Literature Review

The essential role of Speech-Language Pathologists in end-of-life swallowing intervention: A narrative reviewASHA Perspectives; by Sanora Yonan; 9/25Speech-language pathologists (SLPs) are essential in the intervention of dysphagia, particularly at the end of life (EoL), where their guidance can significantly improve patients' comfort and quality of life. However, despite a growing recognition of their importance in this palliative setting, SLPs continue to face obstacles for consistent involvement on the palliative care team. Three primary themes emerged [from this study]: diet texture adjustment, compensatory swallowing strategies, and patient and caregiver education. The review also identified significant barriers to SLP involvement, including inconsistent practices, limited resources, legal concerns, and a lack of interdisciplinary integration.Assistant Editor's note: In my experience, SLPs were rarely, if ever, utilized with hospice patients. However, this article clearly describes ways that SLPs could be helpful for patients with swallowing difficulties. SLPs can also be very useful for patients with speech difficulties. I think the IDT simply does not think of it-does not think of how a SLP could be helpful. Maybe it is also partly due to lack of knowledge of their value. Perhaps, both hospice and palliative care teams might consider arranging for an inservice from a SLP so that team members can learn more about how such therapy could be helpful in improving the quality of life of patients.

Impact of the Affordable Care Act on palliative and hospice care utilization among patients with gastrointestinal cancers: An interrupted time series analysisJournal of Palliative Medicine; by Eshetu Worku, Selamawit Woldesenbet, Mujtaba Khalil, Timothy M Pawlik; 9/25The Affordable Care Act (ACA) aimed to expand insurance coverage, improve health outcomes, and reduce costs. We assessed the impact of the ACA on hospice or palliative care utilization among [Medicare] patients with stage IV gastrointestinal (GI) cancer. Patients from minority racial groups ... and those in moderate ... and high ... Social Vulnerability Index (SVI) counties were less likely to use palliative care in both pre- and post-ACA eras. Palliative care use was associated with $2,633 lower total expenditure. Conclusion: ACA implementation did not improve palliative care utilization for racial minorities and high SVI groups.

The Center to Advance Palliative Care and the National Kidney Foundation make the case for the integration of palliative care into kidney disease management PR Newswire, New York; by The Center to Advance Palliative Care; 10/8/25 Despite facing high rates of distressing symptoms—including fatigue, pruritus, and pain—people living with advanced kidney disease are far less likely than those with cancer to receive appropriate pain and symptom management. And fewer than 10% of older adults receiving dialysis report having had conversations about their goals of care. These are two of the many important statistics highlighted in The Case for Palliative Care in Kidney Care, a new publication from the Center to Advance Palliative Care (CAPC) and the National Kidney Foundation (NKF), which emphasizes the critical need to integrate palliative care services into the treatment of patients with advanced kidney disease. 

Stiff person syndrome in the hospice patient: A case report and discussion  Journal of Palliative Medicine; by Molly Svendsen, B Parker Layton, Shiri Etzioni, Mark Edwin; 10/13/25 Stiff Person Syndrome (SPS) is a rare, progressive autoimmune neurological disorder characterized by painful spasms, muscle rigidity, and heightened sensitivity to external stimuli. Management often relies on therapies that fall outside standard hospice formularies, creating challenges in end-of-life care for affected individuals. ... This case highlights the need for flexible, patient-centered approaches in hospice care for rare neurological conditions like SPS. Continuation of disease-specific therapies for symptom palliation can be ethically and clinically appropriate when integrated with clear goals of care. 

[Italy] The implantable cardioverter-defibrillators at the end of life: A double-edged sword of a life-saving technologyTrends in Cardiovascular Medicine; by Giacomo Mugnai, Davide Genovese, Luca Tomasi, Alessia Gambaro, Flavio Ribichini; 9/25Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death, but their function poses a significant challenge in palliative care, where goals shift from life prolongation to comfort. A substantial percentage of patients receive painful, futile shocks in their final days, causing significant distress. This review synthesizes evidence on the impact of these shocks and underscores the gap between clinical practice and patient-centered care. Key barriers to timely ICD deactivation include clinician discomfort, patient misconceptions, and systemic flaws like fragmented care and absent institutional protocols. This review argues for a paradigm shift towards proactive, interdisciplinary care, calling for structured communication, routine advance care planning, and the integration of palliative cardiology models to ensure this life-saving technology does not compromise a dignified death.

Older COVID-19 survivors more likely to develop new-onset dementia, study finds McKnights Long-Term Care News; by Foster Stubbs; 10/3/25 Adults 50 years and older who survived COVID-19 had higher chances of developing new-onset dementia (NOD) compared to those who were not infected, according to an October study published in npj Dementia. Researchers analyzed data from 54,757 participants aged 50 years and older obtained from the UK Biobank. The sample included 16,017 participants with COVID-19 and 38,740 non-COVID participants. The COVID-19 group consisted of participants who were infected between Jan. 31, 2020 and Feb. 28, 2021, and the median observation period was about two years. 

Medicaid coverage policy variations for chronic pain and opioid use disorder treatmentJAMA Network Open; by Meredith C. B. Adams, Seth M. Eller, Cara McDonnell, Sarjona Sritharan, Rishika Chikoti, Amaar Alwani, Elaine L. Hill, Robert W. Hurley, ; 8/25Co-occurring chronic pain and opioid use disorder (OUD) are associated with a high disease burden for the patient, requiring comprehensive treatment approaches, yet Medicaid benefit structures for evidence-based therapies vary substantially across states. Our systematic economic evaluation reveals both promising developments and persistent challenges in Medicaid coverage for treatment of co-occurring OUD and chronic pain. Universal coverage of fundamental medications and basic interventional procedures provides a foundation for care, but varying implementation approaches create a complex landscape requiring further investigation.

[Spain] Mapping palliative care for people living with advanced cancer in phase 1 clinical trials: A scoping reviewPalliative Medicine; by Diego Candelmi, Alazne Belar, Carla Zapata Del Mar, Ana Landa-Magdalena, Anna Vilalta-Lacarra, Mariano Ponz-Sarvisé, Carlos Centeno; 9/25This review highlights the unique needs of patients and caregivers in Phase 1 Cancer Clinical Trials and the complexities of integrating palliative care. Key results revealed patients' limited life expectancy, high symptom burden, distress and unmet spiritual needs [and]... patients were reluctant to seek prognostic information or engage in end-of-life discussions, complicating advance care planning. End-of-life care involved frequent unscheduled hospital admissions, hospital deaths and late hospice-care referrals. Caregivers experienced significant distress, while healthcare professionals faced barriers to integrating palliative care. Palliative care interventions varied widely in approaches, settings and outcomes.Assistant Editor's note: This article discusses how palliative care could benefit patients that are enrolled in phase 1 clinical trials for cancer. Traditionally, it has not been common practice for palliative care programs to serve these kinds of patients and their loved ones. This represents an opportunity for the expansion of much needed palliative care services.  

Rise in late-stage lung cancer in nonsmokers highlights need for awareness and screening Medscape Medical News; by Evra Taylor; 9/5/25 ... The common thinking is that lung cancer is a smoker’s disease, but that isn’t the full picture, Jessica Moffatt, PhD, vice president of programs and health system partnerships at Lung Health Foundation in Toronto, told Medscape Medical News. ... Moffatt and her colleagues are working to dispel the stigma that smokers “get what they deserve.” Rosalyn Juergens, MD, professor of oncology at McMaster University in Guelph, Ontario, and president of Lung Cancer Canada, said, “If you find out someone has lung cancer, your first question shouldn’t be ‘Did you smoke?’ It should be ‘What can I do to help you along this journey?’ ” 

Assessing the perspectives of genetic counselors with oncology patients at the end of lifeJournal of Genetic Counseling; Rosalyn D. Brown, Lori Williamson, Natalie Brooke Peeples, Jing Jin, Alexandrea Wadley; 8/25Cancer genetic services identify individuals that may have a hereditary component to cancer, as it is estimated that up to 10% of cancers are due to a cancer-predisposition gene variant. When an oncology patient has reached the end of life (EOL), genetic counseling and testing may benefit the patient and their family by clarifying hereditary cancer risks. Despite high comfort and preparedness, 77% of respondents desired additional educational training opportunities about providing genetic counseling to oncology patients at the EOL, supporting the need for ongoing education opportunities. The high comfort levels and preparedness reported in this study suggest that genetic counselors are ready and willing to counsel patients facing a terminal diagnosis of cancer and should be further integrated into multidisciplinary teams.

[India] Cancer cachexia: A meta-analysis of prevalence, outcomes, and interventionsSaudi Journal of Medicine; by Dr Sharique Ahmad, Dr Saeeda Wasim; 8/25Cancer cachexia, also known as cancer wasting, is a debilitating metabolic syndrome characterized by progressive weight loss, skeletal muscle atrophy, and systemic inflammation that cannot be fully reversed with standard nutritional support. It represents a distinct clinical entity, separate from malnutrition, due to its unique pathophysiology involving tumor-hostinteractions, cytokine-driven catabolism, and alterations in energy metabolism. This meta-analysis demonstrates that cancercachexia is highly prevalent, particularly in pancreatic and lung cancers, and strongly predicts poor survival and reduced treatment tolerance. Its high prevalence and significant impact highlight the urgent need for early recognition and systematic management in oncology practice.

Cancer patients are living longer than ever. Pain drugmakers haven’t kept up. Biopharma Dive; by Jacob Bell; 9/25/25 Decades of slow-moving research, along with broader failures of the healthcare system, have left millions of people in daily pain. Doctors fear that’s bound to continue. ... More than 2 million people in the U.S. alone are diagnosed with cancer each year. Conservative estimates hold that between 20% and 50% experience related pain, though that figure can climb as high as 80% for patients with advanced disease. Despite the large number of patients and the need for more therapies, drugmakers have mostly shied away from pain altogether, fearing that its complicated biology makes for too risky a research investment.  ... Opioids remain the core of many treatment regimens. This lack of drug choices is aggravated by much broader failures of the healthcare system.