Online First

Introduction: Refractory cancer pain (RCP) affects 10-20 % of patients with cancer. Ketamine, an anesthetic agent, has been evaluated as a therapeutic alternative in the management of RCP. The aim of this study was to describe the pattern of oral ketamine use in oncology patients. Secondary objectives included assessing opioid consumption, analyzing the proportion of patients achieving predefined a pain control criteria, and describing the drug’s safety profile.
Material and methods: A multicenter prospective observational study was conducted over an 18-month period. All hospitalized patients who initiated oral ketamine were included. Rescue opioid use was recorded on days −5 and −2 before, and on days +2 and +5 after ketamine initiation. A criterion for controlled pain was defined. Adverse events (AEs) were recorded and graded according to CTCAE v5.0.
Results: A total of 37 patients were included. Overall, 97.3% of patients initiated ketamine at a dose of 0.5 mg/kg/day, with 30 mg/day being the most frequent starting dose (70.2%). The mean daily oral morphine equivalent (OME) dose was 354 mg. Median survival from ketamine initiation was 41 days. Breakthrough opioid use was 4.43 (D-5) and 5.30 (D-2) before initiation, decreasing to 3.51 (D+2) and 3.24 (D+5) afterward (mean difference -1.49 breakthrough doses; p < 0.001). A total of 54.1% of patients met the criteria for controlled pain. Fourteen adverse events were recorded in 9 patients (24.3%), including one grade 3 adverse event (2.7%).
Conclusion: Oral ketamine was associated with patients with limited life expectancy and high opioid requirements. A significant reduction in rescue opioid consumption was observed after ketamine initiation, and more than half of the patients achieved controlled pain. The safety profile was acceptable. Further randomized studies are needed to evaluate the efficacy and appropriate indications of oral ketamine.

Common Sense Oncology calls for a rebalancing of cancer care toward what truly matters to patients and their families: quality of life, shared decision-making, therapeutic proportionality, and comprehensive person-centred care. From a palliative care perspective, this movement can be understood as a contemporary formulation of principles long embedded in early, interdisciplinary palliative care focused on suffering, values, and the needs of patients and families. This editorial argues that the humanization of care, the integration of psychosocial complexity, and the structural incorporation of palliative care are essential dimensions for transforming contemporary oncology. It further emphasizes that such transformation cannot rely solely on the individual attitude of professionals, but requires health policies, care pathways, quality indicators, and institutional structures capable of sustaining oncology care that is more proportional, deliberative, compassionate, and genuinely centred on patients and families

Introduction: The global increase in the need for palliative care requires the strengthening of health systems. Ecuador is an upper-middle-income country facing social and health challenges. WHO is promoting a new model for assessing development in six dimensions.
Objective: To describe the development of palliative care in Ecuador using the WHO conceptual framework through a review of the literature.
Methodology: A panoramic review (2018-2023) was conducted in PubMed, Lilacs, Scopus, Scielo, CINAHL, and Web of Science (November 2023), including gray literature. Articles in English and Spanish describing at least one of the WHO dimensions (community empowerment, health policy, research, education, use of essential medicines, and provision of integrated services) were included. Clinical articles were excluded.
Results: Seventy-four articles were identified; three and five government documents were selected. Ecuador has no national palliative care law. The Palliative Care Association is advocating for a specific law. The provision of services has increased by 66%. Only 18% of universities teach palliative care at the undergraduate level, although there is a specialty for physicians. Access to opioids is limited, especially in densely populated provinces.
Discussion: Ecuador has made progress in four of the six WHO dimensions: community empowerment, health policy, training of professionals, and integrated services. However, unmet needs remain. An evaluation of the country's development is needed, with the measurement of relevant indicators in the territory.

Grief as a consequence of the death for a close relationship is a destructuring event in people's lives. It often involves restructuring your world of assumptions, beliefs, values and also your relationships, transforming relationships with the environment and with yourself. Grief presents us with the challenge of learning to live with absence as presence.
Throughout this article and transversally, taking Ricoeur will enable us to think about grief accompaniment in a narrative key where the word allows us to build meaning in a narrative framework in the face of the helplessness of loss. During these lines we will try to get closer to what it means to narrate a disruptive event such as the death of an emotional bond and incorporate it into our biography, our life story.
Berson's conception of time will be taken to stress the need to measure personal processes in temporal terms, in this case the need to establish the duration of pain, anguish, and grief for the death of a close bond.
The possibility of narrative spaces for accompaniment in grief allows the configuration of feeling, meaning and transcendence in pain and makes it possible to recognize the needs and singularities of the process, which is fundamental for the recognition of the other as a subject.

Introduction and Objective: In our country, little is known about end-of-life processes and palliative care in Nursing Homes (NH). The objective of this study is to describe the psychosocial care needs of residents and their families, according to the NH team, and to analyze associated factors. Method: Retrospective descriptive study. Four NH were selected through non-probabilistic convenience sampling. The psychologist conducted two meetings with each team. In these meetings, responses to the “surprise question” from the NECPAL CCOMS-ICO© instrument were collected, along with the perception of whether any residents or family members could benefit from psychosocial care interventions. The two main reasons for requiring intervention were classified using an ad hoc questionnaire. The psychologist also recorded data extracted from the shared clinical history of Catalonia and the NH, including demographic variables, complexity, cognitive status (Short Portable Mental State Questionnaire, emotional (Geriatric Depression Scale), whether an advance directive document was available, and whether residents received family visits. Results: Data from 375 residents were analyzed, with a mean age of 85.15 ± 9.57 years, 71.2% women. Of these, 43.47% presented palliative care needs according to positive response to the ‘surprise question’, and 54.4% of residents and 16% of their relatives were perceived as requiring psychosocial care. Statistically significant differences in psychosocial care needs were found among residents according to cognitive status assessed with the Short Portable Mental State Questionnaire (Mean errors (yes)=7,05±2,92 vs Mean errors (no)=5,72±3,26) and emotional status assessed with the Geriatric Depression Scale (Yesavage) (Mean Score (yes)=6,95±2,69 vs Mean score (no)=5,36±2,67; p=0,001). Conclusion: The high prevalence of psychosocial care needs among residents, and to a lesser extent among their relatives, together with their association with cognitive and emotional impairment, highlights the importance of systematic identification and comprehensive management of these needs in nursing homes.

Malignant psoas syndrome (MPS) is a rare condition resulting from malignant involvement of the psoas muscle. It is characterized by ipsilateral lumbosacral plexopathy and painful hip flexion and is often refractory to multiple therapeutic approaches. We report the case of a woman with MPS secondary to lymphadenopathy and a soft tissue mass caused by sigmoid adenocarcinoma.

Introduction:
Point-of-care ultrasound (POCUS) has become established as a diagnostic and therapeutic support tool in multiple specialties. In palliative care, its usefulness has been described primarily in the hospital setting, with limited evidence in the home setting, where rapid decision-making and the avoidance of unnecessary transfers are particularly relevant.
Objective: To describe the clinical indications for clinical ultrasound in home-based palliative care, the sociodemographic and functional characteristics of the patients in whom it is used, and to analyze its impact on therapeutic management and hospital referrals.
Methods: This was an observational, descriptive, and multicenter study conducted in Home-Based Palliative Care Support Teams (ESAPD) in the Community of Madrid. Patients over 18 years of age with advanced cancer receiving home-based care were included, and clinical ultrasound was performed according to professional criteria. Sociodemographic variables, clinical variables (ICD-10, Palliative Performance Scale), type and location of ultrasound scan, findings, therapeutic changes, and hospital referrals were collected. The analysis was descriptive.

Results: 285 ultrasound scans were performed over a six-month period by 15 physicians from 6 Palliative Care Services (ESAPD). The mean age of the patients was 79.2 years (SD: 13.95), 52% were women, and the median Palliative Performance Scale score was 50. The most frequent scans were abdominal (43.5%) and thoracic (22.8%). Pathological findings were identified in 67% of the ultrasound scans. After the ultrasound scan, a change in therapeutic approach occurred in 62% of cases, and hospital referrals were avoided in 70%.

Conclusions: Clinical ultrasound in home-based palliative care is a feasible and useful tool, integrated into clinical practice, that helps reduce diagnostic uncertainty, optimize therapeutic decision-making, and avoid unnecessary hospital transfers, prioritizing patient comfort and quality of life.

Introduction: Amyotrophic lateral sclerosis (ALS) is a multisystem neurodegenerative disease that affects health-related quality of life (HRQoL) and emotional well-being. International evidence has highlighted the impact of non-motor symptoms—particularly anxiety and depression—as significant determinants of HRQoL. In Uruguay, researchers have not yet systematized data on these aspects. Although researchers have widely established the association with depression, they have studied anxiety and other factors less extensively. We aimed to describe HRQoL, determine the frequency of anxiety and depression symptoms, and analyze their relationship in patients with ALS treated at a national reference center. Patients and methods: We conducted a descriptive, correlational, observational, and cross-sectional study with prospective data collection between July 2023 and August 2024, involving 39 patients with a confirmed diagnosis according to the Gold Coast criteria. We assessed HRQoL using the EuroQol-5D (EQ-5D-5L), functionality with the ALSFRS-R, and emotional symptoms with the HADS. Results:We found a median HRQoL of 0.76, lower than that of the general population. We observed a higher frequency of anxiety (56%) than depression (36%), with 33% of patients presenting mixed symptoms. Anxiety was more prevalent in patients with less than 6 months since diagnosis and in those with more than 12 months. HRQoL correlated positively with functionality and negatively with anxiety and depression; anxiety showed an inverse association with HRQoL (rs = −0.44; p < 0.005).Discussion:These findings reinforce the relevance of non-motor symptoms in the ALS experience and highlight the need for early psychological assessment and multidisciplinary interventions. Future studies should investigate the longitudinal progression of these factors throughout the disease course.