Problems of end stage cancer patients: Challenges for development of palliative care


  • Ruechuta Molek Inpatient Department, Chulabhorn Hospital, Chulabhorn Royal Academy
  • Phongthara Vichitvejpaisal Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University
  • Adisorn Voharn Oncology Medical center , Chulabhorn Hospital , Royal Academy
  • Sureeporn Maneerat Inpatient Department, Chulabhorn Hospital, Chulabhorn Royal Academy
  • Jiraporn Voraraksa Department of Anesthesiology, Chulabhorn Hospital, Chulabhorn Royal Academy
  • Rattiya Chaichompoo Oncology Medical center , Chulabhorn Hospital , Royal Academy


compassion fatigue, end-stage cancer, holistic care, palliative care


This review article research addresses palliative care within the context of end-stage cancer care. It highlights the challenges and constraints faced by palliative teams providing care to patients at the advanced stages of cancer and presents innovative solutions to navigate these complex issues. The first section explores physical challenges, with a focus on pain management, symptom control, and the intricacies of medication management. Psychological and emotional challenges, emphasizing the significance of coping with grief and loss, addressing anxiety and depression, and facilitating difficult conversations, while preserving patient dignity are explored. The ethical and moral dilemmas of end-of-life decision-making, advance care planning, and the imperative of maintaining patient dignity are discussed. Issues of effective communication, encompassing breaking bad news, facilitating challenging conversations, and managing family dynamics and conflicts are explored. Furthermore, the profound impact of end-stage cancer care on palliative care, emphasizing the risk of burnout and compassion fatigue are examined. Practices and solutions, showcasing innovative pain management techniques, psychosocial support interventions, ethics consultation services, communication skills training, and holistic approaches to end-of-life care are explained. These strategies not only alleviate patient suffering but also nurture the well-being of palliative care. Finally, the article touches on future directions and research needs, highlighting emerging trends in palliative care and areas requiring further investigation. The conclusion underscores the vital role of palliative care, emphasizing the importance of education, interdisciplinary collaboration, support, and research in achieving improved end-of-life care for cancer patients.


Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383:1721-30.

Hoerger M, Wayser GR, Schwing G, et al. Impact of Interdisciplinary outpatient specialty palliative care on survival and quality of life in adults with advanced cancer: a meta-analysis of randomized controlled trials. Ann Behav Med 2019;53:674-85.

Hagan TL, Xu J, Lopez RP, et al. Nursing's role in leading palliative care: a call to action. Nurse Educ Today 2018;61:216-9.

Ziegler LE, Craigs CL, West RM, et al. Is palliative care support associated with better quality end-of-life care indicators for patients with advanced cancer? a retrospective cohort study. BMJ Open 2018;8:e018284.

Hoerger M, Greer JA, Jackson VA, et al. Defining the elements of early palliative care that are associated with patient-reported outcomes and the delivery of end-of-life care. J Clin Oncol 2018;36:1096.

Syrjala KL, Jensen MP, Mendoza ME, et al. Psychological and behavioral approaches to cancer pain management. J Clin Oncol 2014;32:1703-11.

Sekse RJT, Hunskar I, Ellingsen S. The nurse's role in palliative care: a qualitative meta-synthesis. J Clin Nurs 2018;27:e21-e38.

Warth M, Zoller J, Kohler F, et al. Psychosocial interventions for pain management in advanced cancer patients: a systematic review and meta-analysis. Current oncology reports 2020;1-9.

Rajabi M, Bastami M, Shahvaroughi N, et al. Religious coping as a predictor of the burden of care in the caregivers of end-stage cancer patients. Iran Journal of Nursing 2018;31:6-16.

Meyer A, Ring M. Complementary and integrative therapies in palliative care. Oxford textbook of palliative nursing. 2019:361-70.

Cotogni P, Saini A, De Luca A. In-Hospital Palliative Care: Should We Need to Reconsider What Role Hospitals Should Have in Patients with End-Stage Disease or Advanced Cancer? J Clin Med. 2018;7:18.

Wilson E, Morbey H, Brown J, et al. Administering anticipatory medications in end-of-life care: a qualitative study of nursing practice in the community and in nursing homes. Palliat Med 2015;29:60-70.

Fraguell-Hernando C, Limonero JT, Gil F. Psychological intervention in patients with advanced cancer at home through Individual meaning-centered psychotherapy-palliative care: a pilot study. Supportive Care in Cancer 2020;28:4803-11.

Vanbutsele G, Pardon K, Van Belle S, et al. Effect of early and systematic integration of palliative care in patients with advanced cancer: A randomised controlled trial. Lancet Oncol 2018;19:394-404.

Paley CA, Boland JW, Santarelli M, et al. Non-pharmacological interventions to manage psychological distress in patients living with cancer: a systematic review. BMC Palliat Care 2023;22:88.

Ellis J, Cobb M, O'Connor T, et al. The meaning of suffering in patients with advanced progressive cancer. Chronic Illn 2015;11:198-209.

Fitch MI, Fliedner MC, O'Connor M. Nursing perspectives on palliative care 2015. Ann Palliat Med 2015;4:150-5.

Sinuff T, Dodek P, You JJ, et al. Improving end-oflLife communication and decision making: the development of a conceptual framework and quality indicators. J Pain Symptom Manage 2015;49:1070-80.

Wallace CL. Family communication and decision making at the end of life: a literature review. Palliat Support Care 2015;13:815-25.

Luz R, Vargas A, Schmidtt H, et al. Ethical problems experienced by oncology nurses. Rev Lat Am Enfermagem 2015;23:1187-94.

Panfilis L, Leo S, Peruselli C, et al. “I go into crisis when…”: ethics of care and moral dilemmas in palliative care. BMC palliative care 2019:1-8.

Chukwuneke N. Ethics of palliative care in late-stage cancer management and end-of-life issues in a depressed economy. Niger J Clin Pract 2015;18 Suppl:S15-9.

Dijxhoorn Q, Brom L, Linden M, et al. Prevalence of burnout in healthcare professionals providing palliative care and the effect of interventions to reduce symptoms: a systematic literature review. Palliat Med 2021;35:6-26.

Gama G, Barbosa F, Vieira M. Personal determinants of nurses' burnout in end of life care. Eur J Oncol Nurs 2014;18:527-33.

Schroeder K, Lorenz K. Nursing and the future of palliative care. Asia Pac J Oncol Nurs 2018;5:4-8.

Cardona-Morrell M, Kim J, Turner M, et al. Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem. Int J Qual Health Care 2016;28:456-69.

Hui D, Kim H, Roquemore J, et al. Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer 2014;120:1743-9.

Pigni A, Alfieri S, Caraceni T, et al. Development of the palliative care referral system: proposal of a tool for the referral of cancer patients to specialized palliative care. BMC Palliat Care 2022;21:209.

Sun W, Zhang Q, Lee S, et al. When social work client self-determination principle meets confucius culture: A living will decision-making case study in China. OMEGA-Journal of Death and Dying 2022;8:1-16.

Higel T, Alaoui A, Bouton C, et al. Effect of living wills on end‐of‐life care: a systematic review. J Am Geriatr Soc 2019;67:164-71.

Riffin C, Pillemer K, Chen K, et al. Identifying key priorities for future palliative care research using an innovative analytic approach. Am J Public Health 2015;105:e15-e21.

Brinkman-Stoppelenburg A, Rietjens A, Heide A. The effects of advance care planning on end-of-life care: a systematic review. Palliat Med 2014;28:1000-25.




How to Cite

Molek R, Vichitvejpaisal P, Voharn A, Maneerat S, Voraraksa J, Chaichompoo R. Problems of end stage cancer patients: Challenges for development of palliative care. J Med Health Sci [Internet]. 2024 Apr. 30 [cited 2024 Jul. 22];31(1):95-106. Available from:



Review article (บทความวิชาการ)