Symptom management and ethics needs in patients with cancer and non-cancer advanced diseases
The November 2024 issue of Annals of Palliative Medicine features 7 Original Articles, 2 Brief Reports, 9 Review Articles, 1 Editorial Commentary, 1 Editorial, 1 Case Report, and several Letters to the Editor. That issue also features articles on the most downloaded articles published in Annals of Palliative Medicine in 2023 and the top reviewers for the journal in 2023, each of which are worthy of special highlighting.
This Message From the Editor-in-Chief focuses on an Original Article from Kojima and colleagues from Japan assessing the needs of patients with non-cancer diseases and their families from hospital-based specialized palliative care teams (1). Such hospital-based specialized palliative care teams were developed for patients with palliative care needs and their families to focus on alleviating suffering, and they have been shown to improve quality of life, reduce patient symptom burden, and improve satisfaction with care (2-4). Most reports to date assessing the value of these specialized palliative care teams, however, have been in populations of patients with cancer. In fact, only 5.3% of cases in the hospital-based specialized palliative care teams registry of the Japanese Society of Palliative Medicine are non-cancer diseases (5). While cancer has been and is projected to continue to be a leading cause of death and health-related suffering, the highest proportional increase in suffering is expected to be in non-cancer conditions, including dementia (6). Therefore, a greater understanding of palliative care needs in the non-cancer population is critical.
Retrospectively analyzing 761 patients referred to the hospital-based specialized palliative care team at the National Center for Geriatrics and Gerontology in Aichi, Japan from 2011 to 2020, including 401 with cancer and 360 without cancer, Kojima and colleagues compared the prevalence of symptom between patients with and without cancer, and they examined changes in symptom intensity after hospital-based specialized palliative care team consultation in patients with non-cancer diseases (1). Dementia, chronic lung disease, and cerebrovascular disorders accounted for two-thirds of non-cancer diseases in their cohort. Patients with non-cancer diseases were older and more often female than those with cancer.
Symptom intensity was assessed using the symptom scores of the Support Team Assessment Schedule between initial and 1-week assessments. One week after the first visit, patients with non-cancer diseases had more dyspnea and sputum production than patients with cancer, whereas those with cancer had greater suffering from pain, numbness, fatigue, nausea, vomiting, constipation, and anxiety than those with non-cancer diseases. Kojima et al. also identified how symptom intensity changed over time in patients with non-cancer diseases. Most symptoms, including pain, dyspnea and anorexia, showed improvements in symptom scores after 1 week of hematopoietic stem and progenitor cell (HSPC) involvement, whereas sputum accumulation was not improved.
The findings in this Japanese cohort add to the recent literature published by Fordjour and colleagues from The University of Hong Kong in the May 2024 issue of Annals of Palliative Medicine focusing on symptom burden in terminally ill patients by (7,8). In that analysis, non-cancer patients were more likely to rank poor mobility as the most distressing symptom, whereas family anxiety was the most distressing symptom among cancer patients. Significant differences across disease types were also seen among perceived physical symptom burden intensity and emotional symptoms. Across symptoms, those investigators found non-cancer patients perceived a higher burden of physical symptoms, emotional symptoms, and communication/practical issues (7).
Beyond physical symptoms, it is noteworthy that Kojima et al. also assessed factors related to ethics support, which they defined as helping patients and their families make complex decisions. They did this by assessing the presence or absence of ethics support requests, and they compared ethics support between patients with cancer and non-cancer diseases. They found that patients with non-cancer diseases, especially those with dementia, received greater ethics support than those with cancer without dementia. Interestingly, there was a greater request for ethics support by geriatric care nurses than palliative care nurses within the hospital-based specialized palliative care teams. As expected, ethics support was more commonly requested when patients or families had impaired decision-making capacity or lacked an advocate.
The authors should be commended for their large cohort report that they describe as the first study to clarify the needs of patients and families from hospital-based specialized palliative care teams for patients with non-cancer diseases in Japan. While it should be noted that the National Center for Geriatrics and Gerontology is a highly specialized center for dementia and geriatric care, and so the findings by Kojima and colleagues may not be widely generalizable, it is clear from their investigation that hospital-based specialized palliative care teams should focus on symptom management and also provide ethics support. Among the needs of patients with advanced non-cancer diseases and their families, symptom management for intractable conditions, such as sputum accumulation, is critical. Furthermore, ethics support is similarly critical, particularly for cases requiring complex decision making and for patients with dementia and impaired decision-making capacity and without advocates.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine. The article did not undergo external peer review.
Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-25-9/coif). The author serves as the co-Editor-in-Chief of Annals of Palliative Medicine from April 2014 to April 2027. The author has no other conflicts of interest to declare.
Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Kojima H, Doi N, Takanashi S, et al. The needs of patients with noncancer diseases and their families from hospital-based specialized palliative care teams in Japan. Ann Palliat Med 2024;13:1385-400. [Crossref] [PubMed]
- Bajwah S, Oluyase AO, Yi D, et al. The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2020;9:CD012780. [PubMed]
- Schelin MEC, Fürst CJ, Rasmussen BH, et al. Increased patient satisfaction by integration of palliative care into geriatrics-A prospective cohort study. PLoS One 2023;18:e0287550. [Crossref] [PubMed]
- Ng AYM, Wong FKY. Effects of a Home-Based Palliative Heart Failure Program on Quality of Life, Symptom Burden, Satisfaction and Caregiver Burden: A Randomized Controlled Trial. J Pain Symptom Manage 2018;55:1-11. [Crossref] [PubMed]
- Palliative Care Team. Registration (Japanese Society for Palliative Medicine). [Accessed 25 November, 2024]. Available online: https://www.jspm.ne.jp/files/palliativeCareTeam/report_jspmpct2022.pdf
- Sleeman KE, de Brito M, Etkind S, et al. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions. Lancet Glob Health 2019;7:e883-92. [Crossref] [PubMed]
- Fordjour GA, Chow AYM, Hui VK, et al. Comparative analysis of symptom burdens and influential factors among diverse terminally-ill patients. Ann Palliat Med 2024;13:513-30. [Crossref] [PubMed]
- Simone CB 2nd. Physical, emotional, and practical symptom burden in patients with terminal illnesses. Ann Palliat Med 2024;13:744-6. [Crossref] [PubMed]
