Ogino B, Kajiura S, Hayashi N
… +11 more, Kawanaka H, Sakamoto J, Entani T, Sakumura M, Nakayama Y, Ueda Y, Motoo I, Ando T, Yoshida A, Hayashi R, Yasuda I
J Palliat Med
· 2026 Jun · PMID 42237597
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BACKGROUND: Monitoring data for anamorelin in pancreatic cancer are limited. OBJECTIVE: To descriptively examine week-three documentation-derived dietary intake category, observed body weight, laboratory-derived prognost...BACKGROUND: Monitoring data for anamorelin in pancreatic cancer are limited. OBJECTIVE: To descriptively examine week-three documentation-derived dietary intake category, observed body weight, laboratory-derived prognostic nutritional index (PNI), and treatment continuation after anamorelin initiation. METHODS: We retrospectively included week-three-evaluable patients with unresectable or recurrent pancreatic cancer who initiated anamorelin at a Japanese hospital (July 2021-October 2024). Dietary intake category was derived from routine documentation. Paired changes used the Wilcoxon signed-rank test. RESULTS: Among patients ( = 40; PNI, = 39), dietary intake was classified as increased in 17, stable in 21, and decreased in 2. Median observed body weight was higher at week three than baseline (51.1 vs. 50.2 kg; = 0.026), whereas median PNI was lower (38.5 vs. 39.8; = 0.006). The median time-to-discontinuation was 60 days; 16 patients (40.0%) continued ≥84 days. CONCLUSION: These descriptive findings require cautious multidimensional interpretation; causal treatment effects cannot be inferred.
Lau E, Miljanovski M, Mah K
… +7 more, Shapiro GK, Loughan AR, Li A, Rydall A, Zimmermann C, Hannon B, Rodin G
Palliat Med
· 2026 Jun · PMID 42237559
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BACKGROUND: Death anxiety is common in advanced cancer, but little is known about risk factors for its occurrence, frequency or severity in those receiving specialized palliative care. AIM: This study aimed to determine...BACKGROUND: Death anxiety is common in advanced cancer, but little is known about risk factors for its occurrence, frequency or severity in those receiving specialized palliative care. AIM: This study aimed to determine the prevalence and correlates of death anxiety in outpatients with advanced cancer receiving specialized palliative care. DESIGN: Cross-sectional observational study. SETTING/PARTICIPANTS: We identified the prevalence of death anxiety in 203 patients with advanced cancer attending an outpatient palliative care clinic in a large tertiary care hospital, and examined its association with sociodemographic factors, time since advanced cancer diagnosis, time since initial palliative care consultation, and proximity to death. Death anxiety was measured using the Death and Dying Distress Scale (DADDS). Variables that demonstrated significant univariable associations were subsequently included in a multivariable regression analysis. RESULTS: Moderate to severe death anxiety (DADDS score ⩾ 25) was reported by 46.3% of participants. Multivariable analysis demonstrated that greater death anxiety was associated with lower household income (⩾$100,000+ vs <$30,000: = -0.30, = 0.002; $60,000-$99,999 vs <$30,000: = -0.27, = 0.004; $30,000-$59,999 vs <$30,000: = -0.31, < 0.001) and living alone ( = 0.16, = 0.03), but not with time since advanced cancer diagnosis or initial palliative care consultation, or with proximity to death. CONCLUSIONS: Moderate to severe death anxiety is reported by almost half of patients with advanced cancer receiving outpatient palliative care and is associated with economic disadvantage and solitary living arrangements. Further research is needed to determine to what extent targeted psychosocial and palliative interventions can alleviate such distress in this population.
Chua IS, Lo YT, Liu D
… +8 more, Succi MD, Zhang M, Yeh J, Skarf LM, Doyle K, Gundersen DA, Mazzola E, Bates DW
J Palliat Med
· 2026 Jun · PMID 42231120
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BACKGROUND: Little is known about large language model (LLM) performance on palliative care (PC)-related knowledge-based tasks. We evaluated two LLMs in answering PC-related test questions and explaining their answer cho...BACKGROUND: Little is known about large language model (LLM) performance on palliative care (PC)-related knowledge-based tasks. We evaluated two LLMs in answering PC-related test questions and explaining their answer choice rationale. METHODS: LLMs were prompted to answer 25 randomly selected questions from the and provide their answer choice rationale. Three PC educators ranked and rated LLM-generated answer choice explanations versus the test's answer key explanations. Linear fixed-effect models evaluated reviewer ranking, and ordinal logistic regression evaluated reviewer ratings of quality, suitability, accuracy, relevance, and comprehensiveness. RESULTS: Both LLMs answered 96% of selected questions correctly. Reviewers rated LLM-generated explanations more highly than explanations. Five themes emerged from reviewer comments: perceived inaccuracies, clarity of writing, educational value, linguistic style, and miscellaneous. CONCLUSIONS: LLMs demonstrated high answer choice accuracy and generated preferable answer explanations when compared to the answer key.
Hall JC, Barrett C, Christensen S
… +4 more, Dalton J, Kaplan S, Jones CA, Johnson MO
J Palliat Med
· 2026 Jun · PMID 42231114
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In some populations with advanced cancers, early palliative care (ePC) has been shown to improve quality of life (QoL) and reduce aggressive interventions, but its role and timing in primary malignant brain tumors (PMBT)...In some populations with advanced cancers, early palliative care (ePC) has been shown to improve quality of life (QoL) and reduce aggressive interventions, but its role and timing in primary malignant brain tumors (PMBT) remains poorly defined. This systematic review assessed existing definitions of ePC in PMBT, trends in its use, and associations between palliative care (PC) timing and patient outcomes. A systematic search was conducted (PROSPERO CRD420251020915). Eligible studies included peer-reviewed, full-text articles reporting outcomes related to PC timing in PMBT. Data on study design, patient characteristics, definitions of ePC, and outcomes were extracted. Study quality was assessed using the risk of bias in non-randomized studies-of interventions tool and the Methodological Index for Non-randomized Studies, as applicable. Of 5115 references, 5 studies met inclusion criteria, encompassing 11,721 people with PMBT. Most studies were retrospective; one was prospective. Definitions of ePC varied with "early" defined relative to diagnosis, treatment milestones, or death. Across studies, a minority of patients received PC (15%-40%), with most referrals occurring late in the disease course. Earlier PC was associated with reduced aggressiveness of EoL care, decreased health care utilization, and, in some cases, longer survival. Demographic factors were not consistent predictors of ePC referral; comorbidity burden was associated with PC use. The prospective feasibility trial demonstrated structured ePC integration was achievable. Evidence suggests ePC for PMBT is infrequently implemented yet feasible and may reduce aggressive EoL care and improve outcomes. However, definitions of "early" vary. Prospective trials are needed to further define and clarify the impact of ePC integration on QoL, survival, and health care utilization in this population.
Varns G, Sidebottom A, Hentges K
… +3 more, Castro-Pearson S, Richardson J, Downing E
J Palliat Med
· 2026 Jun · PMID 42227198
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BACKGROUND: Serious illness conversation (SIC) is a structured conversation framework designed to improve shared decision making and promote goal-concordant care with patients anticipating end-of-life care decisions. OBJ...BACKGROUND: Serious illness conversation (SIC) is a structured conversation framework designed to improve shared decision making and promote goal-concordant care with patients anticipating end-of-life care decisions. OBJECTIVE: Examine reach, timeliness, and quality of SIC implementation across a health system after implementation of a SIC Program (SICP). Examine factors associated with SIC completion for eligible patients. DESIGN: Retrospective observational cohort study of decedents eligible for SIC from 2022 to 2024 in a large health system in the United States. MEASUREMENTS: Proportion of eligible patients with a documented SIC, demographic and clinical characteristics, timing of SIC relative to eligibility and death, number, and quality of SIC sessions. RESULTS: About 7424 patients met the inclusion criteria, and half (49.5%) of those had SIC documentation. Of those, mean number of SICs was 3.6 (SD 5.56). First documented SIC included defined quality components 31.1% of the time. Factors associated with SIC included palliative care visits (OR 2.26, 95% CI 1.84, 2.78), a primary care provider in the system (OR 1.77, 95% CI 1.59, 1.96), and an inpatient admission with discharge to home care (OR 2.36, 95% CI 2.07, 2.70). Patients with dementia (OR 0.58, 95% CI 0.51, 0.66) were less likely to have SIC. CONCLUSION: Systemwide implementation of an SICP engaged half of eligible patients; many of those had multiple documented conversations prior to death. More work is needed to engage eligible patients, especially those with dementia, and to improve conversation quality.
Alzahrani M, Alabbasi A, Sayes M
… +2 more, Alzahrani Z, Sultan FA
J Palliat Med
· 2026 Jun · PMID 42227184
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BACKGROUND: Population-level data on palliative care need remain limited in many regions. Cancer mortality is commonly used as a proxy indicator of population-level palliative care demand. Gulf Cooperation Council (GCC)...BACKGROUND: Population-level data on palliative care need remain limited in many regions. Cancer mortality is commonly used as a proxy indicator of population-level palliative care demand. Gulf Cooperation Council (GCC) countries have undergone rapid demographic and epidemiological transition, highlighting the need for evidence-informed planning. OBJECTIVES: To examine long-term trends in cancer mortality across six GCC countries (Saudi Arabia, United Arab Emirates, Kuwait, Qatar, Bahrain, and Oman) and assess implications for palliative care planning. DESIGN: Ecological time-trend analysis. SETTING/SUBJECTS: National mortality data from six GCC countries (2000-2022). MEASUREMENTS: Age-standardized cancer mortality rates (ICD-10 C00-C97) were obtained from the World Health Organization Global Health Observatory. Trends were evaluated using annual percentage change estimates, segmented (joinpoint) regression, and models accounting for between-country variability. RESULTS: Data availability varied substantially across countries. Bahrain, Kuwait, and Qatar had sufficient longitudinal data and demonstrated statistically significant declines in age-standardized cancer mortality ( < 0.001), with the largest reduction observed in Bahrain. Nonlinear, phase-dependent trends were identified. Countries with limited data were analyzed descriptively. CONCLUSIONS: Cancer mortality trends in GCC countries vary according to data completeness. Declining mortality does not necessarily indicate reduced palliative care need. Cancer mortality remains a pragmatic population-level indicator for planning in settings with limited direct measures of need. Strengthening mortality surveillance and integrating palliative care into national cancer control strategies are essential.
Palliat Med
· 2026 Jun · PMID 42224121
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BACKGROUND: Reflexivity is essential in end-of-life research due to its ethical sensitivity, emotional intensity, and relational complexity, yet it is often left to individual initiative and remains weakly institutionali...BACKGROUND: Reflexivity is essential in end-of-life research due to its ethical sensitivity, emotional intensity, and relational complexity, yet it is often left to individual initiative and remains weakly institutionalized in palliative care research settings. OBJECTIVE: To describe the design, implementation, and initial outputs of a Reflexivity Lab developed as a structured, collective reflexive method embedded within a palliative care research service. METHODS: A Reflexivity Lab was implemented in 2023 within the palliative and supportive care service of the Lausanne University Hospital, in Switzerland. The Lab convenes monthly and brings together clinical and non-clinical researchers engaged in end-of-life fieldwork to reflect collectively on methodological, ethical, and emotional challenges encountered during research. RESULTS: The Lab supported the identification of recurrent reflexive issues and the development of focused collective reflexivity leading to scholarly outputs. An illustrative example on practices of "saying goodbye" to participants at imminent end of life demonstrates how emotionally charged research moments can be transformed into explicit objects of methodological inquiry. CONCLUSION: Embedding a Reflexivity Lab within palliative care research infrastructures offers a practical, transferable approach to institutionalizing reflexivity as an ongoing methodological practice.
Allende-Pérez S, Campbell M, Saldivar-Ruiz AL
… +4 more, Cruz-Sánchez JJ, Toledo-Tinajero OM, Monreal-Carrillo EA, Cabrera-Galeana P
J Palliat Med
· 2026 May · PMID 42219719
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INTRODUCTION: Dyspnea is a common and distressing symptom in patients with cancer, particularly in advanced stages and lung cancer. It is associated with poor quality of life and is often challenging to manage. The Respi...INTRODUCTION: Dyspnea is a common and distressing symptom in patients with cancer, particularly in advanced stages and lung cancer. It is associated with poor quality of life and is often challenging to manage. The Respiratory Distress Observation Scale (RDOS) is a validated tool for assessing dyspnea in noncommunicative patients. OBJECTIVES: To assess the validity of the RDOS by comparing it with patient-reported dyspnea using the revised Edmonton Symptom Assessment System (ESAS-r) in patients with cancer receiving palliative care (PC), and to explore associations with functional status. DESIGN: Observational, cross-sectional study. SETTING/SUBJECTS: The study was conducted at the National Cancer Institute (INCan) in Mexico City from October 2022 to February 2023. A total of 194 adult cancer patients with dyspnea receiving PC were included. MEASUREMENTS: RDOS, ESAS-r, and Karnofsky Performance Status (KPS) scores were assessed. Analyses included Spearman's correlation and comparisons across KPS groups. RESULTS: Median RDOS score was 5 (interquartile range 3-9), with 36.1% experiencing severe dyspnea. Higher RDOS scores were observed in patients with KPS ≤40. RDOS scores correlated significantly with ESAS-r dyspnea, insomnia, and drowsiness. Agreement between RDOS and ESAS-r was higher in moderate/severe cases (79.08%) than in none/mild (63.41%). Notably, 36.59% of patients rated as mild by ESAS-r were classified as moderate/severe by RDOS. CONCLUSION: RDOS is a valuable tool for detecting respiratory distress in cancer patients unable to self-report. Early identification and comprehensive management of dyspnea are crucial, particularly in patients with compromised functional status, or advanced disease, and those vulnerable to undetection because of inability to self-report distress.
Kim M, Bae M, Lee H
… +3 more, Mun M, Woo K, Kim A
J Palliat Med
· 2026 May · PMID 42219718
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BACKGROUND: Hospice care has expanded significantly in recent decades; however, few studies have systematically examined how research themes in this field have evolved over time. OBJECTIVES: This study aimed to explore t...BACKGROUND: Hospice care has expanded significantly in recent decades; however, few studies have systematically examined how research themes in this field have evolved over time. OBJECTIVES: This study aimed to explore the temporal dynamics of hospice care research using topic modeling, identifying emerging and declining areas of focus. METHODS: A total of 14,862 hospice-related articles published up to April 2025 were retrieved from PubMed. Topic modeling analysis was conducted using Latent Dirichlet Allocation to extract thematic structures across the corpus. The optimal number of topics was determined using perplexity, the elbow method, and coherence scores. Temporal trends were assessed across four stages defined by major World Health Organization milestones: the (1) Foundation (≤2001), (2) Expansion (2002-2013), (3) Institutionalization (2014-2019), and (4) Post-pandemic Transition (2020-2025) periods. RESULTS: Ten major research topics were identified, including caregiver support, advance care planning, access to hospice care, and mortality trends. Topic prevalence shifted over time, with increased attention to caregiver support and advance care planning during the Expansion and Institutionalization periods and heightened focus on access to care and mortality trends during the Post-pandemic Transition period. CONCLUSION: Hospice research has shifted from foundational and conceptual inquiries to more applied and policy-oriented themes. The findings reflect the field's growing institutionalization and underscore the need for sustained research targeting underserved areas to promote equity and responsiveness in end-of-life care.
Iturri A, Bertella A, Dóvidas MN
… +2 more, Spector J, Alonso Babarro A
J Palliat Med
· 2026 May · PMID 42219716
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BACKGROUND: Music therapy (MT) and virtual reality (VR) are increasingly being used in palliative care for symptom management, though evidence quality remains low. OBJECTIVES: The aim of our study was to assess the effec...BACKGROUND: Music therapy (MT) and virtual reality (VR) are increasingly being used in palliative care for symptom management, though evidence quality remains low. OBJECTIVES: The aim of our study was to assess the effect of combined MT + VR on the main symptom in palliative cancer patients. DESIGN: This study employed an explanatory sequential mixed methods design based on a randomized controlled clinical trial, integrating quantitative outcomes with qualitative patient experiences. MEASUREMENTS: The main symptom was the symptom rated as most severe by the patient on the Edmonton Symptom Assessment System Revised (ESAS-r) scale. Secondary outcomes included the global ESAS-r score, anxiety (additionally measured with State-Trait Anxiety Inventory-State [STAI-S]), emotional distress (DME scale), and heart rate. All variables were assessed at three time points: baseline (T1), post-intervention (T2), and 24 hours post-intervention (T3). PATIENTS AND SETTINGS: Adult patients attended by palliative care with advanced cancer at a university hospital in Argentina. RESULTS: Sixty patients completed the protocol. Significant differences between baseline (T1) and immediate post-intervention (T2) were observed when comparing the MT + VR condition to the control group for the main symptom (1.5 vs. 0, < 0.001); global symptom score (9 vs. 0.5, < 0.001); and anxiety (0.2 vs. 0.1, < 0.001). No significant differences were found between groups at 24 hours post-intervention (T3) compared with baseline. Several categories of interest emerged: (a) affective states, (b) projections, and (c) transcendental experiences. CONCLUSION: The combination of MT + VR improved the main symptom, as compared with the control group. Patient perceptions add valuable information about the factors that influenced this difference.
Werner K, Feuz M, Theile G
… +3 more, Hertler C, Blum D, Schettle M
J Palliat Med
· 2026 May · PMID 42219715
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BACKGROUND: Complementary therapies are gaining interest in palliative care. This study investigated the implementation of a complementary and integrative medicine (CIM) service on a palliative care unit of a Tertiary Ca...BACKGROUND: Complementary therapies are gaining interest in palliative care. This study investigated the implementation of a complementary and integrative medicine (CIM) service on a palliative care unit of a Tertiary Care Center in Switzerland. AIM: This study aims to explore how health care professionals, patients, and family members perceive complementary medicine in specialized palliative care, identify related challenges and opportunities, and develop strategies for their effective and sustainable implementation into routine practice. METHODS: In a first step, to check acceptability, in 2016, an interview study was carried out by conducting qualitative interviews with nurses, physicians and patients, and their relatives. In a second step, based on the results of the structured interviews, CIM experts developed complementary nursing interventions followed by an educational program and establishing CIM service on the ward. RESULTS: Eight nurses, six doctors, four patients, and three relatives were interviewed. The interviews revealed a generally positive attitude among all stakeholders with high acceptability. Key challenges faced by medical staff included time management, training needs, and interdisciplinary communication. Patients and relatives emphasized the need for CIM to alleviate symptoms, improve quality of life, and enhance confidence in integrated care. The developed nursing interventions include selected measures (wraps/compresses and rhythmic embrocations) targeting common symptoms like pain, nausea, anxiety, and respiratory distress. To ensure quality control and sustainability, the concept also features an organizational framework, regular specialist training, and a detailed manual and accessible videos, along with guidelines for documentation and quality assurance. CONCLUSION: Medical professionals, patients, and relatives viewed the implementation of complementary nursing interventions as beneficial for enhancing symptom management in palliative care. Establishing appropriate framework conditions based on current implementation research is essential, and further research on effectiveness and long-term implementation is needed.
Sebastiani A, Tiozzo E, Marti F
… +2 more, Salata M, Facchinetti G
J Palliat Med
· 2026 May · PMID 42219714
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BACKGROUND: Being the caregiver of a pediatric patient with a complex or serious illness can be emotionally intense and stressful. Caregiver burden significantly affects the biopsychosocial well-being of both the child a...BACKGROUND: Being the caregiver of a pediatric patient with a complex or serious illness can be emotionally intense and stressful. Caregiver burden significantly affects the biopsychosocial well-being of both the child and the caregiver. Interventions such as Narrative Medicine (NM) may help alleviate this burden by enhancing emotional resilience and strengthening support networks. OBJECTIVES: This review aimed to explore which NM interventions can reduce the emotional burden of caregivers of pediatric patients under the age of 18. METHODS: A systematic literature review was conducted to examine the benefits of NM interventions on caregiver well-being. Primary studies were included if they described NM interventions involving active written narration by caregivers (e.g., diaries, digital writing). Studies relying solely on oral storytelling or third-party facilitation (e.g., interviews, dignity therapy) were excluded. Only studies in English or Italian were considered; studies focusing on adult patients or targeting the patient rather than the caregiver were excluded. The review followed PRISMA guidelines. A comprehensive search was conducted in MEDLINE, Embase, CINAHL, Cochrane Library, and APA PsycInfo in July 2024 with no time limits. Study quality was assessed using JBI and NIH tools, and data were synthesized narratively and in tables. RESULTS: The search identified 1078 unique references. After screening, four studies met the inclusion criteria. Interventions ranged from narrative diaries in pediatric intensive care units to online journaling. All studies showed feasibility and acceptability, with reported benefits including emotional expression, perceived support, improved coping, and greater self-reflection. Most participants were women (85%), although the review included all caregivers regardless of gender. CONCLUSIONS: In conclusion, NM appears to be a promising tool to support caregivers of pediatric patients with complex or serious conditions. While preliminary findings are encouraging, further research is needed to assess long-term outcomes. Structured workshops and the involvement of NM facilitators may further support caregiver well-being and reduce psychological burden.
Cheli S, Angeli E, Corli O
… +10 more, Dinegro S, Zambelli A, Carta T, Shazivari R, Smolikova M, Franceschi P, Molà F, Cruzeiro YS, Clementi E, Gori A
Palliat Med
· 2026 May · PMID 42218619
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BACKGROUND: Fever is a frequent but complex symptom in adults with a limited prognosis, arising from multifactorial causes beyond infection. Despite its impact on symptom burden and therapeutic decision-making, evidence...BACKGROUND: Fever is a frequent but complex symptom in adults with a limited prognosis, arising from multifactorial causes beyond infection. Despite its impact on symptom burden and therapeutic decision-making, evidence from inpatient palliative care settings is limited. AIM: To assess the prevalence, characteristics, and associated factors of fever in adults with a limited prognosis receiving inpatient hospice palliative care in order to enhance understanding of this symptom in palliative care settings. DESIGN: Prospective observational cohort study. Collected data included demographic and clinical variables, symptom burden, potential risk factors for infections (such as presence of medical devices and pressure injuries), and fever occurrence. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of fever. SETTING/PARTICIPANTS: The study was conducted in an inpatient hospice palliative care unit within the Luigi Sacco Hospital in Milan, Italy (January and December 2024). A total of 145 adults with a limited prognosis were enrolled. RESULTS: Fever occurred in 40% of patients, with a median onset of 5.5 days after admission. In 39.7% of cases, fever was attributed to infections, mainly catheter-associated urinary tract infection. Medical devices, particularly bladder catheters (89.7%), were strongly associated with fever (adjusted odds ratio: 12.42; confidence interval: 2.39-64.57). CONCLUSIONS: Fever is common among adults receiving inpatient hospice palliative care and is infection-related in about 40% of cases. Its strong association with medical devices highlights the need for proportional, personalised interventions that primarily consider prognosis, symptom relief, and quality of life. REGISTRATION: ClinicalTrials.gov ID NCT07106073.
Ho JFV, Goh PH, Mustafa H
… +4 more, Cheong MWL, Lee QY, Wong PL, Yaakup H
J Palliat Med
· 2026 May · PMID 42198940
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BACKGROUND: Sexual health is an important component of quality of life and relationship quality in advanced cancer patients, yet research on this domain remains limited in the Asian context. OBJECTIVES: To examine how ev...BACKGROUND: Sexual health is an important component of quality of life and relationship quality in advanced cancer patients, yet research on this domain remains limited in the Asian context. OBJECTIVES: To examine how evaluations of sexual satisfaction and frequency of intimacy behaviors are associated with relationship satisfaction and emotional closeness in advanced cancer dyads. DESIGN: Cross-sectional survey study involving patient-partner dyads. SETTING/SUBJECTS: Adult patients with advanced cancer and their partners in an oncology clinic in Malaysia. MEASUREMENTS: Measures of sexual health (sexual satisfaction, frequency of sexual activity, and frequency of nonsexual physical affection) and relationship quality (relationship satisfaction and emotional closeness) were analyzed using descriptive and correlational analyses and dyadic analysis. RESULTS: Responses from 49 patients (mean age 44.7 ± 11.0 years) and their 49 partners (mean age: 45.1 ± 11.4 years) were analyzed. Both patients and partners reported high sexual satisfaction, relationship satisfaction, and emotional closeness. Only patients' evaluation of sexual satisfaction was positively correlated with their relationship satisfaction ( = 0.54, < 0.001, partial = 0.70). Patients' evaluations of sexual and nonsexual physical affection behavior frequencies were not associated with relationship quality. Partners' evaluations of sexual satisfaction and intimacy behavior frequencies were not correlated with patients' evaluations of emotional closeness and relationship satisfaction. CONCLUSION: Relationship satisfaction is linked to subjective sexual satisfaction more than frequency of sexual behaviors among advanced cancer patients. Interventions should prioritize individual perceptions and dyadic communication over behavioral targets. Future research with more diverse cohorts is needed to generalize these findings across varying cultural and relationship contexts.