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Delirium is a frequent neurocognitive complication in cancer patients, particularly in advanced stage and terminal disease. It is associated with increased morbidity and mortality and is a critical source of stress for patients and caregivers. For healthcare staff, delirium poses significant challenges in diagnosis and treatment as well as assessment of other symptoms due to its fluctuating nature, communication impediments, and possible agitation in hyperactive subtypes. Pathophysiological mechanisms underlying delirium are complex, but the approach to adequate symptom management consists of nonpharmacological strategies as well as the use of antipsychotic agents. However, when nonreversible and refractory delirium occurs, palliative sedation is an invaluable treatment option and may be offered after careful consideration. This short review attempts to cover important aspects of clinical features of delirium, diagnostic and treatment strategies as well as the role of palliative sedation in refractory situations in delirious cancer patients at the end of life.

In increasingly multi-ethnic societies fostering cultural awareness and integration of immigrants is not only a political duty but also an obligation for social and healthcare systems. Importantly, cultural beliefs and needs strongly impact on the quality of life of cancer patients and may become even more crucial at the end of life. However, to date, ethnic and cultural aspects of palliative care are insufficiently researched. This qualitative study at the Medical University of Vienna included 21 staff members from different disciplines in oncology and palliative care working with patients with various cultural backgrounds at the end of life. Semi-structured interviews were performed to gain insights into specific aspects of palliative care that are important in the clinical encounter with terminally ill cancer patients with migrant backgrounds and their relatives. Interviews revealed specific aspects of palliative care, which fell into four fundamental categories and were all perceived as beneficial in the clinical encounter with migrant clients: (A) structural and (B) personal conditions of the palliative care setting, (C) specific care and treatment intentions and (D) personnel requirements and attitudes. This study revealed first insights into possibilities and prospects of transcultural palliative care for migrants and their relatives. The results might have important implications for the end of life care in this growing population.

Medical students have to acquire theoretical knowledge, practical skills, and a personal attitude to meet the emerging needs of palliative care. The present study aimed to assess the personal attitude of Austrian medical students towards end of life communication (EOLC), as key part of palliative care. This cross-sectional, mono-institutional assessment invited all medical students at the Medical University of Vienna in 2015. The assessment was conducted web-based via questionnaire about attitudes towards EOLC. Additional socio-demographic and medical education-related parameters were collected. Overall, 743 medical students participated in the present report. Differences regarding the agreement or disagreement to several statements concerning the satisfaction of working with chronically ill patients, palliative care, and health care costs, as well as the extent of information about palliative disease, were found for age, gender, and academic years. The overall attitude towards EOLC in the present sample can be regarded as quite balanced. Nevertheless, a considerable number of medical students are still reluctant to inform patients about their incurable disease. Reservations towards palliative care as part of the health care system seem to exist. The influence of the curriculum as well as practical experiences seems to be important but needs further investigation.

Summary Background Interdisciplinary tumor board decisions improve the quality of oncological therapies, while no such boards exist for end-of-life (EOL) decisions. The aim of this study was to assess the willingness of hemato-oncological and palliative care professionals to develop and participate in EOL boards. An aim of an EOL board would be to establish an interdisciplinary and comprehensive care for the remaining lifetime of patients suffering from advanced incurable diseases. Study design Staff from the interdisciplinary teams of all hemato-oncological and palliative care wards in Vienna were invited to anonymously participate in an online survey. Results 309 professionals responded. 91% respondents reported a need to establish an EOL board, 63% expressed their willingness to actively participate in an EOL board, and 25% were indecisive. Regarding patient presence, 50% voted for an EOL board in the presence of the patients, and 36% voted for an EOL board in the absence of the patients. 95% had the opinion that an EOL board could improve patient care in the last phase of life. 64% stated that the development of an EOL board would be worthwhile, while 28% did not see enough resources available at their institutions. Regarding the desired type of documentation, 61% voted for a centrally available EOL decision, and 31% supported an in-house-based documentation. 94% voted for the availability of an information folder about EOL care. Conclusion The willingness of professionals to establish an EOL board was very high. Further steps should be taken to implement such boards to improve EOL care.

Die Palliative Sedierungstherapie (PST) ist eine wichtige und ethisch akzeptierte Therapie in der Versorgung von ausgewahlten sterbenden Menschen, welche aufgrund therapierefraktarer Symptome fur sie unertragliches Leiden erleben. PST findet zunehmend Anwendung in der Betreuung Sterbender. In Ostereich gibt es keine standardisierte ethisch fundierte Leitlinie fur diese exzeptionelle Therapie, es liegen jedoch Beweise vor, dass die angewandte Praxis bundesweit sehr uneinheitlich ist. Im Auftrag der Osterreichischen Palliativgesellschaft (OPG) erarbeitete eine 16-kopfige multiprofessionelle Arbeitsgruppe aus Experten der Palliative Care und Ethikern die Nationale Leitlinie zur PST auf der Basis jungster systematischer Ubersichtsarbeiten mit dem Ziel, innerhalb der Rahmenleitlinie der Europaischen Palliativgesellschaft (EAPC) zu sein und Osterreichs nationale legale, kulturelle und strukturelle Gegebenheiten zu respektieren. Der Expertenkonsens wurde mittels eines 4‑stufigen Delphiprozesses mit anschliesenden Konferenzen etabliert. Der Delphiprozess folgte strikt der jungst entwickelten EUROIMPACT-sedation-study-checklist und war am AGREE-2-Leitlinieninstrument orientiert. Zum Abschluss wurden nationale Stakeholder eingeladen, die Ergebnisse zu reflektieren. Als Ergebnis eines rigorosen Konsensusprozesses liegt die Langversion der Nationalen Leitlinie zur Palliativen Sedierungstherapie mit 112 Aussagen, kategorisiert in 11 Domanen vor. Erganzung finden diese Aussagen in einem Exkurs einer Philosophin uber das Leiden. Wir haben mittels Delphi-Expertenkonsensus und Einbeziehung der Stakeholder eine Nationale Leitlinie zur Palliativen Sedierungstherapie entwickelt. Die Wirkung der Leitlinie auf die Praxis in Osterreich muss zukunftig evaluiert werden.

Soft tissue sarcomas (STS) are a rare and heterogeneous disease sharing mesenchymal origin. While classification of different STS subtypes has generated insight into their molecular pathogenesis, treatment response, and prognosis, oncological management still poses major clinical challenges. Despite considerable evolution in definition of optimal treatment strategies over the past decade there is a critical need of new and less toxic therapeutic approaches for the treatment of metastatic sarcoma. This review covers the latest clinical study highlights for soft tissue sarcomas and gastroinestinal stromal tumours (GIST) presented at ASCO 2016, demonstrating a constant progress from conventional chemotherapy to histology-tailored therapy as well as immunotherapy approaches.