Josep Porta-Sales

• MD PhD
• Research Director at Catalan Institute of Oncology

Context: Ensuring patient-centered palliative care requires a comprehensive assessment of needs beginning in the initial encounter. However, there is no generally accepted guide for carrying out this multidimensional needs assessment as a first step in a palliative intervention. Objectives: To develop an expert panel-endorsed interview guide tha...

Purpose Breatlessness flares directly impair quality of life of patients with cancer. The aim of this review was to analyse and synthesise the available information related to its terminology, definition and clinical features in patients with cancer. Methods Integrative systematic review according to Preferred Reporting Items for Systematic Review...

Psycho-Oncology in Palliative and End-of-Life Care provides consensus expert advice and clinical management guidelines on the impact of advanced cancer and its treatment on the life and well-being of a patient as they move into palliative care and toward the end of their life. Employing a practical toolkit format, this volume addresses a variety of...

Background In the context of life-threatening illness, loss of control is argued as a source of suffering and loss of perceived dignity, whereas having control over the dying process has been seen as a way of maintaining personal independence. Little is known about the meaning of control from the patients’ perspectives. Thus, the aim of this study...

Background: Episodic dyspnea (ED) is a common problem in patients with advanced lung cancer (LC). However, the prevalence of ED and other related aspects in this patient population is not known. Objectives: To assess and describe the prevalence, clinical features, treatment, and risk factors for ED in outpatients with advanced LC. Design: Multicent...

Background Opioid-induced constipation (OIC) is a frequent and bothersome adverse event related with opioid therapy in cancer patients. Despite the high prevalence, medical management of OIC is often uncertain. The current project aimed to investigate expert opinion on OIC management and provide practical recommendations to improve the clinical app...

Objectives Diagnosis, treatment and care of cancer often involve procedures that may be distressing and potentially painful for patients. The PROCEDIO Study aimed to generate expert-based recommendations on the management of moderate to severe procedural pain in inpatients and outpatients with cancer. Methods Using a two-round Delphi method, exper...

Background The comprehensive assessment of needs in palliative care identifies where patients most want attention to guide clinical decisions that tailor care provision from their first encounters. Aim To define how and what needs are identified by the comprehensive assessment of needs in the original peer-reviewed articles in the field of palliat...

Context: Most older adults will face threats to loss of health and social support, which can affect their perceived dignity. Although problems with perceived dignity increase in the context of cancer, the specific experience for those older compared with younger patients with advanced cancer has not been described despite its contributions to the...

Context: There is a lack of consensus about the appropriate moment to assess a potential wish to hasten death (WTHD) in patients with life-threatening illness, despite evidence of its positive appraisal among patients. Objectives: To evaluate the practical potential and acceptability of questions about the WTHD in the first palliative care (PC) cl...

Background: The most commonly used switching ratio from parenteral to oral methadone is 1:2. Methadone is highly bioavailable and a lower ratio might result in similar analgesia with less toxicity. Objective: To compare success and side effects with two ratios from parenteral to oral methadone: 1:2 versus 1:1.2 in hospitalized patients with cancer...

Background: Opioid-induced constipation (OIC) is a frequent and bothersome adverse event related with opioid therapy in cancer patients. Despite the high prevalence, medical management of OIC is often uncertain. The current project aimed to investigate expert opinion on OIC management and provide practical recommendations to improve the clinical ap...

Background: Opioid-induced constipation (OIC) is a frequent and bothersome adverse event related with opioid therapy in cancer patients. Despite the high prevalence, medical management of OIC is often uncertain. The current project aimed to investigate expert opinion on OIC management and provide practical recommendations to improve the clinical ap...

Background: Opioid-induced constipation (OIC) is a frequent and bothersome adverse event related with opioid therapy in cancer patients. Despite the high prevalence, medical management of OIC is often uncertain. The current project aimed to investigate expert opinion on OIC management and provide practical recommendations to improve the clinical ap...

Background Some evidence suggests the wish to hasten death is related to poor health-related quality of life. Deficits in perceived dignity and self-efficacy are risk factors for wish to hasten death that also impact health-related quality of life. Aim To compare perceived health-related quality of life, dignity and self-efficacy in patients with...

Introduction The benefits of palliative care rely on how healthcare professionals assess patients’ needs in the initial encounter/s; crucial to the design of a personalised therapeutic plan. However, there is currently no evidence-based guideline to perform this needs assessment. We aim to design and evaluate a proactive and systematic method for t...

Background An important concern of healthcare professionals when exploring the wish to hasten death with patients is the risk of causing them some type of distress. Aim To assess the opinion of hospitalized patients with advanced cancer about the proactive assessment of the wish to hasten death. Design Descriptive, cross-sectional study. Setting...

Background Family caregivers play a key role in the lives of patients with multiple myeloma. However, very little is known about the impact that the disease (its diagnosis, course and prognosis) has on the main family caregiver. Aim To achieve a deeper understanding of the lived experience of individuals who are the primary caregiver of a relative...

Background: Episodic dyspnea is an increasingly recognized phenomenon that occurs frequently in patients with cancer. Although numerous definitions have been proposed to describe episodic dyspnea, to date, no common widely accepted definition in Spanish has yet emerged. Without a clear well-accepted definition, it is difficult to design rigorous c...

Objective: To test a model in which perceived loss of dignity and control are proposed, along with symptoms of depression and functional impairment, as risk factors for the wish to hasten death (WTHD) in advanced cancer patients. Methods: This was a cross‐sectional study of 193 patients in an oncology unit. Outcome measures included perceived contr...

[This corrects the article DOI: 10.1371/journal.pone.0146184.].

Introduction: The Desire for Death Rating Scale (DDRS) and the short form of the Schedule of Attitudes toward Hastened Death (SAHD-5) are different approaches to assessing the wish to hasten death (WTHD). Both have clinical threshold scores for identifying individuals with a meaningfully elevated WTHD. However, the agreement between the two measur...

Background Palliative care was originally intended for patients with non-haematological neoplasms and relatively few studies have assessed palliative care in patients with haematological malignancies. Aim To assess palliative care interventions in managing haematological malignancies patients treated by onco-haematology departments. Design Integr...

Resumen Objetivo Analizar y sintetizar la literatura existente sobre guías, protocolos y recomendaciones clínicas que den respuesta a un paciente que manifiesta deseo de adelantar la muerte (DAM). Método Revisión de la literatura. Se diseñó una estrategia de búsqueda que se implementó en MEDLINE PubMed y en el metabuscador Google Académico. Se in...

Context: Evidence for the benefits of early palliative care (EPC) in patients with solid tumors is strong, but EPC has received scant attention in hematological malignancies. Objective: To assess the benefits of outpatient-based EPC for symptom control in patients with multiple myeloma. Methods: Retrospective study of patients attending the Mu...

Context: Meaning in life (MiL) is a key factor for ensuring spiritual wellbeing and quality of life among patients with life-threatening illnesses. However, the role of MiL in relation to the wish to hasten death (WTHD) and its interaction with other physical and psychological factors in patients with advanced cancer has not yet been studied. Obj...

Background Among patients with advanced disease, meaning in life is thought to enhance well-being, promote coping and improve the tolerance of physical symptoms. It may also act as a buffer against depression and hopelessness. As yet, there has been no synthesis of meaning in life interventions in which contextual factors, procedures and outcomes a...

Background Patients with advanced conditions may present a wish to hasten death. Assessing this wish is complex due to the nature of the phenomenon and the difficulty of conceptualising it. Aim To identify and analyse existing instruments for assessing the wish to hasten death and to rate their reported psychometric properties. Design Systematic...

206 Background: Methadone (M) is frequently used for severe cancer pain using the parenteral and oral route. The most commonly used dose ratio (DR) parenteral: oral is 1:2. However, methadone is highly bioavailable and a lower ratio might result in similar analgesia with less toxicity. The main objective of this RCT is to compare success and side e...

Introduction Most clinical reports on methadone rotation describe outcomes in hospitalized patients. The few studies that have included outpatients are retrospective. The aim of this study was to assess the efficacy and safety of methadone as a second-line opioid in adult patients with advanced cancer after rotation in routine clinical practice at...

Objectives Palliative care (PC) services and patients differ across countries. Data on PC delivery paired with medical and self-reported data are seldom reported. Aims were to describe (1) PC organisation and services in participating centres and (2) characteristics of patients in PC programmes. Methods This was an international prospective multice...

Background Research in the end-of-life context has explored the sense of dignity experienced by patients with advanced disease, examining the factors associated with it. Whereas certain perspectives regard dignity as an intrinsic quality, independent of external factors, in the clinical setting it is generally equated with the person’s sense of aut...

Methodological Quality of included studies assessed with CASP: qualitative research checklist. (DOCX)

Methodological Quality of the systematic review assessed with AMSTAR (a measurement tool to assess systematic reviews). (DOC)

Quotations from participants in the primary studies that illustrate each theme. (DOC)

Background Bisphosphonates and denosumab are well-established therapies to reduce the frequency and severity of skeletal-related events in patients with bone metastasis. However, the analgesic effect of these medications on bone pain is uncertain. Aim To identify, critically appraise and synthesize existing evidence to answer the following questio...

Resumen Objetivo Describir la experiencia tras el primer año de funcionamiento de una consulta integrativa de cuidados paliativos en pacientes con mieloma múltiple. Materiales y métodos Se revisaron las historias clínicas de los pacientes visitados por primera vez en la consulta de cuidados paliativos en pacientes con mieloma múltiple. Durante la...

Background: The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to de...

Objective To ascertain the level of agreement and achieve a consensus among cancer pain specialists in Spain with regard to the optimal definition, diagnosis, and management of breakthrough cancer pain (BTcP). Design Two-round Delphi methodology survey (February–May 2013) using seven-point Likert scales (ranging from 1 “strongly disagree” to 7 “str...

The objective of this study was to review the evidence on the use of opioids for treatment of the dyspnea in adult cancer patients. A systematic literature review was conducted in the databases MEDLINE, CINAHL (EBSCO), ScienceDirect, and Cochrane Library of trials testing the effect of opioids in relieving dyspnea in cancer patients. Fourteen trial...

Resumen La prescripción de oxigenoterapia domiciliaria es una práctica común en cuidados paliativos como tratamiento sintomático de la disnea. Su indicación en el paciente no hipoxémico no se apoya en una evidencia científica suficiente. Se propone un algoritmo de abordaje del paciente con disnea sin hipoxemia que incluye el tratamiento con opioide...

Lung cancer, the most common and deadliest malignancy worldwide, is one of the biggest challenges for modern oncology. Although lung cancer presents the same incidence as breast or colorectal cancer, it causes as much deaths as breast and colorectal cancers together. Lung cancer demands our abilities as researchers, physicians, and care-givers in...

Pain in cancer patients is recognized as a major health problem, yet few studies of both inpatient and outpatient populations have been carried out. The study objective was to assess the frequency, type, and characteristics of pain in adult cancer patients, including both inpatients and outpatients. This cross-sectional study involved 1064 adult ca...

The World Health Organization definition of palliative care developed in 2012 established that "Palliative Care is as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable...

To assess the effectiveness of opioid rotation (OR) to manage cancer pain. To describe the adverse events (AEs) associated with OR. Thirty-nine tertiary hospital services. Sixty-seven oncological patients with cancer-related pain treated at outpatient clinics. Prospective multicenter study. Pain intensity was scored using a Numerical Rating Scale (...

Background Qualitative research suggests that the wish to hasten death (WTHD) in the advanced stages of disease is mainly related to overall suffering. This quantitative study explores the relationship between the WTHD and psychological and physical factors, including survival, in patients with advanced cancer.Methods Cross-sectional study of 101 a...

To analyze the short-term efficacy and patients' subjective perception of the use of lidocaine 5 % patches for painful scars (post-thoracotomy and post-mastectomy) and pain caused by chest wall tumors. This is a prospective, descriptive, non-controlled, non-randomized, open-label study of patients seen in the palliative care outpatient clinic. Demo...

Background Venous thromboembolic (VTD) disease in advanced cancer patients is a serious, not always well documented, complication. Primary aim: to determine the frequency of VTD in advanced cancer patients admitted to an Acute Palliative Care Unit. Secondary aim: to assess the thromboprophylaxis (TP) used during hospitalisation, the associated comp...

Context: Breakthrough pain is common in patients with cancer and is a significant cause of morbidity in this group of patients. Objectives: The aim of this study was to characterize breakthrough pain in a diverse population of cancer patients. Methods: The study involved 1000 cancer patients from 13 European countries. Patients were screened f...

Numb chin or Roger syndrome is a sensory neuropathy that is often associated with an underlying malignancy. We report a case of a patient whose tumor progression manifested as mental neuropathy secondary to mandibular metastasis.

Justification Breakthrough cancer pain is defined as a transitory exacerbation of pain experienced by the patient who has relatively stable and adequately controlled baseline pain. A new generation of drugs (fentanyl) with transmucosal absorption mimic the characteristics of breakthrough pain by providing an ideal analgesic profile. Good patient ed...

To describe the structure, characteristics of patients and basic clinical outcomes in cancer patients receiving care from palliative care hospital support teams (HSTs) in Spain. A multi-centre observational two phase study. Phase I: A descriptive survey of all HSTs in Spain. Phase II: A quasi-experimental prospective cohort study to describe the cl...

Objective To conduct a systematic review of the literature on the palliative care intervention in the far-advanced patient with haematological malignancies.Material and methodWe carried out a systematic search of articles in PubMed and Cochrane, from 1 January 2001 to 1t May 2009, published in Spanish or English, and using “Haematology, Palliative...

Catalonia (Spain) has a total population of 7.3 million citizens for whom the National Health Service (NHS) provides health care that is free at the point of access. The prevalence of terminally ill patients is between 30,100 and 39,600. Twenty years ago, the World Health Organization (WHO), in collaboration with the Catalan Department of Health an...

From the 1990s onwards the World Health Organization (WHO) has been proposing palliative care as a key element of health care systems, to be inserted into mainstream planning and organization. Accordingly, WHO Public Health Palliative Care Programmes have been implemented. These programmes are defined as the systematic application of several measur...

Objective: To conduct a systematic review of the literature on the palliative care intervention in the far-advanced patient with haematological malignancies. Material and method: We carried out a systematic search of articles in PubMed and Cochrane, from 1 January 2001 to 1t May 2009, published in Spanish or English, and using "Haematology, Palliat...

Introduction Sedation, understood as lowering a patient’s awareness of pain and distress by reducing her consciousness, is a common manoeuvre frequently indicated and used in a great variety of medical contexts. In a general sense, sedation is applied to allow comfort during some diagnostic procedures, such as, for example, colonoscopy or other inv...

Objectives: To determine the frequency of pain as a reason to visit a Primary Care doctor and to investigate the influence of pain on sleep disturbances. Design: Cross-sectional descriptive study. Setting: Urban Primary Health Care Centre. Participants: The first five patients who came to the primary health care centre with an appointment we...

Introduction: Both patients and their families have physical, emotional, social and spiritual needs to be assessed. Such needs have to be recorded so as to be able to set the therapeutic objectives, the outcomes review, and their further reassessment. The evaluation of these needs using common tools makes it easier to communicate information among...

Oral normal-release morphine has long been considered the gold-standard treatment for cancer breakthrough pain. However, its relatively long time to analgesic onset, delay in maximal analgesic effect and prolonged duration of action make it unsuitable for the management of breakthrough pain episodes. These limitations led to the development of an o...

To determine the frequency of pain as a reason to visit a Primary Care doctor and to investigate the influence of pain on sleep disturbances. Cross-sectional descriptive study. Urban Primary Health Care Centre. The first five patients who came to the primary health care centre with an appointment were included. Those who came with pain were labelle...

In implementing the National Strategy of Palliative Care in Spain, there needs to be an evaluation of services, especially of their effectiveness, efficiency, and satisfaction of patients and families. To assess the effectiveness of palliative care services (PCS) in improving symptom control in Spain. This multicenter, prospective, quasi-experiment...

A wide range of palliative care services has been implemented in Catalonia over the past 20 years. Quantitative and qualitative differences in the organization of palliative care services between districts and settings can result in wide variability in the quality of these services, and their accessibility. We implemented a benchmark methodology to...

Cancer patients with relatively stable chronic background pain may experience transient episodes of pain, known as breakthrough cancer pain (BTP). There is no universally accepted definition for BTP, although recent efforts have been made by the Association for Palliative Medicine of Great Britain and Ireland to refine existing definitions and diag...

Objectives: to review the pharmacologic characters of ketamine, its analgesic properties and its application on cancer pain. Matherial and methods: a review till October 2009 using the key words: ketamine, pain, neoplasm, palliative care. Potencial sources provided by bibliographic references in reviewed articles were used, as well as searches on l...

Este artículo ha sido retirado de la revista por haberse duplicado accidentalmente su publica-ción. De manera involuntaria había sido previamente publicado en Med Paliat. 2010;17(6):348-59. Como consecuencia, las páginas <92-104> ocupadas por este artículo faltan de la publicación on-line. El editor lamenta las molestias que esto puede causar.

Introduction: both Patients and their families have physical, emotional, social and spiritual needs to be assessed. Such needs have to be recorded so as to allow the setting of therapeutic objectives, the outcomes review and their further reassessment. Needs' assessment undergone with common tools, facilitates information transmission among the wid...

Objectives: to provide information on the current status of deep vein thrombosis in cancer patients, and the existing evidence, and to propose a protocol for primary thromboprophylaxis in hospitalized palliative patients. Material and methods: a review till March 2009 using the key words: neoplasm, low molecular weight heparin, pulmonary embolism,...

Conceived as a World Health Organization demonstration project for public health initiatives at the end of life, the palliative care program in Catalonia illustrates the impact that similar initiatives may have in terms of cost savings for a regional health system. In a publicly funded and freely accessible health system, decreasing the number of h...

Refractory malignant ascites is a common medical problem (15-50% of cancer patients) that impairs quality of life in our patients, and leads to multiple admissions. Our objective was assess the efficacy of permanent peritoneal drainage in this type of patient using a subclavian catheter. We discuss our experience with 3 cases. Ascitis was controlle...

The objective of this study was to assess antiemetic efficacy of granisetron in inoperable intestinal obstruction caused by advanced cancer. The study was open, prospective, and multi-centered. We assessed 24 patients (mean age: 61.3 years; 10 males, 14 females) with intestinal obstruction who were refractory to previous antiemetics. Obstruction in...

Objective: to offer current information about the epidemiology of cancer pain. Material y method: a systematic review using MEDLINE, and searching since October 1, 2007. From references obtained other bibliographic sources were looked for. Any other new information known by the authors was also used. Papers with marginal epidemiological data were e...

Introduction: quality assessment should be considered equally relevant and a complement of the quantitative aspects usually described in the evaluation of public palliative care programmes. Objectives: a) to describe the results of the qualitative evaluation of the WHO Palliative Care Demonstration Programme in Catalonia at 15 years after its imple...

Na t i o n a l v i e w p o i n t P alliative care public health programmes (PCPHPs) were proposed by the WHO in the 1990s, and have since been developed, to ensure that palliative care is a key element of any public healthcare system. 1 Several programmes have shown good results in terms of coverage, effectiveness, efficiency and satisfaction with...

Na t i o n a l v i e w p o i n t P alliative care public health programmes (PCPHPs) were proposed by the WHO in the 1990s, and have since been developed, to ensure that palliative care is a key element of any public healthcare system. 1 Several programmes have shown good results in terms of coverage, effectiveness, efficiency and satisfaction with...

The described ratio for methadone conversion from oral route (PO) to parenteral route (PAR) is 2:1 and from PAR to PO is 1:2. Frequently, good control of pain with methadone is PR to PO. We use methadone as a function of opioid rotation and not in the context of mortality outcome and we have noted that the traditional ratio produces toxicity proble...

Objective: to describe the appointment scheduling process in the outpatient clinic, and the main clinical results of the palliative care service at Institut Català d'Oncologia for the period 2001-2005. Patients and methods: patients consecutively visited in the outpatient clinic during the study period. Each patient was evaluated and scheduled foll...