Vol. 12/ Núm. 3 2025 pág. 2317
https://doi.org/10.69639/arandu.v12i3.1462
Lymphoma in a Young Patient with Demoralization
Syndrome: Case Report
Linfoma en una paciente joven con síndrome de desmoralización: reporte de caso
Jhoan Utria Castro
utria624@hotmail.com
https://orcid.org/0009-0002-6400-7263
Asociación de Psiquíatras de Argentina
Cali – Colombia
Luisa María Gaviria
Luisagaviria1@hotmail.com
https://orcid.org/0009-0007-5471-3902
Universidad de los Andes
Bogotá D.C. – Colombia
Nicolás López Castellanos
nicolaslopez@live.com.mx
https://orcid.org/0009-0001-8720-1643
Universidad de Ciencias Aplicadas y Ambientales UDCA
Bogotá D.C. – Colombia
Paola Andrea Muñoz Ortega
https://orcid.org/0009-0009-9761-9638
paolam.ortega@gmail.com
Universidad del Cauca
Popayán – Colombia
Artículo recibido: 18 julio 2025 - Aceptado para publicación: 28 agosto 2025
Conflictos de intereses: Ninguno que declarar.
ABSTRACT
Introduction: This case illustrates a demoralization syndrome in the setting of palliative care for
advanced lymphoma and emphasizes the necessity of a biopsychosocial approach to care.
Demoralization is a syndrome of hopelessness, meaninglessness and existential distress that is
commonly underrecognized in young adult patients at the end of life. Main Findings: A 21-year-
old patient with Hodgkin lymphoma in previous remission presented with tumor reactivation,
severe abdominal pain, and profound emotional deterioration. Symptoms included emotional
withdrawal, disrupted sleep, and loss of meaning, which were indicative of demoralization.
Interventions and Outcomes: Multidisciplinary palliative therapy consisted of advanced analgesia
therapy with hydromorphone and infusion of lidocaine, parenteral nutrition, and cognitive
behavioral psychological care. Notwithstanding these interventions, the patient experienced an
emotional deterioration with no therapeutic comeback possible. Conclusion: This case
emphasizes the importance of comprehensive and age-appropriate interventions to identify and
Vol. 12/ Núm. 3 2025 pág. 2318
manage demoralization early in the course of terminal illnesses, improving quality of life and
preserving patient dignity in end-of-life care.
Keywords: hodgkin lymphoma, palliative care, demoralization syndrome, mental health,
case report
RESUMEN
Introducción: Este caso ilustra un síndrome de desmoralización en el contexto de cuidados
paliativos para linfoma avanzado y enfatiza la necesidad de un enfoque biopsicosocial. La
desmoralización es un síndrome de desesperanza, falta de sentido y angustia existencial que suele
pasar desapercibido en pacientes adultos jóvenes al final de la vida. Hallazgos principales: Un
paciente de 21 años con linfoma de Hodgkin en remisión previa presentó reactivación tumoral,
dolor abdominal intenso y profundo deterioro emocional. Los síntomas incluyeron retraimiento
emocional, alteración del sueño y pérdida de sentido, indicativos de desmoralización.
Intervenciones y resultados: La terapia paliativa multidisciplinaria consistió en analgesia
avanzada con hidromorfona e infusión de lidocaína, nutrición parenteral y atención psicológica
cognitivo-conductual. A pesar de estas intervenciones, el paciente experimentó un deterioro
emocional sin posibilidad de recuperación terapéutica. Conclusión: Este caso enfatiza la
importancia de las intervenciones integrales y adaptadas a la edad para identificar y gestionar la
desmoralización en las primeras etapas de las enfermedades terminales, mejorando así la calidad
de vida y preservando la dignidad del paciente en los cuidados paliativos.
Palabras clave: linfoma de Hodgkin, cuidados paliativos, síndrome de desmoralización,
salud mental, informe de caso
Todo el contenido de la Revista Científica Internacional Arandu UTIC publicado en este sitio está disponible bajo
licencia Creative Commons Atribution 4.0 International.
manage demoralization early in the course of terminal illnesses, improving quality of life and
preserving patient dignity in end-of-life care.
Keywords: hodgkin lymphoma, palliative care, demoralization syndrome, mental health,
case report
RESUMEN
Introducción: Este caso ilustra un síndrome de desmoralización en el contexto de cuidados
paliativos para linfoma avanzado y enfatiza la necesidad de un enfoque biopsicosocial. La
desmoralización es un síndrome de desesperanza, falta de sentido y angustia existencial que suele
pasar desapercibido en pacientes adultos jóvenes al final de la vida. Hallazgos principales: Un
paciente de 21 años con linfoma de Hodgkin en remisión previa presentó reactivación tumoral,
dolor abdominal intenso y profundo deterioro emocional. Los síntomas incluyeron retraimiento
emocional, alteración del sueño y pérdida de sentido, indicativos de desmoralización.
Intervenciones y resultados: La terapia paliativa multidisciplinaria consistió en analgesia
avanzada con hidromorfona e infusión de lidocaína, nutrición parenteral y atención psicológica
cognitivo-conductual. A pesar de estas intervenciones, el paciente experimentó un deterioro
emocional sin posibilidad de recuperación terapéutica. Conclusión: Este caso enfatiza la
importancia de las intervenciones integrales y adaptadas a la edad para identificar y gestionar la
desmoralización en las primeras etapas de las enfermedades terminales, mejorando así la calidad
de vida y preservando la dignidad del paciente en los cuidados paliativos.
Palabras clave: linfoma de Hodgkin, cuidados paliativos, síndrome de desmoralización,
salud mental, informe de caso
Todo el contenido de la Revista Científica Internacional Arandu UTIC publicado en este sitio está disponible bajo
licencia Creative Commons Atribution 4.0 International.
Vol. 12/ Núm. 3 2025 pág. 2319
INTRODUCTION
Patients with advanced lymphoma face multiple physical and emotional challenges that can
significantly deteriorate their quality of life. Beyond the clinical complications inherent to the
disease and the side effects of treatment, the psychological impact associated with prognosis
uncertainty, prolonged suffering, and loss of autonomy can lead to syndromes such as
demoralization, characterized by feelings of hopelessness and despair. These emotional factors
not only compromise the patient’s well-being but also hinder their ability to actively participate
in the management of their disease (6).
In this context, integrated palliative care, which combines physical, psychological, and
social approaches, has emerged as a key strategy to improve the quality of life of patients with
recurrent or advanced lymphoma. Several studies have demonstrated that early access to a
multidisciplinary team can not only alleviate symptomatic and emotional burdens but also prolong
patient survival, underscoring the importance of patient- and family-centered care (4). For
instance, the integration of services such as personalized psychological support, regular sessions
with palliative care specialists, and effective communication regarding symptom management has
been shown to significantly reduce anxiety and depression levels in this population (9).
The present article describes a clinical case of recurrent lymphoma and aims to emphasize
the importance of the multidisciplinary dimension of care, focusing on the need to integrate the
physical, emotional and social domains of care based on the principles of palliative medicine.
Multidisciplinary approaches to palliative care involving hematologists, palliative medicine
specialists, psychologists, and nutritionists, can lead to better control of symptoms, improved
quality of life, and greater satisfaction with care, in patients with hematologic malignancies (1).
Additionally, integrated disease-specific multi-disciplinary tumor boards and clinics for
lymphoma care all contribute to a better understanding of complex therapeutic decisions,
avoidance of unnecessary hospital revisits and are a driving factors towards patient-centered
decision-making. Data from intervention studies in metastatic cancer show that multidisciplinary
palliative care also increases survival and reduces hospital readmissions by clarifying goals of
care and supporting advance care planning (4,10,13)
Highlighting the strength of both interdisciplinary and personalized care, this analysis aims
to add to the discussion how the complicated needs of these patients can best be addressed,
underlining the need for integrated care models suited for both patients’ spectrum of requirements.
In addition, demoralization syndrome has progressively gained consideration as a specific
psychological disorder in patients with advanced cancer, different from clinical depression mainly
for its existential and meaning-based nature. In contrast to depressive syndromes, which generally
respond to antidepressant medication, demoralization requires a targeted psychosocial approach,
concentrating on restoring hope, meaning, and a sense of efficacy for the patient via a therapeutic
INTRODUCTION
Patients with advanced lymphoma face multiple physical and emotional challenges that can
significantly deteriorate their quality of life. Beyond the clinical complications inherent to the
disease and the side effects of treatment, the psychological impact associated with prognosis
uncertainty, prolonged suffering, and loss of autonomy can lead to syndromes such as
demoralization, characterized by feelings of hopelessness and despair. These emotional factors
not only compromise the patient’s well-being but also hinder their ability to actively participate
in the management of their disease (6).
In this context, integrated palliative care, which combines physical, psychological, and
social approaches, has emerged as a key strategy to improve the quality of life of patients with
recurrent or advanced lymphoma. Several studies have demonstrated that early access to a
multidisciplinary team can not only alleviate symptomatic and emotional burdens but also prolong
patient survival, underscoring the importance of patient- and family-centered care (4). For
instance, the integration of services such as personalized psychological support, regular sessions
with palliative care specialists, and effective communication regarding symptom management has
been shown to significantly reduce anxiety and depression levels in this population (9).
The present article describes a clinical case of recurrent lymphoma and aims to emphasize
the importance of the multidisciplinary dimension of care, focusing on the need to integrate the
physical, emotional and social domains of care based on the principles of palliative medicine.
Multidisciplinary approaches to palliative care involving hematologists, palliative medicine
specialists, psychologists, and nutritionists, can lead to better control of symptoms, improved
quality of life, and greater satisfaction with care, in patients with hematologic malignancies (1).
Additionally, integrated disease-specific multi-disciplinary tumor boards and clinics for
lymphoma care all contribute to a better understanding of complex therapeutic decisions,
avoidance of unnecessary hospital revisits and are a driving factors towards patient-centered
decision-making. Data from intervention studies in metastatic cancer show that multidisciplinary
palliative care also increases survival and reduces hospital readmissions by clarifying goals of
care and supporting advance care planning (4,10,13)
Highlighting the strength of both interdisciplinary and personalized care, this analysis aims
to add to the discussion how the complicated needs of these patients can best be addressed,
underlining the need for integrated care models suited for both patients’ spectrum of requirements.
In addition, demoralization syndrome has progressively gained consideration as a specific
psychological disorder in patients with advanced cancer, different from clinical depression mainly
for its existential and meaning-based nature. In contrast to depressive syndromes, which generally
respond to antidepressant medication, demoralization requires a targeted psychosocial approach,
concentrating on restoring hope, meaning, and a sense of efficacy for the patient via a therapeutic
Vol. 12/ Núm. 3 2025 pág. 2320
dialogue and support (3). Prevalence studies report that between 13–52 % of oncology patients
experience clinically significant demoralization, with rates particularly elevated in those facing
advanced disease and poor prognosis (14).
Early psychological screening (e.g. the Demoralization Scale) allows providing timely
psychosocial support, avoiding the development of more severe existential distress (11). By
emphasizing the existential roots of suffering, this tailored approach safeguards patient dignity
and facilitates more compassionate end-of-life care.
The identification and treatment of this syndrome early in the course of illness is necessary
to prevent emotional decline that likely will also compromise treatment adherence and end-of-life
decision-making. This case demonstrates the necessity for the intertwining of medical and
psychological care in the service of improving quality of life and dignity for those patients with
advanced disease.
CASE PRESENTATION
A 21-year-old woman with a prior diagnosis of Hodgkin lymphoma was treated with
chemotherapy and radiotherapy in 2014, achieving complete remission by 2016. She remained
on annual follow-up with no evidence of recurrence until August 2024, when she re-entered the
healthcare system due to abdominal pain, nausea, and anemic syndrome. At that time, reactivation
of the oncologic disease was documented, and she was hospitalized under a palliative care
approach. She lived in Bogotá, had a functional family support network, and worked in aesthetics-
related fields. During hospitalization, she developed marked emotional distress—feelings of
hopelessness, disrupted sleep, and progressive social withdrawal—consistent with a state of
demoralization that compounded her clinical condition.
On presentation, her chief complaint was severe abdominal pain associated with
symptomatic anemia. Examination revealed generalized pallor and a distended, tender abdomen
with signs suggestive of peritoneal irritation, reflecting the multidimensional impact of the disease
across both physical and psychological domains. To investigate the cause of clinical deterioration,
an abdominal computed tomography scan demonstrated intestinal obstruction with associated
peritoneal fluid. Upper endoscopy identified a 10 × 12 mm gastric lesion with irregular borders
and neoplastic characteristics, for which biopsies were obtained. Further testing was limited by
the patient’s declining functional and emotional status. Overall, the assessment confirmed
reactivation of Hodgkin lymphoma with gastric involvement, together with a concurrent
psychiatric condition of demoralization.
Given advanced disease and the prominent affective burden, management was oriented
toward a multidimensional, palliative strategy addressing physical and psychological needs.
Severe visceral pain (rated 8/10 on the visual analog scale) was managed with intravenous
hydromorphone 0.2 mg every 6 hours, complemented by a continuous lidocaine infusion (5
dialogue and support (3). Prevalence studies report that between 13–52 % of oncology patients
experience clinically significant demoralization, with rates particularly elevated in those facing
advanced disease and poor prognosis (14).
Early psychological screening (e.g. the Demoralization Scale) allows providing timely
psychosocial support, avoiding the development of more severe existential distress (11). By
emphasizing the existential roots of suffering, this tailored approach safeguards patient dignity
and facilitates more compassionate end-of-life care.
The identification and treatment of this syndrome early in the course of illness is necessary
to prevent emotional decline that likely will also compromise treatment adherence and end-of-life
decision-making. This case demonstrates the necessity for the intertwining of medical and
psychological care in the service of improving quality of life and dignity for those patients with
advanced disease.
CASE PRESENTATION
A 21-year-old woman with a prior diagnosis of Hodgkin lymphoma was treated with
chemotherapy and radiotherapy in 2014, achieving complete remission by 2016. She remained
on annual follow-up with no evidence of recurrence until August 2024, when she re-entered the
healthcare system due to abdominal pain, nausea, and anemic syndrome. At that time, reactivation
of the oncologic disease was documented, and she was hospitalized under a palliative care
approach. She lived in Bogotá, had a functional family support network, and worked in aesthetics-
related fields. During hospitalization, she developed marked emotional distress—feelings of
hopelessness, disrupted sleep, and progressive social withdrawal—consistent with a state of
demoralization that compounded her clinical condition.
On presentation, her chief complaint was severe abdominal pain associated with
symptomatic anemia. Examination revealed generalized pallor and a distended, tender abdomen
with signs suggestive of peritoneal irritation, reflecting the multidimensional impact of the disease
across both physical and psychological domains. To investigate the cause of clinical deterioration,
an abdominal computed tomography scan demonstrated intestinal obstruction with associated
peritoneal fluid. Upper endoscopy identified a 10 × 12 mm gastric lesion with irregular borders
and neoplastic characteristics, for which biopsies were obtained. Further testing was limited by
the patient’s declining functional and emotional status. Overall, the assessment confirmed
reactivation of Hodgkin lymphoma with gastric involvement, together with a concurrent
psychiatric condition of demoralization.
Given advanced disease and the prominent affective burden, management was oriented
toward a multidimensional, palliative strategy addressing physical and psychological needs.
Severe visceral pain (rated 8/10 on the visual analog scale) was managed with intravenous
hydromorphone 0.2 mg every 6 hours, complemented by a continuous lidocaine infusion (5
Vol. 12/ Núm. 3 2025 pág. 2321
mg/cc) at 9 cc/h through a correctly placed right subclavian central venous catheter, achieving
partial symptom control and improving tolerance to hospital care. Because of obstructive ileus,
continuous parenteral nutrition was initiated at 62 cc/h with a standard formulation adjusted to
caloric and protein requirements; administration was performed using sterile equipment with
continuous monitoring of electrolytes, renal function, and fluid balance.
In parallel, the psychology team implemented a psychosocial support program utilizing
cognitive-behavioral therapy (CBT) techniques to address recurrent negative thoughts and foster
emotional adaptation, with collaborative work involving the patient and her family to strengthen
the support network. The psychiatry team evaluated the potential use of anxiolytic and
antidepressant medications; however, no specific records of psychopharmacologic administration
were found in the clinical notes. As part of comprehensive palliative care, symptomatic measures
included ondansetron 8 mg IV every 8 hours for nausea and omeprazole 40 mg IV every 12 hours
to prevent gastric complications. Comfort-focused measures, such as bed positioning, meticulous
skin care, and pressure-ulcer prevention, were employed to preserve comfort and dignity.
Despite adherence to interventions, clinical monitoring revealed rapid disease progression,
with persistent abdominal symptoms and recurrent episodes of dark vomiting (hematemesis). The
patient remained oriented and hemodynamically stable for most of her hospitalization but
ultimately succumbed to complications associated with the underlying disease.
DISCUSSION
Synopsis and contribution
This case underscores the value of early, integrated palliative care in complex hematologic
malignancies and highlights the clinical relevance of demoralization as a distinct psycho-
oncological syndrome. Comprehensive integration of palliative care across the cancer trajectory
is associated with improved symptom control, communication, and alignment of care with patient
goals—principles emphasized at global and systems levels (1,5) and supported by evidence
syntheses showing benefits for quality of life and, in some trials, survival (4). In hematologic
cancers specifically, early specialty palliative care improves outcomes and care processes, yet
remains underutilized (13). Our patient’s rapid decline, high symptom burden, and marked
demoralization illustrate why proactive, interdisciplinary models are clinically important,
including in resource-limited settings where collaborative practice can still improve inpatient
outcomes (10).
Demoralization: concept, measurement, and clinical relevance
Demoralization—characterized by loss of meaning, helplessness, and a perceived inability
to cope—differs from major depression and merits targeted assessment and management (3,7,11).
It is common in advanced cancer and correlates with worse quality of life and psychological
distress (2,6,11,14). Validated tools (e.g., DS-II) enable reliable screening and monitoring in
mg/cc) at 9 cc/h through a correctly placed right subclavian central venous catheter, achieving
partial symptom control and improving tolerance to hospital care. Because of obstructive ileus,
continuous parenteral nutrition was initiated at 62 cc/h with a standard formulation adjusted to
caloric and protein requirements; administration was performed using sterile equipment with
continuous monitoring of electrolytes, renal function, and fluid balance.
In parallel, the psychology team implemented a psychosocial support program utilizing
cognitive-behavioral therapy (CBT) techniques to address recurrent negative thoughts and foster
emotional adaptation, with collaborative work involving the patient and her family to strengthen
the support network. The psychiatry team evaluated the potential use of anxiolytic and
antidepressant medications; however, no specific records of psychopharmacologic administration
were found in the clinical notes. As part of comprehensive palliative care, symptomatic measures
included ondansetron 8 mg IV every 8 hours for nausea and omeprazole 40 mg IV every 12 hours
to prevent gastric complications. Comfort-focused measures, such as bed positioning, meticulous
skin care, and pressure-ulcer prevention, were employed to preserve comfort and dignity.
Despite adherence to interventions, clinical monitoring revealed rapid disease progression,
with persistent abdominal symptoms and recurrent episodes of dark vomiting (hematemesis). The
patient remained oriented and hemodynamically stable for most of her hospitalization but
ultimately succumbed to complications associated with the underlying disease.
DISCUSSION
Synopsis and contribution
This case underscores the value of early, integrated palliative care in complex hematologic
malignancies and highlights the clinical relevance of demoralization as a distinct psycho-
oncological syndrome. Comprehensive integration of palliative care across the cancer trajectory
is associated with improved symptom control, communication, and alignment of care with patient
goals—principles emphasized at global and systems levels (1,5) and supported by evidence
syntheses showing benefits for quality of life and, in some trials, survival (4). In hematologic
cancers specifically, early specialty palliative care improves outcomes and care processes, yet
remains underutilized (13). Our patient’s rapid decline, high symptom burden, and marked
demoralization illustrate why proactive, interdisciplinary models are clinically important,
including in resource-limited settings where collaborative practice can still improve inpatient
outcomes (10).
Demoralization: concept, measurement, and clinical relevance
Demoralization—characterized by loss of meaning, helplessness, and a perceived inability
to cope—differs from major depression and merits targeted assessment and management (3,7,11).
It is common in advanced cancer and correlates with worse quality of life and psychological
distress (2,6,11,14). Validated tools (e.g., DS-II) enable reliable screening and monitoring in
Vol. 12/ Núm. 3 2025 pág. 2322
clinical practice (12,14). In adolescents and young adults (AYA), additional developmental and
psychosocial needs amplify the impact of existential distress; tailored supportive care and age-
appropriate resources are recommended (8,15). In this case, early detection and structured
intervention for demoralization would be expected to support coping, decision-making, and
engagement with care plans (2,11,14).
How the case aligns with and expands the literature
• Integrated palliative care: The trajectory and needs observed here are consistent with
frameworks advocating concurrent oncologic and palliative approaches from diagnosis
through advanced stages, with emphasis on communication, symptom relief, and care
transitions (1,5,13).
• Interdisciplinary delivery: Evidence from inpatient and outpatient programs supports
interprofessional models (oncology, palliative care, psychology, social work, nursing),
even where resources are constrained (4,10).
• Personalization: Tailored, person-centered interventions, including attention to
psychiatric comorbidity and family context, have been associated with improvements in
clinical and psychosocial outcomes in advanced disease (6,9).
Practice recommendations
1. Embed palliative care early in hematologic oncology. Routine, proactive involvement
of specialty palliative care to manage symptoms, facilitate goals-of-care discussions, and
support complex decision-making (1,4,5,13).
2. Screen systematically for demoralization (e.g., DS-II) and distinguish it from
depression to guide targeted interventions (CBT, meaning-centered strategies, existential
therapies) and referral to psycho-oncology (3,7,11,12,14).
3. Use interprofessional, collaborative pathways that include nursing, psychology, social
work, and spiritual care; these models are feasible and beneficial in resource-limited
hospitals as well (4,10).
4. Personalize supportive care plans: including pain, nutrition, sleep, and family
engagement—considering psychiatric comorbidity and patient values; this person-centered
approach has documented benefits for distress and quality of life (2,6,9).
5. Address AYA-specific needs by integrating age-appropriate informational and
psychosocial resources and peer support options (8,15).
Priorities for future research
• Implementation science on early, integrated palliative care in hematologic malignancies:
identifying barriers, facilitators, and equity considerations across diverse health-system
contexts (1,5,13).
clinical practice (12,14). In adolescents and young adults (AYA), additional developmental and
psychosocial needs amplify the impact of existential distress; tailored supportive care and age-
appropriate resources are recommended (8,15). In this case, early detection and structured
intervention for demoralization would be expected to support coping, decision-making, and
engagement with care plans (2,11,14).
How the case aligns with and expands the literature
• Integrated palliative care: The trajectory and needs observed here are consistent with
frameworks advocating concurrent oncologic and palliative approaches from diagnosis
through advanced stages, with emphasis on communication, symptom relief, and care
transitions (1,5,13).
• Interdisciplinary delivery: Evidence from inpatient and outpatient programs supports
interprofessional models (oncology, palliative care, psychology, social work, nursing),
even where resources are constrained (4,10).
• Personalization: Tailored, person-centered interventions, including attention to
psychiatric comorbidity and family context, have been associated with improvements in
clinical and psychosocial outcomes in advanced disease (6,9).
Practice recommendations
1. Embed palliative care early in hematologic oncology. Routine, proactive involvement
of specialty palliative care to manage symptoms, facilitate goals-of-care discussions, and
support complex decision-making (1,4,5,13).
2. Screen systematically for demoralization (e.g., DS-II) and distinguish it from
depression to guide targeted interventions (CBT, meaning-centered strategies, existential
therapies) and referral to psycho-oncology (3,7,11,12,14).
3. Use interprofessional, collaborative pathways that include nursing, psychology, social
work, and spiritual care; these models are feasible and beneficial in resource-limited
hospitals as well (4,10).
4. Personalize supportive care plans: including pain, nutrition, sleep, and family
engagement—considering psychiatric comorbidity and patient values; this person-centered
approach has documented benefits for distress and quality of life (2,6,9).
5. Address AYA-specific needs by integrating age-appropriate informational and
psychosocial resources and peer support options (8,15).
Priorities for future research
• Implementation science on early, integrated palliative care in hematologic malignancies:
identifying barriers, facilitators, and equity considerations across diverse health-system
contexts (1,5,13).
Vol. 12/ Núm. 3 2025 pág. 2323
• Intervention trials targeting demoralization (screen-and-treat pathways, stepped
psychosocial care, digital adjuncts) with standardized outcomes (DS-II, QoL, health-care
utilization) (11,12,14).
• Interprofessional models in resource-limited settings, including scalable training and
role delineation, and their impact on clinical, humanistic, and system outcomes (4,10).
• AYA-focused supportive care strategies that integrate developmentally tailored resources
and evaluate long-term psychosocial outcomes (8,15).
CONCLUSION
Overall, this case favors early, integrated palliative care in hematologic oncology to guide
treatment based on the patient’s agenda and to address treatment-related side effects, including a
regular screening for demoralization with targeted psycho-oncologic interventions.
Interprofessional pathways are possible even in resource-constrained environments, hold
potential to improved patient-centered outcomes, and future efforts can refine operational screen-
and-treat strategies for demoralization and determine scalable models of early integration
throughout the hematology care continuum (1,4,10,11,13).
• Intervention trials targeting demoralization (screen-and-treat pathways, stepped
psychosocial care, digital adjuncts) with standardized outcomes (DS-II, QoL, health-care
utilization) (11,12,14).
• Interprofessional models in resource-limited settings, including scalable training and
role delineation, and their impact on clinical, humanistic, and system outcomes (4,10).
• AYA-focused supportive care strategies that integrate developmentally tailored resources
and evaluate long-term psychosocial outcomes (8,15).
CONCLUSION
Overall, this case favors early, integrated palliative care in hematologic oncology to guide
treatment based on the patient’s agenda and to address treatment-related side effects, including a
regular screening for demoralization with targeted psycho-oncologic interventions.
Interprofessional pathways are possible even in resource-constrained environments, hold
potential to improved patient-centered outcomes, and future efforts can refine operational screen-
and-treat strategies for demoralization and determine scalable models of early integration
throughout the hematology care continuum (1,4,10,11,13).
Vol. 12/ Núm. 3 2025 pág. 2324
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