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Current Treatment Options in Oncology
Journal Prestige (SJR): 1.24
Citation Impact (citeScore): 3
Number of Followers: 5  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1534-6277 - ISSN (Online) 1527-2729
Published by Springer-Verlag Homepage  [2570 journals]
  • The Need to Prioritize and Re-prioritize Palliative Care Options: Smoking
           Cessation as a Case-in-Point
    • Abstract: Opinion statement Palliative care in cancer patients requires a continuous reprioritization of effort. This review describes the need for this reprioritization and uses smoking cessation as a case-in-point. The treatment of patients with metastatic non-small cell lung cancer has changed dramatically in the past few years. Interestingly, patients who had previously smoked now have an improved prognosis—for a variety of reasons. This review discusses this last observation in detail and raises the question of how forcefully we should advise smoking cessation in patients with incurable metastatic non-small cell lung cancer.
      PubDate: 2019-03-22
       
  • Systemic Immunotherapy for Advanced Cutaneous Squamous Cell Carcinoma
    • Abstract: Opinion statement Advanced (i.e., unresectable) cutaneous squamous cell carcinoma (cSCC) is a rare condition with a dismal prognosis. Although less than 5% of cSCC patients develop metastases or local recurrence after complete excision, advanced cSCC is difficult to treat. These conditions tend to develop in elderly patients, although, at times, metastases are noted in middle-aged patients. Once metastasis occurs in cSCC, the 10-year survival rates fall to less than 20% for patients with regional lymph node involvement and less than 10% for patients with distant metastases, indicating that cSCC can be difficult to treat effectively when it is advanced. Traditionally, platinum-based therapy has been considered as a conventional option for advanced cSCC. It is efficacious to some degree, but the toxic effects of the combination treatments often prohibit their use in elderly patients. It has been a decade since the development of epidermal growth factor receptor (EGFR) inhibitors as agents that are less toxic. However, evidence regarding systemic therapy for advanced cSCC is limited because of a lack of high-quality prospective studies. Remarkably, the US Food and Drug Administration (FDA) approved an anti-PD-1 antibody treatment (cemiplimab) for the treatment of patients who are not candidates for curative surgery or curative radiation. It will be a promising treatment option for these types of rare conditions.
      PubDate: 2019-03-14
       
  • The Role of Surgery in Management of Locally Advanced Non-Small Cell Lung
           Cancer
    • Abstract: Opinion statement Patients with locally advanced non-small cell lung cancer (NSCLC) are treated for cure, but treatment decisions are not straightforward. Chemotherapy is essential due to the high risk of systemic relapse, but local therapy is also required for cure. In the small subset of stage III patients with N0 or N1 disease, surgery is typically the initial therapy and extended resections are frequent. The majority of IIIA patients present with N2 disease and treatment paradigms for these patients are controversial, particularly concerning the role of resection. Surgery has a limited role in bulky IIIA, IIIB, and IIIC disease, which is typically treated with combined systemic therapy and radiation. The authors believe that in resectable IIIA disease, the addition of surgery to multimodality treatment appears to improve local control and overall survival. Induction therapy is essential, and the use of chemotherapy alone or chemoradiotherapy remains an area of debate. Pneumonectomy should be used with caution in IIIA disease, as numerous prospective trials have noted excessive perioperative mortality. The introduction of immunotherapies in this stage may quickly transform treatment decisions.
      PubDate: 2019-03-14
       
  • Contemporary Treatment of Locally Advanced Oral Cancer
    • Abstract: Opinion statement At our institution, locally advanced oral cancer is most commonly treated with surgical resection, immediate reconstruction, and adjuvant radiotherapy with or without concurrent systemic therapy depending on final surgical pathologic analysis. There are patients with markedly advanced local or regional disease who unfortunately will have a low probability of cure. We counsel these patients on induction chemotherapy, emphasizing that this is unlikely to result in a smaller volume of surgical resection. In these patients, a good response to induction chemotherapy is more frequently followed by concurrent chemoradiotherapy. We have not been in the practice of commonly recommending definitive chemoradiotherapy for locally advanced oral cancer when upfront surgery is an option. However, as reviewed below, there is a significant rationale for definitive chemoradiotherapy in patients who are surgical candidates, with the hope of good oncologic outcomes, and potential functional organ preservation. The experts who report their experiences in the studies reviewed below provide a strong argument for considering this approach.
      PubDate: 2019-03-14
       
  • Clinical Use of Measurable Residual Disease in Acute Myeloid Leukemia
    • Abstract: Opinion statement Treatment of acute myeloid leukemia (AML) remains a high-risk venture for the patient suffering from the disease. There is a real risk of succumbing to the treatment rather than the disease, and even so, cure is much less than certain. Since the establishment of complete remission as a prerequisite for cure in the 1960s, a number of years passed before advanced techniques for detecting minute amounts of disease matured sufficiently for clinical implementation. The two main techniques for detection of measurable residual disease (MRD) remain qPCR and multicolor flow cytometry. When performed in expert laboratories, both these modalities offer treating physicians excellent opportunity to follow the amount of residual disease upon treatment and offer unparalleled prognostication. In some AML and age group subsets, evidence now exist to support the choice of both proceeding to allogeneic transplant and not doing so. In other AML subgroups, MRD has sufficient discriminative power to identify patients likely to benefit from allogeneic transplant and patients likely not to. After treatment or transplantation, follow-up by molecular techniques can, with high certainty, predict relapse months before bone marrow function deterioration. On the other hand, options upon so-called molecular relapse are less well tested but recent evidence supports the use of azacitidine both in transplanted patients and patients consolidated with chemotherapy. In conclusion, MRD testing during treatment is a superb prognosticator and a major tool when choosing whether a patient should be transplanted or not. The exact use of MRD testing after treatment is less well defined but evidence is mounting for the instigation of treatment upon rising MRD levels (pre-emptive treatment) before morphologically detectable relapse.
      PubDate: 2019-03-14
       
  • Controversies in the Therapy of Low-Grade Gliomas
    • Abstract: Opinion statement In the context of the new WHO classification system, all low-grade gliomas must have an IDH mutation, with or without 1p/19q codeletion. Upon discovery of the tumor, maximal safe surgical resection is the most appropriate first step due to the current inability to differentiate between IDH mutant and IDH wild–type tumors by imaging alone. In the postoperative setting, based on the synthesis and interpretation of the available data, we recommend utilizing conventional radiation therapy and PCV in all high-risk–low-grade gliomas. For patients felt to be in a low risk category, we recommend maintaining a low threshold to initiate treatment. In the setting of tumor recurrence, consideration of all treatment options is reasonable, but treatment with alkylator therapy has the strongest supporting data.
      PubDate: 2019-03-14
       
  • Current Update on the Molecular Biology of Cutaneous Sarcoma:
           Dermatofibrosarcoma Protuberans
    • Abstract: Opinion statement Cutaneous sarcoma is a group of malignant mesenchymal tumors primarily involving the dermis, and it is characterized by extreme clinicopathological heterogeneity. Although its occurrence rate is rare, dermatofibrosarcoma protuberans (DFSP) is one of the most common types of dermal sarcoma. DFSP grows slowly and tends to relapse locally after inadequate resection. There are various histological variants of DFSP tumors and it often mimics benign lesions such as dermatofibroma and scar, which make accurate diagnosis difficult and delayed, and some cases progress to the stage where the tumor is unresectable. Recent advancements in cancer genetics and molecular biology methods have elucidated the COL1A1-PDGFB fusion gene, some novel fusion gene variants and pathways related to DFSP pathogenesis that have resulted in the evolution of cutaneous sarcoma diagnosis and treatment. For example, some clinical studies have confirmed the efficacy of imatinib methylate, an αPDGFR-targeted therapy for unresectable or metastatic DFSP. The present review summarizes recent updates in DFSP research, diagnostics, and treatment.
      PubDate: 2019-03-14
       
  • Role of Bisphosphonates in Breast Cancer Therapy
    • Abstract: Opinion statement Bisphosphonates are utilized routinely in breast cancer. In metastatic disease with bone involvement, bisphosphonates prevent or delay skeletal-related events and can improve pain control. Different agents have shown benefit compared with placebo or no treatment. While in unselected patients, comparison between zoledronic acid and pamidronate did not show a significant difference, exploratory analyses showed that in patients with osteolytic lesions or hypercalcemia, zoledronic acid is superior to pamidronate. De-escalating treatment with zoledronic acid from every 4 to every 12 weeks has been shown to provide similar control of skeletal morbidity and may result in less toxicity and reduced cost. While available data support bisphosphonate treatment for 2 years in metastatic disease, typical treatment duration is influenced by performance status with treatment discontinued only once patients are not well enough to continue receiving systemic therapy or developed treatment-related adverse events. In early-stage breast cancer, individual trials of adjuvant bisphosphonates have reported inconsistent results. However, the Early Breast Cancer Trialists’ Collaborative Group showed that bisphosphonates significantly reduce distant recurrence, bone recurrence, and breast cancer mortality, an effect observed in postmenopausal women only. The relative benefit of bisphosphonates was not influenced by receptor status, tumor grade, nodal involvement, or administration of adjuvant chemotherapy. Current guidelines support consideration of adjuvant zoledronic acid or oral clodronate for 3–5 years in postmenopausal women with early-stage disease. Although bisphosphonates are tolerated well, serious adverse events, including osteonecrosis of the jaw and renal impairment, can occur, especially for higher dose density schedules utilized in metastatic disease. Decision to include bisphosphonates in the treatment plan should be based on the anticipated absolute benefit and potential for adverse effects. In some patients with both early-stage and metastatic disease, omission of bisphosphonates is reasonable as the potential benefit from this treatment is not likely to outweigh its risks.
      PubDate: 2019-03-14
       
  • Immunotherapy Approaches Beyond PD-1 Inhibition: the Future of Cellular
           Therapy for Head and Neck Squamous Cell Carcinoma
    • Abstract: Opinion statement In a span of a few years, the surprising early successes of programmed cell death 1 (PD-1) inhibitors across a vast range of tumor types have transformed our understanding of cancer immunogenicity and provided proof of principle that T cells, if manipulated, can mediate meaningful tumor regression. In head and neck cancer, only a minority of patients respond to PD-1 therapy, but these small outcomes have fueled the enthusiasm for the next generation of immunotherapy—adoptive cell therapy—which employs recent advances in genetic engineering and cell culturing methods to generate T cells with enhanced anti-tumor efficacy for infusion back into the patient. Head and neck cancer is comprised of biologically distinct cancers, HPV-positive and HPV-negative, and the clinical responses to PD-1 inhibitors in both HPV-positive and HPV-negative head and neck patients have showcased better than any other cancer type that there are distinct pathways to immunogenicity that may lend themselves to different therapeutic approaches. Thus, head and neck cancer is uniquely poised to benefit from the personalized approach of adoptive cell therapy as well as provide a valuable platform to explore contrasting T cell modalities. In this article, we will review the growing portfolio of trials of adoptive cell therapies in head and neck cancer and discuss the future directions of this emerging new field.
      PubDate: 2019-03-14
       
  • Malignant Pleural Mesothelioma: Is Tailoring the Second-Line Therapy
           Really “Raising the Bar'”
    • Abstract: Opinion statement Unresectable or relapsed malignant pleural mesothelioma (MPM) has dismal prognosis. First-line combination therapy with pemetrexed and a platinum analog allows a modest survival benefit, while no clear therapeutic options exist for the second-line therapy. In this setting, pemetrexed seems to be the most active drug; however, the inclusion in front-line treatment limits its use in further lines. Nevertheless, rechallenge with one or both drugs used in first-line remains a feasible strategy for responder patients. Alternatively, only few cytotoxic drugs have demonstrated a mild activity in refractory MPM. Among other options, targeted therapy has unfortunately produced disappointing results as salvage treatment probably due to the lack of a clear understanding of the tumor biology. In contrast, recent data suggest moderate efficacy and mild toxicity of immunotherapy also for the treatment of MPM. The combination of checkpoint inhibitors with chemotherapy or other immunological agents seems promising and could really “raise the bar” in this setting.
      PubDate: 2019-02-21
       
  • Current State of Immunotherapy for Treatment of Glioblastoma
    • Abstract: Opinion statement At this time, there are no FDA-approved immune therapies for glioblastoma (GBM) despite many unique therapies currently in clinical trials. GBM is a highly immunosuppressive tumor and there are limitations to a safe immune response in the central nervous system. To date, there have been several failures of phase 3 immune therapy clinical trials in GBM. These trials have targeted single components of an antitumor immune response. Learning from these failures, the future of immunotherapy for GBM appears most hopeful for combination of immune therapies to overcome the profound immunosuppression of this disease. Understanding biomarkers for appropriate patient selection as well as tumor progression are necessary for implementation of immunotherapy for GBM
      PubDate: 2019-02-21
       
  • The Potential of Targeting P53 and HSP90 Overcoming Acquired
           MAPKi-Resistant Melanoma
    • Abstract: Opinion Statement Melanoma is the deadliest form of skin cancer worldwide. The rising melanoma incidence and mortality, along with its high propensity for metastasis highlights the urgency to identify more effective therapeutic targets. Approximately, one half of advanced melanoma bears a mutation in the BRAF gene that makes BRAF as an important therapeutic target. Significant clinical benefit is associated with BRAF and MEK inhibitors (MAPKi) on targeting patients with BRAF V600 mutations. However, the frequent and rapid development of acquired resistance still is the major challenge facing the melanoma. Several mechanisms by which melanoma passes the inhibitory effects of MAPKi have been characterized and clinically translated, but additional alternations of genetic and epigenetic regulators outside of MAPK and/or AKT networks occurs in a quarter of patients with acquired MAPKi resistance. These studies implicate that targeting signaling networks external MAPK or AKT pathways is critical. In this review, we will focus on two approaches that are under evaluating for targeting melanoma: (1) against genome instability by p53 network restoration and (2) disrupt cancer proteome by chaperone inhibition.
      PubDate: 2019-02-18
       
  • The Role of Angiogenesis Inhibitors in the Era of Immune Checkpoint
           Inhibitors and Targeted Therapy in Metastatic Non-Small Cell Lung Cancer
    • Abstract: Opinion statement The treatment of advanced non-small cell lung cancer (NSCLC) has evolved to include targeted therapy, immunotherapy as well as chemotherapy for selected patients in the first-line setting. Angiogenesis inhibitors have been used in combination with chemotherapy in the first-line and maintenance settings providing improved progression-free survival (PFS) and objective response rate (ORR), as well as overall survival (OS) in selected studies. Biologic rationale exists for combining anti-angiogenic agents with immunotherapy and targeted kinase inhibitors (TKIs). A recent study has demonstrated improved survival when anti-PD-L1 therapy was added to chemotherapy plus bevacizumab. Subgroup analysis of patients with mutations in the epidermal growth factor receptor (EGFR) gene and rearrangements in the anaplastic lymphoma kinase (ALK) gene also demonstrated benefit with combined anti-PD-L1, bevacizumab, and platinum chemotherapy. Further investigation into combination therapy is warranted in the EGFR- and ALK-positive population given this signal. Anti-angiogenics combined with EGFR-targeted treatment in the wild-type population have shown modest PFS benefit with no OS benefit, and their routine use has not been adopted. The combination of EGFR inhibitors plus vascular endothelial growth factor (VEGF) inhibitors in the EGFR mutation-positive population has demonstrated substantial improvements in response and PFS; however, given the higher toxicity and lack of survival benefit to date, combination therapy in this group should be used with caution. At the present time, use of bevacizumab can be recommended with atezolizumab and chemotherapy for the first-line treatment of non-squamous NSCLC patients. Data with other checkpoint inhibitors and anti-angiogenics are too early to make firm recommendations regarding their use.
      PubDate: 2019-02-18
       
  • Postoperative Treatment of Oropharyngeal Cancer in the Era of Human
           Papillomavirus
    • Abstract: Opinion statement Despite an overall decline in the incidence of tobacco-related cancers, human papillomavirus (HPV)–related head and neck squamous cell carcinoma (HNSCC) of the oropharynx is on the rise. The prognosis of HPV-related oropharynx cancer (HPV-OPC) is generally favorable even in locoregionally advanced disease, and a variety of treatment options are available. Though the primary treatment modality of choice remains definitive radiation (RT), surgical resection followed by appropriate adjuvant therapy remains an option, especially in those patients who may not be favorable candidates for definitive radiotherapy, particularly when concurrent chemotherapy is warranted. Upfront resection may offer a chance to avoid the well-described acute toxicity and long-term morbidity associated with concurrent chemoradiotherapy (CRT) in select patients. Despite the overall favorable prognosis of HPV-OPC, indications for therapy remain unchanged from the recommendations for treatment in tobacco-related OPC and other anatomic sites of HNSCC. Ongoing studies assessing deintensification strategies in HPV-OPC are focused on maintaining high cure rates while improving treatment-related toxicities. Currently, no clear guidelines exist for the choice of primary therapy, surgical resection, or RT in patients with HPV-OPC, highlighting the need for multidisciplinary discussion and review of the individual patient before selecting the most appropriate curative modality. This review seeks to present the data for postoperative therapy in HPV-related oropharyngeal HNSCC.
      PubDate: 2019-02-15
       
  • Current Treatment Options for Breast Cancer Brain Metastases
    • Abstract: Opinion statement In the past, the standard of care for treatment of BM was whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and surgery. There has been a greater role for medical therapies in the last two decades due to the discovery of driver mutations and corresponding targeted therapies. These innovations have dramatically altered the approach to treating these patients. Some of the important mutations include epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations in small cell lung cancer, human epidermal growth factor receptor (HER2) mutation in breast cancer, and BRAF mutation in melanoma. Disease-specific graded prognostic assessments have identified prognostic factors for each of the major tumor types associated with BM. These reflect the increased treatment sensitivity of these tumors to specific agents. Furthermore, there is a difference in the genetic makeup of BM compared to their primary tumor. Genomic studies of BM patients comparing somatic point mutations and copy number variations with their primary tumor have demonstrated that while both the primary tumor and BM share a number of common mutations, BM can often develop distinct mutations. Therefore, there is a need to individualize systemic therapies in BM. Several organizations including the Food and Drug Administration and the American Society of Clinical Oncology now emphasize the inclusion of BM patients in various phases of clinical drug development.
      PubDate: 2019-02-15
       
  • Use of Immune Checkpoint Inhibitors in Mesothelioma
    • Abstract: Opinion statement Recent advances in immunology have extended into the mesothelioma field. To date, only Japan has given regulatory approval to salvage nivolumab in chemo-refractory mesothelioma patients. The USA has included in the NCCN guidelines that pembrolizumab (in programmed death ligand 1 (PD-L1) immunohistochemistry (IHC)–positive patients) and nivolumab with or without ipilimumab (whatever the PD-L1 status is) are accepted salvage therapies. Based on the growing body of literature, it is anticipated that checkpoint inhibitors will receive regulatory approval in the USA and Europe soon for salvage therapy. Additional research efforts will determine whether earlier stage patients and frontline unresectable patients will benefit from the addition of immunotherapy to their treatment regimens. The realm of biomarker research has lagged behind in mesothelioma. In general, mesothelioma has less tumor mutation burden than other malignancies. Most of the single-agent salvage checkpoint inhibitor trials have shown a trend correlating higher PD-L1 immunohistochemistry (IHC) with responses. However, survival data remains immature and a larger number of patient outcomes are needed to ascertain the value of PD-L1 IHC as a predictive biomarker. Incorporation of translational studies in all immunotherapy trials and especially window-of-opportunity resectable studies should be supported and instituted in all future mesothelioma trials.
      PubDate: 2019-02-14
       
  • Updates on Minimally Invasive Surgery in Non-Small Cell Lung Cancer
    • Abstract: Opinion statement Video-assisted thoracic surgery (VATS) has become widely used since the 1990s and has become a standard treatment approach mainly for early-stage non-small cell lung cancer. The few randomized controlled trials providing evidence of the effectiveness of VATS lobectomy at present are supported by a large number of propensity-matched studies, several high-quality meta-analyses, and outcome studies. These studies provide comprehensive data demonstrating the lower morbidity, shorter chest tube duration, and shorter hospital stay of VATS than thoracotomy during the postoperative course. Moreover, VATS shows equivalent oncological outcome as thoracotomy and therefore should be performed for lobectomy as much as possible. Importantly, VATS has recently been applied to advanced cases and previously contraindicated complex procedures such as bronchoplasty and chest wall resection. Attention has also been paid to reduced port surgery performed by frontier surgeons. Thus, the indications of VATS have seen a significant expansion. This major development logically negates any hesitation to change to the VATS technique as any doubt will likely constrain its wider applications. Preparation of scientific learning environments is necessary and should be actively pursued to adopt new skills instead of debating between the choice of “VATS or open.”
      PubDate: 2019-02-11
       
  • Management of Nonmetastatic Castration-Resistant Prostate Cancer: Recent
           Advances and Future Direction
    • Abstract: Opinion statement Nonmetastatic castration-resistant prostate cancer (nmCRPC) comprises a relatively narrow niche of advanced prostate cancer, but the treatment landscape for men with nmCRPC has drastically changed over the past year. Prior to the SPARTAN and PROSPER trials, men with nmCRPC were commonly treated with first-generation androgen receptor antagonists, such as bicalutamide or flutamide, or with estrogens or ketoconazole, none of which were associated with any proven survival benefit. The SPARTAN trial evaluated apalutamide versus placebo for men with nmCRPC and found that apalutamide significantly improved metastasis-free survival (MFS), the primary endpoint of this trial. Similarly, the PROSPER trial showed that enzalutamide significantly improved MFS compared with placebo for men with nmCRPC. In both trials, the data for overall survival was immature at the time of analysis. The SPARTAN and PROSPER trials led to the approval of apalutamide and enzalutamide, respectively, for men with nmCRPC. More recently, the phase 3 trial ARAMIS showed that darolutamide, a novel androgen receptor antagonist, also improves MFS compared with placebo for men with nmCRPC, and this trial is expected to garner regulatory approval for darolutamide in the nmCRPC setting. Novel imaging modalities are becoming more prevalent for the diagnostic evaluation of men with prostate cancer and are more sensitive than conventional bone or CT scans for detection of oligometastatic disease that previously was undetected. These modalities are likely to reduce the incidence and prevalence of nmCRPC in the near future. Ultimately, the treatment options for men with nmCRPC have significantly improved over the past 2 years.
      PubDate: 2019-02-11
       
  • Innovating Cancer Care Delivery: the Example of the 4R Oncology Model for
           Colorectal Cancer Patients
    • Abstract: Opinion statement Care delivery innovation is necessary to address the growing complexity of cancer care across specialties and integrate new diagnostics, treatments, and services into care delivery. Informed by Cancer Care Delivery Research (CCDR), multilevel intervention research, and other disciplines, this article describes the 4-step cancer care delivery innovation cycle. The cycle guides collaborative efforts of cancer clinicians, researchers, patients, and other stakeholders to systematically define care delivery problems and formulate, test, and implement care innovations to effectively address problems. We illustrate the 4 steps of the innovation cycle with the example of developing the 4R Oncology Model for colorectal cancer (4R is Right Information and Right Care for the Right Patient at the Right Time). The 4R is a multilevel intervention informed by CCDR, the team science, and lessons learned from other models, such as survivorship care planning. We offer additional considerations for balancing the need to innovate with concerns about constrained resources and overextended workforce. We suggest to focus on care delivery models which are synergistic with other efforts and do not require extensive information systems support in earlier cycles of development.
      PubDate: 2019-02-11
       
  • Palliative Cancer Care in the Outpatient Setting: Which Model Works
           Best'
    • Abstract: Opinion statement Multiple randomized controlled trials have underscored the importance of timely referral to palliative care for patients with advanced cancer. Outpatient palliative care can facilitate timely referral and is increasingly available in many cancer centers. The key question is which model of outpatient palliative care is optimal. There are currently many variations for how palliative care is delivered in the outpatient setting, including (1) Interdisciplinary Specialist Palliative Care in Stand-Alone Clinics, (2) Physician-Only Specialist Palliative Care in Stand-Alone Clinics, (3) Nurse-Led Specialist Palliative Care in Stand-Alone Clinics, (4) Nurse-Led Specialist Palliative Care Telephone-Based Interventions, (5) Embedded Specialist Palliative Care with Variable Team Makeup, and (6) Advanced Practice Providers-Based Enhanced Primary Palliative Care. It is important to make a clear distinction among these delivery models of outpatient palliative care because they have different structures, processes, and outcomes, along with unique strengths and limitations. In this review article, we will provide a critical appraisal of the literature on studies investigating these models. At this time, interdisciplinary specialist palliative care in stand-alone clinics remains the gold standard for ambulatory palliative care because this approach has the greatest impact on multiple patient and caregiver outcomes. Although the other models may require fewer resources, they may not be able to provide the same level of comprehensive palliative care as an interdisciplinary team. Further research is needed to evaluate the optimal model of palliative care delivery in different settings.
      PubDate: 2019-02-11
       
 
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