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Background: Due to modern therapies, survival in metastatic renal cell carcinoma (mRCC) has been significantly prolonged. Nevertheless, patients suffering from advanced disease often present with severe symptoms. Early integration of palliative care into anti-cancer treatment has been shown to improve quality of life and may even prolong survival. Therefore, it is recommended to offer palliative care to patients with complex symptoms at the beginning of an advanced disease stage. To our knowledge, so far, no study has been conducted to examine the role of palliative care in patients with mRCC. Objectives: This study aimed to assess the symptom burden and quality of life before and after an inpatient palliative care treatment. Design: The study design is a retrospective observational study. Methods: We included patients with mRCC, who were admitted to our palliative care unit between 2011 and 2017 due to severe symptoms. The symptom burden was assessed at admission, throughout treatment, and at discharge. The evaluation consisted of the palliative care base assessment and daily documentation of relevant symptoms. Results: We evaluated 110 hospitalizations of 58 RCC patients. On average, patients were admitted to the palliative care unit 7 years after initial diagnosis (range 1–305 months). The median age was 70.5 years, 69% of the patients were male, 3% female. The main causes for admission were pain (52%) and dyspnea (26%), and the most frequent patient-reported symptoms were fatigue/exhaustion (87%), weakness (83%), and need for assistance with activities of daily living (83%). Multidisciplinary palliative care treatment led to a significant reduction in the median minimal documentation system (MIDOS) symptom score (15.6–9.9, p < 0.001), the median numeric pain rating scale (3–0, p < 0.001), and a significant reduction in mean ratings of the distress thermometer (5.5–3.1, p = 0.016). Conclusion: Our analysis shows that the integration of palliative care treatment is effective throughout the disease in mRCC and could measurably reduce the symptom burden in our patient population. Palliative care should not be equated with end-of-life care but should rather be integrated throughout advanced disease, particularly as soon as a cure is impossible. [ABSTRACT FROM AUTHOR]

Background: Cancer patients experience significant changes in their social roles along with various physical and psychological challenges. Despite the growing recognition of the importance of palliative care in Bangladesh, there is a notable gap in research focusing on the psychosocial issues faced by patients with advanced cancer. Aim: This study aims to explore the level of social support perceived by Bangladeshi cancer patients and determine how this support relates to their mental health status. Methods: This cross-sectional study was conducted among 115 advanced cancer (stages III and IV) patients admitted to the palliative medicine department of a tertiary care hospital in Bangladesh. Perceived social support was measured by the Multidimensional Scale of Perceived Social Support, and the mental health status of the patients was assessed by Depression, Anxiety, and Stress Scale-21. Data collection was done from June to November 2023. Relationships between perceived social support, depression, anxiety, and stress were assessed by the Spearman correlation test. The moderating effect of perceived social support on patients' mental health variables was determined by multiple linear regression and simple slope analysis. p Value <0.05 was considered to be statistically significant. Result: The study included an almost equal number of male (49.6%) and female (50.4%) patients, with a mean age of 50.7 ± 14.4 years. Overall, perceived social support was moderate to high for most (74.7%) of the participants. Among the participants, 78.3% experienced anxiety, 77.4% suffered from depression, and 70.5% experienced stress. Depression, anxiety, and stress were all negatively and significantly (p < 0.05) correlated with perceived social support. Younger patients reported higher levels of anxiety, stress, and depression. Perceived social support had a significant buffering effect on depression and anxiety among the younger patients. Conclusion: Perceived social support has a profound and significant effect on the mental health of advanced cancer patients. Integrating psychosocial support early in palliative care can be highly beneficial to the mental health of these patients. Plain language summary: Social support and mental health of cancer patients This cross-sectional study was conducted among 115 patients with advanced cancer (stages III and IV) admitted to the palliative medicine department of a tertiary care hospital in Bangladesh. The majority of the patients with advanced cancer suffer from depression and anxiety and experience high level of stress. Younger patients report more of these psychological issues. High level of perceived social support is associated with lower levels of depression, anxiety, and stress. It acts as a buffer against these negative emotions. Patients who experienced a high level of social support while dealing with physical pain reported less depression. [ABSTRACT FROM AUTHOR]

Background: Groote Schuur Hospital is a large Academic Hospital in South Africa that is in the process of integrating palliative care (PC) via a vertical nurse-led doctor-supported (VNLDS) service that was initially established to deliver clinical care. PC integration should occur across multiple dimensions and may result in variable degrees of integration between levels of the healthcare system. This research evaluates the VNLDS through a theory-driven evaluation to describe how the service affected integration. Methods: A mixed-method sequential design consisting of a narrative literature review on the theory of integration and PC, retrospective quantitative data from a PC service delivery database, qualitative data from semi-structured interviews and document analyses. It was structured in three phases which assisted in confirming and expanding the data. Statistical analyses, deductive thematic coding and documentary analyses were conducted according to the conceptual framework of PC integration. Results: The PC integration process was facilitated in the following ways: (i) the service provided good clinical PC; (ii) it was able to integrate on a professional level into specific diseases, such as cancer but not in all diseases; (iii) developing organizational structures within the service and (iv) the observed benefit of good clinical care increased the value stakeholders assigned to PC, thereby driving the adoption of PC. However, there are still clinicians who do not refer to PC services. This gap in referral may be grounded in assumptions and misconceptions about PC, especially at the organizational level. Discussion: Observed PC service delivery is core to integrating PC across the healthcare system because it challenges normative barriers. However, the VNLDS could not achieve integration in leadership and governance, education and hospital-wide guidelines and policies. Whole system integration, foregrounding organizational commitment to PC excellence, is core to integrating PC. Conclusion: The VNLDS service has effectively linked PC in specific disease profiles and normalized the PC approach where healthcare workers observed the service. These integrational gaps may be grounded in assumptions and misconceptions about PC, especially at the organizational level. Plain language summary: How does a nurse led palliative care service affect palliative care integration in a big teaching hospital? This article evaluates a nurse led doctor supported service in providing palliative care and how it affected the integration of palliative care in an Academic Hospital in South Africa. This study will help us understand the goals of integration, the extent of integration achieved by this service and how and why it was achieved or not. [ABSTRACT FROM AUTHOR]