. Male, educated, and Christian patients favored active roles. Most were satisfied with decisions.

pubmed.ncbi.nlm.nih.gov/37107832/

Helpfulness of Question Prompt Sheet for Patient-Physician Communication Among Patients With Advanced Cancer: A Randomized Clinical Trial - PubMed ClinicalTrials.gov Identifier: NCT03287492.

In this randomized trial among advanced cancer patients, a disease-specific Question Prompt Sheet (QPS) was rated as equally helpful as a general information sheet but was preferred overall. QPS encouraged more questions without increasing anxiety or time.

pubmed.ncbi.nlm.nih.gov/37129892/

Deficiencies with CAGE-AID questionnaire in identifying nonmedical opioid use-a report of two cases - PubMed The CAGE-AID questionnaire alone does not accurately identify risks for NMOU. Screening tools must always be accompanied by a thorough clinical assessment of behaviors and pain mechanism. More researc...

CAGE-AID may not reliably identify nonmedical opioid use in cancer patients. One patient with a positive score had no misuse, while another with a negative score showed misuse behaviors. Clinical judgment must complement screening to assess opioid risk accurately.

pubmed.ncbi.nlm.nih.gov/37691336/

Fentanyl Toxicity Related to Concomitant Use of Ciprofloxacin and its Effects as a CYP3A4 Inhibitor - PubMed Fentanyl Toxicity Related to Concomitant Use of Ciprofloxacin and its Effects as a CYP3A4 Inhibitor

pubmed.ncbi.nlm.nih.gov/37150364/

Burial or cremation? Factors associated with preferences among patients with cancer in Brazil: a cross-sectional study - PubMed Most patients with Cancer in Brazil prefer burial after death. Discussions about death, religious beliefs and involvement, and educational level seem to influence the preference for cremation. A deepe...

Among 220 cancer patients in Brazil, 25% preferred cremation and 71% burial. Cremation was linked to discussing death, weaker religious beliefs, and higher education. Understanding these factors can help improve end-of-life care and respect wishes.

pubmed.ncbi.nlm.nih.gov/37194763/

Some things I learned from the Dr R Neil MacDonald: “administrative arrangements are important”, “you are the boss (to the patient)”, “common things are common”, “ Better someone inside the tent p- ing out than outside the tent p- ing in”, hockey, fried zucchini with soy sauce, love of medicine.

From “cancer pts” to pts with cancer; from “narcotics” to opioids, from “addicts “to non medical opioid use. From “committed suicide “ to died of suicide. The words we use influence the way we think and act. Progress!

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 ...

Italian hematologists support most EOL quality measures but face barriers such as patient expectations and discomfort with goals of care. Most lack training in ACP/GOC, highlighting the need for better communication skills and early palliative care integration.

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

Predictors of a Preference for Telemedicine Virtual Visits in Patients Undergoing Cancer Rehabilitation - PubMed The purpose of this retrospective study was to examine the use of virtual visits (telemedicine) at our cancer rehabilitation outpatient clinics from March 2020 to August 2021, when virtual visits beca...

This retrospective study of 3,971 cancer rehab visits (2020 virtual, 1,951 in-person) found that younger age, non-White race, solid tumors, and shorter distance to clinic were linked to choosing virtual visits, showing broad patient acceptance of telemedicine.

pubmed.ncbi.nlm.nih.gov/38529616/

Association of opioid use with survival in patients with cancer treated with immune checkpoint inhibitors: it is time for evidence-based behaviors - PubMed Cancer is a leading cause of morbidity and mortality worldwide, with pain experienced by most patients undergoing cancer treatment. Opioids are the recommended treatment for cancer pain management, bu...

Opioids remain key for cancer pain, but poor quality studies link their use to worse survival in patients on immunotherapy. Retrospective data and confounding factors, make causality unproven . Caution is advised when interpreting these findings.

pubmed.ncbi.nlm.nih.gov/38688456/

Early palliative care perceptions by patients with cancer and primary caregivers: metaphorical language - PubMed Our results suggest that EPC is perceived positively by patients and their caregivers and provide insights regarding the manner in which EPC could be presented to patients, caregivers and the public.

Patients with advanced cancer and caregivers used metaphors of light, salvation, and safety to describe early palliative care as restoring life, hope, and peace. Both groups viewed EPC positively; caregivers used war metaphors slightly more, though overall rarely.

pubmed.ncbi.nlm.nih.gov/38744447/

Proportional Sedation for Persistent Agitated Delirium in Palliative Care: A Randomized Clinical Trial - PubMed Clinicaltrials.gov Identifier: NCT03743649.

In a multicenter RCT of advanced cancer patients with agitated delirium, lorazepam or lorazepam + haloperidol reduced agitation more than haloperidol or placebo, required fewer rescue meds, and had no increase in adverse events or reduced survival

pubmed.ncbi.nlm.nih.gov/40742738/

Self and proxy symptom reporting in glioma patient-caregiver dyads: the role of psychosocial function in rating accuracy - PubMed The psychosocial context of the family plays an important role in the accuracy of symptom understanding. Inaccurately understanding patients experience is related to poor QOL for both patients and car...

In glioma patient-caregiver pairs, poor illness communication and depressive symptoms were linked to inaccurate caregiver understanding of patient symptoms. Misjudging symptom severity correlated with worse quality of life for both patients and caregivers.

pubmed.ncbi.nlm.nih.gov/39017959/

Top Ten Tips Palliative Care Clinicians Should Know About Interpreting a Clinical Trial - PubMed Evidence-based practice is foundational to high-quality palliative care delivery. However, the clinical trials that compose the evidence base are often methodologically imperfect. Applying their concl...

Evidence-based palliative care requires use of clinical trials, which often have flaws. Clinicians should question study design rather than accept results blindly. Curiosity, not statistics, is key to applying evidence wisely and ensuring patient-centered care.

pubmed.ncbi.nlm.nih.gov/39046924/

Patient considerations of social media account management after death - PubMed Few patients have had conversations on the management of their accounts after death, although more were interested in exploring their options further. More research is needed to examine the role of so...

Few advanced cancer patients (21%) discussed post-mortem social media management. Lower income predicted such talks. The survey spurred most to consider account planning (67%) and explore management (71%). Social media was key for coping; more research needed .

pubmed.ncbi.nlm.nih.gov/39352567/

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 imp...

This study of 34,911 cancer patients (2016–2022) found medical marijuana laws with dispensaries reduced strong opioid prescribing but increased hospital events, while laws without dispensaries raised weak opioid use. Effects on cancer pain management need study.

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

Evaluation of a Five-Minute Meditation Intervention During Weekly Palliative Care Clinical Rounds - PubMed <span><b><i>Introduction:</i></b> Palliative care professionals experience high levels stress and burnout. Meditation improves stress and well-being, with group interventions more promising than indiv...

A survey of 70 palliative care clinicians found 59% joined a five-minute group meditation during rounds, reporting stress reduction and control. Over half also practiced weekly outside work. Participants viewed it as useful, supporting further study.

pubmed.ncbi.nlm.nih.gov/40285484/

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...

In 432 patients with advanced cancer, only one-third accurately understood their curability, with little change over time. Misperception was linked to Asian race, better well-being, and fewer symptoms. Systematic screening is needed

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

La Dra Mariela Bertolino murió hoy. Mariela creo el equipo de que educó a la mayoría de los líderes de CP en Argentina y
Latinoamérica. Su integridad ayudó a miles .
“When sorrows come….” Godspeed Mariela. I am sure you will have great discussions with Bal about pall care,

Dr Balfour Mount died yesterday. Our clinical and spiritual leader, he was the first to use the term “palliative care” and opened the Royal Vic PCU. He inspired all of us to work with energy and integrity . We are all a bit more lonely today. Godspeed, Bal Mount

Palliative care in a cancer center: results in 1984 versus 1987 - PubMed We reviewed the charts of 48 consecutive patients treated by our Palliative Care Team (PCT) during 1984 and compared these results with 50 consecutive patients treated during 1987. The composition of ...

In the 1980s oncologists and internists were using a higher opioid dose before pall care, pall care teams were using a higher dose and more parental, and pain control was better! We’re back to the 70s in cancer pain

pubmed.ncbi.nlm.nih.gov/1691252/

Hypodermoclysis for the administration of fluids and narcotic analgesics in patients with advanced cancer - PubMed Fifty-eight consecutive patients with advanced cancer who required parenteral hydration were treated with hypodermoclysis. A solution of two-thirds 5% dextrose and one-third saline was used in all cas...

In 58 advanced cancer patients, hypodermoclysis provided safe, effective hydration for up to 14 days, with minimal local toxicity and frequent co-administration of opioids and potassium. And 30 ys later still not done in American hospices and hospitals

pubmed.ncbi.nlm.nih.gov/2384700/