The research team, led by Wenjing Guo and Chulin Chen from Nanjing University of Chinese Medicine and Jinling Hospital, searched eight databases from their inception through June 2026, spanning English and Chinese literature. After screening 3,525 records, they identified 18 longitudinal studies published between 2000 and 2025 that tracked quality of life in adults before and after starting home nutrition support. Fifteen of these studies, conducted across Asia, Europe, and North America, contained enough statistical information to be combined quantitatively. The cohort represented a clinically diverse population: eleven studies examined home enteral nutrition delivered by nasogastric tubes, gastrostomy or jejunostomy devices, or oral supplements, while seven examined home parenteral nutrition infused through central venous catheters, often overnight. Most patients had cancer, though Crohn’s disease, short bowel syndrome, intestinal dysmotility, and neurological disorders also appeared among the underlying diagnoses.

Measuring quality of life across such heterogeneous groups posed a methodological challenge, since the studies used different validated instruments, including the EORTC QLQ-C30 for cancer patients, the SF-36 general health survey, the EuroQol EQ-5D, the Inflammatory Bowel Disease Questionnaire, and the nutrition-specific NutriQoL scale. To combine these results, the researchers calculated standardized mean differences, a statistical measure expressing change in units of variability rather than raw score points, so that a positive value consistently indicates improvement. Because most studies did not report the correlation between baseline and follow-up measurements, a coefficient of r = 0.50 was assumed for the primary analysis, with extreme values of 0.10 and 0.90 tested in sensitivity analyses to confirm the results were robust to that assumption. Follow-up assessments were assigned to five predefined windows at 1, 2, 3, 4, and 6 months, and all pooled estimates came from random-effects models to account for the substantial statistical heterogeneity between studies.

The headline result is a clear temporal pattern. Quality of life improved significantly from baseline at 1 month, with a standardized mean difference of 0.29, and the improvement grew steadily stronger at 2 months (0.54), 3 months (0.64), and 4 months (0.61). All four of those estimates reached statistical significance, and the largest gains clustered in the 2-to-4-month range. In practical terms, patients recovering from nutritional deterioration, mastering their feeding equipment, and re-establishing daily routines experienced their most meaningful improvement during the first trimester of therapy. By 6 months, however, the pooled estimate had collapsed to just 0.09, with a 95 percent confidence interval spanning from negative 0.20 to 0.38, meaning the improvement could no longer be distinguished from no change at all.

The authors are careful about how this decline should be read. The studies contributing to each time point were not the same, no formal between-time-point comparison was possible, and the 6-month estimate rested on fewer trials. The pattern, they stress, is descriptive rather than proof of a continuous trajectory of improvement, peaking, and decline. Nevertheless, the sensitivity analyses using different correlation assumptions preserved the same overall shape, with larger estimates at 2 to 4 months than at 1 month and a numerically smaller, non-significant estimate at 6 months, which lends credibility to the temporal trend. Three additional studies that reported domain-specific scores but could not be pooled described consistent improvements in physical and psychosocial dimensions, including physical functioning, bodily pain, vitality, social functioning, and mental health, particularly in the early months of therapy.

Why would early gains fade? The researchers propose several interconnected mechanisms, all framed as hypotheses rather than validated explanations. The first is biological: most patients begin nutrition support in a state of depletion, burdened by weight loss and fatigue, and nutritional repletion restores energy balance and physical function, creating a physiological foundation for psychological adjustment. Qualitative work supports this staged recovery, with patients describing a transition to a new normal, growing self-efficacy in managing pumps and tubes, and a view of nutrition therapy as a lifeline that allows them to resume daily activities. This adaptation phase fits the Chronic Illness Trajectory Model, in which early mastery gives way to the slower realities of long-term dependence.

The second mechanism is the accumulating burden of the technology itself. For home enteral nutrition patients, especially those with head and neck cancer, physical tolerance of the tube may be acceptable while psychological tolerance is poor: two thirds of patients in one cited study longed for tube removal and nearly a quarter avoided going out in public. Home parenteral nutrition carries a different but equally consequential burden profile, including fear of catheter complications, sleep disruption from pump noise and nocturnal infusions, feelings of dependency reported by more than 70 percent of patients, and travel restrictions affecting more than half. These burdens are not static; they intensify as the novelty of home therapy wears off and device dependence becomes a permanent feature of life, progressively straining psychological reserves and social networks.

Third, disease trajectory likely shapes the curve. For patients with advanced cancer, disease progression can gradually overshadow the benefits of nutritional support, and prior longitudinal work found quality of life plateauing or declining after four months of home parenteral nutrition in that population, with the greatest benefit appearing around three months before survival dropped markedly. Patients with benign conditions such as Crohn’s disease follow a fundamentally different course, with more than 80 percent surviving five years on home parenteral nutrition, meaning their quality-of-life trajectory reflects chronic adaptation rather than progressive illness. Because the pooled estimates aggregate across these populations, the attenuation at 6 months may partly reflect the attrition of advanced cancer patients who became too ill to provide follow-up data rather than a universal phenomenon. High attrition rates in the single-arm studies, ranging from zero to 71 percent, underscore this concern.

The methodological quality of the included studies was acceptable overall, assessed with the Joanna Briggs Institute critical appraisal tools, but weaknesses remain. Blinding was rarely feasible in the randomized trials, most single-arm studies did not report how missing data were handled, and only four studies statistically adjusted for confounding. Subgroup analyses showed that the type of nutrition support, enteral versus parenteral, was not a significant source of heterogeneity, while the choice of quality-of-life instrument drove differences at the 1- and 3-month marks, though this finding is confounded by the fact that different instruments tend to track different diseases. No data existed beyond 6 months, and the restriction to English and Chinese publications, along with the fact that roughly 40 percent of the studies came from China, may limit generalizability to health systems with different home care models.

Even with those caveats, the clinical message is actionable. The first four months represent a window in which patients are demonstrably improving and in which nutritional optimization, structured education, and self-management support appear to coincide with the largest gains; the team’s own randomized trial of staged video education for home enteral nutrition patients showed reduced functional impairment, anxiety, and depression, and a telephone follow-up program has been shown to maintain health-related quality of life over time. The fading estimate at 6 months suggests that early improvement is not self-sustaining, and that care models focused narrowly on nutritional parameters and complication management may be missing what patients need next: vocational rehabilitation, psychosocial counseling, and restored social participation. The authors explicitly avoid claiming that interventions timed to this window are proven superior, but they propose a phase-adjusted, multidisciplinary approach as a working hypothesis for future testing. Longer prospective studies with formal comparisons between time points, patient-reported outcomes alongside qualitative experience, and disease-specific subgroup analyses will be needed to determine whether the six-month fade is an inevitable consequence of treatment, a reflection of underlying disease, or simply the cost of care systems that stop supporting patients precisely when the early momentum runs out.

Subject of Research: Longitudinal changes in quality of life among adults receiving home enteral or parenteral nutrition support

Article Title: Longitudinal changes in quality of life among patients receiving home nutrition support: a systematic review and meta-analysis

Article References: Guo, W., Chen, C., Yang, Y., Ni, J., & Wang, X. (2026). Longitudinal changes in quality of life among patients receiving home nutrition support: a systematic review and meta-analysis. Frontiers in Nutrition, 13, Article 1940328. https://doi.org/10.3389/fnut.2026.1940328

Image Credits: AI Generated

DOI: 10.3389/fnut.2026.1940328

Keywords: home nutrition support, home enteral nutrition, home parenteral nutrition, quality of life, meta-analysis, systematic review, intestinal failure, clinical nutrition, cancer patients, patient-reported outcomes, chronic disease, Longitudinal

The correspondence responds to a scoping review by Munir and colleagues, published in the same journal in May 2026, which examined the clinical relevance of sleep disturbance, or insomnia, in patients with advanced cancer receiving palliative care. Scoping reviews are designed to map the breadth of existing evidence rather than pool it statistically, and the original review highlighted how frequently sleep problems are reported by this patient population while also exposing the fragmented ways in which researchers have defined and measured them. Yan and Zhang use their comment to push the conversation further, contending that the clinical relevance of insomnia is not merely a matter of prevalence but of consequence, and that the field needs sharper tools to capture both.

The technical heart of the debate lies in measurement. Sleep disturbance in palliative care has traditionally been assessed through patient-reported instruments, and one of the most widely used is the sleep item of the Edmonton Symptom Assessment System, a brief screening tool that asks patients to rate the severity of their symptoms on simple numeric scales. Research published in BMJ Supportive & Palliative Care by Yennurajalingam and colleagues in 2015 showed that patient-reported sleep disturbance in advanced cancer is common, that it can be predicted from other symptom profiles, and that the ESAS sleep item performs reasonably well as a screening instrument. But a single numeric rating compresses an enormously complex phenomenon, one that spans difficulty falling asleep, frequent awakenings, early morning waking, and non-restorative sleep, into a single point on a scale. Critics argue that this compression obscures the very features of insomnia that carry clinical meaning.

Objectively measured sleep tells a different story again. Actigraphy, a technique in which a small wrist-worn sensor records movement over days or weeks, allows researchers to derive rest-activity rhythms and sleep parameters without relying on subjective report. In an exploratory machine learning study published in Cancers in 2023, Patel, Davies, and colleagues, working with Dijk, combined actigraphy-derived rest-activity and sleep parameters with routine clinical data to explore prognostication in advanced cancer. The study suggested that objective sleep and circadian features, when fused with clinical variables through machine learning models, could contribute to predicting outcomes in this population. For Yan and Zhang, this line of evidence points toward a future in which sleep is not just a symptom to be rated but a physiological signal to be integrated into routine clinical assessment and even prognostic modeling.

The prognostic angle is what gives the correspondence its urgency. In advanced cancer, clinicians and families alike want to know how much time remains, and the search for reliable prognostic markers is one of palliative care’s most active research frontiers. Sleep disturbance may seem an unlikely candidate, but disrupted rest-activity rhythms are known to reflect underlying physiological deterioration, and studies have linked poor sleep quality in advanced lung cancer to anxiety and depression in both patients and caregivers, as He and colleagues reported in BMJ Supportive & Palliative Care in 2020. Mercadante and colleagues, writing in the International Journal of Clinical Practice in 2021, documented high rates of insomnia among patients with advanced lung cancer admitted to palliative care services, underscoring that the problem is not marginal but affects a substantial share of the population at the very end of life.

What makes the Yan and Zhang comment technically significant is its insistence on distinguishing between insomnia as a subjective complaint and sleep disturbance as an objective physiological phenomenon. The two do not always align. A patient may report severe insomnia while actigraphy shows relatively preserved sleep duration, or conversely may underreport disturbance that objective monitoring reveals to be profound. This dissociation matters clinically because the mechanisms driving the two may differ, ranging from pain and medication effects to circadian rhythm disruption and neuroendocrine changes associated with advanced disease. Treating them as a single entity, the correspondence implies, risks misdirecting both research and therapy, and the scoping review’s finding of heterogeneous definitions across studies only reinforces the point.

The therapeutic implications are equally consequential. Insomnia in palliative care is frequently managed with hypnotic medications, yet evidence for their effectiveness in this population is limited, and concerns about sedation, falls, and drug interactions weigh heavily in patients whose systems are already burdened by disease and polypharmacy. Non-pharmacological approaches, including cognitive behavioral therapy adapted for cancer populations, light exposure interventions, and structured sleep hygiene programs, offer alternatives, but their availability in palliative care settings remains uneven. Yan and Zhang’s argument that sleep deserves systematic clinical attention implies that screening should be routine, that assessment should distinguish subjective from objective disturbance, and that treatment pathways should be tailored to the mechanisms identified in each patient rather than applied generically.

There is also a broader scientific payoff to taking sleep seriously in this population. Sleep and circadian biology are increasingly recognized as windows into systemic physiology, and disrupted rest-activity rhythms have been associated with inflammation, metabolic dysregulation, and neuroendocrine stress across a range of diseases. In advanced cancer, where multiple organ systems are failing simultaneously, the pattern of sleep disruption may carry diagnostic information that conventional symptom scales cannot capture. The machine learning approach of Patel and colleagues represents an early attempt to exploit this information, and if future studies validate the prognostic value of actigraphy-derived sleep parameters, sleep monitoring could become as standard in palliative care as pain assessment is today.

For patients and families, the message from this correspondence is ultimately a human one. Sleepless nights in advanced cancer are not a trivial side effect to be endured in silence, but a symptom with measurable physiological correlates, prognostic significance, and treatable mechanisms. The comment by Yan and Zhang, published as a correspondence in Supportive Care in Cancer in October 2026, adds its voice to a growing chorus calling for sleep disturbance to be recognized as clinically relevant in its own right, not merely as a companion symptom to pain or depression. As the field moves from scoping reviews that map the evidence toward studies that test interventions and validate objective monitoring, the hope is that the nights of patients in palliative care will become a little less fragmented, and that clinicians will finally give sleep the attention its clinical relevance demands.

Subject of Research: Palliative Care

Article Title: Comment on: “The clinical relevance of sleep disturbance (‘insomnia’) in patients with advanced cancer receiving palliative care: a scoping review”

Article References: Yan, H., & Zhang, Y. (2026). Comment on: “The clinical relevance of sleep disturbance (‘insomnia’) in patients with advanced cancer receiving palliative care: a scoping review”. Supportive Care in Cancer, 34(11), Article 1115. https://doi.org/10.1007/s00520-026-11359-6

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11359-6

Keywords: insomnia, palliative care, advanced cancer, sleep disturbance, Supportive Care in Cancer, scoping review, symptom assessment, actigraphy, prognostication, patient-reported outcomes, Comment, clinical

The research team, led by Luna Gauchez of the Rehabilitation Research Group at Vrije Universiteit Brussel together with colleagues from the End-of-Life Care Research Group and UZ Brussels, conducted thirty face-to-face, semi-structured interviews across hospital, nursing home, and primary care settings in Brussels and Flanders. The sample was deliberately balanced: ten adults with advanced cancer, ten physicians including oncologists and general practitioners, and ten physical therapists. Using purposive and snowball sampling, the researchers captured perspectives from every link in the referral chain, from the person who would receive the therapy, to the clinician who would order it, to the professional who would deliver it. Interviews were analyzed inductively with the Framework Method, a structured qualitative technique that allows researchers to systematically chart themes across different participant groups while preserving the nuances of individual accounts.

The study’s central finding is deceptively simple: engagement with physical therapy in advanced cancer is shaped by a combination of behavioral factors operating at both the individual and environmental levels, and when these factors fail to align across the three groups, the entire system stalls. Patients may want to move but not know that therapy is available or reimbursed. Physicians may believe in its value but lack knowledge of local providers or referral procedures. Physical therapists may be willing to treat but feel unprepared for the complexities of oncology. Each barrier is small on its own; together they form a wall.

For patients, the decision to engage in physical therapy hinged on several intertwined factors. Symptoms themselves, particularly fatigue, pain, and weakness, could either motivate a search for help or make the prospect of exercise feel overwhelming. Perceived benefits played a decisive role: patients who understood that therapy could improve function and reduce discomfort were far more likely to participate than those who saw it as irrelevant to a life-limiting illness. Coping style mattered as well, with some patients embracing active management of their condition while others preferred to conserve energy or focus elsewhere. Social support from family and friends emerged as a facilitator, and so did practical awareness, including whether patients knew what physical therapists actually do in cancer care and whether the service was covered by health insurance. The researchers found that many patients simply had no clear picture of what physical therapy could offer them at this stage of illness.

Physicians, meanwhile, stood at a different bottleneck. Their referral decisions depended on their knowledge of the indications for physical therapy in advanced cancer, their familiarity with local providers, their understanding of referral procedures, and their expectations about whether therapy would actually produce meaningful outcomes. A physician who did not know a competent oncology-trained physical therapist nearby, or who doubted that a patient with limited life expectancy would benefit, was unlikely to make the referral, even when the patient might have gained substantially from it. This finding echoes earlier international work, including studies documenting the reluctance of palliative care clinicians to refer patients for rehabilitation and analyses showing that underutilization of rehabilitation services among people with advanced cancer is a persistent, well-documented problem in oncology systems worldwide.

On the supply side, the physical therapists interviewed described how their delivery of care was shaped by their oncology-specific knowledge, their confidence in working with patients facing serious illness, their attitudes toward palliative populations, and the organizational support available to them. Therapists without specialized training in cancer care reported uncertainty about safe exercise parameters, symptom management, and how to adapt treatment as the disease progressed. Those embedded in supportive institutional environments, with time, mentorship, and interdisciplinary collaboration, described far greater capacity to serve this population. The study thus identifies workforce competence and organizational structure as critical environmental levers, not merely individual willingness.

The theoretical framing of the study adds scientific weight to these observations. The researchers drew on established behavioral science, including the theory of planned behavior and the health belief model, both of which posit that behavior, whether a patient’s participation or a physician’s referral, is driven by attitudes, perceived norms, perceived control, and expectations of benefit. Earlier work by the same Belgian group had systematically reviewed the use of behavioral theories in end-of-life care research and argued that they could illuminate why health-promoting behaviors are so rarely adopted in palliative contexts. The new study applies that lens empirically, and the results validate the approach: the barriers and facilitators identified map cleanly onto knowledge, motivation, and environmental constraints, the classic domains of behavioral models.

What makes the study particularly compelling is its demonstration of misalignment across the three groups. A patient might be motivated but never referred because the physician lacks procedural knowledge. A physician might refer enthusiastically but the patient declines because they misunderstand the purpose of therapy. A physical therapist might be skilled and available but never reached because no one in the chain knows they exist. Integration, the authors conclude, is not blocked at any single point but by the failure of information, expectations, and communication to flow across the entire pathway. This systems-level insight reframes the problem: fixing one link, say, educating patients about reimbursement, will not suffice if physicians remain unaware of indications or therapists remain undertrained in oncology.

The practical implications are significant for cancer care systems far beyond Belgium. The authors call for multilevel strategies targeting knowledge, roles, communication, and system structures. Concretely, that could mean embedding physical therapists within oncology and palliative care teams so that referral becomes a routine conversation rather than an exceptional one; educating physicians about the evidence base for rehabilitation in advanced disease; clarifying reimbursement pathways so that cost is not a hidden barrier; and expanding oncology-specific training in physical therapy curricula so that graduates feel confident treating patients with complex, progressive illness. Prior systematic reviews by members of the same team have already documented which physiotherapy modalities are recommended for palliative oncology patients and their effects on patient-reported outcomes, giving clinicians an evidence base to act on once the referral barrier is lowered.

The study also carries a human message that resonates well beyond the clinic. Qualitative work with patients across the palliative literature consistently finds that movement, achievement, and purpose matter profoundly to people living with life-limiting illness, and that exercise-based interventions can deliver a sense of agency when so much else feels out of control. The Belgian findings suggest that many patients are being denied that opportunity not because therapy cannot help them, but because the system has not made it visible, accessible, and trusted. As populations age and more people live for years with advanced cancer, closing this gap between what rehabilitation science can offer and what patients actually receive may become one of the defining challenges of supportive cancer care. This study provides the roadmap: align the knowledge, expectations, and communication of the people who give, receive, and refer, and physical therapy may finally take its place as a standard component of advanced cancer care rather than an underused afterthought.

Subject of Research: Barriers and facilitators to integrating physical therapy into advanced cancer care

Article Title: Perspectives on physical therapy in advanced cancer care from those who give, receive, and refer: a qualitative interview study

Article References: Gauchez, L., Beernaert, K., Decoster, L., Deliens, T., Van Ginderdeuren, F., Adriaenssens, N., & Scherrens, A.-L. (2026). Perspectives on physical therapy in advanced cancer care from those who give, receive, and refer: a qualitative interview study. Supportive Care in Cancer, 34(11), Article 1110. https://doi.org/10.1007/s00520-026-11352-z

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11352-z

Keywords: physical therapy, advanced cancer, palliative care, qualitative research, referral barriers, quality of life, oncology rehabilitation, patient engagement, physician referral, behavioral factors, supportive care, Belgium

The numbers behind the study are straightforward but telling. Over a one-year period in 2024, the unit recorded 550 admissions. Twenty-two of those patients, or 4.0 percent, received a diagnosis of pneumonia. That figure may appear modest, but it captures a population whose clinical fragility is extreme: the mean Karnofsky Performance Status, a standard 0-to-100 scale of functional ability, was 44.1, meaning the average patient required substantial assistance with daily activities and spent much of the time resting or in bed. In oncology practice, a KPS in the forties signals a body with limited physiological reserve, where even a localized lung infection can rapidly destabilize multiple organ systems.

What distinguishes this cohort is the diagnostic intensity applied. Every one of the 22 patients underwent computed tomography of the chest to establish the diagnosis. In many palliative settings, imaging beyond a portable chest radiograph is often considered unnecessary or burdensome, particularly when the therapeutic plan would not change. The Palermo team’s decision to obtain CT scans across the board reflects the philosophy of the APCU model: these units are designed to handle acute complications of advanced disease with the same diagnostic rigor as an oncology ward, while keeping the goals of care anchored in symptom relief and rapid stabilization rather than curative pursuit.

Therapeutically, the approach was equally assertive. All patients received antibiotic therapy, and the agents selected were predominantly broad-spectrum intravenous drugs used for hospital-acquired and complicated pneumonias. Piperacillin combined with the beta-lactamase inhibitor tazobactam was the most frequent choice, given to 54.5 percent of the cohort, while the carbapenem meropenem was used in 36.4 percent. These are not marginal drugs; they are workhorses of empirical therapy for serious gram-negative infections, chosen when resistance risk is high or when the clinical picture leaves little room for narrow-spectrum trial and error. The pattern suggests that the treating clinicians regarded these infections as genuine threats requiring potent coverage, not as terminal events to be managed with placebo or minimal intervention.

The outcomes lend weight to that judgment. Among evaluable cases, clinical resolution of the infection was achieved in 80 percent. More striking still, 72.7 percent of the patients were discharged successfully, either to their homes or to community-based palliative care services, and the mortality rate within the APCU itself was 9.1 percent. For a population with a mean KPS of 44 and active pneumonia, those figures challenge the assumption that infection in advanced cancer is an inevitable terminal milestone. Instead, the data support the idea that timely, intensive antimicrobial treatment can buy patients the time and stability needed to return to their preferred care settings, which for most people means being at home.

Symptom trajectories add an important nuance. Dyspnea, the subjective sensation of breathlessness that often accompanies pneumonia, was measured at admission using the Edmonton Symptom Assessment System, a validated patient-reported tool. The mean ESAS dyspnea score was 3.21, with a standard deviation of 2.35, indicating moderate breathlessness on average but with wide variability across patients. Notably, when the researchers compared dyspnea scores at the time of clinical resolution and at discharge against the admission values, they found no statistically significant change, with a p-value of 0.396. In other words, treating the infection did not dramatically worsen or improve the reported breathlessness, a finding that underscores how multifactorial dyspnea is in advanced cancer, where causes such as pleural disease, anemia, muscle weakness, and anxiety frequently coexist with infection.

Oxygen requirements followed a similar pattern of partial stabilization. At admission, 31.8 percent of the patients needed supplemental oxygen. By the time of discharge, that proportion had fallen only slightly, to 27.3 percent. The modest decline suggests that while antimicrobial therapy and supportive care allowed most patients to leave the unit, the underlying respiratory compromise often persisted, consistent with the limited pulmonary reserve typical of this population. For clinicians, the implication is that antibiotic success in this setting should be judged primarily by infection control and functional stabilization rather than by complete normalization of breathing or oxygen needs.

The study sits within a broader and sometimes contentious literature on antimicrobial use at the end of life. Prior research has documented that a large share of hospice and palliative patients receive antibiotics in their final days, raising questions about whether such treatment prolongs suffering, contributes to resistance, or merely delays an inevitable decline. Some studies have found that antibiotics can relieve infection-related symptoms, while others question whether withdrawal of antimicrobials in terminal patients is appropriate or harmful. The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America have published stewardship guidelines that apply to all clinical settings, yet their implementation in palliative contexts remains uneven and ethically fraught. The Palermo data do not resolve these debates, but they do demonstrate that in a specialized acute unit, high-intensity treatment and palliative goals can coexist without the one negating the other.

The APCU model itself is central to interpreting the findings. Acute palliative care units, often embedded within comprehensive cancer centers, are designed for rapid assessment and short-stay management of severe complications such as uncontrolled pain, delirium, bleeding, and infections. Reviews led by some of the same authors have argued that such units should be considered mandatory infrastructure for cancer centers and tertiary hospitals, precisely because they bridge the gap between the ward, where curative or life-prolonging priorities dominate, and hospice, where the focus shifts entirely to comfort. The present study illustrates that bridge in action: patients arrived acutely ill, received CT-based diagnosis and broad-spectrum antibiotics, and most were stabilized and discharged within the unit’s rapid-cycle framework.

Several caveats temper the conclusions. The study is retrospective and single-center, drawing on 22 patients over one year, so the findings may not generalize to units with different staffing, patient mixes, or antimicrobial policies. The abstract does not report microbiological culture results, which limits insight into whether the chosen broad-spectrum regimens matched the actual pathogens. Nor does it detail long-term survival after discharge, an outcome that matters greatly when weighing the burdens of intensive treatment against its benefits. Nonetheless, the core message is clear and clinically useful: in an acute palliative care unit equipped for high diagnostic and therapeutic intensity, pneumonia in advanced cancer is frequently treatable, and treating it does not conflict with palliative intent. For the four in five patients whose infections resolved and the nearly three in four who went home, the aggressive approach translated into time in the place they most wanted to be.

Subject of Research: Prevalence, management, and outcomes of pneumonia among patients admitted to an acute palliative care unit for advanced cancer

Article Title: Pulmonary infections in an acute palliative care unit

Article References: Mercadante, S., Settepani, S., Grassi, Y., Mancuso, G., & Cascio, A. L. (2026). Pulmonary infections in an acute palliative care unit. Supportive Care in Cancer, 34(10), Article 969. https://doi.org/10.1007/s00520-026-11067-1

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11067-1

Keywords: pneumonia, palliative care, acute palliative care unit, advanced cancer, antibiotics, piperacillin-tazobactam, meropenem, dyspnea, Karnofsky Performance Status, supportive care, antimicrobial stewardship, cancer center

The study, led by Rasha A. Mohamed of Mansoura University and the University of Bisha together with an international team of nursing researchers, used a qualitative descriptive design to capture the lived experiences of nurses who deliver palliative care to patients with advanced cancer. Participants were recruited purposively, meaning the researchers deliberately selected nurses with direct, relevant experience rather than sampling at random. Data were gathered through four focus group discussions, each audio-recorded and transcribed verbatim, and then analyzed using an inductive thematic approach. In this method, researchers code the transcripts line by line, group the codes into categories, and iteratively refine overarching themes through team consensus, allowing the structure of the findings to emerge from the data itself rather than from a predetermined framework.

The setting matters. Saudi Arabia presents a distinctive context for end-of-life care, one in which cultural and religious values shape how death, dying, and family involvement are understood and navigated. The authors note that qualitative evidence on nurses’ experiences in this setting has been limited, despite the fact that palliative care is a crucial component of comprehensive cancer care. Understanding what nurses actually encounter, the researchers argue, is essential for building tailored strategies that strengthen palliative practice and support the workforce that sustains it. This is not an abstract concern: as cancer incidence rises globally and survival trajectories lengthen, the number of patients living with, and dying from, advanced disease continues to grow, and the nurses caring for them carry an increasingly complex professional and emotional load.

The first theme identified in the analysis, preserving dignity through holistic palliative care, speaks to the ethical core of the work. Nurses described their role as safeguarding the personhood of patients whose bodies and independence were being eroded by disease. Dignity preservation, in this framing, is not a courtesy but a clinical intervention in its own right, woven into everything from symptom management to the way nurses speak with patients about their condition. The finding echoes a long tradition in palliative care philosophy, which holds that a good death is defined not only by the absence of pain but by the presence of respect, autonomy, and comfort in the fullest sense.

The second theme, navigating multidimensional professional responsibilities throughout the illness trajectory, captures how the nurse’s job changes shape as a patient moves from diagnosis toward the end of life. Nurses in the study described acting as advocates for their patients, coordinating care across specialties and settings, and communicating in ways that are culturally and religiously sensitive. This is technically demanding work. It requires clinical judgment about symptom control, organizational skill to align families, physicians, and support services, and the communication finesse to discuss prognosis and goals of care in a manner consistent with patients’ values. The illness trajectory, the study suggests, is not a single care scenario but a shifting set of demands that nurses must continually renegotiate.

Central to the nurses’ accounts was the third theme: delivering holistic nursing care that integrates physical, emotional, and spiritual support. This multidimensional model treats the patient not as a set of failing organs but as a whole person facing existential as well as physical distress. Pain and other symptoms must be managed pharmacologically, but nurses also described attending to fear, grief, and spiritual needs, dimensions of care that are harder to measure and often under-resourced. In the Saudi context, spiritual support carries particular weight, since religious frameworks strongly inform how patients and families approach dying. Nurses who can work within these frameworks, rather than around them, are better positioned to provide care that patients and families actually experience as compassionate.

The fourth theme is where the study’s findings turn sobering: balancing compassionate care with emotional and organizational challenges. The nurses acknowledged significant emotional burdens inherent in repeated exposure to death and dying, a well-documented occupational hazard that can accumulate into burnout, moral distress, and attrition from the specialty. At the same time, they identified organizational obstacles, insufficient support structures, resource limitations, and the absence of policies that integrate palliative care smoothly across the illness trajectory. The interplay between these two categories of challenge is important from a health systems perspective. Emotional exhaustion is often treated as an individual problem to be managed with resilience training, but the study’s findings point toward a structural reading: when organizations fail to support nurses, the emotional costs of compassionate care compound rather than resolve.

The fifth theme looks forward. Nurses in the study envisioned a stronger palliative care system built on three pillars: education, collaboration, and public awareness. Targeted education would strengthen the clinical and communication skills that end-of-life care demands, from complex symptom management to difficult conversations about prognosis. Collaboration would knit together the multidisciplinary actors, physicians, nurses, social workers, chaplains, and family caregivers, whose coordination determines whether palliative care is seamless or fragmented. Public awareness initiatives, meanwhile, aligned with cultural and religious values, would help communities understand what palliative care is and is not, reducing stigma and encouraging earlier engagement with supportive services. The authors conclude that overcoming current barriers requires precisely this kind of coordinated intervention rather than piecemeal fixes.

What gives the study its force is the consistency of the underlying message across all five themes. Nurses see palliative care as a fundamentally holistic, person-centered practice, and they are committed to delivering it, yet they report that emotional, communication, educational, and organizational barriers repeatedly impede consistent, high-quality end-of-life care. That gap between ideal and reality is not unique to Saudi Arabia; studies across many health systems have documented similar strains. But the Saudi findings carry particular significance for a region where palliative care as a distinct specialty is still maturing and where cultural and religious considerations shape clinical practice in ways that imported models do not always anticipate. Locally grounded qualitative research of this kind provides the evidence base for adaptations that fit.

Methodologically, the study’s strengths lie in its transparency and rigor. The use of verbatim transcription, iterative coding, and team consensus in theme development guards against individual researcher bias, and the researchers report that findings were shared with participants for feedback on the relevance of the themes, a validation step that strengthens qualitative credibility. The protocol was approved by the University of Bisha’s Institutional Review Board, conducted under the ethical guidelines of the Declaration of Helsinki, and all participants gave informed written consent. The study received no external funding, and the authors declare no competing interests. Published open access as an early, citable version with a permanent DOI, the research invites both scrutiny and uptake.

For health policymakers and hospital administrators, the implications are concrete. The study argues for organizational reforms that give palliative nurses the support structures their work requires, and for policies that embed palliative care across the entire cancer trajectory rather than reserving it for the final days. For nursing educators, it makes the case for curricula that build not only technical competence but also the communication skills and cultural literacy that end-of-life care demands. And for the public, it is a reminder that behind every well-managed death stands a nurse who has absorbed the physical, emotional, and spiritual weight of that process. Meeting the growing demand for palliative care will depend, above all, on whether health systems choose to support the people who provide it.

Subject of Research: Nurses' experiences delivering palliative care to patients with advanced cancer

Article Title: Exploring nurses experiences in delivering palliative care to patients with advanced cancer

Article References: Mohamed, R. A., Alkalash, S. H., Gab Allah, A. R., Alanazi, M. O., ElShora, S. N. A. E., Mohammed, S. F., Anbar, R., Dakhilallah, H., Alshahrani, M., Elfaki, E., & Almowafy, A. A. (2026). Exploring nurses experiences in delivering palliative care to patients with advanced cancer. BMC Nursing, 25(1), Article 879. https://doi.org/10.1186/s12912-026-05401-5

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05401-5

Keywords: palliative care, advanced cancer, oncology nursing, nurses' experiences, qualitative research, end-of-life care, Saudi Arabia, holistic care, nursing education, burnout, patient dignity, health policy

The study, part of the PRiSM project and led by Amy Taylor and Andrew Davies of Trinity College Dublin and Our Lady’s Hospice & Care Services, together with a large collaborative group of experts, employed an electronic Delphi methodology to distill the views of specialists across the continent. The Delphi technique is a structured process designed to achieve group agreement without the distortions of face-to-face dynamics: participants answer questionnaires independently, receive anonymized feedback on how the whole group responded, and then revise their answers over successive rounds. In this case, the researchers ran three rounds, inviting participants to rank their agreement with statements derived from systematic literature reviews, to suggest modifications, and to review responses relevant to the group’s collective position. Consensus was pre-defined as at least 75 percent agreement, and the researchers used Spearman’s rank order correlation to test whether opinions had stabilized between rounds, along with the chi-square test for goodness of fit to compare group results.

The scale of the expert engagement is one of the study’s most striking features. Eighty-six specialists in palliative care and 54 oncology experts from across Europe took part, drawn from international and national organizations as well as patient advocacy bodies. From the process, seventy relevant statements reached consensus. That number matters because it represents not the opinion of a single committee but a quantified, statistically tested convergence of more than 140 clinicians and advocates from different countries, disciplines, and healthcare systems. The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidance, approved by the Trinity College Dublin Faculty of Health Sciences Research Ethics Committee, and reported following established recommendations for conducting and reporting Delphi studies in palliative care.

So what did the experts agree on? At the core of the consensus is a clear statement of purpose: specialist palliative care services should support people with locally advanced or metastatic cancer for both cancer-related problems and problems arising from cancer treatment itself, alongside the holistic dimensions of care that address psychological, social, and spiritual suffering. The experts endorsed the involvement of a dedicated multidisciplinary team, reflecting the understanding that the needs of this population rarely fit within the competence of any single professional group. Pain, fatigue, neuropathy, lymphedema, anxiety, depression, financial strain, and existential distress can coexist in the same patient, and each demands a different kind of expertise.

This framing represents a significant conceptual shift. Specialist palliative care services have traditionally been organized around people approaching the end of life, with referral often triggered by decline rather than by the ongoing needs of patients who may live for years with stable metastatic disease. The consensus statements acknowledge that this group faces unique problems requiring different strategies. A patient whose disease is controlled on a targeted therapy may need help managing chronic treatment-related neuropathic pain, rehabilitation after surgery, or support returning to work, needs that differ substantially from those of a patient in the final weeks of life. The study’s findings will be used to inform a model of care designed to formalize this extended role.

Yet the experts were equally candid about the gaps. The consensus identified specific areas in which specialist palliative care services themselves require further training, including certain pain management strategies, psychological therapies, and the adverse effects of modern anticancer treatments. This admission is notable because it comes from within the specialty. As cancer treatment has evolved toward targeted agents, immunotherapies, and chronic oral regimens, the toxicities and long-term effects of these treatments have created clinical problems that traditional palliative care training, oriented toward symptom control at the end of life, did not necessarily cover. The study thus points to a two-way educational imperative: oncologists need to understand what specialist palliative care can offer earlier in the disease course, and palliative care specialists need to deepen their knowledge of contemporary oncological therapeutics.

The study also confronted the structural obstacles standing in the way of extending these services. Lack of resources emerged as a major barrier, a finding that will surprise no one working in European health systems where palliative care provision varies enormously between and within countries. Perhaps more insidiously, the experts identified misperceptions about specialist palliative care as a barrier to service extension. The persistent association of palliative care with death and dying means that patients and even referring physicians may resist involvement, fearing that a referral signals abandonment of active treatment. Previous research has documented how the naming of services, with some centers adopting the term supportive care in place of palliative care, reflects and reinforces these attitudes among oncology professionals. The new consensus statements provide an evidence-based counterweight: a formal, expert-endorsed description of what these services actually do for people living with advanced disease.

The methodological rigor underlying these conclusions deserves attention, because consensus studies are only as credible as the process that produces them. By pre-defining the consensus threshold at 75 percent, the researchers avoided the retrospective tuning of criteria that has undermined some Delphi studies. By testing stability between rounds with rank order correlation, they ensured that agreement reflected genuine convergence rather than fatigue or drift. The use of literature reviews to generate the initial statements grounded the exercise in published evidence rather than pure opinion, and the inclusion of patient advocacy organizations alongside clinical specialists brought the perspectives of those who use these services into the process. The study conformed to European data protection regulations and obtained informed consent from all participants.

The broader context makes the timing of this work significant. Recent years have seen growing international recognition that metastatic cancer survivorship is a distinct clinical domain. A 2022 National Cancer Institute meeting report in the United States addressed survivorship for individuals living with advanced and metastatic cancers, and subsequent work has called for a reconsideration of clinical care, policy, and research priorities for this population. Systematic reviews have documented extensive unmet supportive care needs among people with advanced cancer and their caregivers, and international standards and practice recommendations have been developed by the Multinational Association of Supportive Care in Cancer and the American Society of Clinical Oncology. What has been missing, the PRiSM investigators argue, is clarity about the specific role that specialist palliative care services should play within this evolving landscape, particularly in Europe where definitions and standards have been redefined through consensus processes in recent years.

The practical implications of the study extend well beyond academic debate. For health system planners, the seventy consensus statements constitute a blueprint for what a properly resourced specialist palliative care service for people with advanced cancer should look like, from the composition of the multidisciplinary team to the scope of physical and holistic interventions. For training bodies, the identified educational gaps define a curriculum for the specialty’s next generation. For oncologists and patients, the statements offer a shared, authoritative description of when and why to involve these services, potentially dismantling the misperceptions that currently delay referrals. And for researchers, the consensus provides a foundation on which models of care can be built and tested. As more people live longer with metastatic cancer, the question is no longer whether specialist palliative care has a role in their care, but how that role should be organized, staffed, and delivered. This European consensus gives the field its clearest answer yet, and the model of care that follows from it will determine whether the promise of longer survival is matched by a better quality of that survival.

Subject of Research: Expert consensus on the role of specialist palliative care services in the care of people with stable locally advanced or metastatic cancer

Article Title: PRiSM project: e-Delphi study on the role of specialist palliative care services in the care of people with stable locally advanced or metastatic cancer

Article References: Taylor, A., Davies, A., PRiSM e-Delphi Group, Abela, J., Ahmedzai, S. H., Antonuzzo, A., Aquilano, M., Solabarrieta, M. A., Arends, C., Arends, J., Baird, A.-M., Balding, L., Bana, M., Gimeno, E. B., Barry, C., Bergqvist, J., Boland, J., Boland, L., Bouleuc, C., … Sarmento, T. (2026). PRiSM project: e-Delphi study on the role of specialist palliative care services in the care of people with stable locally advanced or metastatic cancer. Supportive Care in Cancer, 34(10), Article 982. https://doi.org/10.1007/s00520-026-11211-x

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11211-x

Keywords: palliative care, metastatic cancer, e-Delphi study, cancer survivorship, supportive care, oncology, consensus statements, multidisciplinary team, symptom management, advanced cancer, Europe, model of care

The starting point for the debate is the 2016 consensus paper, also published in Supportive Care in Cancer, in which Lebel, Ozakinci, Humphris, Mutsaers, Thewes, Prins, Dinkel, Butow and colleagues at the University of Ottawa Fear of Cancer Recurrence Colloquium defined fear of cancer recurrence as a normal response moving toward a clinical problem. That definition deliberately covered a spectrum, from the fleeting worry that nearly every survivor experiences after a scan or an anniversary date, to the severe, persistent and intrusive fear that can dominate a person’s life and function as a psychological disorder. By folding both recurrence, meaning the return of disease after treatment, and progression, meaning the advance of existing disease, into a single slash-linked construct, the field gained a shared language but may have blurred important clinical distinctions.

The scale of the problem explains why the construct matters so much. A systematic review and individual participant data meta-analysis published in 2022 in Psycho-Oncology, with Luigjes-Huizer, Tauber, Humphris, Kasparian, Lam, Lebel, Simard, Smith, Zachariae, Custers and many collaborators among its authorship, estimated the prevalence of fear of cancer recurrence across cancer survivors and patients and confirmed that it is widespread, affecting a substantial minority at clinically significant levels. Psychological interventions have been developed in response, and a 2019 meta-analysis in the Journal of Clinical Oncology led by Tauber and colleagues showed that these treatments do reduce fear, although effect sizes were modest, leaving considerable room for refinement. It is precisely that refinement, the new commentary argues, that may require a sharper conceptual toolkit.

The technical heart of the argument lies in psychometrics and construct validity. The Fear of Cancer Recurrence Inventory, developed and validated by Simard and Savard in 2009, established a multidimensional measure that has anchored assessment for more than fifteen years. More recently, however, Coutts-Bain, Sharpe and colleagues published a study in Psycho-Oncology in 2022 asking directly whether fear of cancer recurrence and fear of progression are equivalent constructs, and a 2023 study in the Journal of Behavioral Medicine showing that death anxiety predicts both fear of recurrence and fear of progression in ovarian cancer patients over and above other cognitive factors. These findings suggest that the two fears share common psychological machinery, particularly cognitive avoidance and worry processes described in the cognitive avoidance theory of worry cited by the commentary, while also hinting that they may diverge in clinically meaningful ways.

That divergence becomes most visible in the context of advanced disease. For patients living with metastatic cancer on ongoing systemic treatment, the binary of recurrence versus no recurrence simply does not apply. A 2022 scoping review in Cancers by Kolsteren, Deuning-Smit, Chu and colleagues examined the psychosocial aspects of living long term with advanced cancer and ongoing treatment, and a 2024 international modified Delphi study published in the Journal of Psychosocial Oncology Research and Practice, again led by Kolsteren with Kwakkenbos, Prins, Sharpe, Lebel and Custers, formally identified the features of fear of progression in this population. The experiences described there, including uncertainty about how long a treatment will keep working, vigilance toward every scan and every blood marker, and the challenge of holding hope and mortality in mind simultaneously, differ in kind from the fear of a cured patient that the disease might silently return.

Precision medicine has amplified this mismatch. Targeted therapies and immune checkpoint inhibitors have transformed some advanced cancers into chronic conditions managed over years. Research on the survivorship experience of patients with metastatic melanoma on immune checkpoint and BRAF-MEK inhibitors, published in the Journal of Cancer Survivorship in 2019 by Lai-Kwon, Khoo and colleagues, documented how these patients live in a permanent state of surveillance, dependent on drugs whose durability is uncertain. In such a world, the question is not whether the cancer will come back but whether the current therapy will continue to hold it in check. A construct defined around recurrence after curative treatment struggles to capture that existential position, which is closer to what psychotherapy researchers such as Colosimo, Nissim, Pos, Hales, Zimmermann and Rodin have described as double awareness in patients living with advanced cancer.

The commentary also situates the debate within a broader transdiagnostic movement. Sharpe, Michalowski, Richmond, Menzies and Shaw published a systematic review and meta-analysis in Health Psychology Review in 2023 demonstrating that fear of progression occurs in chronic illnesses other than cancer, treating it as a transdiagnostic construct that cuts across diagnostic categories. If fear of progression is a general phenomenon of chronic illness, while fear of recurrence is more specific to the cancer survivorship trajectory, then merging the two may obscure both their shared mechanisms and their distinct triggers. The measurement field has begun to respond: Sharpe, Menzies, Richmond, Todd, MacCann and Shaw developed and validated the Worries About Recurrence or Progression Scale, known as WARPS, in the British Journal of Health Psychology in 2024, and Smith, Sharpe, Winiarski and Shaw followed with a cancer-specific version, WARPS-C, validated in Psycho-Oncology as a screening tool for fear of cancer recurrence.

What would separation actually mean in practice? The authors suggest that distinguishing the two constructs could sharpen screening, since the questions that detect fear of recurrence in a disease-free survivor may not detect fear of progression in a patient on maintenance therapy. It could also refine treatment selection, because interventions that target catastrophic misinterpretation of bodily symptoms, a core driver of recurrence fear in survivors, may need different emphasis from interventions that help patients with advanced disease tolerate uncertainty and balance awareness of dying with engagement in living. Furthermore, separating the constructs would allow researchers to test whether death anxiety, which the ovarian cancer data identified as a powerful predictor, plays a larger role in progression fear than in recurrence fear, with direct implications for which therapeutic techniques should be deployed for which patients.

The commentary does not claim that the field should abandon a decade of accumulated evidence, and its authors, who wrote the original draft together and revised it with the full international group, are careful to frame the question as one for the community to weigh. The original 2016 definition succeeded in legitimizing fear of cancer recurrence as a clinical problem worthy of research funding, validated instruments and psychological trials. The risk now, they imply, is that a construct built for the curative-treatment era is being stretched across patient populations whose clinical realities it was never designed to describe. As precision medicine continues to convert advanced cancer into a long-term managed disease, the psychological sciences of oncology may need vocabulary that keeps pace, and the question posed by Custers, Lebel, Sharpe and their colleagues is likely to shape the next round of consensus discussions about how fear of cancer returning, spreading and progressing should be defined, measured and treated.

Subject of Research: Distinguishing fear of cancer recurrence from fear of progression in psycho-oncology

Article Title: Rethinking fear of cancer recurrence/progression in the era of precision medicine: is it time to consider separating?

Article References: Custers, J. A. E., Chu, A., Smith, B., Dinkel, A., Humphris, G., Ng, D. W. L., Prins, J. B., Poort, H., Braam, C. I. W., Kemme, N. D. F., van der Lee, M. L., Zwanenburg, L. C., Schellekens, M. P. J., Sharpe, L., & Lebel, S. (2026). Rethinking fear of cancer recurrence/progression in the era of precision medicine: is it time to consider separating?. Supportive Care in Cancer, 34(10), Article 985. https://doi.org/10.1007/s00520-026-11233-5

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11233-5

Keywords: fear of cancer recurrence, fear of progression, psycho-oncology, precision medicine, cancer survivors, advanced cancer, psychometrics, death anxiety, WARPS scale, supportive care, construct validity, cancer survivorship

Cancer-related anemia, often abbreviated CRA, arises from a tangle of mechanisms: the tumor itself can suppress red blood cell production through inflammatory cytokines, chemotherapy and radiotherapy damage the bone marrow, nutritional iron deficiency can develop, and bleeding or kidney dysfunction can compound the deficit. The result is a reduced hemoglobin concentration, which starves tissues of oxygen and manifests clinically as fatigue, breathlessness, dizziness, and diminished quality of life. In late-stage disease, where patients are often receiving their third or subsequent lines of treatment, the cumulative toxicity of repeated regimens makes the problem especially acute.

The Beijing study quantified the severity of anemia using standard hemoglobin thresholds. Among the 1,006 anemic patients, the average hemoglobin level was 96.85 grams per liter, with a standard deviation of 14.32. Mild anemia accounted for just over half of cases at 51.3 percent, moderate anemia for 35.8 percent, severe anemia for 10.2 percent, and extremely severe anemia for 2.7 percent. In other words, roughly one in eight anemic patients had fallen into a range serious enough to threaten daily functioning and potentially require urgent intervention.

Red blood cell morphology added another layer of diagnostic insight. Normocytic anemia — red cells of normal size — predominated at 75.3 percent of cases, a pattern consistent with the anemia of chronic disease and marrow suppression rather than classic iron deficiency. Macrocytic anemia, in which red cells are abnormally large, followed at 20.7 percent, a finding that can reflect chemotherapy effects on DNA synthesis, folate or vitamin B12 disturbances, or certain targeted therapies. Microcytic anemia, typically associated with absolute iron deficiency, was the least common at just 4.0 percent, suggesting that straightforward iron replacement alone would address only a small fraction of the problem in this population.

The distribution of severity varied meaningfully by tumor type. Advanced lung cancer and gastrointestinal tumors had the highest proportions of mild anemia, at 56.2 percent and 55.4 percent respectively, meaning most of their anemic patients remained in the least severe category. Gynecologic tumors told a different story: 18.2 percent of anemic patients with these cancers had severe anemia, a rate significantly higher than the 6.3 percent seen in advanced lung cancer and the 6.0 percent in breast cancer. The authors suggest this may reflect the biology and treatment of gynecologic malignancies, including the potential for tumor-related and treatment-related blood loss, though the retrospective design cannot pin down the exact mechanisms.

Perhaps the most sobering finding concerns treatment. Despite the availability of established therapies for cancer-related anemia — iron supplementation, erythropoiesis-stimulating agents, and red blood cell transfusion — only 22.4 percent of the 1,006 anemic patients received any anti-anemia therapy. The treatment gap tracked severity closely: just 10.1 percent of patients with mild anemia were treated, compared with 59.2 percent of those with severe anemia and 96.3 percent of those with very severe anemia. The pattern suggests that clinicians often wait until anemia becomes debilitating before intervening, a reactive approach that the study’s authors argue should give way to earlier, standardized management.

To identify who is most at risk of severe anemia, the researchers performed multivariate logistic regression, a statistical technique that isolates the independent effect of each factor while controlling for the others. The results were revealing. A Karnofsky Performance Status score of 60 or higher — a measure of a patient’s functional ability, where higher scores indicate better day-to-day functioning — was associated with an approximately 62 percent reduction in the odds of severe anemia, with an odds ratio of 0.38. This suggests that a patient’s overall physical condition, and the biological reserve it represents, plays a protective role against the steepest hemoglobin declines.

Tumor type emerged as another independent determinant. Compared with lung cancer, gynecologic tumors carried roughly 3.3 times the risk of severe anemia, with an odds ratio of 3.33, while gastrointestinal tumors carried 1.83 times the risk. A prior history of blood transfusion was also linked to a 76 percent increase in the risk of severe anemia, with an odds ratio of 1.76 — a finding that likely marks patients whose anemia has already proven refractory or recurrent, rather than transfusion itself causing the problem. Notably, age, gender, history of prior tumors, the specific third-line regimen, stage IV disease at initial diagnosis, liver metastasis, and lung metastasis showed no independent association with severe anemia, indicating that these commonly monitored variables are less predictive than performance status and tumor origin.

The study joins a lineage of large surveys, including the European Cancer Anaemia Survey, that have documented the high prevalence and undertreatment of anemia in oncology. What distinguishes the new work is its focus on a heavily pretreated population — patients on third-line or later therapy — a group that is often underrepresented in clinical trials yet increasingly common as cancer survival extends and treatment sequences lengthen. With an incidence of 65.1 percent in this setting, anemia is not a marginal side effect but a central feature of advanced disease management, with direct consequences for treatment tolerance, dosing intensity, and quality of life.

The authors conclude that greater attention and standardized management of anemia should be implemented among cancer patients, and the data point to concrete priorities: routine hemoglobin monitoring and earlier intervention for patients with gynecologic and gastrointestinal tumors, proactive anemia assessment for those with poor performance status, and a lower threshold for treatment before hemoglobin levels fall into the severe range. As cancer care continues to extend lives through successive lines of therapy, the study serves as a reminder that the blood counts of these patients deserve the same systematic attention as their tumors.

Subject of Research: Cancer-related anemia in advanced cancer patients receiving third-line or higher anti-cancer treatment

Article Title: A survey of the current status of cancer-related anemia in 1006 advanced cancer patients undergoing third-line or higher anti-cancer treatment: a multicenter retrospective study in nine tertiary hospitals in Beijing area

Article References: Xu, J., Zhang, Q., Kang, N., Yan, D., Feng, Y., Yin, Y., Liu, J., Jiang, J., Yuan, J., Liu, Z., Han, X., Li, X., & Hou, L. (2026). A survey of the current status of cancer-related anemia in 1006 advanced cancer patients undergoing third-line or higher anti-cancer treatment: a multicenter retrospective study in nine tertiary hospitals in Beijing area. BMC Cancer. https://doi.org/10.1186/s12885-026-17100-0

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17100-0

Keywords: cancer-related anemia, advanced cancer, hemoglobin, chemotherapy, gynecologic tumors, gastrointestinal tumors, lung cancer, performance status, blood transfusion, retrospective study, anemia treatment, oncology

The research team, led by Larissa Pereira Santos and colleagues working with the GPQual palliative care and quality of life research group at Barretos Cancer Hospital and the National Cancer Institute in Rio de Janeiro, set out to fill a conspicuous gap in the literature. Handgrip strength has been extensively studied in community-dwelling older adults and in patients undergoing active cancer treatment, but data specific to specialized palliative care settings remain scarce. Even fewer studies have examined which factors are associated with low grip strength in this context, and, according to the authors, none had previously analyzed these factors separately for men and women. That distinction matters because of well-established muscular dimorphism, hormonal differences, and divergent trajectories of lean mass loss between the sexes.

The study was conducted between August 2023 and August 2025 at the palliative care unit of a national cancer referral center in Brazil. Patients attending their first outpatient visit were consecutively recruited if they were at least 20 years old, had metastatic disease confirmed by histological, cytological, or radiological evidence, or had local or locoregional recurrence without ongoing antineoplastic therapy. All participants had a Karnofsky Performance Status, or KPS, of at least 40 percent, a threshold chosen because the outpatient setting required participants to be physically capable of completing a standardized grip test. Patients with more severe functional impairment, who typically require inpatient care and substantial assistance with daily activities, were therefore not part of the final analytical sample.

The measurement protocol was rigorous. Grip strength was assessed bilaterally with a Jamar hydraulic dynamometer, the instrument widely regarded as a clinical standard. Patients sat with feet flat on the floor, knees flexed at 90 degrees, and arms resting at their sides, with the elbow of the tested limb bent at 90 degrees and the forearm in a neutral position. Each hand was tested three times in alternating fashion, with one-minute intervals between trials, and the highest value regardless of hand dominance was used for analysis. All measurements were performed by a trained nutritionist during the enrollment visit. Because no validated grip strength cutoffs exist specifically for patients with advanced cancer in palliative care, the researchers classified the lowest sex-specific tertile of their sample as low grip strength, which worked out to 12 kilograms or less for women and 20 kilograms or less for men.

The results were striking in their consistency. Among women, low grip strength was significantly more prevalent in those aged 60 or older, those without a marital relationship, those with fewer than nine years of formal education, those who had previously received chemotherapy or radiotherapy, those with comorbidities such as hypertension and cardiovascular disease, those with a KPS of 50 percent or below, and those flagged as being at nutritional risk by the Patient-Generated Subjective Global Assessment short form. Among men, low grip strength clustered in older patients, those with a partner, those with prior chemotherapy exposure, and those with reduced performance status. In the crude analyses, age, education, KPS, hypertension, cardiovascular disease, and nutritional risk all reached statistical significance for women, while age and KPS dominated for men.

But when the researchers built adjusted multivariable logistic regression models using a backward stepwise approach, the field narrowed dramatically. For women, only two variables survived: age of 60 or older, which carried an odds ratio of 2.29, and a KPS of 40 to 50 percent, which carried an odds ratio of 5.06. For men, the pattern was similar but even more pronounced for age, with an odds ratio of 4.02 for being 60 or older and 3.89 for the lowest KPS category. In practical terms, a woman with severely limited functional status was roughly five times more likely to fall into the weakest grip tertile than a comparable patient with better preserved function, and older men were about four times more likely than younger men to do so. The models accounted for 13 percent of the variability in women and 16 percent in men, a modest but meaningful share given the multifactorial nature of muscle weakness in advanced disease.

The convergence between low grip strength and poor performance status is biologically and clinically plausible, the authors argue, although the cross-sectional design prevents any claim of causation. Patients with KPS scores between 40 and 50 percent experience substantial limitations in daily activities and increased dependency, and the tight coupling of these variables suggests that a dynamometer reading may serve as a rapid, objective approximation of global functional capacity. The relationship is likely bidirectional: functional decline reduces muscle use and strength, while diminished strength in turn accelerates the loss of autonomy. This feedback loop is precisely what makes early detection valuable in palliative oncology, where interventions aimed at preserving function must be timed carefully.

The new findings align with a growing international evidence base. Studies in the oldest old have shown that weak grip predicts decline in daily activities, while work in advanced cancer patients has demonstrated that those with grip strength at or below the tenth percentile exhibit poorer performance status, reduced lean mass, greater fatigue, worse quality of life, higher prevalence of sarcopenia, lower body mass index, and reduced hemoglobin and albumin levels. A prospective study published in the Journal of Cachexia, Sarcopenia and Muscle found that lower grip strength was independently associated with increased mortality in patients with predominantly advanced cancer. Perhaps most tellingly, research in advanced or recurrent lung cancer found that muscle strength measures were associated with survival, whereas skeletal muscle mass alone was not. Grip strength, in other words, appears to capture something that imaging-based muscle mass assessments miss, and reductions in strength may even precede measurable losses of muscle mass, enabling earlier detection of functional impairment.

The clinical implications are immediate and pragmatic. A dynamometer costs little, requires seconds to use, and can be deployed in settings where complex performance-based tests are infeasible, including with frail individuals who cannot complete gait speed or chair-stand assessments. Identifying patients with weak grip can inform care planning, risk stratification, and resource allocation, and can trigger timely nutritional support, symptom management, or palliative rehabilitation. Notably, the study found that while 36 percent of women and 31 percent of men overall were classified as having low grip strength, the prevalence jumped to 63 percent in women and 71 percent in men who were both over 60 and had KPS scores of 50 percent or below. Age and performance status alone therefore cannot identify every vulnerable patient, but they can serve as accessible screening flags that direct clinicians toward formal dynamometry.

The authors are candid about the study’s limitations. The sample was predominantly older and functionally preserved, so the results may not extend to hospitalized patients or those with KPS below 40 percent. The use of sample-specific tertiles rather than externally validated thresholds limits comparability with studies applying the European or Asian Working Group for Sarcopenia criteria, and the similarity of the cutoffs to those from a prior palliative care study should not be read as external validation. The hydraulic dynamometer also requires a minimum force of three to four kilograms to register a reading, meaning the frailest patients who could not activate the device were excluded, which may have underestimated the true magnitude of muscle weakness. The assessor was not blinded to clinical information, introducing a potential for observer bias. Still, the researchers call for longitudinal studies to determine whether grip strength declines before functional deterioration, and for pragmatic trials testing whether intensive nutrition, physical therapy, or multimodal rehabilitation can alter the functional trajectory of these patients. If those questions are answered affirmatively, the humble grip test could become a routine vital sign of vulnerability at the end of life.

Subject of Research: Factors associated with low handgrip strength in patients with advanced cancer receiving palliative care

Article Title: Low handgrip strength in advanced cancer: associated factors and clinical implications in palliative care

Article References: Santos, L. P., Paiva, B. S. R., Da Costa Rosa, K. S., Paiva, C. E., & De Oliveira, L. C. (2026). Low handgrip strength in advanced cancer: associated factors and clinical implications in palliative care. Supportive Care in Cancer, 34(10), Article 1020. https://doi.org/10.1007/s00520-026-11249-x

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11249-x

Keywords: handgrip strength, advanced cancer, palliative care, Karnofsky Performance Status, sarcopenia, cachexia, nutritional risk, functional decline, dynamometry, oncology, frailty, sex-stratified analysis

The World Health Organization defines sexual health as a state of physical, emotional, mental, and social well-being in relation to sexuality, not merely the absence of dysfunction. By that broad standard, cancer is a formidable adversary. Estimates cited in the study suggest that over 90 percent of cancer patients experience some form of sexual dysfunction, ranging from diminished libido and altered satisfaction to difficulties with arousal. Despite this prevalence, clinicians are less likely to raise sexual health with patients on life-prolonging or palliative treatments than with those pursuing curative care, and prior research indicates that discussions about treatment effects on sexual function reach men roughly twice as often as women, at rates of 64 percent versus 28 percent.

The Malaysian study recruited participants from an oncology outpatient clinic at a private quaternary hospital between March 2023 and March 2024. Eligible patients had advanced solid-organ cancer, were at least 18 years old, had a sexual partner, and were proficient in English. The average participant was 49.1 years old, 63.3 percent were women, and 82.5 percent had good performance status as measured by the Eastern Cooperative Oncology Group scale, where lower scores indicate better physical function. Breast cancer was the most common diagnosis at 28.3 percent, followed by gastrointestinal malignancies at 26.7 percent and lung cancer at 13.3 percent. Most participants were married, lived with their partner, and had been in their relationship for more than two decades.

Participants completed the EORTC QLQ SH-22, which assesses functional domains such as sexual satisfaction, activity, libido, and partner relationships alongside symptom domains including sexual pain, vaginal dryness, erectile function, fatigue, and treatment impact. Scores are transformed to a 0 to 100 scale, with higher values indicating more severe symptoms or dysfunction. The researchers supplemented this with the six-item Female Sexual Function Index, adapted so that the lubrication item also captured erection, and with single-item measures of self-esteem, life satisfaction, and relationship satisfaction rated on seven-point scales. Statistical analysis employed Pearson correlations, independent t-tests, analyses of variance, and multiple linear regression using SPSS version 25, with effect sizes interpreted according to Cohen’s conventions.

One of the most striking findings was that 51.6 percent of participants reported sexual activity within the previous four weeks, a figure that contrasts sharply with studies from other populations. Research cited by the authors found that nearly 60 percent of highly educated men with advanced cancer in stable relationships had abstained from sexual activity in the preceding month despite yearning for intimacy, while a study of urban Chinese breast cancer survivors found that fewer than one-third had been sexually active in the past year, often fearing that intercourse could impede recovery. The authors suggest that stable long-term partnerships, cultural and relational factors, and the healthcare context may all shape these divergent patterns, underscoring that sexual behavior in serious illness is not determined by disease status alone.

The correlational results revealed clear gender-specific signatures. Among women, better sexual functioning was associated with higher perceived importance of sex (r = 0.60), greater sexual satisfaction (r = 0.61), less vaginal dryness (r = -0.43), less sexual pain (r = -0.33), and less interference of treatment with sex (r = -0.35), all statistically significant. Among men, better functioning tracked with erectile confidence (r = 0.51), perceived importance of sex (r = 0.46), greater satisfaction, and less treatment interference (r = -0.49). Direct comparisons showed that an active sex life mattered more to men than to women, with a moderate effect size (p = 0.005, d = 0.54), while women reported substantially more sexual pain than men, with a large effect size (p < 0.001, d = 0.87).

Physical function emerged as a second major axis of sexual well-being. Patients with poor performance status, defined as an ECOG score of 2 or above, reported significantly greater impact of fatigue on their sex lives (p = 0.010, d = 0.65) and more worries about incontinence (p = 0.013, d = 0.60) than those with good performance status. Interestingly, apparent differences in sexual pain between cancer types dissolved when gender was added to a regression model, suggesting that gender, with its physiological and sociocultural dimensions, exerts a stronger influence on sexual pain than tumor site alone. The authors note that treatments such as surgery, chemotherapy, radiotherapy, and endocrine therapy may contribute to sexual difficulties through effects on body image, fatigue, menopausal symptoms, and organ function.

The sources of sexual distress also diverged sharply by gender. Men who experienced more sex-related stress reported poorer body image, feeling less masculine, greater insecurity about satisfying their partners, and lower sexual satisfaction, consistent with evidence that men place heavy emphasis on sexual performance. Women’s distress, by contrast, was linked to vaginal dryness and worries about incontinence, pointing to physical discomfort as a central driver. Only among women were sexual health variables associated with self-esteem, life satisfaction, and relationship satisfaction; among men, none of the QLQ SH-22 domains correlated significantly with these broader well-being measures. Both genders showed a link between sex-related stress and more communication with health professionals, hinting that distressed patients may actively seek conversations that clinics rarely initiate.

The cultural context of Malaysia adds a distinctive layer to these findings. Norms of modesty, religiosity, and traditional gender roles can inhibit open discussion of sexuality, particularly among older adults and women, contributing to underreporting and unmet needs. Qualitative research from Malaysian hospitals has found that healthcare providers cite embarrassment, limited knowledge, sociocultural taboos, and time constraints when explaining why they avoid sexual health conversations, often prioritizing disease management over comprehensive care. Surveys of Malaysian medical students similarly reveal widespread feelings of being ill-equipped to discuss sexual matters, pointing to gaps in training that begin long before clinical practice.

The authors argue that these findings justify integrating structured sexual health assessment into routine oncology and palliative care. They propose a simple screening question, asking whether cancer or its treatment has affected intimacy or sexual well-being, followed by fuller evaluation with validated instruments such as the QLQ SH-22 for patients who report concerns. Gender-sensitive pathways could offer women management of vaginal symptoms, gynecological assessment, and body image support, while men might benefit from interventions targeting erectile confidence and communication with partners. Referral networks spanning gynecology, urology, psycho-oncology, counseling, and palliative care could support multidisciplinary management. The study’s limitations, including its cross-sectional design, the predominance of educated Malaysian Chinese women in stable relationships, recruitment at a single private center, and the absence of partner perspectives, caution against broad generalization. Even so, the message is clear: sexuality does not disappear with an advanced cancer diagnosis, and culturally responsive, person-centered care must make room for it.

Subject of Research: Sexual health and function in Malaysian patients with advanced cancer assessed using the EORTC QLQ SH-22 questionnaire

Article Title: Exploring sexual health and function among Malaysian patients with advanced cancer: insights from the EORTC QLQ SH-22 questionnaire

Article References: Yaakup, H., Goh, P. H., Mustafa, H., Ho, J. F. V., Lee, Q. Y., Wong, P. L., & Cheong, M. W. L. (2026). Exploring sexual health and function among Malaysian patients with advanced cancer: insights from the EORTC QLQ SH-22 questionnaire. Supportive Care in Cancer, 34(10), Article 1042. https://doi.org/10.1007/s00520-026-11261-1

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11261-1

Keywords: advanced cancer, sexual health, sexual dysfunction, EORTC QLQ SH-22, palliative care, supportive care, quality of life, Malaysia, gender differences, oncology, performance status, patient-reported outcomes