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Klastersky J, Libert I, Libert Y, Echterbille MA. A new comprehensive and stratified concept for supportive care in cancer patients. Curr Opin Oncol 2024; 36:206-210. [PMID: 38726807 DOI: 10.1097/cco.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Supportive care in oncology has evolved alongside effective anticancer treatments since the 1960s, beginning with the advent of chemotherapy for acute leukemia. It was initially focused on managing treatment-induced complications, and expanded to address broader aspects of patient well being; the scope of supportive care needs to be periodically re-assessed. RECENT FINDINGS Early palliative care interventions, and more recently advance care planning emerged as vital components, improving patient outcomes and quality of life. Despite barriers, such as prognostic uncertainty, these approaches have demonstrated significant benefits for patients with advanced disease. Additionally, the management of cancer survivors requires ongoing medical surveillance and psycho-social support. In the last years, integrative medicine has also emerged as a complementary approach to address survivors' holistic needs. SUMMARY A proposed stratified model of supportive care emphasizes interventions based on patients' prognosis, with interdisciplinary collaboration ensuring comprehensive care across all stages of the cancer journey. This model provides a framework for the development of integrated supportive care units.
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Affiliation(s)
- Jean Klastersky
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Oncology
| | - Isabelle Libert
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Oncology
| | - Yves Libert
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Service de Psychologie (Secteur Psycho-Oncologie)
- Université libre de Bruxelles (ULB), Faculté de Psychologie, Sciences de l'Éducation et Logopédie, Unité de Recherche en Psychosomatique et Psycho-oncologie (URPP)
| | - Marie-Aline Echterbille
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Department of Medical Oncology
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Medical Direction, Bruxelles, Belgium
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Krooupa AM, Stone P, McKeever S, Seddon K, Davis S, Sampson EL, Tookman A, Martin J, Nambisan V, Vivat B. Do palliative care patients and relatives think it would be acceptable to use Bispectral index (BIS) technology to monitor palliative care patients' levels of consciousness? A qualitative exploration with interviews and focus groups for the I-CAN-CARE research programme. BMC Palliat Care 2022; 21:86. [PMID: 35610644 PMCID: PMC9131519 DOI: 10.1186/s12904-022-00949-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Bispectral index (BIS) monitoring uses electroencephalographic data as an indicator of patients' consciousness level. This technology might be a useful adjunct to clinical observation when titrating sedative medications for palliative care patients. However, the use of BIS in palliative care generally, and in the UK in particular, is under-researched. A key area is this technology's acceptability for palliative care service users. Ahead of trialling BIS in practice, and in order to ascertain whether such a trial would be reasonable, we conducted a study to explore UK palliative care patients' and relatives' perceptions of the technology, including whether they thought its use in palliative care practice would be acceptable. METHODS A qualitative exploration was undertaken. Participants were recruited through a UK hospice. Focus groups and semi-structured interviews were conducted with separate groups of palliative care patients, relatives of current patients, and bereaved relatives. We explored their views on acceptability of using BIS with palliative care patients, and analysed their responses following the five key stages of the Framework method. RESULTS We recruited 25 participants. There were ten current hospice patients in three focus groups, four relatives of current patients in one focus group and one individual interview, and eleven bereaved relatives in three focus groups and two individual interviews. Our study participants considered BIS acceptable for monitoring palliative care patients' consciousness levels, and that it might be of use in end-of-life care, provided that it was additional to (rather than a replacement of) usual care, and patients and/or family members were involved in decisions about its use. Participants also noted that BIS, while possibly obtrusive, is not invasive, with some seeing it as equivalent to wearable technological devices such as activity watches. CONCLUSIONS Participants considered BIS technology might be of benefit to palliative care as a non-intrusive means of assisting clinical assessment and decision-making at the end of life, and concluded that it would therefore be acceptable to trial the technology with patients.
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Affiliation(s)
- Anna-Maria Krooupa
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.
| | - Patrick Stone
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Stephen McKeever
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kathy Seddon
- grid.419428.20000 0000 9768 8171Marie Curie Palliative Care Research Voices, London, UK
| | - Sarah Davis
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Elizabeth L. Sampson
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Adrian Tookman
- grid.419428.20000 0000 9768 8171Marie Curie Hospice Hampstead, London, UK ,Field Editor Cochrane; Palliative and Supportive Care, Oxford, UK
| | - Jonathan Martin
- grid.450578.b0000 0001 1550 1922Central & North West London NHS Foundation Trust, London, UK ,grid.52996.310000 0000 8937 2257National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Bella Vivat
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
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Ahn HK, Ahn HY, Park SJ, Hwang IC. Characteristics Associated with Survival in Patients Receiving Continuous Deep Sedation in a Hospice Care Unit. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2021; 24:254-260. [PMID: 37674644 PMCID: PMC10180067 DOI: 10.14475/jhpc.2021.24.4.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/07/2021] [Accepted: 09/30/2021] [Indexed: 09/08/2023]
Abstract
Continuous deep sedation (CDS) is an extreme form of palliative sedation to relieve refractory symptoms at the end of life. In this study, we shared our experiences with CDS and examined the clinical characteristics associated with survival in patients with terminal cancer who received CDS. We conducted a chart audit of 106 consecutive patients with terminal cancer who received CDS at a single hospice care unit between January 2014 and December 2016. Survival was defined as the first day of admission to the date of death. The associations between clinical characteristics and survival were presented as hazard ratios and 95% confidence intervals using a Cox proportional hazard model. The mean age of participants was 65.2 years, and 33.0% (n=35) were women. Diazepam was the most commonly administered drug, and haloperidol or lorazepam were also used if needed. One sedative was enough for a majority of the patients. Stepwise multivariate analysis identified poor functioning, a high Palliative Prognostic Index score, hyperbilirubinemia, high serum ferritin levels, and a low number of sedatives as independent poor prognostic factors. Our experiences and findings are expected to be helpful for shared decision-making and further research on palliative sedation.
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Affiliation(s)
- Hee Kyung Ahn
- Oncology Division, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Hong Yup Ahn
- Department of Statistics, Dongguk University, Seoul, Korea
| | | | - In Cheol Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Refractory psycho-existential distress and continuous deep sedation until death in palliative care: The French perspective. Palliat Support Care 2021; 18:486-494. [PMID: 31551106 DOI: 10.1017/s1478951519000816] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Since February 2016, French Claeys-Leonetti law has recognized patients' right to confront incurable diseases with short-term prognosis and refractory physical or psychological or existential symptoms by requesting continuous deep sedation until death (CDSUD). Determining when psychological or existential distress is refractory and unbearable remains complex and controversial.This review provides a comprehensive thought on CDSUD for advanced incurable patients with refractory psychological and/or existential distress in palliative care settings. It offers guidance on psychiatric or psychological diagnosis for explaining patients' requests for CDSUD. METHOD A narrative literature review (2000-2019) was conducted on the MedLine search about the use of palliative sedation in cases of refractory psychological and/or existential distress. RESULTS (1) Definitions of "refractory symptom," "refractory psychological distress," and "refractory existential distress" are inconsistent; (2) alternative diagnoses might obscure or be obscured by psycho-existential distress; and (3) criteria on meanings, reasons for requests, decision-making processes, and functions are evolving in practice. SIGNIFICANCE OF RESULTS Before implementing CDSUD, palliative healthcare professionals should seek input from psycho-oncologists in palliative care. Mental health professionals should analyze and assess the reasons for psychological and/or existential distress, consider the intentionality processes of requests, and explore alternative diagnoses, such as depressive or adjustment disorders, demoralization syndrome, desire to hasten death, and desire for euthanasia. Therapeutic responses (e.g., pharmacological and psychotherapeutic) should be implemented before deciding that psycho-existential distress is refractory.
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Gamblin V, Berry V, Tresch-Bruneel E, Reich M, Da Silva A, Villet S, Penel N, Prod'Homme C. Midazolam sedation in palliative medicine: retrospective study in a French center for cancer control. BMC Palliat Care 2020; 19:85. [PMID: 32560644 PMCID: PMC7305615 DOI: 10.1186/s12904-020-00592-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 06/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND French legislation about sedation in palliative medicine evolved in 2016 with the introduction of a right to deep and continuous sedation, maintained until death. The objective was to describe midazolam sedation at the COL (Centre Oscar Lambret [Oscar Lambret Center], French regional center for cancer control), in order to establish a current overview before the final legislative changes. METHODS Descriptive, retrospective and single-center study, concerning major patients in palliative care hospitalized from 01/01/2014 to 12/31/2015, who had been sedated by midazolam. The proven sedations (explicitly named) and the probable sedations were distinguished. RESULTS A total of 54 sedations were identified (48 proven, 6 probable). Refractory symptoms accounted for 48.1% of indications, complications with immediate risk of death 46.3%, existential suffering 5.6%. Titration was performed in 44.4% of cases. Sedation was continuous until death for 98.1% of the cases. Probable sedation had a higher failure rate than proven sedation. Significant differences existed for the palliative care unit compared to other units regarding information to the patient, their consent, anticipation, mention by correspondence and carrying out titrations. When patients had already been treated with midazolam, the induction doses, initial maintenance doses, and doses at the time of death were significantly higher. For those receiving opioids, the maintenance dose at the time of death was higher. No comparison found a difference in overall survival. CONCLUSIONS After a sufficient follow-up has enabled teams to familiarize with this new legislation, reflection on sedation should be conducted to adapt to final recommendations.
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Affiliation(s)
- Vincent Gamblin
- Palliative care unit, Oscar Lambret center, 3 rue Frédéric Combemale, 59020, Lille, France.
| | - Vincent Berry
- Palliative care unit, Maison Médicale Jean XXIII, 3 Place Erasme de Rotterdam, 59160, Lille, France
| | - Emmanuelle Tresch-Bruneel
- Direction of Research and Innovation, Oscar Lambret center, 3 rue Frédéric Combemale, 59020, Lille, France
| | - Michel Reich
- Palliative care unit, Oscar Lambret center, 3 rue Frédéric Combemale, 59020, Lille, France
| | - Arlette Da Silva
- Palliative care unit, Oscar Lambret center, 3 rue Frédéric Combemale, 59020, Lille, France
| | - Stéphanie Villet
- Palliative care unit, Oscar Lambret center, 3 rue Frédéric Combemale, 59020, Lille, France
| | - Nicolas Penel
- Direction of Research and Innovation, Oscar Lambret center, 3 rue Frédéric Combemale, 59020, Lille, France
- Lille University Hospital and Medical School, 59000, Lille, France
| | - Chloé Prod'Homme
- Lille University Hospital and Medical School, Palliative care unit, 59000, Lille, France
- ETHICS (Experiment, Transhumanism, Human Interactions, Care and Society) - EA 7446, Lille Catholic University, 59800, Lille, France
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Dickinson GE, Hoffmann HC. Animal hospice and palliative care: Veterinarians' experiences and preferred practices. J Vet Behav 2019. [DOI: 10.1016/j.jveb.2019.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Vivat B, Bemand-Qureshi L, Harrington J, Davis S, Stone P. Palliative care specialists in hospice and hospital/community teams predominantly use low doses of sedative medication at the end of life for patient comfort rather than sedation: Findings from focus groups and patient records for I-CAN-CARE. Palliat Med 2019; 33:578-588. [PMID: 30747052 PMCID: PMC6537030 DOI: 10.1177/0269216319826007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Little research has explored the detail of practice when using sedative medications at the end of life. One work package of the I-CAN-CARE research programme investigates this in UK palliative care. AIMS To investigate current practices when using sedative medication at the end of life in London, UK, by (1) qualitatively exploring the understandings of palliative care clinicians, (2) examining documented sedative use in patient records and (3) comparing findings from both investigations. DESIGN We conducted focus groups with experienced palliative care physicians and nurses, and simultaneously reviewed deceased patient records. SETTING/PARTICIPANTS In total, 10 physicians and 17 senior nurses in London hospice or hospital/community palliative care took part in eight focus groups. Simultaneously, 50 patient records for people who received continuous sedation at end of life in the hospice and hospital were retrieved and reviewed. RESULTS Focus group participants all said that they used sedative medication chiefly for managing agitation or distress; selecting drugs and dosages as appropriate for patients' individual needs; and aiming to use the lowest possible dosages for patients to be 'comfortable', 'calm' or 'relaxed'. None used structured observational tools to assess sedative effects, strongly preferring clinical observation and judgement. The patient records' review corroborated these qualitative findings, with the median continuous dose of midazolam administered being 10 mg/24 h (range: 0.4-69.5 mg/24 h). CONCLUSION Clinical practice in these London settings broadly aligns with the European Association for Palliative Care framework for using sedation at the end of life, but lacks any objective monitoring of depth of sedation. Our follow-on study explores the utility and feasibility of objectively monitoring sedation in practice.
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Affiliation(s)
- Bella Vivat
- Marie Curie Palliative Care Research Department, UCL, London, UK
| | | | - Jane Harrington
- Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Sarah Davis
- Marie Curie Palliative Care Research Department, UCL, London, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, UCL, London, UK
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Abstract
Palliative sedation (PS) is performed in the terminally ill patient to manage one or more refractory symptoms. Proportional PS, which means that drugs can be titrated to the minimum effective dose, is the form most widely used. From a quarter to a third of all terminally ill patients undergo PS, with a quarter of these requiring continuous deep sedation. The prevalence of PS varies according to the care setting and case mix. The most frequent refractory physical symptoms are delirium and dyspnea, but PS is also considered for existential suffering or psychological distress, which is an extremely difficult and delicate issue to deal with. Active consensus from the patient and advanced care planning is recommended for PS. The decision-making process concerning the continuation or withdrawal of other treatments is not the same as that used for PS. The practice differs totally from euthanasia in its intentions, procedures, and results. The most widely used drugs are midazolam and haloperidol for refractory delirium, but chlorpromazine and other neuroleptics are also effective. In conclusion, some patients experience refractory symptoms during the last hours or days of life and PS is a medical intervention aimed at managing this unbearable suffering. It does not have a detrimental effect on survival.
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Affiliation(s)
| | | | - Romina Rossi
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
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Bodnar J. A Review of Agents for Palliative Sedation/Continuous Deep Sedation: Pharmacology and Practical Applications. J Pain Palliat Care Pharmacother 2017; 31:16-37. [PMID: 28287357 DOI: 10.1080/15360288.2017.1279502] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Continuous deep sedation at the end of life is a specific form of palliative sedation requiring a care plan that essentially places and maintains the patient in an unresponsive state because their symptoms are refractory to any other interventions. Because this application is uncommon, many providers may lack practical experience in this specialized area and resources they can access are outdated, nonspecific, and/or not comprehensive. The purpose of this review is to provide an evidence- and experience-based reference that specifically addresses those medications and regimens and their practical applications for this very narrow, but vital, aspect of hospice care. Patient goals in a hospital and hospice environments are different, so the manner in which widely used sedatives are dosed and applied can differ greatly as well. Parameters applied in end-of-life care that are based on experience and a thorough understanding of the pharmacology of those medications will differ from those applied in an intensive care unit or other medical environments. By recognizing these different goals and applying well-founded regimens geared specifically for end-of-life sedation, we can address our patients' symptoms in a more timely and efficacious manner.
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Tursunov O, Cherny NI, Ganz FD. Experiences of Family Members of Dying Patients Receiving Palliative Sedation. Oncol Nurs Forum 2016; 43:E226-E232. [PMID: 27768142 DOI: 10.1188/16.onf.e226-e232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe the experience of family members of patients receiving palliative sedation at the initiation of treatment and after the patient has died and to compare these experiences over time.
. DESIGN Descriptive comparative study.
. SETTING Oncology ward at Shaare Zedek Medical Center in Jerusalem, Israel.
. SAMPLE A convenience sample of 34 family members of dying patients receiving palliative sedation.
. METHODS A modified version of a questionnaire describing experiences of family members with palliative sedation was administered during palliative sedation and one to four months after the patient died. Descriptive statistics were used to describe the results of the questionnaire, and appropriate statistical analyses were conducted for comparisons over time.
. MAIN RESEARCH VARIABLES Experiences of family members and time.
. FINDINGS Most relatives were satisfied with the sedation and staff support. Palliative sedation was experienced as an ethical way to relieve suffering. However, one-third felt that it shortened the patient's life. An explanation of the treatment was given less than half of the time and was usually given on the same day treatment was started. This explanation was given by physicians and nurses. Many felt that they were not ready for changes in the patient's condition and wanted increased opportunities to discuss the treatment with oncology care providers. No statistically significant differences in experiences were found over time.
. CONCLUSIONS Relatives' experiences of palliative sedation were generally positive and stable over time. Important experiences included timing of the initiation of sedation, timing and quality of explanations, and communication.
. IMPLICATIONS FOR NURSING Nurses should attempt to initiate discussions of the possible role of sedation in the event of refractory symptoms and follow through with continued discussions. The management of refractory symptoms at the end of life, the role of sedation, and communication skills associated with decision making related to palliative sedation should be a part of the core nursing curriculum. Nursing administrators in areas that use palliative sedation should enforce good nursing clinical practice as recommended by international practice guidelines, such as those of the European Association for Palliative Care.
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Affiliation(s)
| | | | - Freda DeKeyser Ganz
- Director of the clinical masters program, Henrietta Szold Hadassah Medical Organization, Jerusalem, Israel
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Goldberg KJ. Veterinary hospice and palliative care: a comprehensive review of the literature. Vet Rec 2016; 178:369-74. [DOI: 10.1136/vr.103459] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Katherine J. Goldberg
- Whole Animal Veterinary Geriatrics and Hospice Services; East Tompkins Street Ithaca New York 14850 USA
- Dr Goldberg also has a courtesy lecturer appointment at College of Veterinary Medicine; Cornell University; Tower Road Ithaca New York 14853 USA
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Robijn L, Chambaere K, Raus K, Rietjens J, Deliens L. Reasons for continuous sedation until death in cancer patients: a qualitative interview study. Eur J Cancer Care (Engl) 2015; 26. [PMID: 26515814 DOI: 10.1111/ecc.12405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2015] [Indexed: 11/28/2022]
Abstract
End-of-life sedation, though increasingly prevalent and widespread, remains a highly debated medical practice in the context of palliative medicine. This qualitative study aims to look more specifically at how health care workers justify their use of continuous sedation until death and which factors they report as playing a part in the decision-making process. In-depth interviews were held with 28 physicians and 22 nurses of 27 cancer patients in Belgium who had received continuous sedation until death in hospitals, palliative care units or at home. Our findings indicate that medical decision-making for continuous sedation is not only based on clinical indications but also related to morally complex issues such as the social context and the personal characteristics and preferences of individual patient and their relatives. The complex role of non-clinical factors in palliative sedation decision-making needs to be further studied to assess which medically or ethically relevant arguments are underlying daily clinical practice. Finally, our findings suggest that in some cases continuous sedation was resorted to as an alternative option at the end of life when euthanasia, a legally regulated option in Belgium, was no longer practically possible.
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Affiliation(s)
- L Robijn
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - K Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - K Raus
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Bioethics Institute Ghent, Department of Philosophy and Moral Science, Ghent University, Ghent, Belgium
| | - J Rietjens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - L Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
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Klastersky J, Libert I, Michel B, Obiols M, Lossignol D. Supportive/palliative care in cancer patients: quo vadis? Support Care Cancer 2015; 24:1883-8. [DOI: 10.1007/s00520-015-2961-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/14/2015] [Indexed: 12/01/2022]
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Affiliation(s)
- Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
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