Literature Review

Cachexia and anorexia in serious illness: A podcast with Eduardo BrueraGeriPal [podcast]; by Eric Widera, Alex Smith, Eduardo Bruera; 6/13/24I always find cachexia in serious illness puzzling. I feel like I recognize it when I see it, but I struggle to give a clear definition or provide effective ways to address it. In today’s podcast, we had the opportunity to learn from a renowned expert in palliative care, Eduardo Bruera, about cachexia and anorexia in serious illness. Eduardo established one of the first palliative care programs in 1984, created the Edmonton Symptom Assessment Scale (ESAS), and significantly contributed to the evidence base for palliative care symptoms that many of us rely on daily. During our discussion with Eduardo, we delved into how we can define cachexia and anorexia, why they occur in conditions like cancer, how to assess for them, and explored the interventions that are helpful and those that are not in the treatment of these conditions.

"A wholeness that grows out of that which is lacking": Providing palliative care to patients with anorexia nervosaPsychiatric Times; by Rabbanit Allissa Thomas-Newborn, BCC; 6/13/24Sitting with the patient, I brought in a nesting doll, separating each doll and lifting the layers of self that surrounded the smallest version of herself within. We spoke about layers. Layers and walls we put up to protect ourselves. Layers that hide the things we are afraid for anyone—worst of all, ourselves—to see. Layers that embrace and comfort and hold us together. ... With the fullness of the nesting doll displayed, we gave witness to her story together. ... To see ourselves as stories of wholeness growing out of that which is lacking requires that we accept what is lacking without judgment. We do not need to fix or fill whatever is lacking, or to pretend it is not there. It is there and may always be there. And there is a wholeness that can still grow. Editor's Note: Rabbanit Thomas-Newborn is a board-certified chaplain at New York-Presbyterian Columbia University Irving Medical Center and Morgan Stanley Children’s Hospital. She specializes in Behavioral Health, Palliative Care, and Critical Care chaplaincy. She is the president of Neshama: Association of Jewish Chaplains. 

Navigating Aging: New help for dealing with aggression in people with dementia Northern Kentucky Tribune; by Judith Graham, KFF Health News; 6/9/24Caring for older adults with dementia is stressful, especially when they become physically or verbally aggressive, wander away from home, develop paranoia or hallucinations, engage in inappropriate or repetitive behaviors, or refuse to let caregivers help them. Upward of 95% of patients experience these neuropsychiatric symptoms of dementia, which tend to fluctuate over time and vary in intensity. They’re the primary reasons people with dementia end up in assisted living facilities or nursing homes. At some point, families and friends trying to help at home simply can’t manage. “When people think about dementia, they usually think about forgetfulness and memory impairment,” said Mary Blazek, director of the geriatric psychiatry clinic at the University of Michigan. “But it’s behavioral and psychological disturbances that are most disruptive to patients’ and caregivers’ lives.”

Design, creation, and 13-month performance of a novel, web-based activity for education in primary cardiology palliative care Journal of Pain and Symptom Management; by Jill M Steiner, Caroline L Doherty, Jill A Patton, Jadry Gruen, Sarah Godfrey, John Mulrow, Richard A Josephson, Sarah J Goodlin; 6/5/24 online ahead of print Cardiovascular disease (CVD) clinicians who care for seriously ill patients frequently report that they do not feel confident nor adequately prepared to manage patients' palliative care (PC) needs. With the goal, therefore, of increasing PC knowledge and skills amongst interprofessional clinicians providing CVD care, the ACC's PC Workgroup designed, developed, and implemented a comprehensive PC online educational activity. This paper describes the process and 13-month performance of this free, online activity for clinicians across disciplines and levels of training, "Palliative Care for the Cardiovascular Clinician" (PCCVC).Editor's Note: Reiterating, this "free, online activity [is] for clinicians across disciplines and levels of training." The trajectories for cardiovascular diseases can elicit enormous anxiety--due to their roller-coaster changes that can result in sudden death--in contrast to the more predictable trajectories for cancer. Whether you use this resource or another, educate your interdisciplinary clinical managers and team members to the all-important disease and care factors for cardiology palliative care, relevant to the scope of professionals' different roles. 

Telehealth delivers early palliative care as effectively as in-person careAJMC, American Society of Clinical Oncology; by Laura Joszt, MA; 6/2/24 Early palliative care can be delivered via telehealth with equivalent quality-of-life effects as palliative care delivered in person to patients with advanced non–small cell lung cancer (NSCLC), according to late-breaking results presented during [a] plenary session at the 2024 American Society of Clinical Oncology (ASCO) annual meeting. Whether the palliative care was delivered in person or via telehealth, the most common topics discussed during the visit were similar and included building and establishing rapport to create a relationship with the patient and their family, identifying symptoms and grading symptom management, and coping with serious illness, explained Joseph Greer, PhD, codirector of the Cancer Outcomes Research & Education Program at Massachusetts General Hospital Cancer Center and associate professor of psychology in the Department of Psychiatry at Harvard Medical School ...

ASCO updates Guidelines on Palliative Care Hematology Adviosor; by Jen Smith; 5/30/24 The American Society of Clinical Oncology (ASCO) has released an update to its guidelines on palliative care for cancer patients. The guidelines and related information were published in the Journal of Clinical Oncology and JCO Oncology Practice. To develop updated recommendations for integrating palliative care into cancer care, an expert panel reviewed randomized controlled trials, systematic reviews, and meta-analyses published during 2015-2023. Based on their findings, the experts recommend that patients with advanced cancer be referred to specialized interdisciplinary palliative care teams soon after diagnosis, while the patients are still receiving active cancer treatment.

How palliative care is changing in today’s health care environment Hospice News; by Molly Bookner; 5/29/24 As the palliative care field continues to grow and transform, understanding the current trends, outlook, relevant challenges and necessary skills for future leaders is critical. Two significant trends impacting the field of palliative care currently, according to experts, are the expansion of services and the integration of technology, particularly artificial intelligence (AI). Dr. Vicki Jackson, board president of the American Academy of Hospice and Palliative Medicine (AAHPM), noted that palliative care has demonstrated a positive impact on patient-reported outcomes across various illnesses, including cancer, heart, liver, kidney disease and dementia. 

Disparities in palliative care use for patients with blood cancer who died in the hospital The American Journal of Hospice & Palliative Care; by Tien-Chan Hsieh, Yee Hui Yeo, Guangchen Zou, Chan Zhou, Arlene Ash; 5/27/24 online ahead of printBackground: Palliative care can enhance quality of life during a terminal hospitalization. Despite advances in diagnostic and treatment tools, blood cancers lag behind solid malignancies in palliative use. It is not clear what factors affect palliative care use in blood cancer. Conclusions: This study highlights disparities in palliative care use among blood-cancer patients who died in the hospital. It seems likely that many of the 46% who did not receive palliative care could have benefitted from it. Interventions are likely needed to achieve equitable access to ideal levels of palliative care services in late-stage blood cancer.

Nurse practitioners improve skilled nursing's dementia care outcomes, but regulatory barriers remain: studyMcKnights Long-Term Care News; by Josh Henreckson; 5/13/24[Nurse pracitioners'] NPs’ involvement can significantly improve end-of-life care outcomes for residents with Alzheimer’s disease and related dementias (ADRD), according to the results of a new study in JAMA Health Forum. ... Those benefits, however, were shrunk by state regulations on the scope of care NPs are allowed to provide. ...  Elizabeth White, PhD, assistant professor of health services, policy and practice at Brown University [describes,] “For example, when a state restricts NPs from signing Do Not Resuscitate orders, that can serve as a barrier to advance care planning and could contribute to unnecessary hospitalizations at the end of life.” Editor's Note: We posted this JAMA Health Forum article on : Nurse Practitioner care, scope of practice, and end-of-life outcomes for nursing home residents with dementia. 

New dementia guide provides best Standards of Care from 100+ not-for-profit hospice, palliative and advanced illness organizations PR Newswire; by National Partnership for Healthcare and Hospice Innovation (NPHI); 5/9/24 The National Partnership for Healthcare and Hospice Innovation (NPHI), the national voice for not-for-profit hospice care, in collaboration with Aliviado Health and the Center to Advance Palliative Care (CAPC), announces today the release of the NPHI "Dementia Care Resources Provider Guide." The new guide aims to improve the quality of life for patients with dementia, reducing hospitalizations, and easing the burden of advanced illness for families and caregivers. A dementia diagnosis poses substantial challenges for both patients and their families, impacting millions of Americans nationwide. Shockingly, the Alzheimer's Association reports that an estimated 6.7 million individuals in the U.S. currently live with dementia. 

Thyme Care launches virtual palliative care program, appoints medical director MobileHealthNews; by Jessica Hagen; 5/2/24 Value-based cancer care platform Thyme Care is launching Enhanced Supportive Care, a virtual palliative care support program to assist its members and caregivers with managing physical and psychological symptoms accompanying cancer diagnosis and treatment. The program will be led by Dr. Julia Frydman, the company's first medical director for palliative care. Frydman previously worked in the geriatric and palliative medicine program at New York City's Mount Sinai Health System.

The cancer caregiving burden trajectory over time: varying experiences of perceived versus objectively measured burden The Oncologist, by Laura A Siminoff, Maureen Wilson-Genderson, Marcin Chwistek, Maria Thomson; 4/23/24 Conclusions: Cancer caregiving is dynamic; [caregivers] CGs must adjust to the progression of the patient's disease. We found an association between subjective and objective burden both within and between CGs. Black CGs were more likely to report lower subjective burden compared to their White counterparts. More detailed investigation of the sociocultural components that affect caregiver experience of burden is needed to better understand how and where to best intervene with targeted supportive care services.

Black patients with ovarian cancer had lower-quality end-of-life care, study says American Journal of Managed Care (AJMC), by Brooke McCormick; 4/21/24 Non-Hispanic Black (NHB) patients with ovarian cancer (OC) received lower-quality end-of-life (EOL) care than non-Hispanic White (NHW) patients, according to a study published in Cancer Research Communications. ... Although trends and disparities in EOL care among patients with OC are well documented, the researchers noted that the role of health care access (HCA) in quality EOL care has not been well characterized; HCA is comprised of 5 distinct, interrelated care access dimensions, namely affordability, availability, accessibility, accommodation, and acceptability.