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Overview and Recommendations
Background
- •Gastric cancer is the fifth most common cancer worldwide, with advanced disease (unresectable, metastatic, or recurrent) carrying a 5-year survival <10%. Palliative care is integral to managing the high symptom burden, pain, bleeding, obstruction, cachexia, and to improving quality of life (QoL) for patients and families.
- •NCCN and ASCO guidelines recommend early palliative care integration alongside active oncologic treatment, but implementation remains poor: a nationwide Finnish study found only 21% of patients with advanced esophageal or gastric cancer had early SPC (>30 days before death), while 79% had late or no SPC.
- •Early SPC is associated with meaningful reductions in acute healthcare utilization in the last month of life: fewer emergency department contacts (44% vs 60%, p<0.001), fewer secondary care hospitalizations (32% vs 61%, p<0.001), and more hospital-at-home care (56% vs 6%). In U.S. hospitalized gastric cancer patients, palliative care consultation was associated with a $36,240 reduction in hospital charges and higher odds of do-not-resuscitate orders (aOR 4.77).
- •Significant disparities exist: Black patients have 32% lower odds of receiving palliative care compared to White patients (aOR 0.68). Higher income, large urban teaching hospitals, and private insurance are associated with greater palliative care use, highlighting the need for systematic efforts to ensure equitable access.
- •Key domains of palliative care in advanced gastric cancer include pain management, acute bleeding control, gastric outlet obstruction (GOO) relief, psychosocial and spiritual distress, caregiver burden, and end-of-life planning. Interventions include pharmacotherapy, radiotherapy, endoscopic stenting, transcatheter arterial embolization, and structured family therapy.
- •Older adults (≥75 years) are often excluded from trials and may be undertreated: in a real-world cohort, 77% did not receive palliative chemotherapy, with age cited in 25%. However, those who received chemotherapy had outcomes comparable to younger patients, underscoring that age alone should not be a barrier.
Evaluation
- •Suspect need for palliative care in any patient with advanced gastric cancer, unresectable, metastatic, or recurrent disease, regardless of symptom severity. Initiate referral early, ideally >30 days before expected death.
- •Assess symptom burden systematically: perform a comprehensive symptom inventory including pain (location, intensity, character), dysphagia, nausea, early satiety, vomiting, fatigue, bleeding (melena, hematemesis), and cachexia. Use validated tools like the Edmonton Symptom Assessment System (ESAS) or the Palliative Performance Scale (PPS).
- •Evaluate for gastric outlet obstruction (GOO) when patients report persistent vomiting, inability to tolerate oral intake, and epigastric distension. Confirm with upper GI series or CT if needed.
- •Assess for acute upper gastrointestinal bleeding (UGIB): check hemodynamic status (tachycardia, hypotension), hemoglobin drop, and melena or hematemesis. Determine if endoscopic management is feasible based on tumor location and patient stability.
- •Perform psychosocial assessment: screen for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Assess spiritual well-being with the FACIT-Sp scale, noting that self-efficacy for spiritual coping is the lowest domain in this population.
- •Evaluate caregiver burden: ask about psychological distress, physical health (including appetite and weight loss), and economic impact. A case report highlights that caregivers can develop Wernicke encephalopathy from thiamine deficiency due to stress-related nutritional neglect.
- •In older adults (≥75 years), perform a geriatric assessment to identify modifiable vulnerabilities: polypharmacy, malnutrition, functional decline, emotional distress. Use this to guide treatment decisions rather than age alone.
- •Order relevant imaging (CT chest/abdomen/pelvis) to assess disease extent and guide procedural decisions, but avoid unnecessary testing in the terminal phase. Assess peritoneal carcinomatosis on CT, as it predicts lower clinical success for GOO stenting.
- •Determine performance status using ECOG or Karnofsky score. Poor performance status (ECOG 2-3) predicts clinical failure of endoscopic stenting and may influence choice of palliative procedures.
- •Discuss advance care planning early: elicit patient values, goals of care, and code status. Use the Palliative Prognostic Index to estimate survival and guide conversations. Assess hospice eligibility (life expectancy ≤6 months) when appropriate.
- •Consider the need for multidisciplinary input: gastroenterology for stenting, interventional radiology for embolization, radiation oncology for palliative radiotherapy, and spiritual care or chaplaincy for existential distress.
Management
- •Initiate early specialist palliative care referral for all patients with advanced gastric cancer, ideally >30 days before death. Concurrent care with active oncology improves QoL and may extend survival.
- •Manage pain using the WHO analgesic ladder: start with acetaminophen 500-1000 mg PO q6h or NSAIDs (e.g., ibuprofen 400 mg PO q6h) for mild pain; for moderate-to-severe pain, initiate morphine 5-10 mg PO q4h with immediate-release breakthrough (morphine IR 5-10 mg q1h PRN). Titrate to pain ≤3/10. Consider fentanyl patch for stable pain or hydromorphone for renal impairment.
- •For acute upper GI bleeding, attempt endoscopic hemostasis first. If endoscopy fails or is not feasible, proceed to transcatheter arterial embolization (TAE). TAE has a technical success rate of 94.9% and clinical success rate of 72% (95% CI 66-79%), with a rebleeding rate of 11%. Major complications occur in 2.4% (ischemic events, perforation). Monitor for 30-day mortality (26.4%, mostly due to disease progression).
- •For gastric outlet obstruction (GOO), choose the intervention based on performance status and life expectancy. For patients with ECOG 2-3 or life expectancy <3 months, place a self-expanding metallic stent (SEMS): technical success >96%, clinical success 79-97%. Use a covered SEMS with anti-migration design (WAVE stent) to improve 16-week patency (68.6% vs 41.2% uncovered) and reduce restenosis (7.1% vs 37.8%).
- •For patients with good performance status (ECOG 0-1) and longer expected survival (>3 months), consider surgical gastrojejunostomy (GJJ). GJJ provides longer patency (by 167 days), lower reintervention rates (OR 0.16), and potentially longer survival (by 103 days) compared to SEMS, but has longer procedure time, slower oral intake, and longer hospital stay.
- •For malignant biliary obstruction, perform endoscopic or percutaneous stent placement. Biliary stenting reduces hyperbilirubinemia in 96% of patients, but infectious complications occur in 28% (most commonly cholangitis). Median overall survival after stenting is 20.3 weeks. Use a double-stent system with duodenal extension if needed.
- •Administer palliative radiotherapy (RT) for bleeding: deliver a biologically effective dose (BED) ≥40 Gy10 to achieve a 77% pooled bleeding response rate. Higher BED is independently associated with hemostasis (p=0.006). Fractionated regimens (e.g., 30 Gy in 10 fractions) are common. RT also improves obstruction (68% response) and pain (67% response). Grade 3-4 toxicity occurs in up to 15% with RT alone.
- •Manage psychosocial distress with structured interventions: refer to a family-cohesion-centered frailty intervention based on the Satir Family Therapy Model (5 weekly sessions). This has been shown to significantly improve frailty, family cohesion, self-efficacy, anxiety, depression, and QoL in older patients and their caregivers. No adverse events reported.
- •Address caregiver burden: assess caregiver nutrition and monitor for thiamine deficiency if appetite has been poor for weeks, Wernicke encephalopathy can develop rapidly and is reversible with IV thiamine 100 mg. Provide education on postoperative dietary management, emphasizing positive attitude (which correlates with better practice) rather than knowledge alone (which is negatively correlated with practice).
- •Support spiritual well-being: actively explore existential concerns, facilitate meaning-making, and refer to chaplaincy or counseling. Self-efficacy for spiritual coping is the lowest domain in this population, so targeted interventions may improve overall well-being.
- •Initiate advance care planning (ACP) early: discuss goals of care, code status, and hospice preferences. Use personalized prognostic information to improve communication. Physicians should seek training in handling emotions and discussing end-of-life goals, as skill levels are often low.
- •Avoid chemotherapy in the last week of life: it does not improve outcomes and may cause harm. Artificial nutrition should also be limited in the final weeks, as it may increase distress without benefit. In the last month of life, focus on comfort measures, symptom control, and psychosocial support.
- •Refer to hospice when life expectancy is ≤6 months and the patient's goals shift to comfort. Hospice utilization is low (only 9% of upper GI cancer decedents died in hospice), but early SPC increases the likelihood of dying at home rather than in hospital.
- •Monitor for complications of procedures: stent migration (5-10%), reobstruction (especially with uncovered SEMS), perforation, infection (cholangitis after biliary stenting). Reintervention may be needed; consider GJJ for recurrent obstruction after SEMS.
- •For malignant ascites, consider paracentesis for symptom relief or diuretics (spironolactone) if evidence of portal hypertension, though evidence in this population is limited.
- •For dysphagia, consider palliative radiotherapy or esophageal stent placement if appropriate. Data from the retrieved literature are sparse; clinical judgment is required.
- •Use geriatric assessment to identify modifiable vulnerabilities in older patients: polypharmacy, malnutrition, emotional distress. Address these to improve treatment tolerance and QoL. Age alone should not be a barrier to palliative chemotherapy or symptom management.
- •Ensure equitable access: advocate for palliative care referral regardless of race, income, or hospital type. Systematic efforts are needed to overcome disparities, as Black patients and those with high social vulnerability are less likely to receive palliative care or die at home.
Board Review — High Yield
- •Early SPC, More than 30 days before death reduces ED visits (44% vs 60%) and hospitalizations (32% vs 61%), and increases home deaths (19% vs 11%). Only 21% of patients receive it.
- •TAE for bleeding, When endoscopy fails, transcatheter arterial embolization has technical success 95% and clinical success 72%, with rebleeding 11% and major complications 2.4%.
- •SEMS vs GJJ, For GOO, SEMS provides faster relief but shorter patency; GJJ has better long-term outcomes (longer patency by 167 days, lower reintervention). Choose based on performance status and life expectancy.
- •Palliative RT for bleeding, Pooled bleeding response 77% with BED ≥40 Gy10. Higher BED independently associated with hemostasis.
- •Disparities, Black patients have 32% lower odds of receiving palliative care (aOR 0.68). High social vulnerability reduces odds of dying at home.
- •Self-efficacy for spiritual coping, Lowest domain of coping self-efficacy in advanced gastric cancer; assess and support to improve well-being.
- •Caregiver thiamine deficiency, Wernicke encephalopathy can develop from nutritional neglect; give IV thiamine 100 mg if suspected.
- •Chemotherapy in last week, Avoid; 35.9% receive it in third month before death, dropping to 7.9% in last week. No benefit.
- •Advance care planning skills, Physicians score low on handling emotions (mean 0.7/6) and discussing end-of-life goals (mean 7.4/16); training needed.
Deep Dive — Evidence Details
When to Integrate Palliative Care
- ▸Early SPC (>30 days before death) reduces acute care utilization in last month.
- ▸Only 21% of patients receive early SPC; disparities exist by race and income.
Palliative care should be initiated early in advanced , concurrent with active treatment. NCCN guidelines recommend palliative care principles influence treatment [11]B2a. Despite this, only 21% of patients have early specialist palliative care (SPC) contact (>30 days before death) [15]B3b. Early SPC reduces emergency department contacts (44% vs 60%) and hospitalizations (32% vs 61%) in the last month of life, and increases hospital-at-home care (56% vs 6%) and SPC ward deaths (19% vs 4%) [15]B3b. Disparities exist: Black patients have 32% lower odds of receiving palliative care (aOR 0.68) [13]B3b. In older adults, geriatric assessment is recommended; age alone should not preclude chemotherapy [9]D5[19]B3b.
Pearl: Early specialist palliative care (>30 days before death) reduces emergency department visits and hospitalizations in the last month of life, yet fewer than one in four patients receive it [15]B3b.
Symptom Management
- ▸TAE is effective for UGIB when endoscopy fails (clinical success 72%).
- ▸Psychological support and nutritional optimization improve pain control.
Pain is multifactorial; multimodal pharmacotherapy is cornerstone. Psychological intervention with enhanced nutritional support improves pain (VAS, p<0.05) [24]A1b. For acute upper gastrointestinal bleeding (UGIB) when endoscopy fails or is not feasible, transcatheter arterial embolisation (TAE) achieves technical success 94.9%, clinical success 72% (95% CI 66-79%), rebleeding 11%, major complications 2.4%, 30-day mortality 26.4% [37]B2a. Antithrombotic therapy increases bleeding risk (OR 2.02 for ESD) [36]A1a. In HER2-positive advanced disease, emtansine is associated with grade 3+ anemia 26% and serious bleeding events [21]B2b. Follow WHO analgesic ladder with regular assessment.
Pearl: For acute upper gastrointestinal bleeding from gastric cancer, transcatheter arterial embolisation offers a 95% technical success rate and a 72% clinical success rate, with a 2.4% major complication rate, making it the preferred intervention when endoscopy fails or is not feasible [37]B2a.
| Outcome | Rate (95% CI) |
|---|---|
| Technical success | 94.9% |
| Clinical success | 72% (66-79%) |
| Rebleeding | 11% (3-18%) |
| Major complications | 2.4% |
| 30-day mortality | 26.4% |
| Source: [37]B2a |
Psychosocial, Spiritual, and Caregiver Support
- ▸Caregivers may develop thiamine deficiency from stress-related neglect; consider IV thiamine if Wernicke suspected.
- ▸Spiritual coping self-efficacy is lowest; support spiritual well-being.
Patients with advanced gastric cancer have elevated anxiety, depression, and loneliness, and lower spiritual well-being [52]B3b. Self-efficacy (SE) for spiritual coping is the lowest domain; SE for maintaining activity and independence significantly contributes to QoL [44]D5. Caregivers bear substantial burden: psychological distress, physical consequences (e.g., from thiamine deficiency due to stress-related nutritional neglect) [51]C4, and economic costs (US$423 million national cost in Taiwan) [46]D5. A family-cohesion-centered frailty intervention based on Satir therapy improved frailty, family cohesion, self-efficacy, anxiety, depression, and QoL in older patients [41]A1b. Assess caregiver nutritional intake and consider thiamine levels if appetite poor > weeks. Support spiritual coping through chaplaincy or counseling.
Pearl: For caregivers, assess nutritional intake and consider thiamine levels if appetite has been poor for weeks, Wernicke encephalopathy can develop rapidly and is reversible with IV thiamine [51]C4. For patients, the lowest self-efficacy domain is spiritual coping, not medical information-seeking; assessing and supporting spiritual coping may improve overall well-being [44]D5.
Palliative Procedures
- ▸RT effective for bleeding (77% response); BED ≥40 Gy10 associated with higher response.
- ▸SEMS vs GJJ: trade-off between faster recovery and longer-term outcomes.
Palliative radiotherapy (RT) for bleeding response rate 77% [55]B2a; response correlates with BED (p=0.0001) [55]B2a. Grade 3-4 toxicity up to 15% with RT alone [56]B2a. For (GOO), self-expanding metallic stent (SEMS) technical success >96%, clinical success 79-97% [54]A1b[61]B3b[66]C4. Covered SEMS (WAVE) has superior 16-week patency (68.6% vs 41.2%, p=0.005) [54]A1b. Peritoneal carcinomatosis predicts lower clinical success (66.7% vs 88.6%) [66]C4. Compared to gastrojejunostomy (GJJ), SEMS provides shorter procedure time, faster oral intake, shorter hospital stay, but GJJ has lower re-obstruction (OR 7.75), reintervention (OR 6.27), and longer patency (by 167 days) and survival (by 103 days) [53]B2a. For biliary obstruction, stenting reduces hyperbilirubinemia in 96%, but infectious complications in 28% [59]C4.
| Outcome | SEMS | Gastrojejunostomy |
|---|---|---|
| Procedure time | Shorter (WMD -80.9 min) [53]B2a | Longer |
| Time to oral intake | Faster (WMD -3.5 days) [53]B2a | Slower |
| Hospital stay | Shorter (WMD -7.7 days) [53]B2a | Longer |
| Major complications | Higher (OR 6.91) [53]B2a | Lower |
| Re-obstruction | Higher (OR 7.75) [53]B2a | Lower |
| Reintervention | Higher (OR 6.27) [53]B2a | Lower |
| Patency duration | Shorter | Longer (by 167 days) [53]B2a |
| Overall survival | Shorter | Longer (by 103 days) [53]B2a |
Pearl: For GOO, choose SEMS when life expectancy is short or performance status poor; choose gastrojejunostomy for patients with good performance status and longer expected survival, as it provides superior long-term patency, lower reintervention rates, and potentially better survival [53]B2a[65]B3b[67]B3b.
End-of-Life Care and Hospice
- ▸Early SPC improves end-of-life outcomes; only 21% receive it.
- ▸Palliative care reduces hospital costs and increases DNR orders.
Only 32% of patients with advanced esophageal/gastric cancer have any SPC contact; 21% early SPC [15]B3b. Early SPC reduces ED contacts (44% vs 60%) and hospitalizations (32% vs 61%) in last month, and increases home deaths (19% vs 11%) [15]B3b. Disparities persist: Black race (aOR 0.68) and high social vulnerability (OR 0.64) associated with lower odds of home death [13]B3b[73]D5. Advance care planning (ACP) is often suboptimal; physicians show low skill in handling emotions and discussing end-of-life goals [77]D5. Provision of personalized prognostic information increases intentions to discuss prognosis [76]D5. Chemotherapy use declines as death approaches (35.9% to 7.9% in last week), but artificial nutrition paradoxically increases (9.6% to 16.0%) [75]D5. Palliative care during terminal hospitalization reduces hospital charges by $36,240 (95% CI -$51,506 to -$20,974) and increases DNR orders (aOR 4.77) [13]B3b.
Pearl: Early specialist palliative care (contact >30 days before death) reduces emergency visits and hospitalizations and increases the chance of dying at home; clinicians should initiate SPC referral proactively in advanced gastric cancer, especially given that only one in five patients currently receives timely palliative care [15]B3b.
Related Pages
- ▸Refer to parent page for diagnosis and staging.
- ▸Child pages cover specific management modalities.
Part of the Gastric Cancer family. Cross-cutting management is split across dedicated child pages:
- : diagnostic page (definition, epidemiology, staging, biomarkers, prognosis)
- Gastric Cancer Surgical Management : operations by stage, fertility-sparing options, sentinel node mapping, adjuvant triggers
- Gastric Cancer Radiation Management : EBRT + image-guided brachytherapy + concurrent chemoradiation, dose/fractionation, OAR constraints
- : concurrent/adjuvant/metastatic chemotherapy, targeted therapy, immune checkpoint inhibitors
- Gastric Cancer Surveillance and Follow-up : post-treatment surveillance schedule, late toxicity, survivorship, patient counselling
- Gastric Cancer Recurrent and Metastatic Disease : local-regional salvage, distant metastatic systemic therapy, oligometastatic disease
Pearl: Use these links to hop between management modalities; the parent Gastric Cancer page carries diagnosis + staging that informs every decision here.
References
- [1]
Rosati G, Bilancia D, Germano D et al.. “Reduced dose intensity of docetaxel plus capecitabine as second-line palliative chemotherapy in patients with metastatic gastric cancer: a phase II study.” Annals of oncology : official journal of the European Society for Medical Oncology (2007). PMID: 17591806 ↗
L2NON_RANDOMIZED_TRIALCited in: When to Integrate Palliative Care - [2]
Ly QP, Sasson AR. “Modern surgical considerations for gastric cancer.” Journal of the National Comprehensive Cancer Network : JNCCN (2008). PMID: 18926098 ↗
L5NARRATIVE_REVIEWCited in: When to Integrate Palliative Care - [3]
Fiori E, Crocetti D, Sapienza P et al.. “Palliative Surgery or Metallic Stent Positioning for Advanced Gastric Cancer: Differences in QOL.” Medicina (Kaunas, Lithuania) (2021). PMID: 33925171 ↗
L1RCTCited in: When to Integrate Palliative Care - [4]
Case A, Williams F, Prosser S et al.. “Reconsidering the Role of Radiotherapy for Inoperable Gastric Cancer: A Systematic Review of Gastric Radiotherapy Given With Definitive and Palliative Intent.” Clinical oncology (Royal College of Radiologists (Great Britain)) (2024). PMID: 39642760 ↗
L1SR_MA_RCTCited in: When to Integrate Palliative Care, Palliative Procedures - [5]
Guchelaar NAD, Nasserinejad K, Mostert B et al.. “Intraperitoneal chemotherapy for peritoneal metastases of gastric origin: a systematic review and meta-analysis.” The British journal of surgery (2024). PMID: 38722803 ↗
L1SR_MA_RCTCited in: When to Integrate Palliative Care - [6]
Ruzzo A, Graziano F, Kawakami K et al.. “Pharmacogenetic profiling and clinical outcome of patients with advanced gastric cancer treated with palliative chemotherapy.” Journal of clinical oncology : official journal of the American Society of Clinical Oncology (2006). PMID: 16622263 ↗
L5OTHERCited in: When to Integrate Palliative Care - [7]
Ghiglieri C, Dempster M, Wright S et al.. “Psychosocial functioning in individuals with advanced oesophago-gastric cancer: a mixed methods systematic review.” BMC palliative care (2023). PMID: 37891568 ↗
L2SR_COHORTCited in: When to Integrate Palliative Care - [8]
Hong J, Chen Y, Li J et al.. “Comparison of gastrojejunostomy to endoscopic stenting for gastric outlet obstruction: An updated Systematic Review and Meta-analysis.” American journal of surgery (2021). PMID: 34728070 ↗
L2SR_COHORTCited in: When to Integrate Palliative Care - [9]
Joharatnam-Hogan N, Shiu KK, Khan K. “Challenges in the treatment of gastric cancer in the older patient.” Cancer treatment reviews (2020). PMID: 32065879 ↗
L5NARRATIVE_REVIEWCited in: When to Integrate Palliative Care - [10]
Luo D, Xu H, Jiang C et al.. “The prognostic role of palliative gastrectomy in advanced gastric cancer: a systematic review and meta-analysis.” BMC cancer (2024). PMID: 39227821 ↗
L2SR_COHORTCited in: When to Integrate Palliative Care - [11]
Kopecky K, Monton O, Rosman L et al.. “Palliative interventions for patients with advanced gastric cancer: a systematic review.” Chinese clinical oncology (2022). PMID: 36632980 ↗
L2SR_COHORTCited in: When to Integrate Palliative Care, Palliative Procedures - [12]
Meyer HJ, Wienke A, Surov A. “Sarcopenia as a Prognostic Marker for Survival in Gastric Cancer Patients Undergoing Palliative Chemotherapy. A Systematic Review and Meta Analysis.” Nutrition and cancer (2022). PMID: 35603926 ↗
L2SR_COHORTCited in: When to Integrate Palliative Care - [13]
Lee J, Lee J, Tripathi R et al.. “Sociodemographic Disparities and Impact of Palliative Care Utilization During End-of-Life Hospitalizations in Patients with Gastric Cancer.” Journal of palliative medicine (2025). PMID: 41466501 ↗
L3RETROSPECTIVE_COHORTCited in: When to Integrate Palliative Care, End-of-Life Care and Hospice - [14]
Kim WJ, Choi CW, Kim SJ et al.. “Predictors of clinical failure after stenting for malignant esophageal stricture: a single-institution retrospective analysis.” Surgical endoscopy (2025). PMID: 40835762 ↗
L3COHORTCited in: When to Integrate Palliative Care, Palliative Procedures - [15]
Kitti P, Anttonen A, Nuutinen M et al.. “Specialist palliative care is associated with reduced healthcare utilization in patients with advanced esophageal and gastric cancer: a nationwide register-based study.” Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2025). PMID: 40471285 ↗
L3RETROSPECTIVE_COHORTCited in: When to Integrate Palliative Care, End-of-Life Care and Hospice - [16]
Kim JW, Choi JY, Park W et al.. “Pilot Study for Feasibility of Onco-Geriatric Intervention Model in Older Patients with Cancer in a Tertiary Academic Hospital.” Cancer research and treatment (2025). PMID: 40083083 ↗
L4COHORTCited in: When to Integrate Palliative Care - [17]
Engborg J, Winbladh A, Lindblad M et al.. “Centralization of gastric cancer surgery-impact on treatment strategies and survival-a national population-based cohort study.” Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (2024). PMID: 39510159 ↗
L3COHORTCited in: When to Integrate Palliative Care - [18]
Hoek DWBD, van de Water LF, Vos PG et al.. “Oncologists' communication about tobacco and alcohol use during treatment for esophagogastric cancer: a qualitative observational study of simulated consultations.” Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2024). PMID: 39302465 ↗
L3COHORTCited in: When to Integrate Palliative Care - [19]
Wang X, Allen MJ, Espin-Garcia O et al.. “Outcomes in older adults with metastatic esophageal and gastric carcinoma treated with palliative chemotherapy.” The oncologist (2024). PMID: 39046894 ↗
L3RETROSPECTIVE_COHORTCited in: When to Integrate Palliative Care - [20]
Song Y, Chen E, Ikoma N et al.. “Palliative Surgery for Patients with Gastroesophageal Junction or Gastric Cancer: A Report on Clinical Observational Outcomes.” Annals of surgical oncology (2024). PMID: 38743284 ↗
L3COHORTCited in: When to Integrate Palliative Care - [21]
Thuss-Patience PC, Shah MA, Ohtsu A et al.. “Trastuzumab emtansine versus taxane use for previously treated HER2-positive locally advanced or metastatic gastric or gastro-oesophageal junction adenocarcinoma (GATSBY): an international randomised, open-label, adaptive, phase 2/3 study.” The Lancet. Oncology (2017). PMID: 28343975 ↗
L2RCT_PHASE2Cited in: Symptom Management - [22]
Zhang Y, Lao LST, Shen X et al.. “Perioperative outcomes of a novel laparoscopic-like "3-arm + 2-port" model in robot-assisted distal gastrectomy in patients with resectable, non-metastatic gastric cancer: a randomized controlled trial.” Journal of robotic surgery (2026). PMID: 42484711 ↗
L1RCTCited in: Symptom Management - [23]
Meng C, Cao S, Li L et al.. “Short-term outcomes of preoperative computed tomography angiography versus standard assessment in patients with BMI ≥ 25.0 kg/m2 undergoing laparoscopic gastrectomy: the GISSG20-01 randomized clinical trial.” Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association (2025). PMID: 39786664 ↗
L1RCTCited in: Symptom Management - [24]
Wang G, Pan S. “Combined Effects of Psychological Intervention and Enhanced Nutritional Support on Postoperative Recovery in Gastric Cancer Patients.” Nutrition and cancer (2025). PMID: 40996438 ↗
L1RCTCited in: Symptom Management - [25]
Mirza W, Cheema YI, Khan HM et al.. “Robotic versus laparoscopic gastrectomy for gastric cancer: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials on operative metrics, lymphadenectomy, and postoperative complications.” Journal of robotic surgery (2025). PMID: 41023463 ↗
L1SR_MA_RCTCited in: Symptom Management - [26]
Deng Y, He LJ, Li X. “Robotic versus laparoscopic gastrectomy for gastric cancer in asia: A meta-analysis of short-term outcomes from six randomized controlled trials.” European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (2025). PMID: 40633143 ↗
L1SR_MA_RCTCited in: Symptom Management - [27]
Tian Y, Guo H, He J et al.. “Single-incision robot-assisted distal gastrectomy for gastric cancer (FUTURE-05): short-term outcomes of a nonrandomized descriptive exploratory feasibility study using the SHURUI (SR-ENS-600) robotic system.” Surgical endoscopy (2026). PMID: 41651956 ↗
L4NON_RANDOMIZED_TRIALCited in: Symptom Management - [28]
Park JH, Kim J, Lee D et al.. “Feasibility and safety of the synchroseal articulating bipolar energy-based device for robotic gastrectomy in patients with gastric cancer: a prospective single-arm clinical trial with historical controls.” Updates in surgery (2025). PMID: 40760308 ↗
L4NON_RANDOMIZED_TRIALCited in: Symptom Management - [29]
Zhang Z, Zhan W, Tian H et al.. “An initial exploratory clinical study and outcome assessment of gastrointestinal surgeries using advanced robotic-assisted techniques.” Surgical endoscopy (2024). PMID: 39572427 ↗
L2NON_RANDOMIZED_TRIALCited in: Symptom Management - [30]
Fernandes MHF, Valério-Alves AP, Colares RA et al.. “Indocyanine green-guided lymphadenectomy in gastric cancer after neoadjuvant chemotherapy: A systematic review and meta-analysis.” European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (2025). PMID: 41092717 ↗
L2SR_COHORTCited in: Symptom Management - [31]
Qin X, Tian L, Li M et al.. “Comparison of total robotic distal gastrectomy and robot-assisted distal gastrectomy for gastric cancer: a systematic review and meta-analysis.” Journal of robotic surgery (2025). PMID: 40760388 ↗
L2SR_COHORTCited in: Symptom Management - [32]
Yu Y, Yamauchi S, Zhang P et al.. “Short-term outcomes of robotic versus laparoscopic gastrectomy for proximal gastric cancer: a systematic review and meta-analysis of propensity score-matched or baseline-balanced retrospective studies.” Journal of robotic surgery (2025). PMID: 40549062 ↗
L2SR_COHORTCited in: Symptom Management - [33]
Kossenas K, Moutzouri O, Georgopoulos F. “Robotic vs laparoscopic distal gastrectomy with Billroth I and II reconstruction: a systematic review and meta-analysis.” Journal of robotic surgery (2024). PMID: 39699804 ↗
L2SR_COHORTCited in: Symptom Management - [34]
Li W, Wei SJ. “Perioperative outcomes of robot-assisted versus laparoscopic distal gastrectomy for gastric cancer: a systematic review and meta-analysis of propensity score matching studies.” Journal of robotic surgery (2024). PMID: 39231865 ↗
L2SR_COHORTCited in: Symptom Management - [35]
Winter K, El-Sourani N, Szardenings C et al.. “Enhanced recovery and reduced opioid requirements following robot-assisted minimally invasive gastrectomy: a retrospective cohort study.” Journal of robotic surgery (2025). PMID: 41037210 ↗
L2PROSPECTIVE_COHORTCited in: Symptom Management - [36]
Gu Y, Zhao S. “Risk factors for postoperative bleeding following endoscopic submucosal dissection in early gastric cancer: A systematic review and meta-analysis.” Medicine (2024). PMID: 38608116 ↗
L1SR_MA_RCTCited in: Symptom Management - [37]
Hall T, Temperley HC, Mac Curtain BM et al.. “Transcatheter arterial embolisation (TAE) to treat acute upper gastrointestinal bleeding secondary to gastric cancer: A systematic review and meta-analysis.” The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland (2024). PMID: 39414468 ↗
L2SR_COHORTCited in: Symptom Management - [38]
Lim D, Han J, Noh J et al.. “Comparison of textbook outcomes and postoperative pain trajectories between reduced-port and conventional robotic distal gastrectomy: a cumulative sum (CUSUM)-adjusted propensity score-matched analysis.” Journal of robotic surgery (2026). PMID: 42298275 ↗
L3RETROSPECTIVE_COHORTCited in: Symptom Management - [39]
Sanberg J, Noordman BJ, Lindblad M et al.. “Robot-assisted versus laparoscopic total gastrectomy: a western high-volume tertiary referral center experience.” Journal of robotic surgery (2026). PMID: 42156604 ↗
L3RETROSPECTIVE_COHORTCited in: Symptom Management - [40]
Yan Z, Zhao R, Ouyang J et al.. “Association between additional operation timing and perioperative outcomes after noncurative endoscopic submucosal dissection for early gastric cancer.” Surgery (2026). PMID: 42105700 ↗
L3RETROSPECTIVE_COHORTCited in: Symptom Management - [41]
Guo Y, Chen Y, Zhao K et al.. “Impact of the family cohesion-centered frailty intervention on older gastric cancer patients: a non-randomized controlled trial.” BMC medicine (2026). PMID: 41896874 ↗
L1RCTCited in: Psychosocial, Spiritual, and Caregiver Support - [42]
Xiaoyun C, Fenglan L. “The relationships among insecure attachment, social support and psychological experiences in family caregivers of cancer inpatients.” European journal of oncology nursing : the official journal of European Oncology Nursing Society (2019). PMID: 31751851 ↗
L3CROSS_SECTIONALCited in: Psychosocial, Spiritual, and Caregiver Support - [43]
Luo D, Xu H, Jiang C et al.. “Knowledge, attitudes, and practices of primary caregivers of gastric cancer patients regarding postoperative dietary management.” BMC cancer (2024). PMID: 39627744 ↗
L3CROSS_SECTIONALCited in: Psychosocial, Spiritual, and Caregiver Support - [44]
Rha SY, Song SK, Lee J. “Self-efficacy for coping with cancer and quality of life in advanced gastric cancer patients.” European journal of oncology nursing : the official journal of European Oncology Nursing Society (2022). PMID: 35378392 ↗
L5OTHERCited in: Psychosocial, Spiritual, and Caregiver Support - [45]
Xiao H, Bertwistle D, Khela K et al.. “Patient and caregiver socioeconomic burden of first-line systemic therapy for advanced gastroesophageal adenocarcinoma.” Future oncology (London, England) (2022). PMID: 34984914 ↗
L5OTHERCited in: Psychosocial, Spiritual, and Caregiver Support - [46]
Hong J, Tsai Y, Novick D et al.. “The economic burden of advanced gastric cancer in Taiwan.” BMC health services research (2017). PMID: 28915812 ↗
L5OTHERCited in: Psychosocial, Spiritual, and Caregiver Support - [47]
Taleghani F, Ehsani M, Farzi S et al.. “Nutritional challenges of gastric cancer patients from the perspectives of patients, family caregivers, and health professionals: a qualitative study.” Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2021). PMID: 33392766 ↗
L5OTHERCited in: Psychosocial, Spiritual, and Caregiver Support - [48]
Zhou Y, Che CC, Chong MC et al.. “Understanding the patient-spouse communication experience during chemotherapy for gastric cancer based on the couple's adaptation to cancer intimacy model: a directed content analysis.” Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2025). PMID: 40515864 ↗
L5OTHERCited in: Psychosocial, Spiritual, and Caregiver Support - [49]
Ghiglieri C, Dempster M, Graham-Wisener L. “"You're just in such crisis mode…frantic to get through the next day": an interpretative phenomenological analysis of adjustment experiences among carers of patients with advanced oesophago-gastric cancer.” BMC palliative care (2025). PMID: 40596987 ↗
L5OTHERCited in: Psychosocial, Spiritual, and Caregiver Support - [50]
Gu YY, Chen YM, Ye YQ et al.. “Quality of life dynamics in the gastric cancer dyad: an actor-partner interdependence model analysis guiding the development of a family-centered nursing framework.” Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation (2026). PMID: 42400829 ↗
L5OTHERCited in: Psychosocial, Spiritual, and Caregiver Support - [51]
Ishida M, Uchida N, Yoshioka A et al.. “Wernicke encephalopathy in a caregiver: A serious physical issue resulting from stress in a family member caring for an advanced cancer patient.” Palliative & supportive care (2022). PMID: 34809731 ↗
L4CASE_SERIESCited in: Psychosocial, Spiritual, and Caregiver Support - [52]
Cao H, Zhou H. “Loneliness, Spiritual Well-Being, Anxiety, Depression, and Attitude to Death of Gastrointestinal Cancer Patients Treated with Rumor Resection.” The Tohoku journal of experimental medicine (2024). PMID: 39019596 ↗
L3CASE_CONTROLCited in: Psychosocial, Spiritual, and Caregiver Support - [53]
Bian SB, Shen WS, Xi HQ et al.. “Palliative Therapy for Gastric Outlet Obstruction Caused by Unresectable Gastric Cancer: A Meta-analysis Comparison of Gastrojejunostomy with Endoscopic Stenting.” Chinese medical journal (2016). PMID: 27098799 ↗
L2SR_COHORTCited in: Palliative Procedures - [54]
Lee H, Min BH, Lee JH et al.. “Covered metallic stents with an anti-migration design vs. uncovered stents for the palliation of malignant gastric outlet obstruction: a multicenter, randomized trial.” The American journal of gastroenterology (2015). PMID: 26372507 ↗
L1RCTCited in: Palliative Procedures - [55]
Viani GA, Arruda CV, Hamamura AC et al.. “Palliative radiotherapy for gastric cancer: Is there a dose relationship between bleeding response and radiotherapy?” Clinics (Sao Paulo, Brazil) (2020). PMID: 32901671 ↗
L2SR_COHORTCited in: Palliative Procedures - [56]
Tey J, Soon YY, Koh WY et al.. “Palliative radiotherapy for gastric cancer: a systematic review and meta-analysis.” Oncotarget (2017). PMID: 28445941 ↗
L2SR_COHORTCited in: Palliative Procedures - [57]
Kawamoto T, Saito T, Kosugi T et al.. “Temporal Profiles of Symptom Scores After Palliative Radiotherapy for Bleeding Gastric Cancer With Adjustment for the Palliative Prognostic Index: An Exploratory Analysis of a Multicentre Prospective Observational Study (JROSG 17-3).” Clinical oncology (Royal College of Radiologists (Great Britain)) (2022). PMID: 35654667 ↗
L3COHORTCited in: Palliative Procedures - [58]
Takeda K, Sakayauchi T, Kubozono M et al.. “Palliative radiotherapy for gastric cancer bleeding: a multi-institutional retrospective study.” BMC palliative care (2022). PMID: 35413824 ↗
L4COHORTCited in: Palliative Procedures - [59]
Corbera A, Rios-Hoyo A, Visa L et al.. “Incidence of complications associated to bile duct stents, in patients with advanced cancer: a single-center experience.” Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2022). PMID: 35094137 ↗
L4RETROSPECTIVE_COHORTCited in: Palliative Procedures - [60]
Saito T, Kosugi T, Nakamura N et al.. “Treatment response after palliative radiotherapy for bleeding gastric cancer: a multicenter prospective observational study (JROSG 17-3).” Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association (2021). PMID: 34580795 ↗
L3COHORTCited in: Palliative Procedures - [61]
Haga Y, Hiki N, Kinoshita T et al.. “Treatment option of endoscopic stent insertion or gastrojejunostomy for gastric outlet obstruction due to gastric cancer: a propensity score-matched analysis.” Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association (2020). PMID: 31982964 ↗
L3RETROSPECTIVE_COHORTCited in: Palliative Procedures - [62]
Novick D, Leonardi F, Lee Kay Pen D et al.. “Retrospective analysis of patients with advanced or metastatic gastric cancer in Colombia.” Journal of medical economics (2019). PMID: 31066594 ↗
L3COHORTCited in: Palliative Procedures - [63]
Hiramoto S, Kikuchi A, Tetsuso H et al.. “Efficacy of palliative radiotherapy and chemo-radiotherapy for unresectable gastric cancer demonstrating bleeding and obstruction.” International journal of clinical oncology (2018). PMID: 30019177 ↗
L4COHORTCited in: Palliative Procedures - [64]
Gwon DI, Ko GY, Kim JW et al.. “Double-Stent System with Long Duodenal Extension for Palliative Treatment of Malignant Extrahepatic Biliary Obstructions: A Prospective Study.” Korean journal of radiology (2018). PMID: 29520180 ↗
L4COHORTCited in: Palliative Procedures - [65]
Jang SH, Lee H, Min BH et al.. “Palliative gastrojejunostomy versus endoscopic stent placement for gastric outlet obstruction in patients with unresectable gastric cancer: a propensity score-matched analysis.” Surgical endoscopy (2017). PMID: 28281127 ↗
L3COHORTCited in: Palliative Procedures - [66]
Rademacher C, Bechtler M, Schneider S et al.. “Self-expanding metal stents for the palliation of malignant gastric outlet obstruction in patients with peritoneal carcinomatosis.” World journal of gastroenterology (2016). PMID: 27920476 ↗
L4COHORTCited in: Palliative Procedures - [67]
Park JH, Song HY, Yun SC et al.. “Gastroduodenal stent placement versus surgical gastrojejunostomy for the palliation of gastric outlet obstructions in patients with unresectable gastric cancer: a propensity score-matched analysis.” European radiology (2015). PMID: 26662027 ↗
L3RETROSPECTIVE_COHORTCited in: Palliative Procedures - [68]
Kondoh C, Shitara K, Nomura M et al.. “Efficacy of palliative radiotherapy for gastric bleeding in patients with unresectable advanced gastric cancer: a retrospective cohort study.” BMC palliative care (2015). PMID: 26238344 ↗
L4RETROSPECTIVE_COHORTCited in: Palliative Procedures - [69]
Keränen I, Kylänpää L, Udd M et al.. “Gastric outlet obstruction in gastric cancer: a comparison of three palliative methods.” Journal of surgical oncology (2013). PMID: 24590674 ↗
L3COHORTCited in: Palliative Procedures - [70]
Uy J, White DB, Mohan D et al.. “Physicians' decision-making roles for an acutely unstable critically and terminally ill patient.” Critical care medicine (2013). PMID: 23552510 ↗
L3COHORTCited in: End-of-Life Care and Hospice - [71]
Brown J, Liepa AM, Bapat B et al.. “Clinical management patterns of advanced and metastatic gastro-oesophageal carcinoma after fluoropyrimidine/platinum treatment in France, Germany, Spain and the United Kingdom.” European journal of cancer care (2019). PMID: 31883156 ↗
L3COHORTCited in: End-of-Life Care and Hospice - [72]
Cruz-Carreras MT, Chaftari P, Viets-Upchurch J. “Advance care planning: challenges at the emergency department of a cancer care center.” Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2017). PMID: 28918550 ↗
L4CASE_SERIESCited in: End-of-Life Care and Hospice - [73]
Rashid Z, Khalil M, Khan MMM et al.. “Upper gastrointestinal cancers: Trends and determinants of location of death.” Surgery (2024). PMID: 39299855 ↗
L5OTHERCited in: End-of-Life Care and Hospice - [74]
Barnato AE, Mohan D, Lane RK et al.. “Advance care planning norms may contribute to hospital variation in end-of-life ICU use: a simulation study.” Medical decision making : an international journal of the Society for Medical Decision Making (2014). PMID: 24615275 ↗
L5OTHERCited in: End-of-Life Care and Hospice - [75]
Kempf E, Tournigand C, Rochigneux P et al.. “Discrepancies in the use of chemotherapy and artificial nutrition near the end of life for hospitalised patients with metastatic gastric or oesophageal cancer. A countrywide, register-based study.” European journal of cancer (Oxford, England : 1990) (2017). PMID: 28458120 ↗
L5OTHERCited in: End-of-Life Care and Hospice - [76]
Han PK, Dieckmann NF, Holt C et al.. “Factors Affecting Physicians' Intentions to Communicate Personalized Prognostic Information to Cancer Patients at the End of Life: An Experimental Vignette Study.” Medical decision making : an international journal of the Society for Medical Decision Making (2016). PMID: 26985015 ↗
L5OTHERCited in: End-of-Life Care and Hospice - [77]
Mohan D, Alexander SC, Garrigues SK et al.. “Communication practices in physician decision-making for an unstable critically ill patient with end-stage cancer.” Journal of palliative medicine (2010). PMID: 20642362 ↗
L5OTHERCited in: End-of-Life Care and Hospice - [78]
Barnato AE, Hsu HE, Bryce CL et al.. “Using simulation to isolate physician variation in intensive care unit admission decision making for critically ill elders with end-stage cancer: a pilot feasibility study.” Critical care medicine (2008). PMID: 18936694 ↗
L5OTHERCited in: End-of-Life Care and Hospice
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- ← Gastric Cancer Recurrent and Metastatic Disease (Detailed)
- ← Gastric Cancer Systemic Therapy (Detailed)
- ← Gastric Cancer Surveillance and Follow-up
- ← Gastric Cancer Radiation Management
- ← Gastric Cancer Recurrent and Metastatic Disease
- ← Gastric Cancer Surveillance and Follow-up (Detailed)
- ← Gastric Cancer Surgical Management (Detailed)