The Oncological Patient in the Palliative Situation

Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 197)


Palliative care approaches the patient and his or her suffering with a biopsychosocial-spiritual model. Thus, it is the strength of palliative care to complement the diagnosis driven approach of medical cancer care by a problem and resources-based assessment, participatory care plan, and patient-directed interventions. Interventions need to reflect timely prognosis, target population (the patient, the family carer, the professional), and level of trust and remaining energy. In palliative care the relevance of psycho-oncological aspects in the care of the terminally ill is considerable in the understanding of the overall suffering of patients approaching death and their loved ones and in their care and support. There is little evidence to date in terms of clinical benefit of specific psycho-oncological interventions in the last months or weeks of life, but there is evidence on effects of stress reduction and reduced anxiety if locus of control can stay within the patient as long as possible. One major difficulty in psychosocial research at the end-of-life, however, is defining patient relevant outcomes.


Palliative Care Advance Care Planning Adjustment Disorder Edmonton Symptom Assessment System Dignity Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Albers G, Echteld MA, de Vet HC, Onwuteaka-Philipsen BD, van der Linden MH, Deliens L (2010) Evaluation of quality-of-life measures for use in palliative care: a systematic review. (Eval Stud Rev) Palliat Med 24(1):17–37. doi:  10.1177/0269216309346593 Google Scholar
  2. Baker P, Beesley H, Dinwoodie R, Fletcher I, Ablett J, Holcombe C, Salmon P (2012) You’re putting thoughts into my head: a qualitative study of the readiness of patients with breast, lung or prostate cancer to address emotional needs through the first 18 months after diagnosis. Psychooncology. doi: 10.1002/pon.3156 PubMedGoogle Scholar
  3. Breitbart W (2003) Palliative and supportive care: introducing a new international journal; the “Care” journal of palliative medicine. Palliat Support Care 1(1):1–2CrossRefGoogle Scholar
  4. Breitbart W (2006) Waiting. Palliat Support Care 4(3):313–314PubMedCrossRefGoogle Scholar
  5. Breitbart W, Poppito S, Rosenfeld B, Vickers AJ, Li Y, Abbey J, Cassileth BR (2012) Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer (Comparative study randomized controlled trial research support, non-US gov’t). J Clin Oncol, 30(12):1304–1309. doi:  10.1200/JCO.2011.36.2517
  6. Breitbart W, Rosenfeld B, Gibson C, Pessin H, Poppito S, Nelson C, Olden M (2010) Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial (Randomized controlled trial research support, NIH, extramural research support, non-US gov’t). Psychooncology 19(1):21–28. doi:  10.1002/pon.1556 Google Scholar
  7. Broderick JE, Junghaenel DU, Schneider S, Bruckenthal P, Keefe FJ (2011) Treatment expectation for pain coping skills training: relationship to osteoarthritis patients’ baseline psychosocial characteristics (Clinical trial multicenter study randomized controlled trial research support, NIH, research support, non-US gov’t). Clin J Pain 27(4):315–322. doi:  10.1097/AJP.0b013e3182048549 Google Scholar
  8. Brown CA, Seymour B, Boyle Y, El-Deredy W, Jones AK (2008) Modulation of pain ratings by expectation and uncertainty: behavioral characteristics and anticipatory neural correlates (Research support, non-US gov’t). Pain 135(3):240–250. doi:  10.1016/j.pain.2007.05.022 Google Scholar
  9. Bultz BD, Carlson LE (2005) Emotional distress: the sixth vital sign in cancer care (Comp Stud Lett). J Clin Oncol 23(26):6440–6441. doi:  10.1200/JCO.2005.02.3259 Google Scholar
  10. Butt Z, Wagner LI, Beaumont JL, Paice JA, Peterman AH, Shevrin D, Cella D (2008) Use of a single-item screening tool to detect clinically significant fatigue, pain, distress, and anorexia in ambulatory cancer practice. J Pain Symptom Manage 35(1):20–30. doi:  10.1016/j.jpainsymman.2007.02.040 Google Scholar
  11. Calman KC (1984) Quality of life in cancer patients: an hypothesis. J Med Ethics 10(3):124–127PubMedCrossRefGoogle Scholar
  12. Chochinov HM, Hassard T, McClement S, Hack T, Kristjanson LJ, Harlos M, Murray A (2008) The patient dignity inventory: a novel way of measuring dignity-related distress in palliative care (Research support, non-US gov’t). J Pain Symptom Manage 36(6):559–571. doi:  10.1016/j.jpainsymman.2007.12.018 Google Scholar
  13. Chochinov HM, Kristjanson LJ, Breitbart W, McClement S, Hack TF, Hassard T, Harlos, M (2011) Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial (Comparative study randomized controlled trial research support, NIH, extramural research support, non-US gov’t). Lancet Oncol 12(8):753–762. doi:  10.1016/S1470-2045(11)70153-X
  14. Cohen SR, Mount BM (2000) Living with cancer: “good” days and “bad” days: what produces them? Can the McGill quality of life questionnaire distinguish between them? (Research support, non-US gov’t). Cancer 89(8):1854–1865PubMedCrossRefGoogle Scholar
  15. Cohen SR, Mount BM, Bruera E, Provost M, Rowe J, Tong K (1997) Validity of the McGill quality of life questionnaire in the palliative care setting: a multi-centre Canadian study demonstrating the importance of the existential domain (Research support, non-US gov’t). Palliat Med 11(1):3–20PubMedCrossRefGoogle Scholar
  16. Colleoni M, Mandala M, Peruzzotti G, Robertson C, Bredart A, Goldhirsch A (2000) Depression and degree of acceptance of adjuvant cytotoxic drugs (Letter). Lancet 356(9238):1326–1327. doi: 10.1016/S0140-6736(00)02821-X PubMedCrossRefGoogle Scholar
  17. Detering KM, Hancock AD, Reade MC, Silvester W (2010) The impact of advance care planning on end of life care in elderly patients: randomised controlled trial (Randomized controlled trial research support, non-US gov’t). BMJ 340:c1345. doi:  10.1136/bmj.c1345
  18. Eychmuller S (2012) SENS is making sense: on the way to an innovative approach to structure palliative care problems. Ther Umsch 69(2):87–90. doi: 10.1024/0040-5930/a000256 PubMedCrossRefGoogle Scholar
  19. Faller H, Bulzebruck H, Drings P, Lang H (1999) Coping, distress, and survival among patients with lung cancer (Research support, non-US gov’t). Arch Gen Psychiatry 56(8):756–762PubMedCrossRefGoogle Scholar
  20. Fegg MJ, Kramer M, L’Hoste S, Borasio GD (2008) The schedule for meaning in life evaluation (SMiLE): validation of a new instrument for meaning-in-life research (Research support, non-US gov’t validation studies). J Pain Symptom Manage 35(4):356–364. doi:  10.1016/j.jpainsymman.2007.05.007
  21. Fox E (1997) Predominance of the curative model of medical care: a residual problem (Comment editorial). JAMA 278(9):761–763Google Scholar
  22. Ganz PA (2008) Psychological and social aspects of breast cancer (Review). Oncology (Williston Park) 22(6):642–646, 650; discussion 650, 653Google Scholar
  23. Herschbach P, Heusser P (2008) Einführung in die psychoonkologische Behandlungspraxis, 1st edn. Klett-Cotta, StuttgartGoogle Scholar
  24. Holland JC (2006) Psycho-oncology: from empirical research to screening program. In: Herschbach P, Heussner P, Sellschopp A (eds) Psycho-onkologie, perspektiven heute (pp 9–43): Pabst Science publishersGoogle Scholar
  25. Holland JC, Andersen B, Breitbart WS, Dabrowski M, Dudley MM, Fleishman S, Zevon MA (2007) Distress management (Practice guideline). J Natl Compr Cancer Netw 5(1): 66–98Google Scholar
  26. Junger S, Payne S (2011) Guidance on postgraduate education for psychologists involved in palliative care. Europ J Pall Care 18(5):238–252Google Scholar
  27. Kissane DW, Clarke DM, Street AF (2001) Demoralization syndrome: a relevant psychiatric diagnosis for palliative care (Research support, non-US gov’t review). J Palliat Care 17(1): 12–21Google Scholar
  28. Kolva E, Rosenfeld B, Pessin H, Breitbart W, Brescia R (2011) Anxiety in terminally ill cancer patients (Research support, NIH, extramural). J Pain Symptom Manage 42(5):691–701. doi: 10.1016/j.jpainsymman.2011.01.013 PubMedCrossRefGoogle Scholar
  29. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies (Meta-analysis). Lancet Oncol 12(2):160–174. doi: 10.1016/S1470-2045(11)70002-X PubMedCrossRefGoogle Scholar
  30. Mount B, Kearney M (2003) Healing and palliative care: charting our way forward (Editorial). Palliat Med 17(8):657–658PubMedGoogle Scholar
  31. Nakazawa Y, Miyashita M, Morita T, Umeda M, Oyagi Y, Ogasawara T (2010) The palliative care self-reported practices scale and the palliative care difficulties scale: reliability and validity of two scales evaluating self-reported practices and difficulties experienced in palliative care by health professionals (Validation studies). J Palliat Med 13(4):427–437. doi: 10.1089/jpm.2009.0289 PubMedCrossRefGoogle Scholar
  32. National Comprehensive Cancer Network (2003) Distress management clinical practice guidelines. J Natl Comp Cancer Network 1:344–374Google Scholar
  33. Network NNCC (2003) Distress management: clinical practice guidelines (Practice guideline). J Natl Compr Cancer Netw 1(3):344–374Google Scholar
  34. NICE (2011) The diagnosis and treatment of lung cancer (Update), vol 212. Cardiff (UK)Google Scholar
  35. Nissim R, Gagliese L, Rodin G (2009) The desire for hastened death in individuals with advanced cancer: a longitudinal qualitative study (Research support, non-US gov’t). Soc Sci Med 69(2):165–171. doi: 10.1016/j.socscimed.2009.04.021 PubMedCrossRefGoogle Scholar
  36. Parker PA, Baile WF, de Moor C, Cohen L (2003) Psychosocial and demographic predictors of quality of life in a large sample of cancer patients (Comparative study). Psychooncology 12(2):183–193. doi: 10.1002/pon.635 PubMedCrossRefGoogle Scholar
  37. Shipley V, Fairweather J (2001) A programme of individualized and self-administration of medicines in a hospice. Int J Palliat Nurs 7(12):581–586PubMedGoogle Scholar
  38. Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM, Von Roenn JH (2012) American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol 30(8):880–887. doi:  10.1200/JCO.2011.38.5161 Google Scholar
  39. Surbone A, Baider L, Weitzman TS, Brames MJ, Rittenberg CN, Johnson J (2010) Psychosocial care for patients and their families is integral to supportive care in cancer: MASCC position statement (Practice guideline). Support Care Cancer 18(2):255–263. doi: 10.1007/s00520-009-0693-4 PubMedCrossRefGoogle Scholar
  40. Temel JS, Greer JA, Admane S, Gallagher ER, Jackson VA, Lynch TJ, Pirl WF (2011) Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care (Randomized controlled trial research support, non-US gov’t). J Clin Oncol 29(17):2319–2326. doi:  10.1200/JCO.2010.32.4459
  41. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Lynch TJ (2010) Early palliative care for patients with metastatic non-small-cell lung cancer (Randomized controlled trial research support, non-US gov’t). N Engl J Med 363(8):733–742. doi:  10.1056/NEJMoa1000678 Google Scholar
  42. WHO (2002) Definition palliative care, 2013Google Scholar
  43. Yoshida W, Seymour B, Koltzenburg M, Dolan RJ (2013) Uncertainty increases pain: evidence for a novel mechanism of pain modulation involving the periaqueductal gray. J Neurosci 33(13):5638–5646. doi: 10.1523/JNEUROSCI.4984-12.2013 PubMedCrossRefGoogle Scholar
  44. Zhang B, Wright AA, Huskamp HA, Nilsson ME, Maciejewski ML, Earle CC, Prigerson HG (2009) Health care costs in the last week of life: associations with end-of-life conversations (Research support, NIH, extramural research support, non-US gov’t). Arch Intern Med 169(5):480-488. doi:  10.1001/archinternmed.2008.587 Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.University Center for Palliative CareInselspital BernBernSwitzerland
  2. 2.Department of OncologyUniversity Hospital BaselBernSwitzerland

Personalised recommendations