Palliative Care

High-flow nasal oxygen eases dyspnea in hospitalized adults with advanced cancer

This systematic review and meta-analysis included seven trials (374 adults with cancer), six of which (272 patients) contributed to pooled analysis. High-flow nasal oxygen significantly improved dyspnea compared with other oxygen or air delivery devices (SMD −0.60; 95% CI −1.02 to −0.17; I2 = 65%). Benefit was confined to hypoxemic patients, where effect size was larger (SMD −0.87; 95% CI −1.33 to −0.40; I2 = 58.7%). Most trials had high or concerning risk of bias, so HFNO should be an adjunct, not a default, breathlessness therapy. Clinicians may prioritize HFNO availability for hospitalized, hypoxemic adults with advanced cancer whose dyspnea persists despite standard oxygen. 1

Deprescribing in life-limiting illness reduces pill burden with limited evidence of harm

This systematic review synthesized 46 studies of deprescribing among people with life-limiting conditions, mostly pre–post and cohort designs in nursing homes and hospitals. All studies assessing medication counts reported reduced overall medication burden or inappropriate drugs, or no significant change after deprescribing efforts. Most studies found no mortality effect, while smaller subsets reported both increased and decreased mortality, without a consistent directional signal. Other clinical outcomes typically showed no significant change, whereas several studies reported cost reductions with deprescribing. For palliative clinicians, these data support proactive, individualized deprescribing to decrease medication load and costs, with ongoing monitoring for patient-specific harms. 2

Early palliative care implementation in community oncology requires flexible, pragmatic approaches

This process evaluation explored ENABLE early palliative care implementation within nine National Cancer Institute Community Oncology Research Program practice clusters. Although 78% of clusters reported some palliative services, none routinely referred all newly diagnosed advanced cancer patients as guidelines recommend. Major barriers included limited staffing during and after COVID-19, low physician buy-in, perceived overlap with existing services, and participant burden. Investigators responded with iterative adaptations, increasing flexibility in trial procedures and ENABLE delivery to better fit clinical workflows. The findings suggest early palliative integration needs protected staffing, oncologist engagement strategies, and streamlined patient processes in community settings. 3