Literature Review

[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. 

The role of the palliative medicine and supportive oncology APP Oncology Nursing News; by Antonia Corrigan, MSN, ANP-C; 9/22/25 ... A cancer diagnosis can bring an avalanche of psychosocial and physical obstacles for patients to navigate. ... Advanced practice providers (APPs) are key in providing quality supportive care. ... The American Society of Clinical Oncology (ASCO) guidelines recommend that patients with cancer be referred to interdisciplinary palliative care teams within 8 weeks of diagnosis. Early palliative referral benefits patients with high symptom burden, both physical and psychosocial, and enhances caregiver support. 

Heart disease tops US mortality in 2024, CDC reports McKnights Long-Term Care News; by Foster Stubbs; 9/12/25 The leading causes of death in the United States in 2024 were heart disease, cancer and unintentional injury, the Centers for Disease Control and Prevention said in a September report. ... In total, there were 3,072,039 total deaths that occurred in the US in 2024 with a death rate of 722.0 per 100,000 people. This was 3.8% lower than the totals in 2023. Death rates also decreased for all race and ethnicity groups but rates for Black people remain higher than those for all other groups. Overall, death rates were highest for males, older adults and Black people, demonstrating a need for further examination of the health of these demographic groups. Heart disease caused 683,037 deaths, cancer caused 619,812 deaths and unintentional injury resulted in 196,488 deaths. Mortality statistics were collected by The National Center for Health Statistics’ (NCHS) National Vital Statistics System (NVSS) using US death certificate data. [The CDC Report is at Vital Statistics Rapid Release, Number 039, September 2025.]

A workflow initiative to increase the early palliative care referral rate in patients with advanced cancer MDedge - Federal Practitioner - Quality Improvement; by Judy Lim, MD and Linda D. Nguyen, DNP, NP-C, MD; 9/3/25 ... The American Society of Clinical Oncology and the World Health Organization recommend that every patient with advanced cancer should be treated by a multidisciplinary palliative care team early in the course of the disease and in conjunction with anticancer treatment. Despite the documented benefits and the recommendations, early PC is still not often offered in clinical practice. 

How to move a parent with dementia against family resistance—and stay legal Advisorpedia; by Carolyn Rosenblatt; 9/3/25 The phone call came to Dad’s daughter (FD) at 6 AM. Again. This time, it was the night caregiver reporting that her father had fallen while trying to get out of bed. She had jumped up and tried to stop him but she could only get to him in time to break his fall. ... The caregiver was exasperated. She needed more help and SW did not provide it. It was the third incident in two weeks, and FD knew something had to change.

Palliative care use and end-of-life care quality in HR+/HER2- metastatic breast cancerBreast Cancer Research and Treatment; by Julia G Cohn, Susan C Locke, Kris W Herring, Susan F Dent, Thomas W LeBlanc; 8/25Metastatic breast cancer (MBC) is incurable, despite therapeutic advances, especially in hormone receptor positive (HR+) and human epidermal growth factor-2 negative (HER2-) disease. Of 102 patients, 85 died during the study period, and over half (55%) received aggressive EoL [end of life] care. Half had some form of SPC [specialist palliative care], and rates of aggressive EoL care were comparable between those who engaged with SPC and those who did not. The most common indicators of aggressive EoL care included multiple ED visits (28%) and hospital admissions (23%) in the last 30 days of life as well as in-hospital location of death (24%). Although 72% enrolled in hospice care, 9% of patients were on hospice for ≤ 3 days. This real-world study demonstrates that many patients with HR + /HER2- MBC [metastatic breast cancer] receive aggressive EoL care despite some engaging with SPC and many enrolling in hospice.