Pallium: palliative and hospice care

From editor-in-chief

2025-09-20T22:03:52+03:00

I am glad to welcome you to the pages of the new issue of the Russian scientific and practical journal Pallium: Palliative and hospice care

The Federal Research and Practice Center for Palliative Medical Care of Sechenov University Becomes a WHO Collaborating Centre: A New Stage in Specialist Training Development in the Eurasian Region

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In June 2025, the first WHO Collaborating Centre for Training in Palliative Care in the Russian Federation was established at the Federal Research and Practice Center for Palliative Medical Care of Sechenov University, under the Ministry of Health of Russia. It will serve as an educational and methodological platform for training specialists in Eastern Europe, Central Asia, and CIS countries. The article presents the goals, objectives, and activities of the center and discusses the main outcomes of the roundtable held in honor of its inauguration, including speeches by WHO representatives and international experts. Special attention is given to the role of the Federal Center in the development of human resources and international cooperation in the field of palliative care.

Clinical Case Study: Palliative Medical Care for a Patient with a Malignant Disease

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Th is article discusses a clinical case of providing palliative medical care to a 20-year-old patient with a malignant brain tumor. Due to the patient’s categorical refusal of specialized treatment, the progression of the disease, and the presence of severe symptoms, the patient was under the care of the palliative care service almost from diagnosis until death.

Th e case illustrates a situation where psychological support plays a critical role in ensuring the quality of life for both the patient and the family:

– Relatives and healthcare workers had to accept the patient’s informed choice, even though it did not align with doctors’ recommendations or the family’s wishes;

–Th e chosen strategy by palliative care specialists allowed for dynamic follow-up and timely identifi cation and treatment of severe burdensome symptoms, including pain. Constant monitoring, evaluation of disease progression, and adjustments in treatment strategies were ensured through eff ective communication, focus on patient comfort, and support from family and palliative care professionals.

Palliative care in pulmonology

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Despite advances in targeted therapies, cystic fi brosis (CF) remains a severe genetic disease with progressive clinical course, where complications signifi cantly impair patients’ quality of life. Modern approaches to treatment have increased the average life expectancy to 44 years, but there are limitations in the long-term eff ectiveness of targeted therapy and the impact of severe CF on the prognosis of patients. A distinct subgroup comprises patients with progressive CF, defi ned by criteria including FEV1 < 40% predicted, arterial hypercapnia, concomitant pulmonary hypertension, and frequent disease exacerbations. For these patients, early integration of palliative care aimed at improving quality of life, symptom control, and psychosocial support is particularly relevant. Th is review discusses consensus recommendations for incorporating palliative care into standard CF management.

Cytokinogenetic Therapy as Part of Antitumor Treatment for Pancreatic Cancer

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Treatment of locally advanced and metastatic pancreatic cancer remains one of the most challenging issues in clinical oncology. Modern chemotherapy drugs do not ensure long-term survival of patients. Th e use of immuno- oncological drugs is also not eff ective enough in the treatment of this pathology. Among the possible immunotherapy options, cytokinogenetic therapy (CGT) drugs are of interest, having proven themselves well in the treatment of a number of solid tumors in combination with cytostatics. Objective: to study the possibility of cytokinogenetic therapy using in the treatment of locally advanced and metastatic pancreatic cancer.

Materials and methods. Th e study included 30 patients aged 58–83 years (median 64±1,2 years) with locally advanced and metastatic PC with a histologically confi rmed diagnosis. Th e examination of patients included an assessment of the Karnofsky status, determination of the level of tumor necrosis factor alpha (TNF-α) in the blood using the enzyme immunoassay method, computed tomography of the chest, abdomen and pelvis with intravenous contrast. Cytokinogenetic therapy drugs were used to treat patients— human recombinant interferon gamma and recombinant tumor necrosis factor- thymosin-α1 according to the scheme developed in the clinic. In 27 patients, treatment was carried out in combination with courses of polychemotherapy, in 3 cases only cytokinogenetic therapy was used due to concomitant pathology and high prevalence of the tumor process. Th e obtained digital material was processed using the Statistica 12.0 soft ware package.

Results. According to computed tomography data using RECIST 1.1 criteria, a partial response was registered in 14 patients, and stabilization of the disease was registered in 16 patients. Th ere were no cases of tumor progression against the background of combined use of CGT and cytostatic therapy if the treatment regimen was followed. Th e average survival time of patients from the moment of disease detection was 15 +, in the group of locally advanced cancer, and 19 + months in patients with metastatic cancer. Carrying out CGT improved the quality of life of patients and was not accompanied by severe toxicity, and did not increase the incidence of adverse events during chemotherapy. As the treatment courses were carried out, there was an increase in the Karnofsky status and an increase in the level of TNFα. A clinical observation of a patient suff ering from metastatic pancreatic cancer with multiple foci in the liver is given as an example of successful use of CGT in combination with cytostatic therapy.

Conclusions. Th e combined use of interferon gamma, recombinant tumor necrosis factor- thymosin-α1 recombinant and cytostatic drugs can be considered as an eff ective treatment option in patients with locally advanced and metastatic prostate cancer.

Nasogastric Tube vs. Gastrostomy: Comparative Analysis, Pros and Cons

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Th e article presents a comparative analysis of two enteral feeding methods: nasogastric tube and gastrostomy. Th e topic is highly relevant due to the large number of patients requiring long-term tube feeding. Th e nasogastric tube is a more short-term solution, delivering nutritional mixtures through the nose/mouth into the stomach, but is associated with discomfort and aspiration risks. Gastrostomy is more suitable for long-term feeding, involves surgical intervention, but provides bett er comfort and quality of life. Th e choice of method should be based on the patient’s individual needs and the expected duration of feeding. Th e article is aimed at medical professionals studying care approaches for patients with impaired natural feeding.

Emetic Syndrome in Adult Patients Receiving Palliative Medical Care in Outpatient and Inpatient Settings: Results of a Pilot Epidemiological Study

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The article presents the results of a study on the prevalence of emetic syndrome among patients in need of palliative medical care, its most common causes, and preferred treatment methods. The study was conducted via an online survey of palliative care physicians working in specialized palliative care facilities — 133 physicians in inpatient and 95 in outpatient settings from 43 regions of the Russian Federation. According to the respondents, emetic syndrome occurs in 16–50% of palliative care patients. Therapy-resistant emetic syndrome is observed in 1–10% of cases. The most commonly cited causes were tumor intoxication (77%) and drug side effects (76%). Metoclopramide is used by 97% of doctors as the first-line antiemetic, and haloperidol is used by 52% as second-line therapy. On average, it takes physicians 5–7 days to select an effective antiemetic therapy.

Psycho-emotional Condition of Relatives Caring for Cancer Patients

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The aim of this study is to characterize the psychoemotional state of relatives of cancer patients. The research was conducted at the Mobile Service of St. Petersburg State Healthcare Institution “Hospice No. 1.” The respondents included 15 relatives of hospice cancer patients: spouses, parents, children, and siblings aged 23 to 77, who were primary caregivers for their loved ones.

The participants were asked to complete the associative test “Who Am I?” (M. Kuhn & T. McPartland), the “Codependency Profile Questionnaire” (adapted by N. G. Artemtseva), a short version of the “Hardiness Test” (E. N. Osin), and the psychosemantic method “Semantic Differential of

Life Situation” (O. V. Alexandrova, I. B. Dermanova). Data collection was conducted through personal interviews. The respondents revealed that relatives of cancer patients primarily describe themselves as kind and other- oriented individuals. They tend to exhibit a cooperative coping style, high levels of loneliness, unmet safety needs, and a focus on social desirability and utility. Those facing the illness of a loved one demonstrate elevated anxiety levels linked to the situational stress, reduced psychoemotional well-being , decreased life satisfaction, and a heightened sense of overall tension. Given the high levels of anxiety, helplessness, and codependency, it is evident that relatives of cancer patients require psychological support

Existential Deficits, Secondary Traumatic Stress, and Compassion Fatigue as Predictors of Burnout Syndrome Formation in Palliative Care Physicians

2025-09-20T22:03:56+03:00

Th e article presents an up-to-date analysis of the concept of emotional burnout, provides data on the prevalence of burnout syndrome of oncologists and examines predictors of emotional burnout in palliative care physicians, including the role of existential defi cits, secondary traumatic stress, and compassion fatigue in the development of burnout syndrome. It also suggests steps that physicians can take to improve personal well-being and professional satisfaction.

Assessing the Burden of Care on Relatives of Adult Patients in the Palliative Medical Care Unit

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This article presents the results of a pilot study examining the burden of care experienced by family members of adult patients in need of palliative care during the home-based care period, as well as their related needs. The study was conducted through an online survey of 26 caregivers during the initial days following the patient’s hospital admission. The majority of respondents were women (69.2%) of working age, many of whom combined caregiving responsibilities with other duties. Most participants (20 individuals) served as the primary caregiver. Over half (54%) rated their level of fatigue as 4 or 5 on a five-point scale. A total of 63.8% of respondents reported spending more than half of their time on caregiving , while 27.3% indicated that it occupied nearly all of their time. The main difficulties identified by caregivers were hygiene-related procedures and moral and psychological strain. A significant number of respondents also reported a lack of time, resources, and energy to provide care, as well as limited financial means to hire professional assistance. These findings underscore the pressing need for comprehensive support programmes for family caregivers, including training , psychological support, and enhanced access to specialised services.