Palliative Care

Hospital-to-community transitions in palliative care are fraught with insecurity and competing priorities

This qualitative systematic review of 10 studies explores how patients with advanced illness and caregivers decide about transitions from hospital to community palliative care. Decisions about place of care were shaped by perceived risks, insecurity about leaving hospital, and fear of inadequate support at home. Patients and caregivers weighed medical backup, caregiving capacity, and personal commitments, often feeling under-supported when psychosocial needs were complex. Care settings carried spiritual and existential meaning, tied to love, belonging, and regaining a sense of life’s meaning. The authors recommend proactive clinician involvement, strong communication skills, and use of decision aids to provide comprehensive information and reduce decisional burden. 1

Mobility loss in advanced cancer is a dynamic, multidimensional source of suffering and adaptation

This longitudinal qualitative study followed 10 people with advanced cancer and two caregivers through changing mobility over 6–24 weeks. Participants described mobility loss as fracturing their sense of self, disrupting identity, agency, and participation in daily life. Family roles were reconfigured as patients became more dependent, creating relational strain and renegotiation of autonomy. Coping involved dynamically resisting or reframing losses, but support was often delayed or absent, with mobility needs overlooked by clinicians. The authors argue that mobility loss should be recognised as a multidimensional symptom requiring anticipatory, holistic assessment and intervention. 2

Consensus definition for patients living long-term with incurable cancer

This modified hybrid Delphi study sought agreement on terminology and criteria for patients living long-term with incurable cancer. Seventy-eight stakeholders, including patients, caregivers, clinicians, epidemiologists, and advocates, participated in three Delphi rounds in the Netherlands. Panelists reached 88% consensus on the term **“patients living long-term with incurable cancer.” Definition consensus (94%) specified patients living ≥2 years with incurable metastatic, locally advanced, or hematologic malignancies, or exceptional long survivors not meeting the 2-year threshold. The resulting framework aims to standardize recognition of this group and support development of tailored care approaches and research designs. 3

Hospice use in Puerto Rico Medicaid cancer decedents substantially lowers costs and acute care use

This population-based cohort included 4,481 Puerto Rico Medicaid beneficiaries who died of cancer between 2016 and 2022. Only 21.7% used hospice, yet non-hospice patients had consistently higher expenditures over the last 7–180 days of life. Cost differences favoring hospice reached approximately $19,000 over the last 180 days, with non-overlapping confidence intervals. Non-hospice patients had higher emergency department visit and hospitalization rates across all examined periods, and greater likelihood of dying in acute settings. Hospice enrollment was thus associated with lower spending and less acute care at end of life, supporting sustained coverage beyond 2027. 4