Literature Review

Scans tell us about the cancer. Functional status tells us about the patient. South Florida Hospital News and Healthcare Report; by Dr. Ileana Leyva; 8/1/26 In an era of precision oncology, we closely track biomarkers, imaging findings and treatment response. Yet one of the strongest predictors of how a patient is truly doing often receives less attention: functional status. When patients experience progressive fatigue, need more assistance with daily activities or spend more time in bed, clinicians and families may normalize these changes as expected consequences of cancer or treatment. Yet progressive functional decline is frequently the clearest indication that an illness trajectory is changing. It is often a signal that warrants a broader conversation about prognosis, goals of care and whether the current treatment plan still aligns with what matters most to the patient. As physicians, we routinely rely on objective measures to assess disease progression. While scans tell us how a tumor is behaving, functional status tells us how the patient is living. Both are essential to understanding prognosis and making care decisions that align with patient goals.Editor's Note: Read this phrase again, "While scans tell us how a tumor is behaving, functional status tells us how the patient is living." Whule this article is for oncologist, your hospice interdisciplinary teams' interactions with patients and caregivers provide rich, relevant, time-sensitive conversations, observations, and supportive interventions. What kinds of team coordination exist between your physicians and team members who visit regularly in the patient's home setting (aka, home/ALF/LTC)?

Serious illness and health care threats to personal legacy goalsThe Permanente Journal; by Marlaine Figueroa Gray, Matthew P Banegas, Nora B Henrikson; 6/26High-quality care for people with serious illness requires understanding what matters most. Although goals-of-care conversations may emphasize values and treatment preferences, patients hold goals related to identity, relationships, and legacy; how they wish to be remembered and what they hope to leave behind. Five themes emerged [from the participant interviews]: 1) participants actively planned for legacy, with legacy goals often clarified by serious illness; 2) illness and its care introduced threats to legacy goals; 3) financial strain and insurance coverage were major threats; 4) participants believed their care would differ if teams understood their legacy goals; and 5) participants wanted to communicate their legacy goals to their care teams. Integrating legacy-related conversations into palliative care may enhance person-centered care by addressing identity, relationships, and meaning alongside medical preferences.Assistant Editor's note: This article summary describes a very important aspect of end-of-life planning. Exploring with patients their legacy goals is as important as discussing their preferences surrounding their care. Including legacy goals as an integral component of goals of care and advance care planning discussions would yield a greater understanding of what kind of care would most honor the patient.

Utilization of hospice and palliative care among patients with mental illness: a retrospective cohort study Journal of the American Geriatrics Society; by Sean O'Mahony, Utpol Das, Yuanyi Zhang, Anirudh S. Babu, Mukaila A. Raji, James Gerhart, Yong-Fang Kuo; 7/11/26 Background: Individuals with mental illness (MI) experience premature mortality and health disparities, yet little is known about their access to hospice and palliative care. Conclusions: Mental illnesses were associated with complex hospice utilization patterns characterized by longer length-of-stay, higher likelihood of enrollment far from death, lower likelihood of enrollment within 180 days before death, and lower palliative care consultation use in some groups.

Missed opportunities to promote flourishing in cancer care: a brief examination of multiple myeloma Supportive Care in Cancer; by Natalie Tuckey, Hannah R. Wardill, Xavier Symons, Melissa Cantley, Kathina Ali, Hayley Beer, Gregory B. Crawford, Angelina Yong & Matthew Iasiello; 7/8/26... We propose that certain elements of flourishing, such as meaning and purpose, deep personal relationships, and cultivating virtue, can be uniquely realized if targeted appropriately toward the end of life. ...  Participants reported personal growth following their diagnosis through acceptance, meaning-making, and connection, yet reported the loneliness of dying with cancer with a desire to have discussions about death with their clinicians in addition to them maintaining treatment. On the contrary, health professionals were hesitant to discuss death with their patients, balancing hope in treatments with preparation for dying. We argue that the hesitation to discuss death thwarts the opportunity to flourish and that existing solutions such as dignity therapy, meaning-centered psychotherapy, early palliative care, and multidisciplinary support can close this gap without diminishing hope in treatments.Editor's Note: For a recent, similar research article about "flourishing," examine "Flourishing within vulnerability: on human fragility and the conditions for a habitable environment."

Supporting mental health in end-of-life care – associate professor Sarah Yardley ehospice; by Dr. Sarah Yardley; 6/29/26 [Based on hospice observations described earlier in this article] ... I propose several ideas that support relationship centered care:

Ketamine for depression in serious illness: Evidence, safety, and practical approachesJournal of Pain & Symptom Management; by Paul Noufi, Joshua B. Borris, Danielle Chammas, Cara L. McDermott, Nneka N. Ufere, Jason A. Webb, Daniel Shalev; 4/26Patients with serious illness and short prognoses often experience depression and suicidal ideation. Traditional antidepressants are limited by delayed onset, creating a need for rapidly acting therapies. Ketamine and esketamine [nasal spray] offer the strongest evidence among rapid-acting antidepressants and may be preferred when urgent symptom relief is needed. However, rigorous psychiatric trials in serious illness are lacking. Clinicians should consider prognosis, access to Risk Evaluation and Mitigation Strategies-certified esketamine programs or equivalent regulatory frameworks outside the US, and the need for an appropriate maintenance regimen when integrating ketamine into palliative care depression management.

"Taps" Bugle Call: USMC Drum & Bugle Corps [YouTube]YouTube, filmed at the National Mall, Washington DC, retrieved from the internet 5/22/25Editor's note: We invite you to start this Memorial Day with this reflective playing of "Taps," with backdrops of the Washington Memorial, the Vietnam Veterans Memorial, the Korean War Veterans Memorial, and more. Ongoing, we share with you these resources below for the veterans and their families whom you serve.

Second-generation antipsychotics for depression in serious illness: A first-line augmentation strategyJournal of Pain & Symptom Management; by Gregg Robbins-Welty, Mia Pattillo, Danielle Chammas, Karolina Sadowska, Cara L McDermott, Nneka Ufere, Jason A Webb, Daniel Shalev; 3/26Depression in serious illness is common, disabling, and often requires rapid improvement. In the psychiatric literature, SGA [second-generation antipsychotics] augmentation improves response and remission rates ... , with onset of improvement within 1-2 weeks. Monotherapy is less well tolerated and not guideline-recommended. No RCTs have evaluated SGAs specifically for depression in serious illness, but numerous cancer trials support their safety for nausea, appetite, and other symptoms. Despite the absence of serious illness-specific psychiatric trials, SGAs have the strongest evidence base among augmentation options and may offer meaningful benefits when prognosis or symptom severity necessitates rapid improvement. Low-dose augmentation should be considered early, rather than only after multiple failed antidepressants, particularly when SGAs can also target co-occurring physical symptoms relevant to palliative care.

Challenges in the end-of-Life care for patients with severe persistent mental illness: a case series Psychogeriatrics; by Kaushadh Jayakody, Isha Bajaj, Doug Blomeley; 4/7/26 Conclusions: ... This study emphasises the importance of improved clinician training, clearer referral pathways and integrated care models in addressing this disparity. Implementing these measures will aid in addressing longstanding inequalities and ensure individuals with SPMI receive appropriate and timely palliative and EOL care.