Current Issue : April-June Volume : 2026 Issue Number : 2 Articles : 5 Articles
Discontinuing active oncological treatment and initiating palliative care is a critical moment in cancer care, requiring oncologists to address complex clinical, ethical, and emotional challenges. This narrative review aims to provide clinicians with practical guidance for conducting conversations about treatment discontinuation and transitioning patients to palliative or hospice care. Drawing from current clinical guidelines, empirical research, and expert perspectives, the article reviews evidence-based communication strategies and frameworks, including the SPIKES protocol, Ask–Tell–Ask, the WHO model, and the disclosure model. The article also explores the clinical, functional, psychosocial, and ethical criteria relevant to treatment withdrawal decisions, as well as the timing and structure of end-of-life discussions. A practical algorithm is proposed, synthesizing key principles into a step-by-step guide for use in daily oncology practice. The algorithm supports clinicians in balancing medical indications with patient values and preferences, fostering shared decision-making and maintaining therapeutic relationships even in the most difficult circumstances. The review concludes that structured yet flexible communication enhances patient understanding, reduces unnecessary interventions, and improves the quality of end-of-life care. By promoting patient-centered care and timely palliative integration, this article offers oncologists a clear and adaptable approach to one of the most sensitive aspects of cancer care....
Introduction: The majority of cancer patients in Africa are diagnosed at an advanced stage of the disease. The clinical burden of cancer and the need for palliative care are evident, particularly in Francophone West Africa. What is the state of palliative care in oncology in this region? Method: Between October and December 2023, an anonymous and voluntary online questionnaire was distributed via Google Forms to physicians working in cancer care services. Results: A total of 53 physicians participated in the survey, representing six countries: Burkina Faso, Côte d’Ivoire, Mali, Togo, Benin, and Senegal, with 69.8% being male. Medical oncology was the most common professional profile. Radiotherapy was available in all countries except Benin, and all six countries had medical oncology services. However, no country had a mobile palliative care unit, and only Senegal had a fixed palliative care unit. The availability and regulation of morphine distribution remain limited, with access to morphine deemed average. Furthermore, palliative care is poorly integrated into cancer control programs, and training in this area is considered essential. Approximately 50% of patients seen in consultation require palliative care. Conclusion: There exists a significant gap between the demand for and the provision of palliative care, and numerous challenges must be addressed....
Introduction: In rectal cancer, the choice of treatment strategy depends on the tumor stage and the response to neoadjuvant therapy. Accurate assessment of tumor regression through magnetic resonance imaging (MRI) may help to guide personalized approaches, including delayed or nonoperative management. This study aimed to assess the correlations between pathological complete response (pCR) and clinical staging before and after neoadjuvant treatment in rectal cancer patients. Methods: We conducted a retrospective analysis of rectal cancer patients treated with neoadjuvant therapy followed by radical resection in our oncological surgery department between July 2012 and December 2024. Clinical staging and tumor response were assessed using MRI, focusing on T- and N-stage evaluation. Pathological complete response (pCR) was defined as the absence of tumor cells on histopathological examination. Associations between pCR and clinical variables were explored. Results: Out of a total of 1693 rectal cancer patients, 783 (46.25%) received neoadjuvant therapy, with 62 patients (7.92%) presenting pCR. The majority had tumor stage cT3 (n = 45, 72.6%) and lymph node stage cN2b (n = 25, 40.3%) before treatment. Post-treatment MRI showed complete tumor response (T0) in 20 patients (32.3%) and nodal downstaging to N0 in 34 patients (54.8%). MRI provided imaging findings that indicate a limited correlation between clinical assessment of tumor response and pathological outcome. Six patients (9.6%) developed distant metastases, and there were no local recurrences. Conclusions: While MRI provides valuable preoperative information, its accuracy in predicting pCR remains limited. Achieving pCR is a favorable prognostic indicator, but it does not eliminate the risk of distant metastasis; therefore, continued surveillance and individualized management strategies remain essential to optimize outcomes in rectal cancer patients....
Target trial emulation (TTE) has demonstrated popularity because of its ability to improve the reliability of causal inference from observational data. Nevertheless, knowledge about the current use, potential challenges, and insights of target trials in oncology is scarce. A total of 90 TTE studies in cancer areas were identified through systematic reviews in PubMed and Embase. Among the 54 applications in cancer treatment, registry databases (44.4%) and overall survival (OS, 63.0%) were predominantly used as data sources and primary endpoints, respectively. Approximately 30 (55.6%) of the included TTE cases were associated with immortal time bias, and 21 (38.9%) were associated with prevalent user bias. Among the 21 trials from 13 studies that aimed to calibrate the results from preexisting randomized controlled trials (RCTs), only 42.9% met both statistical agreement and estimate agreement. The availability of fit-for-purpose data sources and uncertainty about result concordance were the main hurdles limiting the quantity and quality of TTE in oncology areas. Promoting regulatory acceptance by initiating special projects could be crucial for the expanded application of real-world data (RWD) using TTE. Potential solutions, such as the integration of electronic medical records at the regional or country level, linkage with insurance claims databases, the modernization of eligibility criteria, the use of OS as the primary endpoint, and other best practices, were recommended for improving the feasibility and quality of oncology TTE....
Background: Preoperative optimization has emerged as a critical strategy in enhancing surgical outcomes, particularly for oncological patients. By addressing modifiable risk factors before surgery, healthcare providers aim to improve postoperative outcomes. The aim of this study was to evaluate the impact of a preoperative optimization program on postoperative outcomes and improvements in modifiable risk factors (anemia, malnutrition, smoking, and endocrine management) among oncology patients undergoing elective surgery. Methods: A retrospective pretest–posttest study was conducted including all oncology patients who underwent elective general surgery at King Hussein Cancer Center between January 2020 and December 2021. The preoperative optimization program was launched in May 2020 and fully implemented by December 2020. Program elements included anemia management, nutritional support, smoking cessation, and glycemic control. Patients were divided into pre-implementation and post-implementation cohorts, and outcomes were assessed at baseline, immediately preoperatively, and 30 days postoperatively. Results: The sample included 503 individuals, 53.9% had preoperative anemia, 15.5% had malnutrition, 40.6% were smokers, and 41.6% had uncontrolled DM. The optimized group demonstrated significant improvements in hemoglobin, albumin, and smoking cessation rates. In contrast, the control group showed worsening hemoglobin and albumin levels over the same period. Serious complications (Clavien–Dindo III–IV) were significantly more frequent in the control group (p = 0.006). The likelihood of postoperative complications among the control group was significantly higher than the optimized group (OR: 2.2, 95%CI: 1.5–3.2, p < 0.001). Conclusions: Implementation of a comprehensive preoperative optimization program significantly improved modifiable risk factors and reduced serious postoperative complications, highlighting its value for adoption in oncology surgical care....
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