brueraeduardo.bsky.social
Eduardo Bruera
@brueraeduardo.bsky.social
600 followers 510 following 770 posts
Chair, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center
Posts Media Videos Starter Packs
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 7h
Opioids remain key for cancer pain, but poor quality studies link their use to worse survival in patients on immunotherapy. Retrospective data and confounding factors, make causality unproven . Caution is advised when interpreting these findings.

pubmed.ncbi.nlm.nih.gov/38688456/
Association of opioid use with survival in patients with cancer treated with immune checkpoint inhibitors: it is time for evidence-based behaviors - PubMed
Cancer is a leading cause of morbidity and mortality worldwide, with pain experienced by most patients undergoing cancer treatment. Opioids are the recommended treatment for cancer pain management, bu...
pubmed.ncbi.nlm.nih.gov
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 7h
Patients with advanced cancer and caregivers used metaphors of light, salvation, and safety to describe early palliative care as restoring life, hope, and peace. Both groups viewed EPC positively; caregivers used war metaphors slightly more, though overall rarely.

pubmed.ncbi.nlm.nih.gov/38744447/
Early palliative care perceptions by patients with cancer and primary caregivers: metaphorical language - PubMed
Our results suggest that EPC is perceived positively by patients and their caregivers and provide insights regarding the manner in which EPC could be presented to patients, caregivers and the public.
pubmed.ncbi.nlm.nih.gov
1
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 1d
In a multicenter RCT of advanced cancer patients with agitated delirium, lorazepam or lorazepam + haloperidol reduced agitation more than haloperidol or placebo, required fewer rescue meds, and had no increase in adverse events or reduced survival

pubmed.ncbi.nlm.nih.gov/40742738/
Proportional Sedation for Persistent Agitated Delirium in Palliative Care: A Randomized Clinical Trial - PubMed
Clinicaltrials.gov Identifier: NCT03743649.
pubmed.ncbi.nlm.nih.gov
1
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 3d
In glioma patient-caregiver pairs, poor illness communication and depressive symptoms were linked to inaccurate caregiver understanding of patient symptoms. Misjudging symptom severity correlated with worse quality of life for both patients and caregivers.

pubmed.ncbi.nlm.nih.gov/39017959/
Self and proxy symptom reporting in glioma patient-caregiver dyads: the role of psychosocial function in rating accuracy - PubMed
The psychosocial context of the family plays an important role in the accuracy of symptom understanding. Inaccurately understanding patients experience is related to poor QOL for both patients and car...
pubmed.ncbi.nlm.nih.gov
1
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 3d
Evidence-based palliative care requires use of clinical trials, which often have flaws. Clinicians should question study design rather than accept results blindly. Curiosity, not statistics, is key to applying evidence wisely and ensuring patient-centered care.

pubmed.ncbi.nlm.nih.gov/39046924/
Top Ten Tips Palliative Care Clinicians Should Know About Interpreting a Clinical Trial - PubMed
Evidence-based practice is foundational to high-quality palliative care delivery. However, the clinical trials that compose the evidence base are often methodologically imperfect. Applying their concl...
pubmed.ncbi.nlm.nih.gov
2
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 5d
Few advanced cancer patients (21%) discussed post-mortem social media management. Lower income predicted such talks. The survey spurred most to consider account planning (67%) and explore management (71%). Social media was key for coping; more research needed .

pubmed.ncbi.nlm.nih.gov/39352567/
Patient considerations of social media account management after death - PubMed
Few patients have had conversations on the management of their accounts after death, although more were interested in exploring their options further. More research is needed to examine the role of so...
pubmed.ncbi.nlm.nih.gov
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 6d
This study of 34,911 cancer patients (2016–2022) found medical marijuana laws with dispensaries reduced strong opioid prescribing but increased hospital events, while laws without dispensaries raised weak opioid use. Effects on cancer pain management need study.

pubmed.ncbi.nlm.nih.gov/41031641/
Medical marijuana policies, opioid prescriptions, and adverse events among patients undergoing cancer resection surgery - PubMed
MML policies may have affected the type of opioid prescribed and increased adverse hospital events among patients with cancer and resection surgery. Additional investigation of medical marijuana's imp...
pubmed.ncbi.nlm.nih.gov
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 7d
A survey of 70 palliative care clinicians found 59% joined a five-minute group meditation during rounds, reporting stress reduction and control. Over half also practiced weekly outside work. Participants viewed it as useful, supporting further study.

pubmed.ncbi.nlm.nih.gov/40285484/
Evaluation of a Five-Minute Meditation Intervention During Weekly Palliative Care Clinical Rounds - PubMed
<span><b><i>Introduction:</i></b> Palliative care professionals experience high levels stress and burnout. Meditation improves stress and well-being, with group interventions more promising than indiv...
pubmed.ncbi.nlm.nih.gov
2
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 7d
In 432 patients with advanced cancer, only one-third accurately understood their curability, with little change over time. Misperception was linked to Asian race, better well-being, and fewer symptoms. Systematic screening is needed

pubmed.ncbi.nlm.nih.gov/40992638/
Systematic Screening of Advanced Cancer Patients' Curability Perception: A Longitudinal Analysis - PubMed
Only one in three patients with advanced cancer had an accurate understanding of their curability, with limited improvement over time. Systematic screening may provide opportunities to improve illness...
pubmed.ncbi.nlm.nih.gov
1
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 8d
La Dra Mariela Bertolino murió hoy. Mariela creo el equipo de que educó a la mayoría de los líderes de CP en Argentina y
Latinoamérica. Su integridad ayudó a miles .
“When sorrows come….” Godspeed Mariela. I am sure you will have great discussions with Bal about pall care,
1
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 8d
Dr Balfour Mount died yesterday. Our clinical and spiritual leader, he was the first to use the term “palliative care” and opened the Royal Vic PCU. He inspired all of us to work with energy and integrity . We are all a bit more lonely today. Godspeed, Bal Mount
1 3 20
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 9d
In the 1980s oncologists and internists were using a higher opioid dose before pall care, pall care teams were using a higher dose and more parental, and pain control was better! We’re back to the 70s in cancer pain

pubmed.ncbi.nlm.nih.gov/1691252/
Palliative care in a cancer center: results in 1984 versus 1987 - PubMed
We reviewed the charts of 48 consecutive patients treated by our Palliative Care Team (PCT) during 1984 and compared these results with 50 consecutive patients treated during 1987. The composition of ...
pubmed.ncbi.nlm.nih.gov
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 11d
In 58 advanced cancer patients, hypodermoclysis provided safe, effective hydration for up to 14 days, with minimal local toxicity and frequent co-administration of opioids and potassium. And 30 ys later still not done in American hospices and hospitals

pubmed.ncbi.nlm.nih.gov/2384700/
Hypodermoclysis for the administration of fluids and narcotic analgesics in patients with advanced cancer - PubMed
Fifty-eight consecutive patients with advanced cancer who required parenteral hydration were treated with hypodermoclysis. A solution of two-thirds 5% dextrose and one-third saline was used in all cas...
pubmed.ncbi.nlm.nih.gov
1
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 11d
Opioid rotation in palliative care improved toxicity symptoms in 73% of patients and enhanced pain control with lower doses than predicted, showing benefit for long-term management. After this paper it took many years before rotation became accepted practice!

pubmed.ncbi.nlm.nih.gov/7673770/
Opioid rotation for toxicity reduction in terminal cancer patients - PubMed
Accumulation of active (toxic) metabolites of opioids might explain cases of opioid toxicity when high doses are used for long periods of time. Other mechanisms of late toxicity of opioids may be foun...
pubmed.ncbi.nlm.nih.gov
2
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 13d
In a pilot RCT of 100 advanced cancer patients on phase I therapies, adding weekly remote monitoring to monthly palliative care visits improved symptoms and quality of life versus SPC alone. Benefits were seen at 2 weeks and sustained at 12 weeks

pubmed.ncbi.nlm.nih.gov/40986798/
Integration of Remote Monitoring Into Palliative Care for Patients With Advanced Cancer Undergoing Phase I Therapies: A Randomized Clinical Trial - PubMed
Incorporating RM into SPC may improve symptoms and HRQOL beyond SPC alone for patients with moderate-to-high symptom burden. Our findings are considered preliminary and larger confirmatory trials are ...
pubmed.ncbi.nlm.nih.gov
1
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 13d
In 432 patients with advanced cancer, only one-third accurately understood their curability, with little change over time. Misperception was linked to Asian race, better well-being, and fewer symptoms. Systematic screening may help identify needs and support .

pubmed.ncbi.nlm.nih.gov/40992638/
Systematic Screening of Advanced Cancer Patients' Curability Perception: A Longitudinal Analysis - PubMed
Only one in three patients with advanced cancer had an accurate understanding of their curability, with limited improvement over time. Systematic screening may provide opportunities to improve illness...
pubmed.ncbi.nlm.nih.gov
1
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 15d
Among 375 cancer patients (2016–2021), opioid doses prescribed by oncologists fell five-fold (37.5→7.5 mg/day). ER opioids declined, while no-opioid cases rose. Higher pain and CAGE-AID received more and non-English speakers received less.

pubmed.ncbi.nlm.nih.gov/40138614/
Trends in Outpatient Opioid Prescriptions for Cancer Pain Between 2016 and 2021 - PubMed
During the study period, we observed a five-fold decline in opioid dose prescribed by oncologists for cancer pain. This raises concerns for undertreatment of pain in patients with cancer.
pubmed.ncbi.nlm.nih.gov
1
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 15d
We compared ChatGPT, Bard, and Bing on palliative care terms found ChatGPT most accurate (9/10) and comprehensive (8.5/10). Credibility was low (3/10) across all. Readability was poor (FRE 41.7; grade 14.1). Clinician oversight is needed to avoid misinformation.

pubmed.ncbi.nlm.nih.gov/40138176/
Performance of Three Conversational Artificial Intelligence Agents in Defining End-of-Life Care Terms - PubMed
<span><b><i>Background:</i></b> Conversational artificial intelligence agents, or chatbots, are a transformational technology understudied in end-of-life care. <b><i>Methods:</i></b> OpenAI's ChatGPT,...
pubmed.ncbi.nlm.nih.gov
2 1
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 16d
In 128 advanced cancer patients with end-of-life delirium, breakthrough restlessness peaked between 3–11 PM, with higher rescue med use and RASS ≥+1 episodes. This “sundowning” pattern may guide monitoring, timing, and caregiver education in palliative care.

pubmed.ncbi.nlm.nih.gov/40239874/
Circadian Rhythm in End-Of-Life Delirium: A Secondary Analysis of Two Randomized Controlled Trials - PubMed
Delirious patients were more restless between 3 PM and 11 PM. This observation of "sundowning" may help clinicians to better anticipate this symptom, schedule monitoring and treatments, and educate pa...
pubmed.ncbi.nlm.nih.gov
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 16d
In a tertiary hospital palliative clinic, 28% of 47 advanced cancer patients were high-risk for NMOU. Risk linked to younger age, higher opioid doses, substance use, and employment. SOAPP-SF showed good agreement with SOAPP-R, retaining most predictive accuracy
pubmed.ncbi.nlm.nih.gov/40252199/.
Frequency and predictors of risk of non-medical opioid use among patients with cancer in a specialized outpatient palliative care clinic - PubMed
Among outpatients with advanced cancer, 28% had high NMOU risk, which was associated with younger age, higher opioid doses, greater substance use, and higher employment rates. SOAPP-SF retained most o...
pubmed.ncbi.nlm.nih.gov
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 17d
In a study of 444 cancer patients in an acute palliative care unit, 38% required palliative sedation (PS), mainly for delirium. PS patients were younger, had longer stays, and advance directives. 28% needed multiple drugs, linked to longer PS and hydration.

pubmed.ncbi.nlm.nih.gov/40442717/
Frequency and predictors of palliative sedation among patients with cancer who died in a specialist inpatient palliative care unit: a retrospective study - PubMed
A total of 38% of patients with cancer receiving specialized palliative care required PS before death. Patients who received PS were younger, had a longer hospital stay, were more likely to have their...
pubmed.ncbi.nlm.nih.gov
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 18d
A Brazilian study of 248 non-cancer patients in home palliative care (mean age 80.8) found neurological/circulatory diseases most common. Median stay was 50 days, with high functional decline and frequent visits. All died at home, showing intensive PC works
. pubmed.ncbi.nlm.nih.gov/40971993/
Home-Based Palliative Care for Patients With Non-Cancer Diagnoses: Clinical Characteristics, Symptom Burden, and Service Delivery - PubMed
IntroductionPopulation aging has contributed to the increased prevalence of chronic non-communicable and disabling diseases, increasing the demand for home-based palliative care.ObjectiveTo describe t...
pubmed.ncbi.nlm.nih.gov
1
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 19d
A five-minute group meditation during palliative care rounds was well received, with most clinicians participating and reporting stress reduction, satisfaction, and continued practice outside rounds.

pubmed.ncbi.nlm.nih.gov/40285484/
Evaluation of a Five-Minute Meditation Intervention During Weekly Palliative Care Clinical Rounds - PubMed
<span><b><i>Introduction:</i></b> Palliative care professionals experience high levels stress and burnout. Meditation improves stress and well-being, with group interventions more promising than indiv...
pubmed.ncbi.nlm.nih.gov
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 19d
pubmed.ncbi.nlm.nih.gov/40526009/
Financial Crises Bring Opportunities - PubMed
Financial Crises Bring Opportunities
pubmed.ncbi.nlm.nih.gov
brueraeduardo.bsky.social
Eduardo Bruera @brueraeduardo.bsky.social · 19d
pubmed.ncbi.nlm.nih.gov/40545622/
Breaking free from prognostic paralysis in chronic advanced diseases - PubMed
Breaking free from prognostic paralysis in chronic advanced diseases
pubmed.ncbi.nlm.nih.gov