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Introduction: A 53-year-old female presented with a large (945 cc) unresectable leiomyosarcoma of the uterus, with metastasis in the lungs, significant abdominal/pelvic pain and evidence of hydronephrosis secondary to obstruction caused by the mass. In an effort to palliate symptoms, radiation was recommended. Methods: Given the size of the lesion, the patient was treated with crossfire GRID, a type of spatially fractionated radiotherapy (18 Gy × 1), followed four weeks later by a short course of external beam radiation (4 Gy × 5). Results: The patient experienced significant symptom relief. Her abdominal/pelvic pain resolved, and a stent was placed to relieve her hydronephrosis. The tumour volume had decreased significantly (5·5 months post-treatment 276 cc, 8·5 months post-treatment 17 cc). Unfortunately, at 9 months post-treatment, the patient died from progression of her metastatic disease in the lungs. Conclusions: The use of GRID radiotherapy resulted in effective and sustained palliation of a large uterine leiomyosarcoma in this patient's case. [ABSTRACT FROM AUTHOR]

AbstractEnd stage renal disease (ESRD) is known to be associated with pain, malaise and decreased quality of life. Pain management in the setting of dialysis is particularly challenging from a pharmacologic standpoint given altered pharmacokinetics of pain medications. Buprenorphine, a partial mu opioid receptor agonist, demonstrates superior safety profile compared to full mu opioid receptor agonists. In this case report, we demonstrated buprenorphine buccal film (Belbuca) as a safe and effective opioid treatment option for pain palliation in a dialysis dependent patient. Future studies may be warranted with larger sample size and longer follow up period to study the effect of buprenorphine in the setting of hemodialysis and non-dialysis dependent ESRD population. [ABSTRACT FROM AUTHOR]

Aim. In patients with cyanotic congenital heart defects, pulmonary blood flow is maintained by a functioning patent ductus arteriosus (PDA). Most patients with complex duct-dependent cyanotic defects require intermediate palliative treatment before proceeding of total repair. Timely and complex outpatient monitoring by a pediatrician and pediatric cardiologist are important for patient survival following palliative treatment, along with determining optimal timing for consultations at specialized cardiac surgical centers. To present the outcomes of two methods for increasing pulmonary blood flow (systemic-to-pulmonary artery shunt (SPAS) and stenting of patent ductus arteriosus (PDA st.)), as well as the features of outpatient cardiological observation and treatment in these patients. Materials and Methods. From 2000 to February 2024, 22 patients underwent SPAS (SPAS group), and stenting of patent ductus arteriosus was performed on 27 patients (PDA st. group) at the Ukrainian Cardiac Center. Results and Discussion. After interventions, the mean arterial oxygen saturation (SatO2) significantly increased in both groups, with a significantly higher improvement in the PDA st. group (p

Lung cancer is the largest contributor to new cancer diagnoses and cancer deaths worldwide. Respiratory symptomatology is common in the context of this diagnosis: cough, expectoration, hemoptysis, chest pain, dyspnea, fever, dysphonia, etc. But this symptomatology can be accentuated in the context of the psychological reaction to the diagnosis, which is very common in the oncologic context. The physical symptoms occurring in the oncologic context are assessed in this study by the IPOS questionnaire, which assesses at the same time emotional symptoms as well as communication and practical problems. Psychiatric medication is administered as soon as possible after diagnosis and reduces physical symptoms, irrespective of their organic, affective or mixed etiology. In this study we attempt to prove the decrease in respiratory symptomatology in the context of adding psychiatric medication to specific oncologic treatment. The improvement in respiratory symptoms leads to improvement in affective state, as scored by HAM-D17, CGI-S and CGI-I, and decrease in psychomotor agitation. The aim of this study is to try to change the therapeutic protocols used in oncology, in order to introduce psychiatric medication as quickly as possible, regardless of the amplitude of physical and affective symptoms, with the purpose of improving the oncologic patient’s condition.

Introduction: Various techniques are available to treat and alleviate pain and other symptoms in liver metastasis (LM) or advanced hepatocellular carcinoma (HCC) patients. One of such technique is the external beam radiotherapy to whole liver. This study aimed to evaluate the feasibility, efficacy, tolerability and patient’s reaction to external beam radiotherapy (EBRT) in palliation of symptoms and quality of life (QoL) LM patients or HCC patients. Material and Method: A total of 50 patient of either liver metastasis or HCC were included and planned on single 8Gy/fraction to whole liver radiotherapy. Ultrasonographic guided marking of liver was done prior to treatment and pretreatment dexamethasone and antiemetic was given. Evaluation was done at 1 week and 1 month after the end of treatment. Results: After the whole liver radiotherapy, significant improvement was reported in the bilirubin level (68%), pain level (75.5%), and nausea (32%). Talking about the quality of life, the radiotherapy was reported to found potentially effective in enhancing the quality of life among the patients. Greatest percentage improvementwas reported for pain (75.6%), Global health status (39.6%), physical functioning (32.4%), rolefunctioning (36%), social functioning (36%) and appetite loss (30.6%). [ABSTRACT FROM AUTHOR]

A number of studies have revealed the productivity of the palliative care in enhancing the cancer end-of-life patients' quality of life, yet the issues of its underuutilization become a challenge. This systematic review shall conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), which is an abbreviation of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The literature search will be carried out covering different databases that include PubMed, Scopus, Web of Science, and Google Scholar for articles released before May 2024. In this abstract the author describes targeted educational interventions, better incorporation of the palliative services into the oncology treatment and strong policy measures for increasing the acceptance and accessibility of the palliative care. In a community 6.1 per 1000 population needs some form of palliative care. The overall awareness in a community of a developed country is 71%, yet people still feel, it is for cancers. According to the National Trends Survey, 66% of cancer survivors had no knowledge of palliative care, 18% had a limited understanding, and just 17% could describe palliative care to others. This includes even physicians in whom, 15% lack a comprehensive knowledge on palliative care. About 40% of the physicians felt incompetent in discussing the concept of palliative care with their patients. The inclusion of palliative care can actually be integrated from the beginning of the treatment with benefits in regard to the symptoms and may also contribute to an increased lifespan. On the forefoot, awareness and reduction of the negative perception held by the patients and their families about such services is possible with availability of patient educative materials on palliative care. Secondly, there is a poor concordance between the integration of palliative care into oncology care. Some literature points to the fact that timely referral to palliative care enhances patients' prognosis and decreases the costs to the system. Policy development requires this integration by putting in place policies, supporting structures, and reward systems for the integration of oncology and palliative care. Third, it is crucial to preserve community-based practices and outreach in regard to the early introduction of palliative care services. Strategic alliances between the hospitals and primary health care providers and with other NGOs can provide services such as skills enhancement programs, awareness programs, follow up support and home visits to patients and families affected by the neuro advantage. The final strategy in improving the taking of palliative care services is through the use of technology and telemedicine, especially in the rural and under-served regions. Using telehealth, remote monitoring of the patient, and the offering of support groups facilitating group therapy help fill the gap where patients cannot access palliative care services. Enhancing the awareness and use of palliative care among cancer patients will help not only to improve the patients' quality of life but will also address the needs of families in distress. We need to include a special drive to increase the awareness among cancer survivors, community as a whole, and even physicians with a thrust on developing countries. [ABSTRACT FROM AUTHOR]

Introduction: Palliation of malign biliary obstruction is important which is commonly carried out by percutaneous biliary stenting. Our primary aim with this study was assessment of performance of wall stents, and nitinol stents for the palliation of malign biliary obstruction. Methods: The medical records of 157 patients who underwent biliary stenting in our department between January 1, 1995, and December 31, 2005, were retrospectively analyzed. Technical success, treatment success, mortality in the first 30 days, minor, and major complications were evaluated and compared among the wall stent, and the nitinol stent groups in all patients which constituted the primary study endpoints. Additionally, stent patency, and mean patient survival times after stent implantation were evaluated in patients for whom follow-up information could be obtained. Results: A total of 213 metallic stents were placed in 157 patients. Wall stent was placed in 83 of the patients with mean age, and SD of 60.4 and 13.5. Nitinol stent was placed in 74 of the patients with mean age of 57.8, and SD of 15.5. Gender ratio was equal in both groups. Biliary stent dysfunction was observed in 13 patients in each of nitinol, and wall stent groups throughout the study period. There was no statistical difference among re-occlusion rates (p = 0.91). For the nitinol stent group median primary patency time was 119 days (90–185 days CI 95%), and for the wall stent group median primary patency time was 81 days (60–150 days CI 95%). Conclusion: Nitinol stents, and wall stents are safe options that can be safely used in the percutaneous treatment of malignant biliary obstruction with similar treatment and therapeutic success, low complication rates, and patency times that can extend beyond expected survival times. [ABSTRACT FROM AUTHOR]

The therapeutic possibilities of endoscopy have rapidly increased in the last decades and now allow organ-sparing treatment of early upper gastrointestinal malignancy as well as an increasing number of options for symptom palliation. This review contains an overview of the interventional endoscopic procedures in upper gastrointestinal malignancies. It describes endoscopic treatment of early oesophageal and gastric cancers, and the palliative options in managing dysphagia and gastric outlet obstruction. It also provides an overview of the therapeutic possibilities of biliary endoscopy, such as retrograde stenting and radiofrequency biliary ablation. Endoscopic ultrasound-guided therapeutic options are discussed, including biliary drainage, gastrojejunostomy and coeliac axis block. To aid in clinical decision making, the procedures are described in the context of their indication, efficacy, risks and limitations. • Endoscopy now offers curative treatments for early oesophageal and gastric cancer. • Interventional endoscopy can offer effective symptom palliation for dysphagia, pain and jaundice. • Duodenal stents and EUS-guided interventions provide effective palliation in gastric obstruction. [ABSTRACT FROM AUTHOR]

Patients born with obstructed total anomalous pulmonary venous return have a high risk of morbidity and mortality in the neonatal period, which only increases when combined with single ventricle physiology and non-cardiac congenital anomalies such as heterotaxy syndrome. Despite advances in management of congenital heart disease, surgery within the first weeks of life to repair the pulmonary venous connection and establish pulmonary blood flow with a systemic-to-pulmonary shunt has historically led to disappointing outcomes. A multidisciplinary approach with pediatric interventional cardiology and cardiac surgery is required to reduce morbidity and mortality in this extremely high-risk patient population. Extending the time between birth and cardiac surgery can lessen postoperative complications and mortality risk, especially in patients with abnormal thoracoabdominal relationships. Our team was able to successfully utilize transcatheter stent placement in a vertical vein and patent ductus arteriosus to delay and stage cardiac surgeries in an infant born with obstructed total anomalous pulmonary venous return, unbalanced atrioventricular septal defect with pulmonary atresia and heterotaxy, thus reducing the morbidity and mortality associated with this diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: The optimal treatment strategy for symptomatic young infants with tetralogy of Fallot (TOF) is unclear. We sought to compare the outcomes of staged repair (SR) (shunt palliation followed by second-stage complete repair) versus primary repair (PR) at 2 institutions that have exclusively adopted each strategy. Methods: We performed propensity score-matched comparison of 143 infants under 4 months of age who underwent shunt palliation at one institution between 1993 and 2021 with 122 infants who underwent PR between 2004 and 2018 at another institution. The primary outcome was mortality. Secondary outcomes were postoperative complications, durations of perioperative support and hospital stays, and reinterventions. Median follow-up was 8.3 years (interquartile range, 8.1-13.4 years). Results: After the initial procedure, hospital mortality (shunt, 2.8% vs PR, 2.5%; P = .86) and 10-year survival (shunt, 95%; 95% confidence interval [CI], 90%-98% vs PR, 90%; 95% CI, 81%-95%; P = .65) were similar. The SR group had a greater risk of early reinterventions but similar rates of late reinterventions. Propensity score matching yielded 57 well-balanced pairs. In the matched cohort, the SR group had similar freedom from reintervention (55%; 95% CI, 39%-68% vs 59%; 95% CI, 43%-71%; P = .85) and greater survival (98%; 95% CI, 88%-99.8% vs 85%; 95% CI, 69%-93%; P = .02) at 10 years, as the result of more noncardiac-related mortalities in the PR group. Conclusions: In symptomatic young infants with TOF operated at 2 institutions with exclusive treatment protocols, the SR strategy was associated with similar cardiac-related mortality and reinterventions as the PR strategy at medium-term follow-up.

Thyroid angiosarcoma is an extraordinarily sparse malignancy, often populating alpine regions. Clinically, thyroid angiosarcomas tend to be nonspecific in presentation, starkly dependent on site, size, extension, and metastases. Tumors are locally aggressive and can present with sudden onset pain due to intra-nodular hemorrhage and compressive symptoms from sudden expansion. Due to the disease being a scarcely reported entity, there is little scholarship regarding its management. We report an interesting case of a 63-year-old man presenting with a swelling in the neck, incidentally found to be a thyroid angiosarcoma with a first-time reported associated spinal metastasis. The patient has a uniquely presenting thyroid angiosarcoma and is the first patient to present as such within a non-alpine South Asian region. [ABSTRACT FROM AUTHOR]

Introduction: Palliative stenting fur relieving malignant obstruction of the gastrointestinal tract is routinely practical in western world. Obstructing advanced 67 malignancy requires bypass or exteriorization of proximal gut before NACT or as a bridge to definite surgery. The aim of the study was to review the experience at tertiary cancer hospital and short-term outcome with endoscopic stalling in lieu of palliative bypass surgery for advanced and obstracting GI malignancy. Materials and Methods: This observation study was carried out in the surgical out-patient department of NICRH where all therapeutic endoscopic facilities were available. All patients treated with stenting in a 2 years period from 2018- 2020 were studied. Results: Fifty-six patients received 60 stents. No case of perforation occurred. In fifteen cases (26.78%) clogging with food occurred: in 5 cases (8.92%) displacement occur. Tumour overgrowth was noted in 7(12.66%) cases. Four patients (6.72%) received a second stent. Mean survival of patients with esophageal stent was 221 days. Four patients received 4 stents in their colon or rectum. The stents were placed in the sigmoid (n=2), the descending colon (n=l), and the transverse colon (n=1). Mean survival of colonic stent patients was 331 days. No perforation, no clogging by stool and no tumour ingrowth among patients with colonic stent but one (25%) had displacement. Eighteen patients received a total of IS stents because of obstructing stomach cancer. 12 (61.22%) patients had tumour at cardia. Mean survival after gastric stent placement was 176 days. There was no perforation, one case of clogging (8.33%), and two cases of tumour ingrowth (16.66%). 5 patients underwent duodenal stenting. Remaining one at Billroth II anastomotic site. Single patients (20%) required laparotomy and stent extraction due to duodenal stent migration. Mean survival after duodenal stent placement was 242 days. No perforation, no clogging and no tumour ingrowth. Conclusions: The present series shows that placement of expandable metallic stents in the obstructing GI tract malignancy us an alternative to bypass surgery is safe, cost effective, low complications, short hospital stay and provides good palliation. [ABSTRACT FROM AUTHOR]

Many cancer patients develop bone metastases, however the prognosis of overall survival differs. To provide an optimal treatment for these patients, especially towards the end of life, a reliable prediction of survival is needed. The goal of this study was to find new clinical factors in relation to overall survival. Prospectively 22 clinical factors were collected from 734 patients. The Kaplan–Meier and Cox regression models were used. Most patients were diagnosed with lung cancer (29%), followed by prostate (19.8%) and breast cancer (14.7%). Median overall survival was 6.4 months. Fourteen clinical factors showed significance in the univariate analyses. In the multivariate analyses 6 factors were found to be significant for the overall survival: Karnofsky performance status, primary tumor, gender, total organs affected, morphine use and systemic treatment options after radiotherapy. Morphine use and systemic treatment options after radiotherapy, Karnofsky performance status, primary tumor, gender and total organs affected are strong prediction factors on overall survival after palliative radiotherapy in patients with bone metastasis. These factors are easily applicable in the clinic. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer has a high prevalence in Asia and may only be diagnosed in advanced stages. Therefore, patients with gastric cancer may experience fatal symptoms, such as bleeding or stenosis at the time of consultation. In this review, we aimed to describe the effectiveness and toxicity of hemostatic radiotherapy (RT). Methods: A total of 17 retrospective and 3 prospective studies were analyzed. The prescription dose, biologically effective dose, equivalent dose in 2 Gy fractions, response rate, survival prognosis, and toxicities were also reported. Results: Using 20 studies, the following observations were made the hemostatic effect was ∼ 80 %, the mean survival time after irradiation was about 3 months, and prescribed doses of 30 Gy/10 fractions and 20 Gy/5 fractions were considered suitable. Conclusion: In this review, studies on hemostatic irradiation have been summarized, and the most optimal treatment method has been proposed. 30 Gy/10 fractions and 20 Gy/5 fractions were ideal. However, because palliative RT is preferably completed within a short period of time, a randomized trial is needed to determine whether the 8 Gy/single fraction treatment is equivalent to fractionated RT. Therefore, more prospective studies are warranted to establish a standard of care for palliative RT in gastric cancer.

This review of the palliation of various gastro-intestinal (GI) symptoms encountered in cancer patients is by no means exhaustive. Frequent symptoms such as constipation, nausea and vomiting, bowel obstructions, ascites and bleeds will be discussed, focusing on their assessment and most importantly, how to control the associated symptoms. All of these symptoms and GI complications can significantly impact patients’ quality of life (QOL) and should be treated as quickly and aggressively as possible.

In newborns with congenital heart defects and duct-dependent pulmonary circulation, the first stage of palliative intervention may involve the systemic-to-pulmonary artery shunt (SPAS) placement or the patent ductus arteriosus (PDA) stenting. SPAS placement is a traditional method, but the trend towards reducing the invasiveness of surgical interventions has led to PDA stenting use as a preferred method to ensure a reliable source of pulmonary blood flow. The aim. To compare pre- and postoperative indicators, complications, and long-term outcomes in two groups of patients after SPAS placement and PDA stenting. Materials and methods. This single-center retrospective study included 82 newborns who underwent SPAS placement (Group I) and 47 patients who underwent PDA stenting (Group II) from 2015 to 2023. Baseline clinical data were similar in both groups. The arterial blood oxygen saturation (SaO2) was significantly lower in the PDA stenting group compared to the SPAS group (65.7 ± 11.1% vs. 79.2 ± 10.6%, respectively) (p < 0.00001). There was higher percentage of genetic/concomitant pathology in Group II, 13 (27.6%) versus 10 (12.2%), p = 0.02. Results. There was no statistically significant difference between the analyzed patient groups in clinical status indicators in the postoperative period, including: the duration of artificial lung ventilation (165.5 ± 94 and 150 ± 113 in groups I and II, respectively) (p = 0.87) and length of stay in the intensive care unit (14 ± 7 and 13.6 ± 9.4 days) (p = 0.76). However, SaO2 was higher in Group I than in Group II (81 ± 5.5% vs. 85 ± 4.6%, respectively) (p = 0.02). Before the next stage of surgical correction, the Nakata index in Group II was significantly higher than that in Group I (225 ± 87.4 mm2/m2 vs. 168 ± 35.9 mm2/m2, respectively) (p = 0.048). The percentage of reoperations was higher in Group II (17 [36.1%] versus 14 [17.1%]), however, the overall (14.9% and 26.8%) and late (9.1% and 19.5%) mortality rates were lower in Group II. Conclusion. Considering the similar results in both patient groups, stenting may be an effective option to increase the pulmonary blood flow in newborns. Due to its minimally invasive procedure, this method may be a choice for premature newborns and children with complex comorbidities. However, SPAS placement remains an important palliative intervention, particularly in cases where ductus arteriosus is tortuous and in congenital heart defects with complex intracardiac anatomy postponing radical correction until older age.

Background: Palliative care is underrepresented in our community at large. End-of-life care is offered mainly in palliative care hospices or hospitals worldwide. As access to such a facility is often sparse, and since many of them are located far away from home, most families wish to go home if a curative treatment option does not exist. Aims and Objectives: The study was done to analyze the preferences for the location of end-of-life care for families of children with cancer. We analyze the reasons for the same and offer suggestions for improving this situation. Materials and Methods: Parents of 77 children who died following a diagnosis of childhood cancer between 2019 and 2023, either due to progressive or refractory disease or due to toxic death, were interviewed to understand their choice of location for end-of-life care. The interview was done telephonically or face to face. Results: 41 out of 77 deaths were anticipated, and out of these, we observed that only 3 (7.3%) opted for a formal palliative care center. Fifteen families (36%) opted for end-of-life treatment in the hospital, and 23 families (56%) went home despite having no support at home for palliation. The decision is taken considering the practical needs of the rest of the family, although it is more difficult to implement. The reasons behind the decision are analyzed here. Conclusion: We recommend that integrated home-based palliation for end-of-life care in children be developed instead of hospice support. Hospices that take care of adults may be used with children where required. A multidisciplinary team that can support the needs of families and can visit them at home needs to be developed around centers managing children with cancer.

Light chain amyloidosis is a plasma–cell disorder with a poor prognosis. It is a progressive condition, causing worsening pain, disability, and life-limiting complications involving multiple organ systems. The medical regimen can be complex, including chemotherapy or immunotherapy for the disease itself, as well as treatment for pain, gastrointestinal and cardiorespiratory symptoms, and various secondary symptoms. Patients and their families must have a realistic awareness of the illness and of the goals and limitations of treatments in making informed decisions about medical therapy, supportive management, and end-of-life planning. Palliative care services can thus improve patients' quality of life and may even reduce overall treatment costs. Light chain (AL) amyloidosis is a clonal plasma cell disorder characterized by the excessive secretion of light chains by an indolent plasma cell clone that gradually accumulates in vital organs as amyloid fibrils and leads to end-organ damage. With progressive disease, most patients develop diverse clinical symptoms and complications that negatively impact quality of life and increase mortality. Complications include cardiac problems including heart failure, hypotension, pleural effusions, renal involvement including nephrotic syndrome with peripheral edema, gastrointestinal symptoms leading to anorexia and cachexia, complex pain syndromes, and mood disorders. The prognosis of patients with advanced AL amyloidosis is dismal. With such a complex presentation, and high morbidity and mortality rates, there is a critical need for the establishment of a palliative care program in clinical management. This paper provides an evidence-based overview of the integration of palliative care in the clinical management of AL amyloidosis as a means of reducing ER visits, rehospitalizations, and in-hospital mortality. We also discuss potential future collaborative directions in various aspects of clinical care related to AL amyloidosis. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to evaluate the efficacy and safety of metal stents compared with plastic stents when bilateral side‐by‐side stents were deployed for malignant hilar biliary obstruction (MHBO). Methods: Fifty patients with unresectable advanced MHBO were randomly assigned to the metal stent (MS, n = 25) or plastic stent group (PS, n = 25). Fully covered self‐expandable metal stents with 6 mm diameter and plastic stents with either 7F straight or double pigtail were used for MS and PS groups, respectively. Time to recurrent biliary obstruction (TRBO) was evaluated as the primary outcome. Results: Both groups had 100% technical success rates; 88% and 76% of clinical success rates were obtained in MS and PS, respectively. Although stent migrations were more frequent in MS than PS (48% vs. 16%, P = 0.02), the mean TRBO was significantly longer in MS (190 days; 95% confidence interval [CI] 121–260 days vs. 96 days; 95% CI 50–141 days, P = 0.02). The placement of plastic stents (hazard ratio 2.42; 95% CI 1.24–4.73; P = 0.01) was the only significant risk factor associated with TRBO in multivariable analysis. The rates of adverse events were similar between the two groups (difference 0%; 95% CI −25% to 25%; P > 0.99). Conclusions: During bilateral side‐by‐side deployment in MHBO, the use of metal stents appears to be preferable to plastic stents in terms of TRBO, despite a higher frequency of stent migration. [ABSTRACT FROM AUTHOR]

Patients with oncological diseases are very vulnerable to the action of psychological, physical and toxic stressors, requiring active monitoring by a multidisciplinary team. Quality of life and general well-being depend largely on early detection and the integration into case management of all aspects that influence the physical and mental health of these patients. In the context of the development of liaison psychiatry and psycho-oncology, this literature review emphasizes the importance of introducing psychotropic medication as soon as possible in combination with palliative medication to increase the quality of life of the terminally ill cancer patient. Based on the existing data in the literature, the main symptoms that require attention from the mental health specialists integrated into the team that ensures the case management of the oncological patient are pain, sleep disorders, lack of appetite, asthenia, anxiety, and depression. The initiation of psychotropic treatment in patients with oncological conditions must be early and must take into account all the somatic, psychological, social and pharmacological dimensions. In conclusion, the psychiatrist, as part of the multidisciplinary team that provides medical assistance to the oncological patient, is responsible for the early detection of psychiatric symptoms associated with the oncological condition, but also for initiating psychotropic medication as quickly as possible, along with monitoring its effectiveness and tolerability throughout the treatment. [ABSTRACT FROM AUTHOR]

Purpose of Review: Increasing life expectancy among patients with advanced cancer has placed a greater emphasis on optimizing pain control and quality of life. Concurrently, significant advancements in radiotherapy for bone metastases have permitted for dose escalation strategies such as stereotactic radiotherapy. This review aims to provide updated information on the management of bone metastases in light of these developments. Recent Findings: We reviewed recent studies regarding the role and details of external beam radiotherapy for bone metastases, with emphasis on differences by treatment site as well as intention (palliative versus ablative for oligometastases). Conventional palliative radiotherapy remains a mainstay of management. While stereotactic radiotherapy may augment durability of pain relief and even survival time, there are significant questions remaining regarding optimal dosing and patient selection. Summary: Radiotherapy for bone metastases continues to evolve, particularly with increasing use of stereotactic radiotherapy. Future studies are needed to clarify optimal dose, fractionation, modality, and patient selection criteria among different radiotherapy approaches. [ABSTRACT FROM AUTHOR]

This review of the palliation of various gastro-intestinal (GI) symptoms encountered in cancer patients is by no means exhaustive. Frequent symptoms such as constipation, nausea and vomiting, bowel obstructions, ascites and bleeds will be discussed, focusing on their assessment and most importantly, how to control the associated symptoms. All of these symptoms and GI complications can significantly impact patients' quality of life (QOL) and should be treated as quickly and aggressively as possible. [ABSTRACT FROM AUTHOR]

The surgeon's role in modern cancer management has evolved beyond that of technician with a scalpel and now encompasses a wide ranging role in diagnosis, counselling, screening, prevention, resource management and palliative care as well as the traditional role of surgical excision. Many surgeons also have an active academic interest at teaching hospitals, conducting cancer research and teaching in associated medical schools. The UK has three established cancer screening programmes for breast, cervical and colorectal cancer, where surgeons are required to perform clinical assessment, diagnostic biopsies and plan surgical treatments. The multidisciplinary team remains the cornerstone of cancer treatment in the UK and each oncological subspecialty has regular meetings to discuss tailored cancer treatment for each individual. Alongside oncologists, radiologists, specialist nurses and pathologists, the surgeon is a key member of this multidisciplinary team and in the decision-making process. There are many different surgical techniques available for surgical treatment of cancer, many of which allow a minimally invasive approach including laparoscopic, endoscopic and robotic surgery. The progress of medical genetics and gene profiling now allows identification of 'at-risk' individuals for specific types of cancer where prophylactic or risk reducing surgery may be of benefit. Cancer treatment may result in disfigurement and loss of function, so reconstructive surgery is now an Integral part of cancer management. Patients with advanced disease can often be helped by surgery to relieve symptoms and improve the quality of their remaining life and so the surgeon may play a key role in end-of-life care. [ABSTRACT FROM AUTHOR]

The purpose of this article is to explore social inequity in palliative care in Denmark, a country that is seen as a stronghold of universal health care. Using data stemming from 2 years of research, we have selected two cases for analysis. They consist of palliative conversations with two quite different patients. Drawing on sociocultural class theory, we find that the conversations involve social exclusion processes due to discourses of active ageing. We find that one privileged patient performs in line with an entrepreneurial self and is supported by the nurse. The other, disadvantaged patient performs in a passive way, and the conversation mainly alleviates the disrespect he has experienced in healthcare encounters. We conclude that palliative care reinforces classifying practices and distinctions between "good" and "bad" patients, when active ageing becomes a dominant factor. We suggest improving the quality and sensitivity of medical training and call for increased reflexivity among professionals on the unequal situation of patients in order to reduce inequity in access to health care when close to death. [ABSTRACT FROM AUTHOR]

Background: Palliative care is underrepresented in our community at large. End-of-life care is offered mainly in palliative care hospices or hospitals worldwide. As access to such a facility is often sparse, and since many of them are located far away from home, most families wish to go home if a curative treatment option does not exist. Aims and Objectives: The study was done to analyze the preferences for the location of end-of-life care for families of children with cancer. We analyze the reasons for the same and offer suggestions for improving this situation. Materials and Methods: Parents of 77 children who died following a diagnosis of childhood cancer between 2019 and 2023, either due to progressive or refractory disease or due to toxic death, were interviewed to understand their choice of location for end-of-life care. The interview was done telephonically or face to face. Results: 41 out of 77 deaths were anticipated, and out of these, we observed that only 3 (7.3%) opted for a formal palliative care center. Fifteen families (36%) opted for end-of-life treatment in the hospital, and 23 families (56%) went home despite having no support at home for palliation. The decision is taken considering the practical needs of the rest of the family, although it is more difficult to implement. The reasons behind the decision are analyzed here. Conclusion: We recommend that integrated home-based palliation for end-of-life care in children be developed instead of hospice support. Hospices that take care of adults may be used with children where required. A multidisciplinary team that can support the needs of families and can visit them at home needs to be developed around centers managing children with cancer. [ABSTRACT FROM AUTHOR]

Purpose: Spinal metastases (SM) are a common radiotherapy (RT) indication. There is limited level I data to drive decision making regarding dose regimen (DR) and target volume definition (TVD). We aim to depict the patterns of care for RT of SM among German Society for Radiation Oncology (DEGRO) members. Methods: An online survey on conventional RT and Stereotactic Body Radiation Therapy (SBRT) for SM, distributed via e‑mail to all DEGRO members, was completed by 80 radiation oncologists between February 24 and April 29, 2022. Participation was voluntary and anonymous. Results: A variety of DR was frequently used for conventional RT (primary: n = 15, adjuvant: n = 14). 30 Gy/10 fractions was reported most frequently. TVD in adjuvant RT was heterogenous, with a trend towards larger volumes. SBRT was offered in 65% (primary) and 21% (adjuvant) of participants' institutions. A variety of DR was reported (primary: n = 40, adjuvant: n = 27), most commonly 27 Gy/3 fractions and 30 Gy/5 fractions. 59% followed International Consensus Guidelines (ICG) for TVD. Conclusion: We provide a representative depiction of RT practice for SM among DEGRO members. DR and TVD are heterogeneous. SBRT is not comprehensively practiced, especially in the adjuvant setting. Further research is needed to provide a solid data basis for detailed recommendations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Continuous outpatient inotrope infusion therapy (COIIT) can be used as palliative or interim treatment in patients with advanced heart failure (AHF). Despite widespread use, there is a relative lack of data informing best practices. This study aimed to examine whether patterns of COIIT use differed by region and to explore whether observed differences influenced clinical outcomes. METHODS: Retrospective study of AHF patients receiving COIIT from May 2009 through June 2016. The primary outcome was regional difference, the secondary outcome was persistence (duration) on therapy. Cox proportional hazards model was used to calculate hazard ratios for treatment regimens. RESULTS: There were 3,286 patients, mean (SD) age 61.9 (14.4) years and 74.0% (2,433) male. Inotrope selection and beta blocker use varied by region by chi square (χ2 (21) = 166.9, p

Children diagnosed with life-limiting or life-threatening diseases are at risk of complex, chronic, multisystemic illnesses due to immune system deficiencies and significant organ fragility. There is little research on the dental care of children with such serious pathology, where oral and general health is compromised. Our study aims to investigate the impact of terminal illnesses on oral health, identifying oral and dental deficiencies present in a group of 35 children diagnosed with life-limiting diseases, between 2015-2022, in the palliative care services at the Palliative Care Center for Children – Lumina Association Bacau, Romania. Material and method: The study consists of retrospective analysis of data from medical records of children diagnosed with life-threatening illnesses. Results: The 35 children included in the study provided us with essential information about the types of dental conditions they face and the role of the dentist qualified for palliative care as an integral part of medical management. Against the backdrop of immunosuppression, the main odontogenic conditions encountered in the children in the study group were: Dental caries, gingival inflammation or bleeding, recurrent fungal and viral infections, malocclusion or dental alignment deficiencies; edentulism, dysfunctional tooth development, oral hygiene deficiencies, nutritional deficiencies, dysphagia, xerostomia, facial aesthetic deficiencies and compromised speech ability, all of which deteriorate quality of life and put it at risk. Conclusions: Pediatric patients diagnosed with life-limiting diseases are prone to premature loss of oral health through severe odontogenic dysfunction. The palliative care dentist must identify, assess and alleviate these difficulties through specific actions designed to alleviate symptoms and minimise pain and suffering. Psychological counselling must precede any medical, therapeutic and palliative care act.

Aim: The purpose of this study is to explore the experiences physiotherapists have in providing physiotherapy treatment to residents with long-term care in Norwegian nursing homes, and to look at how physiotherapists are involved in the treatment of residents in the end-of-life phase. Method and material: This article is based on exploratory qualitative interviews with six physiotherapists who work in nursing homes. The interviews were semi-structured and the data was analyzed with systematic text condensation. Findings: The participants largely adopt a traditional physiotherapist role with focus on physical exercises. They recognize that physiotherapists have knowledge and skills that are relevant to residents at the end of life but are scarcely involved in the interdisciplinary team that care for the dying person. Conclusion: Physiotherapists who work in long-term wards in nursing homes spend most of their time on traditional physiotherapy. The participants are not involved in end-of-life treatment or care, but believe that physiotherapists have relevant knowledge and are thus an unexploited resource. The lack of physiotherapists in the multidisciplinary palliative team is a result of the physiotherapists themselves not expressing that they want to contribute, and doctors and nurses not requiring their knowledge in this area. The organization of the physiotherapy service in nursing homes also influences interdisciplinary collaboration.

Background and purpose: This large population-based, retrospective, single-center study aimed to identify prognostic factors in patients with brain metastases (BM) from gynecological cancers. Material and methods: One hundred and forty four patients with BM from gynecological cancer treated with radiotherapy (RT) were identified. Primary cancer diagnosis, age, performance status, number of BM, presence of extracranial disease, and type of BM treatment were assessed. Overall survival (OS) was calculated using the Kaplan–Meier method and the Cox proportional hazards regression model was used for multivariable analysis. A prognostic index (PI) was developed based on scores from independent predictors of OS. Results: Median OS for the entire study population was 6.2 months. Forty per cent of patients died within 3 months after start of RT. Primary cancer with the origin in cervix or vulva (p = 0.001), Eastern Cooperative Oncology Group (ECOG) 3–4 (p < 0.001), and the presence of extracranial disease (p = 0.001) were associated with significantly shorter OS. The developed PI based on these factors, categorized patients into three risk groups with a median OS of 13.5, 4.0, and 2.4 months for the good, intermediate, and poor prognosis group, respectively. Interpretation: Patients with BM from gynecological cancers carry a poor prognosis. We identified prognostic factors and developed a scoring tool to select patients with better or worse prognosis. Patients in the high-risk group have a particular poor prognosis, and omission of RT could be considered.

Introduction: When a seriously ill and dying parent is hospitalized, the families are at risk of developing problems. Only sparse evidence is available on the effects of creating family-friendly rooms in hospitals. Aim: This study investigates how a seriously ill parent to children aged 0–18 experiences staying in a hospital room with family-friendly furnishing. Methods: From September 2012 to September 2015, seriously ill and dying patients with children ages 0–18 were offered the opportunity to stay in a family-friendly room at the North Denmark Regional Hospital. The sick parents were interviewed about how the changed room impacted themselves, their children, and their family. Results: The analysis led to three themes: (1) The ability to visit a sick parent, (2) maintaining family functions and relationships, and (3) room for children and adults. Conclusion: By offering the families a hospital room with cozy furniture and a big TV screen, seriously ill parents see that their children are more comfortable when visiting the hospital. A family-friendly hospital is not just an idealistic thought, it is a real opportunity to improve the final period of a dying parent's life. [ABSTRACT FROM AUTHOR]

Corticosteroids are commonly prescribed in oncology, but few studies have examined its adverse events (AEs) compared to placebo control. Using data from a double-blind, placebo-controlled randomized trial, we evaluated the association between the dose and duration of dexamethasone and serious AEs. This is a pre-planned secondary analysis of the Alleviating Breathlessness in Cancer Patients with Dexamethasone (ABCD) trial in which patients were randomized to dexamethasone 8 mg BID x1 week, then 4 mg BID x1 week or placebo, followed by an optional open-label phase with 4 mg BID x1 week, then 2 mg BID x1 week. The primary outcome was Grade 3+ AEs (CTCAE v4.03). We evaluated the association between AEs and dexamethasone exposure using multivariable logistic regression. Among 119 cancer patients, 32 received intervention followed by open label (mean exposure 243 mg over 27 days), 47 received intervention with no open label, 20 received placebo followed by open label, and 20 received no dexamethasone. The most common AEs included insomnia (31%), dyspepsia (21%), neuropsychiatric symptoms (18%), and infections (17%). Overall, 38 (32%) had Grade 3+ AEs and 27 (23%) were hospitalized. Patients with the greatest exposure to dexamethasone experienced more Grade 3+ AEs compared to those with no exposure (65% vs. 15%); odds ratio of 15.1 (95% CI 1.4–160.8, P = 0.01). Greater dexamethasone exposure, even at moderate doses, was associated with more serious AEs. Prescribers should cautiously weigh the risks and benefits of dexamethasone use, especially when considering for palliation of symptoms. [ABSTRACT FROM AUTHOR]

Simple Summary: Despite ongoing medical advancements, glioblastoma remains a nearly uniformly fatal disease with a median survival of less than two years. This is largely attributable to its aggressive infiltration of surrounding brain parenchyma, which leads to a high risk of locoregional recurrence after the first line of therapy. Many strategies have been explored in an attempt to improve locoregional control, including hypofractionation. Here, we review a range of preclinical and clinical research on hypofractionation in the neoadjuvant, adjuvant, and recurrent or palliative setting. Additionally, we discuss novel hypofractionation strategies currently under investigation, such as FLASH radiotherapy. Glioblastoma (GBM) is the most common primary brain malignancy in adults, and its incidence is increasing worldwide. Its prognosis remains limited despite recent imaging and therapeutic advances. The current standard of care is maximal safe resection followed by conventionally fractionated radiotherapy with concurrent and adjuvant temozolomide (TMZ), with or without tumor-treating fields (TTF). However, hypofractionated radiotherapy (HFRT) has also been utilized for a variety of reasons. It is an established treatment option in the palliative setting, where shortened treatment duration can positively impact the overall quality of life for older patients or those with additional health or socioeconomic considerations. HFRT, and in particular stereotactic radiosurgery (SRS), has also been explored in both the pre- and post-operative setting for newly diagnosed and recurrent diseases. In this review, we summarize the ways in which HFRT has been utilized in the GBM patient population and its evolving role in the experimental space. We also provide commentary on scenarios in which HFRT may be indicated, as well as guidance on dose and fractionation regimens informed by our institutional experience. [ABSTRACT FROM AUTHOR]

Introduction: Women with advanced ovarian cancer commonly present with peritoneal disease both at primary diagnosis and relapse, with risk of subsequent bowel obstruction. The aims of this study were to assess the cumulative incidence of and survival after intervention for bowel obstruction in women with advanced ovarian cancer, to identify factors predictive of survival and the extent to which the intended outcome of the intervention was achieved. Material and methods: Women diagnosed with advanced ovarian cancer stages III and IV in 2009–2011 and 2014–2016 in the Stockholm‐Gotland Region in Sweden were identified in the Swedish Quality Registry for Gynecologic Cancer. Through hospital records, types of intended and executed interventions for bowel obstruction were assessed, and as well as when in the course of oncologic treatment, the intervention was performed. Time from first intervention to death was analyzed with survival methodology and proportional hazard regression was used. Results: Of 751 identified women, 108 had an intervention for bowel obstruction. Laparotomy was the most prevalent intervention and was used in 87% (94/108) of all women, with a success rate of 87% (82/94). An intervention for bowel obstruction was performed before or during first line treatment in 32% (35/108) with a cumulative incidence in the whole cohort of 14% (108/751, 95% confidence interval [CI] 11–16). Median survival after intervention for bowel obstruction was 4 months (95% CI 3–6). The hazard of death increased when the intervention was performed after completion of primary treatment (HR 4.46, 95% CI 1.61–12.29, P < 0.01), with a median survival of 3 months. In women subjected to radical surgery during primary treatment, the hazard of death after intervention for bowel obstruction decreased (hazard ratio [HR] 0.54, 95% CI 0.32–0.91, P = 0.02). Conclusions: Women with advanced ovarian cancer undergoing intervention for bowel obstruction have a dismal prognosis, regardless of which line of oncologic treatment the intervention was performed. In the majority of women an intervention for bowel obstruction was performed in a relapse situation with an even worse survival. Our findings emphasize the importance of a holistic approach in the decision‐making before an intervention for bowel obstruction in women with advanced ovarian cancer. [ABSTRACT FROM AUTHOR]

Palliative chemotherapy options for dogs with macroscopic non‐osseous mesenchymal tumours are limited. The purpose of this study was to assess the response rate of these tumours to carboplatin chemotherapy. Medical records of 28 dogs treated with carboplatin for macroscopic mesenchymal neoplasia between 1990 and 2022 were retrospectively reviewed. Sixteen dogs with soft tissue sarcoma and 12 dogs with haemangiosarcoma were included. Responses observed included one complete response and three partial responses, for an overall response rate of 14.2% (4/28) and median time to progression of 42 days (range 21–259 days). Responses were only seen in patients with haemangiosarcoma, for a response rate of 33.3% (4/12) and median time to progression for responders of 103 days (range 39–252 days). Median time to progression for dogs with metastatic disease was similar to those with only local disease (distant median: 44 days; local median: 23 days, p = 0.56). Dogs with chemotherapy‐naïve disease were compared to dogs having received previous chemotherapy treatment and had a median time to progression of 75 days and 40.5 days respectively (p = 0.13). Twenty‐two dogs experienced 48 adverse events, with most being grade 1 or 2 (79%). Carboplatin was well tolerated, with variable macroscopic anti‐tumour activity and short response duration. Carboplatin may be an acceptable rescue option for dogs with macroscopic haemangiosarcoma, especially those patients that cannot receive doxorubicin. [ABSTRACT FROM AUTHOR]

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is often used to provide internal biliary drainage in patients with unresectable perihilar cholangiocarcinoma; however, clinical success is not achieved in some patients. The aim of this study was to evaluate the factors associated with clinical success of ERCP with biliary drainage in unresectable perihilar cholangiocarcinoma. Methods: We retrospectively evaluated 68 patients with unresectable perihilar cholangiocarcinoma who underwent ERCP with biliary drainage from 2010 to 2018. Patients received either unilateral or bilateral metallic stents. Unsuccessful biliary drainage was defined as a reduction in serum bilirubin of less than 50% from baseline levels within 2 weeks. Student’s t-test and Pearson’s Chi-square test were utilized for analyses. Results: The rate of successful biliary drainage was 60.3%. Elective biliary drainage exhibited a significantly higher success rate compared to emergency biliary drainage [odds ratio (OR)=3.903, 95% CI, 1.212-12.566, P=.032]. High serum total bilirubin was associated with a significantly higher success rate compared to low serum total bilirubin (OR=1.069, 95% CI, 1.008-1.134, P=.025). Conclusion: Higher serum total bilirubin levels and elective intervention were identified as factors affecting the success rate of ERCP with biliary drainage. These factors should be assessed to identify patients who might benefit from this procedure. [ABSTRACT FROM AUTHOR]

Simple Summary: Palliative endoscopy has a fundamental role in the management of patients with advanced bilio-pancreatic cancers, which can involve the biliary tract and infiltrate the duodenal lumen or other close organs. Clinical presentations of these advanced cancers are mainly gastric outlet obstruction (GOO), obstructive jaundice, and unresponsive pain, which influence the patient's quality of life (QoL) and the oncologic management in terms of initiating or restarting systemic therapy. Our aim was to perform a literature review focusing on the role of endoscopy in the palliation of these advanced pancreatic and biliary cancers. Therapeutic endoscopy permits many and various treatments for cancer palliation in patients with bilio-pancreatic cancers, enabling different options, supporting patients during their route to oncologic treatments, and trying to improve their quality of life. Therefore, both endoscopic and endoscopic ultrasound (EUS)-guided techniques are performed in this scenario. We performed a literature review focusing on the role of endoscopy in the palliation of those advanced pancreatic and biliary cancers developing malignant biliary obstruction (MBO), gastric outlet obstruction (GOO), and pain unresponsive to medical therapies. Therefore, we explored and focused on the clinical outcomes of endoscopic procedures in this scenario. In fact, the endoscopic treatment is based on achieving biliary drainage in the case of MBO through endoscopic retrograde cholangiopancreatography (ERCP) or EUS-guided biliary drainage (EUS-BD), while GOO is endoscopically treated through the deployment of an enteral stent or the creation of EUS-guided gastro-entero-anastomosis (EUS-GEA). Furthermore, untreatable chronic abdominal pain is a major issue in patients unresponsive to high doses of painkillers, so EUS-guided celiac plexus neurolysis (CPN) or celiac ganglia neurolysis (CGN) helps to reduce dosage and have better pain control. Therefore, therapeutic endoscopy in the palliative setting is an effective and safe approach for managing most of the clinical manifestations of advanced biliopancreatic tumors. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether patients with advanced cancer prefer surgeons to use the best case/worst case (BC/WC) communication framework over the traditional risk/benefit (R/B) framework in the context of palliative surgical scenarios. Background: Identifying the patient's preferred communication frameworks may improve satisfaction and outcome measures during difficult clinical decision-making. Methods: In a video-vignette--based randomized, double-blinded study from November 2020 to May 2021, patients with advanced cancer viewed 2 videos depicting a physician-patient encounter in a palliative surgical scenario, in which the surgeon uses either the BC/WC or the R/B framework to discuss treatment options. The primary outcome was the patients' preferred video surgeon. Results: One hundred fifty-five patients were approached to participate; 66 were randomized and 58 completed the study (mean age 55.8 ± 13.8 years, 60.3% males). 22 patients (37.9%, 95% CI: 25.4%--50.4%) preferred the surgeon using the BC/WC framework, 21 (36.2%, 95% CI: 23.8%--48.6%) preferred the surgeon using the R/B framework, and 15 (25.9%, 95% CI: 14.6%--37.2%) indicated no preference. High trust in the medical profession was inversely associated with a preference for the surgeon using BC/WC framework (odds ratio: 0.83, 95% CI: 0.70--0.98, P = 0.03). The BC/WC framework rated higher for perceived surgeon's listening (4.6 ± 0.7 vs 4.3 ±0.9, P = 0.03) and confidence in the surgeon's trustworthiness (4.3 ± 0.8 vs 4.0 ± 0.9, P = 0.04). Conclusions: Surgeon use of the BC/WC communication framework was not universally preferred but was as acceptable to patients as the traditional R/B framework and rated higher in certain aspects of communication. A preference for a surgeon using BC/WC was associated with lower trust in the medical profession. Surgeons should consider the BC/WC framework to individualize their approach to challenging clinical discussions. [ABSTRACT FROM AUTHOR]

Deciding whether to transition to wound palliation is challenging for health care professionals because there is no agreed definition or understanding of palliative wound care, including the goals, core elements and differences from general wound management. To conduct a scoping review with qualitative synthesis to define palliative wound care in terms of its conceptual framework, goals, principles, components, and differences from general wound management, and provide a new definition of palliative wound care based on this scoping review. Published literature that refers to the definitions, concept, goals and core elements of palliative wound care using any methodological approach, without any time limits, published in English. The searches were conducted in CINAHL Complete via Ebsco, Medline via Ovid, Cochrane Library, Scopus, and Google Scholar. A data extraction form was developed by the review team and used independently for data charting purposes. Braun and Clarke's six phases of thematic analysis guided the qualitative synthesis. A total of 133 publications met the inclusion criteria. Three main themes were developed to define palliative wound care and understand its differences from general wound management: 1- Healing potential of wounds and patient vulnerability, 2- Understanding the impact on individuals and family to address needs, 3- Towards new goals and perspectives in approach to care. Palliative wound care focuses on symptom management, comfort, and dignity, but does not always target the healing of the wound, which is the goal of general wound care. The needs of the individual and their family must be addressed by clinicians through the provision of care and support that takes into account the true meaning of living and dying with a palliative wound. A review protocol was developed but not registered. • We propose a new person- and family-centred definition of palliative wound care that is holistic and interdisciplinary. • Palliative wound care differs from general wound care and is not limited to symptom control and management. • It focuses on protecting comfort and dignity and targets both wounds that may or may not heal. • Palliative wound care includes treatment of persons who are vulnerable and have impaired quality of life. • The true meaning of living and dying with a palliative wound must be understood to align care with patient and family needs. [ABSTRACT FROM AUTHOR]

Oncological gastrectomy, despite remaining a mainstay of gastric cancer treatment, is reportedly associated with high morbidity and mortality in elderly patients. Less invasive modalities suitable for senior gastric cancer patients with insufficient surgical tolerance are thus needed. We adopted laparoscopic and endoscopic cooperative surgery as an alternative for elderly gastric cancer cases unsuitable for aggressive gastrectomy. To date, we have experienced three cases (80–86 years old) undergoing palliative laparoscopic and endoscopic cooperative surgery. Postoperative courses were uneventful in two cases, while sutural leakage occurred in the other, which was managed conservatively. Postoperative loss of body weight and skeletal muscle mass appeared to be minimal according to bioelectrical impedance analyses. No gastric cancer recurrence was detected in any of our three cases. As to the balance between radicality and safety, laparoscopic and endoscopic cooperative surgery is potentially a viable option for geriatric gastric cancer patients in whom conventional gastrectomy is contraindicated. [ABSTRACT FROM AUTHOR]