The following lists palliative care research primarily conducted by Australian research groups. The list is based on application of the CareSearch search filter for palliative care to identify articles held within the PubMed database and corresponding to the strongest evidence. Articles have been selected based on relevance and new articles are added on a weekly basis.
Whilst not an exhaustive list, the aim is to keep the community informed by providing a snapshot of recent research findings and planned studies in the Australian setting.
Hardy JR, Good P.
Following sustained public pressure and despite a paucity of evidence to support medical benefit, medicinal cannabis (MC) was legalised in Australia in 2016 for use in resistant childhood epilepsy, chemotherapy-induced nausea and vomiting (CINV), spasticity associated with multiple sclerosis, chronic non-cancer pain and ‘palliative care’. Over subsequent years, there has been an exponential rise in the number of prescriptions approved and an associated ‘indication creep’. Most common Special Access Scheme applications to the Therapeutic Goods Administration are for pain, anxiety, sleep disorders and cancer symptoms. Popular brands include those with tetrahydrocannabinol (THC), the most common psychoactive cannabinoid. This is despite the fact that THC is associated with significant side effects, and it is illegal to drive while taking THC in most states.
Cannabis remains popular amongst cancer patients. A recent review reports that one-quarter of adults receiving cancer treatment at a cancer clinic in the United States had used cannabis in the past 30 days in an attempt to fight cancer or ameliorate the symptoms related to the disease or its treatment. The most common reasons given by over 1000 cancer patients and survivors in South Carolina were difficulty in sleeping, stress/anxiety/depression and pain. The ongoing interest is not surprising when uncontrolled trials continually report significant benefits, supported by strong media bias towards positive results. A fake news story claiming that cannabis cured cancer received 100-fold more media attention than the evidence-based story debunking the theory.
Over recent years, much research has been undertaken to answer many of the unknowns around cannabis (e.g. what combination of cannabinoids is best, at what dose and by what schedule) and to explore where it might be most effective. Uncontrolled studies and case reports continue to report benefit for a range of conditions. Randomised controlled trials (RCTs) do not. So, what is the hard evidence to date in oncology/palliative care?
Schuler T, Roderick S, Wong S, Kejda A, Grimberg K, Lowe T, et al.
Abstract: The feasibility of simulation-free radiation therapy (SFRT) has been demonstrated but information regarding its routine care impact and scalability is lacking.
Methods and materials: In this single-institution, retrospective cohort study, all patients receiving palliative radiation therapy at an Australian tertiary cancer center were eligible for consideration of SFRT unless mask immobilization, a stereotactic technique, or a definitive dose was indicated. Coprimary endpoints were SFRT utilization, impact on consultation-to-RT time, and on-couch treatment duration. Timing metrics were compared with a contemporary local cohort that received simulation-based palliative radiation therapy using unadjusted Wilcoxon rank-sum tests and a propensity score-matched regression. Electronic patient-reported outcomes captured 2-week toxicity and pain response.
Results: Between April 2018 and February 2024, 2849 palliative radiation courses were delivered, of which 1904 were eligible. Of the 1904 courses, 1000 (52.5% SFRT utilization) received SFRT, including 668 using intensity-modulated radiation therapy/volumetric-modulated arc therapy. A total of 788 individual patients received SFRT and the median age was 71 years (IQR, 61-80) with 59% being male and 42% being Eastern Collaborative Oncology Group 2-4. SFRT utilization increased from 41% to 54% between years 2018-2019 and 2022-2024. SFRT reduced median consultation-to-RT time from 7.0 to 5.1 days (P < .0001) corresponding to an adjusted average treatment effect in the treated of -2.1 days (95% CI, -2.8 to -1.3). SFRT increased median on-couch treatment duration from 17.8 to 20.5 minutes (P < .0001; adjusted average treatment effect in the treated 2.6 minutes, 95% CI, 1.3-3.9). Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events grade 3 acute toxicity was 9% and at 4 weeks after RT, patients with moderate/severe pain at baseline (≥5/10) had a mean pain reduction of 3.5 points (7.1-3.6; P < .0001).
Conclusions: Using widely available technologies, the SFRT-1000 cohort demonstrates routine care scalability with patient-centered and workflow benefits. SFRT is an attractive new paradigm implementable in most settings following adaptation to local requirements. Thus, SFRT opens new avenues to potentially improve access to palliative RT, which remains a global area of need.
Bartley N, Rodriguez Grieve L, Cooper C, Kirsten L, Wilson C, Sajish B, et al.
Abstract: Bereavement care can facilitate adjustment to death and reduce immediate distress and long-term morbidity, mortality and health service utilisation. This systematic review aimed to identify international models of bereavement care, and barriers and facilitators to implementing such models. A systematic search of MEDLINE, Embase, CINAHL and PsycINFO identified 64 studies for inclusion. The most common forms of bereavement support were bereavement packs, memory-making activities, condolence cards, memorial services, and follow-up contact. Only 14 models included a formal assessment of complex grief, and 17 studies considered culturally and linguistically diverse populations. Barriers included lack of institutional/financial support, staff discomfort delivering care, lack of dedicated staffing, and difficulty collecting/maintaining information. Facilitators were adequate funding/infrastructure, formal protocols/procedures, dedicated staffing, and staff training and support. Future research should address bereavement models of care in settings beyond palliative care, considering culturally and linguistically diverse populations, and should provide implementation data and strategies.
Butler C, Michael N, Kissane D.
Objectives: To explore the potential of incorporating personally meaningful rituals as a spiritual resource for Western secular palliative care settings. Spiritual care is recognized as critical to palliative care; however, comprehensive interventions are lacking. In postmodern societies, the decline of organized religion has left many people identifying as "no religion" or "spiritual but not religious." To assess if ritual could provide appropriate and ethical spiritual care for this growing demographic requires comprehensive understanding of the spiritual state and needs of the secular individual in postmodern society, as well as a theoretical understanding of the elements and mechanisms of ritual. The aim of this paper is to provide a comprehensive and theoretically informed exploration of these elements through a critical engagement with heterogeneous literatures.
Methods: A hermeneutic narrative review, inspired by complexity theory, underpinned by a view of understanding of spiritual needs as a complex mind-body phenomenon embedded in sociohistorical context.
Results: This narrative review highlights a fundamental spiritual need in postmodern post-Christian secularism as need for embodied spiritual experience. The historical attrition of ritual in Western culture parallels loss of embodied spiritual experience. Ritual as a mind-body practice can provide an embodied spiritual resource. The origin of ritual is identified as evolutionary adaptive ritualized behaviors universally observed in animals and humans which develop emotional regulation and conceptual cognition. Innate human behaviors of creativity, play, and communication develop ritual. Mechanisms of ritual allow for connection to others as well as to the sacred and transcendent.
Significance of results: Natural and innate behaviors of humans can be used to create rituals for personally meaningful spiritual resources. Understanding the physical properties and mechanisms of ritual making allows anyone to build their own spiritual resources without need of relying on experts or institutionalized programs. This can provide a self-empowering, client-centered intervention for spiritual care.
Cooper AL, Panizza N, Bartlett R, Martin-Robins D, Brown JA.
Background: Advanced chronic kidney disease is a life-limiting disease that is known to benefit from palliative care. Unmet palliative care need in patients with kidney failure is commonly reported but the level of need among patients receiving haemodialysis is unknown.
Methods: A period prevalence study of adult patients attending two hospital-based dialysis units was conducted. Patient medical records were reviewed using the Gold Standards Framework Proactive Indication Guidance to assess for potential palliative care need.
Results: A total of 128 patient medical records were reviewed, 45% (n = 58) of patients could have potentially benefitted from palliative care. Of the patients with indicators for palliative care, 72% (n = 42) had no evidence of receiving or awaiting any form of palliative care. High levels of palliative care need were found in patients who identified as Aboriginal or Torres Strait Islander and non-Indigenous patients.
Conclusions: This study found high levels of palliative care need among adult patients attending hospital-based dialysis units. The majority of patients with indicators were not receiving any form of palliative care.
Last updated 30 April 2024