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This qualitative research explored the information needs and seeking experiences of family members of terminal cancer patients. Semi-structured interviews were conducted with twelve individuals. Th...

The cancerous method is a result of disturbed cell performance. This can be due to excess genetic and epigenetic changes inside the cell, expressed within the accumulation of body or molecular aberrations, that results in genetic instability. It's tough to assess the validity of individual factors which can cause a diseased condition; however, it can be suggested that interaction of various risk factors has the biggest contribution to cancer development and metastasis. Environmental and individual factors, together with genetic makeup contribute to the development of cancer. Medical research on malignant tumors has focused on the effects of environmental and genetic factors on cancer cases occurring and death rate. According to the information available, 80–90% of malignant tumors are a result of external environmental factors i.e. Carcinogens. Medical studies have indicated that the most factors leading to metastasis of cancer among humans are due to environmental factors which develop due to human activities. The studies show that smoking, excessive alcohol consumption and diet play an important role in metastasis of preexisting tumors. According to WHO, there might be ten million deaths by the end of 2020, out of which 7–8 million will be in developing countries and 2–3 million in developed countries. The aim of this study was to accumulate knowledge regarding the risk factors leading to metastasis of tumor and providing them with the most recent results.

This study aimed to examine family members’ attitudes and perceptions regarding their choice of care in the event of terminal illness, based on their experience in a caregiver’s role, while a loved one was terminally ill. All participants ( N = 10) had cared for an immediate family member with terminal cancer. Snowball sampling was used. Qualitative data were collected through in-depth, semi-structured interviews. The data were transcribed verbatim and analyzed using thematic analysis. Five themes were identified from the data. These included two themes relating to participants’ experience of care, two themes in relation to participants’ attitudes toward the type of care they experienced and a final theme related to the role of religion and spirituality in dealing with loss. The findings of this study support the integration of multidisciplinary healthcare teams and the introduction of holistic care as early as possible within hospitals for individuals with terminal cancer, using the biopsychosocial–spiritual model.

ObjectiveThe terminal phase of cancer represents a major crisis for the family system. Regardless of the caregiving role they undertake, family members are forced to address multiple impacts when facing the approaching death of their terminally ill loved one. International guidelines recognize the importance of integrating the family into a care plan. However, more needs to be known about how to deliver optimal family support. The purpose of this study is to review the current state of the art in family/caregiver-focused interventions of people with terminal cancer in palliative care.MethodFor this purpose, an overview of the literature's systematic reviews on the topic was conducted to select Randomized Controlled Trials (RCTs) on family/caregiver-focused interventions.ResultsNine interventions were found in the systematic reviews of literature and meta-analysis. These family/caregiver-focused interventions were then thoroughly and critically analyzed. Despite the heterogeneity with regard to their characteristics, the interventions commonly focused on caregiving matters, were brief in duration, and delivered by non-mental health experts. The efficacy of such interventions was seen as modest.Significance of resultsFamily/caregiver-focused interventions in palliative care remain a matter of concern and more research is needed to identify adequate and effective ways of helping families that face the crisis of terminal illness in the system.

We consider uncertainty in relation to clinical trials for terminal non-small cell lung cancer, which is an aggressive and difficult to treat form of cancer. Using grounded theory to analyse 85 clinical interactions between doctors, patients and family members, we argue that uncertainty is a major source of tension for terminally ill patients, with individuals confronting a choice between transitioning to palliative care or volunteering for an experimental/trial medication that might postpone death. Regardless of their efficacy, patients must also consider how such experimental treatments might impact their quality-of-life. We argue that clinical trials produce uncertainty through (i) discussions about the efficacy of clinical trials; (ii) the physiological consequences of clinical trial medications; and (iii) the impact clinical trials have on patient's prognostic understanding of their terminal cancer. Accordingly, while study participants encounter high prognostic certainty (i.e. they have a fatal cancer), they nonetheless experience considerable uncertainty in relation to their participation in clinical trials.

This research explored the information needs and seeking behaviors of family members and friends who experienced a terminal cancer diagnosis of a loved one that included a predicted lifespan (e.g. ...

Satisfaction with care is an important indicator for family caregivers of patients with terminal cancer and is linked to the quality of life. Despite this, few studies have examined the aspects of satisfaction with care of family caregivers of inpatients with cancer in general wards. This qualitative study aimed to elucidate the elements of satisfaction with the care that inpatients with terminal cancer in general wards and their family caregivers receive from medical staff, as perceived by the family caregivers. Semi-structured interviews were conducted with 10 family caregivers of inpatients with terminal cancer. Participants were asked about the care received until then from medical staff, the features of satisfactory care, and the aspects of care they felt were unsatisfactory or could become satisfactory with improvement. The data were analyzed with the content analysis method and the six categories were extracted. For family caregivers of inpatients with terminal cancer in general wards, along with the care identified as important in palliative care, the methods of alleviating symptoms and explaining the patient’s condition were also important. The results highlight the importance of determining a patient-oriented approach and explanations together with each patient and family caregiver, based on an understanding of the long treatment process.

Caring for a patient with terminal cancer poses difficulties for family caregivers. Although families of patients with cancer have been classified by type, little is known about the relation between family functioning and quality of life (QOL) in family caregivers. This study aimed to develop a typology of family functioning in family caregivers of patients with terminal cancer and then examine the relation between the family functioning and QOL of family caregivers. From December 2013 to August 2014, fifty-one family caregivers of patients with terminal cancer were recruited at three hospitals in Tokyo, Japan. Perceptions of family functioning were assessed with the Family Relationship Index, and its three subscores were classified into three groups by cluster analysis. Caregivers’ QOL was measured with the Caregiver Quality of Life Index-Cancer. The average total FRI score among 51 caregivers was 8.5 (SD = 2.8). Family functioning was categorized into three clusters: supportive (n = 12), communicative (n = 30), or conflictive (n = 8). Their QOL was categorized into two groups: the communicative group, with relatively high confliction, showed high QOL comparable to the supportive group. Family functioning in the families of patients with terminal cancer hospitalized in general wards was not good. For improving the QOL of family caregivers, it may be important for the family members to express their feelings and distress if they have conflicts.

Introduction Fan therapy has been suggested by some studies as one of the nonpharmacological supportive interventions to alleviate breathlessness for dyspneic patients with terminal cancer. Unfortunately, data among Asians are limited and there are currently no published data showing that this intervention works among Filipinos—thus this study. Study Design This study was an open-label, randomized, placebo-controlled, crossover Phase 2 trial. The experimental group had a fan blowing air directly to the patient’s face for 5 minutes, and the control group had a fan blowing air to the patient’s legs. Treatment crossover was done after a washout period of 1 hour. The primary outcome, which is dyspnea, was measured subjectively using the Modified Borg Scale (MBS). Differences in the patient’s respiratory rate (RR) and oxygen saturation were also measured. Results A total of 48 patients were enrolled in this trial. The mean age of the patients enrolled was 51 years, and the most common primary tumor was lung cancer (21%). In the control group, results showed that the mean difference before and after intervention in the MBS was 0.15, and the mean difference in RR was 0.25. On the other hand, the intervention group showed a statistically significant decrease in the patient’s dyspnea as evidenced by a mean MBS decrease of 2.79 (p < 0.0001), and a mean RR decrease of 1.88 (p < 0.0001). Conclusion The results of this study reveal that fan on face (FAFA) therapy in terminally ill Filipino cancer patients in addition to the prescribed standard of care can significantly alleviate their level of dyspnea. Thus, FAFA therapy should be considered as an adjunct to standard of care for these patients.

Introduktion/Bakgrund: Cancer i sen palliativ fas innebär ett stort lidande för många människor.Copingstrategier kan hjälpa patienter att minska lidande och öka livskvalitet. Sjuksköterskor har en viktiguppgift i att identifiera och stötta val av copingstrategiSyfte: Syftet med denna litteraturstudie är att undersöka copingstrategier hos patienter med cancer i senpalliativ fas.Metod: Polit och Becks nio steg användes för denna litteraturstudie. Systematisk databassökning gjordes föratt finna artiklar att basera resultat på. Deduktiv ansats som utgick från Lazarus och Folkmans teorier omcopingstrategier användes för att kategorisera resultat.Resultat: Patienterna använde sig av problemfokuserad coping för att aktivt bibehålla sin autonomi samt tainitiativ till att söka råd och stöd från vårdpersonal och närstående. Känslofokuserad coping användes för attvända situationen emotionellt till något positivt, ofta med hjälp av närstående, mindfullness eller meditering.Meningsfokuserad coping delas in i existentiell- och acceptansfokuserad coping. Dessa strategier hjälptepatienter att använda sig av sin religiösa grundsyn samt acceptera sin situation för att minska lidande.Slutsats: En stor mängd olika val av copingstrategier och upplevelser kopplade till dessa kunde identifierashos patienter med cancer i sen palliativ fas.

The article hermeneutically analyses the poetics of sick body in the three novels by the French modernist writer, representative of Catholic literary revival – Georges Bernanos. Whereas «The star of Satan» (1926), «The diary of a country priest» (1936) and «Monsieur Ouine» (1948) belong to different periods in the author’s oeuvre, the article highlights Bernanos’ established approach to the problem of afflicted body and ruined soul. The article reveals that multiple diseases from which most of Bernanos’ characters suffer reflect the damage done to their souls. The body is inseparably connected to the soul, thus unhealthy body means affected soul and vice versa. The disordered body is represented as individual or collective, subsequently embodied in the metaphors of tabernacle and mystical Christ’s body directly referred to in the texts under discussion. Symbolically, the individual sick body is inscribed in the mysticism of sainthood, specifically problematized in the two priest figures called to sanctitude: Donissant and the cure of Ambricourt – the one healthy and physically strong, who takes his salvation in his own hands fighting for it, and the second dying of the terminal cancer, only hoping and asking to be saved. The collective body is associated with afflicted and disrupted mystic Christ’s body incarnated in the image of parish dying of multiple physical and mental maladies represented by cancer tumor in «Monsieur Ouine». Thuswise, the analysis proves that Bernanos speaking from a Catholic perspective unites the disability of individual body with the revivification of soul, concurrently using the disordered collective body as the illustration of ill secular society.

Background: Accurate prognosis in terminal cancer patients is useful to improve their quality of life and also to decide the cessation of fluid administration. Nonetheless, few prognostic indicator...

Background: Evidence about how inflammatory biomarkers vary during the end-stage cancer trajectory is lacking. This study investigates the longitudinal changes in albumin and C-reactive protein (CRP) levels, and CRP/albumin ratio (CAR) in patients with terminal cancer receiving palliative care in the last three months of life.Methods: This is a retrospective analysis of variables extracted from a prospective cohort study that included admitted patients to the exclusive Palliative Care Unit of the National Cancer Institute in Brazil. Routine blood examination results of albumin and CRP were recorded at 0-15 (T1), 16-30 (T2), 31-45 (T3), 46-60 (T4), 61-75 (T5), and 76-90 (T6) days before death and only patients with at least two measurements were included. Crude and adjusted linear mixed-effects regression models were performed to verify the relationships between the longitudinal trajectories of biomarkers and death. Results: A total of 1,635 patients were included. Median albumin was 3.00g/dL across the whole time-period analyzed (interquartile range, IQR: 2.50-3.60) and decreased with the approach of death, while median CRP was 9.31mg/L (IQR: 4.42-17.30) and CAR was 3.20 (IQR: 1.40-6.60), and both increased. The albumin (slope: 0.01 to 0.02; p p p Conclusions: The longitudinal change levels of inflammatory biomarkers worsen with the approach of death and could be used to predict end-stage in patients with terminal cancer.

Insomnia is one of the most frequent symptoms and usually generates significant stress in 60% of patients with advanced cancer. Worries from the patients’ and relatives’ perspective are crucial to improve the patients’ quality of life but have received limited attention. The aims were to identify the concerns of patients with insomnia in the terminal illness stage in a palliative care unit and the relatives’ perception, and to compare both. Here, 63 patients and 53 relatives answered a questionnaire about worries in the personal, spiritual, family-related and economic area, as well as a quality-of-life uniscale. The results showed that the relatives’ most frequent concern was “Having lived life to the fullest” (100%), and the most intense was “The possible suffering during the process” (9.2/10). The patients’ most expressed concern was: “Having unfinished business” (100%), and the most intense was “Suffering during the process” (9.3/10). Quality of life showed an average value of 6.95 out of 10. Relatives only coincided significantly in: “Not knowing what happens after death” (r = 0.600, p = 0.000). These results bring visibility to concerns during the final stage of oncological palliative patients with insomnia from the patients’ and relatives’ perspective. Knowing both is useful for professionals to foster the well-being for a short, yet very important, period for patients, relatives and the caregiving team.

1) PurposeThe need for hospice palliative care continues to grow as the number of deaths from cancer increases with increasing interest in and need for the management of end stage cancer patients. We conducted this study to determine differences in quantity and cost of drugs used by end-stage cancer patients who were hospitalized in general wards or hospice wards for 7 days before death.2) MethodsAmong patients who died in the hospice ward or the general ward of a university hospital in a metropolitan city (Seoul) from January 2016 to September 2019, patients aged over 18 years with a hospital stay of 8 days or more were selected. A total of 526 patients were selected, including 290 from hospice wards and 236 from general wards.3) ResultsNumbers of PO, injections, and fluid, but not opioids, used in the hospice ward were significantly lower than those in the general ward. Cost of PO, injections, fluid, and total costs were significantly lower in the hospice ward than in the general ward. In the case of opioids, the cost was higher for the hospice ward. Total costs including all drug costs in the hospice ward were significantly lower than those in the general ward. 4) ConclusionCaring for people with terminal cancer in a hospice can lower costs and increase satisfaction for dying patients. Reducing the proportion of patients caring for terminal cancer in general wards and increasing access to hospice services can address health insurance deficits and exhaustion.

Aim of the study The socio-economic impact of caring for a cancer patient in the family is unknown in Colombia. This survey aimed to evaluate the existence of financial burden caused by cancer on the caregiving families of terminally ill patients. Methods We used the Covinsky Family Impact Scale in a telephone survey with families of patients who died from cancer between May 2019 and June 2020 in three Colombian hospitals. Results We obtained answers of 176 caregivers, of whom 74.4 % indicated to have experienced at least one hardship of the Covinsky items. The most commonly reported financial hardship involved the use of all or most of the family savings for the care provided to the patient (45.6 %); 27.6 % indicated that a major source of family income was lost. A quarter (25 %) postponed educational or other important plans of family members and 10–11 % indicated to have moved to another home or postponed medical treatments. Conclusion In Colombia, a country with universal health coverage, substantial financial impacts of terminal cancer care exist not only for patients, but also for family members and other caregivers. The system is failing to avoid financial toxicity of cancer among this group. Policy summary statement Informal caregivers are of vital importance for cancer patients but also to the healthcare system, particularly in LMICs. It is very important for policy makers to consider the hardships, not only emotionally but also financially, that the care for a (terminally ill) cancer patient implies on caregivers.

Hypercalcemia of malignancy affects 2%-2.8% of cancer patients and is associated with an increased risk of mortality and other symptom-related complications. Standard treatment consists of fluid resuscitation, intravenous bisphosphonates, and calcitonin. Little is known, however, about the benefits of treatment of malignant hypercalcemia in patients with late-stage terminal cancer. We present a case of a hospice patient with squamous cell lung cancer brought to our hospital with newly altered mental status who was found to have hypercalcemia of malignancy. Our discussion centers on the diagnostic dilemma of deciding which patients seeking comfort-focused care may benefit from fluid resuscitation for symptoms of hypercalcemia of malignancy while maintaining the unambiguous goal of comfort care.

While end-of-life (EOL) care has been a relatively common option for patients with terminal cancer, the utilization of EOL care in Alzheimer disease and other dementias has become available more recently. By the time end-stage dementia is present, the clinicians and caregivers become faced with multiple clinical issues—their inability to provide subjective complaints of pain and discomfort, behavioral symptoms, delirium, food refusal, and so on. In addition to providing quality EOL care to the patients, clinicians need to work with their families in an open and empathic manner, assuring that their loved ones will receive supportive measures to keep them comfortable.

Objective: To measure and assess differences by educational level in the place of death for cancer patients, and to determine whether patterns of geographical disparities are associated with access to palliative care services in the municipality of residence. Method: We analysed the death certificates of adults (older than 24) who died of cancer (ICD-10 C00 to C97) in Spain during 2015, either at home, in hospital or in a long-term care centre. Of the 105,758 individuals included in the study population, 75.2% lived in one of the 746 identifiable municipalities (more than 10,000 inhabitants). This individual database was combined with three economic databases at municipal level and with a directory of palliative care resources published by the Sociedad Española de Cuidados Paliativos. Multilevel models were estimated to predict the place of death according to individual characteristics. Generalised least squares regression models were then applied to the municipal effects estimated in the first stage. Results: The probability of dying in long-term care centre decreases as levels of education increase; the probability of dying at home, rather than in hospital, is higher for patients with higher education. Dying in hospital is an urban phenomenon. There are large differences between Spanish regions. Access to palliative services is only of marginal significance in accounting for the systematic differences observed between municipalities. Conclusions: Developing specific plans for palliative care, with an active role being played by primary care teams, may help improve end-of-life care in Spain. Resumen: Objetivo: Medir y evaluar las diferencias por nivel educativo respecto al lugar de muerte de pacientes con cáncer en España, y determinar si los patrones de desigualdad geográfica están asociados con el acceso a servicios de cuidados paliativos en el municipio de residencia. Método: Analizamos los certificados de defunción de mayores de 24 años que murieron de cáncer (CIE-10 C00-C97) en España durante 2015, en el hogar, en el hospital o en una residencia sociosanitaria. Sobre una población total de 105.758 personas, el 75,2% vivía en uno de los 746 municipios identificables (más de 10.000 habitantes). La base de datos individual se combina con datos económicos de ámbito municipal y con el directorio de recursos de cuidados paliativos publicado por la Sociedad Española de Cuidados Paliativos. Se estiman modelos multinivel para predecir el lugar de la muerte de acuerdo con las características individuales. A continuación, se estiman modelos de regresión por mínimos cuadrados generalizados sobre los efectos municipales estimados en el modelo anterior. Resultados: La probabilidad de morir en casa, frente al hospital, es mayor en los pacientes con educación superior. Morir en el hospital resulta un fenómeno urbano. Hay grandes diferencias entre regiones. El acceso a los servicios paliativos solo tiene una importancia marginal en la explicación de las diferencias entre municipios. Conclusión: El desarrollo de planes específicos para cuidados paliativos, con un papel más activo de los equipos de atención primaria, puede ayudar a mejorar la atención sanitaria al final de la vida en España. Keywords: Palliative care, Death, Neoplasms, Socioeconomic factors, Spain, Palabras clave: Cuidados paliativos, Muerte, Cáncer, Factores socioeconómicos, España

Background: Dyspnea is a common distressing symptom in patients with malignant and nonmalignant diseases. Fan therapy, which uses a fan to blow air toward the patient’s face, can alleviate dyspnea; however, its efficacy remains unclear. Aim: To examine the immediate efficacy of fan therapy for alleviation of dyspnea at rest. Design: Meta-analysis. Data sources: We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE EBSCO, CINAHL EBSCO, and Scopus from January 1, 1987, to August 21, 2018 (PROSPERO-CRD42018108610). In addition, we hand-searched studies and used the similar articles feature on PubMed to search for articles. Randomized controlled trials comparing the effects of fan therapy with placebo or other interventions to alleviate dyspnea at rest, in which patients were aged ≥18 years, were eligible for inclusion in the review. We excluded articles on long-term intervention involving fan therapy and complex intervention (including fan therapy). The risk of bias assessment was conducted using the Cochrane tool, and the meta-analysis was performed using RevMan version 5.3. Results: We identified a total of 218 studies; 2 met our criteria for inclusion in the meta-analysis. Fan therapy significantly improved dyspnea at rest in terminally ill patients with cancer compared to control groups (mean difference: −1.31, 95% confidence interval: −1.79 to −0.83, P < .001). There were no studies that met the inclusion criteria regarding fan therapy for patients with nonmalignant disease. Conclusions: This meta-analysis demonstrated that fan therapy may be an effective intervention for dyspnea at rest in patients with terminal cancer.

Background and objectives Clinical management for terminal patients should consider various aspects, particularly the patient's functional assessment, which correlates well with the short-term prognosis. The prognosis could improve if the presence of symptoms strongly associated with a poorer progression were included. The study's main objective was to assess whether the prognosis according to the Palliative Performance Scale (PPS) improved with the presence/absence of pain-dyspnea-delirium symptoms. The secondary objective was to determine caregiver satisfaction with the transfer to medium-stay palliative care units (MSPCUs), which are prepared for medium stays of approximately one month. Patients and method We conducted a prospective, observational, multicentre (regional) study that analyzed survival in MSPCUs according to the PPS dichotomized to >20% and ≤20%. We estimated the mean survival functions using the Kaplan–Meier method and compared them according to the Cox proportional hazards ratios (HR). Caregiver satisfaction was studied using an anonymous self-administered Likert questionnaire. Results The study included 130 patients. The PPS ≤ 20% and PPS > 20% subgroups had a median survival of 6 (3–13) days and 21 (11–42) days, respectively, with an unadjusted mortality HR 3.1-fold greater in the PPS ≤ 20% subgroup. The HR did not change when adjusted for the symptoms. Eighty-three percent of the caregivers found the transfer beneficial, and 40% observed better patient care. Conclusions For patients transferred from general hospitals to MSPCUs, PPS scores ≤ 20% were associated with survival shorter than one week, with a 3-fold higher mortality HR than patients with PPS scores > 20%, without the analysis adjusted for the presence of pain-dyspnea-delirium providing greater prognostic accuracy. The caregivers found benefits mainly in the convenience of the facilities and distance.

Background: Some terminal cancer patients wish to “go to a memorable place” or “return home.” However, owing to various symptom burdens and physical dysfunction, these wishes are difficult...

Background: There is no established method to objectively predict short-term prognosis. Recently, we proposed objective, short-term, prognostic predictive methods that are combinations of ...