Journal of pain and symptom management最新文献

{"title":"Palonosetron Plus Megestrol Acetate Versus Palonosetron Plus Dexamethasone in Preventing Moderately Emetogenic Chemotherapy-induced Nausea and Vomiting: A Randomized, Multicenter, Crossover Trial.","authors":"Qiaoqi Li, Yingzhe Luo, Yaqin Zhao, Hongfeng Gou, Shihui Min, Biao Yang, Cheng Yi","doi":"10.1016/j.jpainsymman.2025.07.034","DOIUrl":"10.1016/j.jpainsymman.2025.07.034","url":null,"abstract":"<p><strong>Backgrounds: </strong>Evidence shows that megestrol acetate (MA) is a potential antiemetic for preventing chemotherapy-induced nausea and vomiting (CINV). No persuasive clinical trials have been performed to validate the efficacy and safety of MA. Here we designed a randomized controlled trial to assess the efficacy of palonosetron plus MA versus palonosetron plus dexamethasone (DEX) in preventing CINV following moderately emetogenic chemotherapy (MEC) regimens.</p><p><strong>Methods: </strong>This was a multicenter, randomized, single-blinded, crossover, clinical trial practiced in three medical centers. The eligible patients were recruited to the DEX-MA and MA-DEX groups using a computer-generated random number table. Briefly, the DEX-MA group received palonosetron and DEX for the first chemotherapy cycle and then received palonosetron and MA for the second cycle. The MA-DEX group received the antiemetic treatment in the reverse order. Evaluating patients' efficacy and quality of life (QOL) with these two antiemetic regimens. The primary endpoint was complete response (CR). This trial has been registered with the Chinese Clinical Trial Register (ChiCTR2000037447).</p><p><strong>Results: </strong>Ninety-two patients were enrolled between June 2020 and July 2023, and 86 were eventually evaluated in the study. Forty-one patients were randomized in the DEX-MA group and forty-five in the MA-DEX group. Of all subjects, 51.1% were male, and 48.9% were female. complete response (CR) rates showed no significant difference in the acute phase (0-24 h) (DEX vs. MA, 81.4% vs. 82.6%, P = 0.843), delayed phase (24-120 h) (DEX vs. MA, 81.4% vs. 82.6%, P = 0.843), or overall phase (DEX vs. MA, 72.1% vs. 73.3%, P = 0.864). The QOL showed significant differences in dyspnea symptoms (P = 0.002) and appetite loss symptoms (P = 0.039). This result implied that MA led to less dyspnea, appetite loss, and a better QOL after chemotherapy.</p><p><strong>Conclusions: </strong>MA may have equivalent efficacy to DEX in the prevention of moderately emetogenic regimen CINV, and no obvious side events occurred. Compared with DEX, MA can significantly improve QOL, especially in decreasing dyspnea and appetite loss. An extension phase III study is going on to validate this observation.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proceedings of the First Neuropalliative Care Research Summit (NeuroCARES).","authors":"Claire J Creutzfeldt, Jori Bogetz, Carey Candrian, Kathryn L Colborn, Rita Caroline Crooms, Corey R Fehnel, Jori E Fleisher, Romana Hasnain-Wynia, Maria Hopfgarten, David Y Hwang, Benzi M Kluger, Heather E Leeper, Monica E Lemmon, Susanne Muehlschlegel, Christine S Ritchie, Altaf Saadi, Malenna Sumrall, Lauren Treat, Ana-Maria Vranceanu, Darin B Zahuranec","doi":"10.1016/j.jpainsymman.2025.08.024","DOIUrl":"10.1016/j.jpainsymman.2025.08.024","url":null,"abstract":"<p><p>Neuropalliative care is a rapidly evolving field of healthcare that is essential for addressing the complex needs of individuals with serious neurological disorders and their care partners. Effectively addressing these needs will require advances in Neuropalliative care research designed to improve the quality of life for all people affected by neurological disorders and their care-partners. On April 12, 2024, the first Neuropalliative Care Research Summit (NeuroCARES), funded by the National Institute of Neurological Disorders and Stroke (NINDS) and supported by the International Neuropalliative Care Society (INPCS), provided an opportunity for clinicians, researchers, representatives from NIH and patient and family advocates to come together to identify and discuss neuropalliative care research challenges and opportunities. The summit hosted 80 transdisciplinary researchers and clinicians from 47 institutions, including 25 virtual attendees. The conference featured three roundtable discussions, six scientific sessions, and two junior investigator mentoring workshops. Research priorities identified included: 1) developing strategies to address healthcare inequities; 2) increasing methodological rigor concerning data collection and intervention development; 3) increasing care partner involvement through initiatives such as Community Advisory Boards to ensure that research aligns with real-world needs; 4) utilizing big data to examine differences in neuropalliative care delivery across the U.S. healthcare system; 5) developing standardized metrics including common data elements and tailoring them to neuropalliative care; and 6) creating enhanced training, mentoring, and funding opportunities for early career neuropalliative care investigators. This article summarizes key takeaways and deliverables from the summit while emphasizing the need for a biopsychosocial approach to neuropalliative care.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Palliative Care in Extracorporeal Life Support: A Systematic Review.","authors":"Whitney A Kiker, Anna L Condella, Astrid Grouls, Daniel Brodie, Leanne Delaney, Eddy Fan, Teresa Jewell, Erin K Kross, Jamie T Nomitch, Lauren Pollack, Rashmi Sharma, Ann L Jennerich","doi":"10.1016/j.jpainsymman.2025.08.016","DOIUrl":"10.1016/j.jpainsymman.2025.08.016","url":null,"abstract":"<p><strong>Context: </strong>Use of palliative care in extracorporeal life support (ECLS) has increased, but its impact on patient- and family-centered outcomes remains unclear.</p><p><strong>Objective: </strong>To examine the relationship between specialty palliative care and patient- and family-centered outcomes for patients receiving ECLS.</p><p><strong>Methods: </strong>We conducted a systematic review of PubMed, EMBASE (Elsevier), CINAHL Complete (EBSCOhost), Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials (Wiley) through August 26, 2024. Two investigators independently screened titles and abstracts, followed by full-text review for inclusion. Data were extracted for prespecified critical and important outcomes, and evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>Nine observational studies were included, incorporating data from 21,417 patients receiving ECLS, with 4368 seen by specialty palliative care. For all outcomes, certainty of evidence was very low. Two studies included a critical outcome: one found no difference in \"average pain\" and one reported more goals-of-care notes, comparing those seen by palliative care to those not seen. Five studies reported longer ECLS duration among those with palliative care consultation compared to those without. Three studies performed statistical comparisons of survival for patients with and without palliative care consultation and found no significant differences in hospital mortality.</p><p><strong>Conclusion: </strong>Few studies have investigated patient- and family-centered outcomes related to specialty palliative care for patients receiving ECLS. Specialty palliative care does not appear to correlate with mortality, supporting the concept that palliative care can support goals-of-care conversations and end-of-life decision making without negatively affecting patient survival. However, limitations of the existing data preclude meaningful conclusions about the relationship between specialty palliative care and other patient- and family-centered outcomes. Additional research is needed to clarify the optimal role of specialty palliative care in this population.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Does Home-Based Palliative Care Impact Informal Carers? A Scoping Review.","authors":"L Challis, J Ellershaw, D Hughes, S Mason","doi":"10.1016/j.jpainsymman.2025.07.029","DOIUrl":"10.1016/j.jpainsymman.2025.07.029","url":null,"abstract":"<p><strong>Context: </strong>Informal carers can provide a wealth of support to patients, which may enable them to be cared for and die at home. Whilst caring for someone with a life-limiting illness can be rewarding, the time and effort required can cause burden and poorer quality of life. Research is needed to understand the various and complex impacts of home-based palliative care services on carers.</p><p><strong>Objectives: </strong>To identify the existing evidence on the impacts of home-based palliative care on carers of people with a life-limiting illness.</p><p><strong>Methods: </strong>Searches were conducted in MEDLINE (via Ovid), Scopus, CINAHL, the Cochrane Library and grey literature sources for articles published between August 2012 and March 2025, in line with the Joanna Briggs Institute (JBI) methodological guidance (Peters MDJ, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis. 2020;18(10)). Titles and abstracts were screened against an inclusion and exclusion criterion; articles were included if they involved adult informal carers of adults with life-limiting conditions who received home-based palliative care services. Data were extracted using a charting table and thematically analysed. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) (Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-73).</p><p><strong>Results: </strong>173 papers were included in the review. Analysis generated seven interrelated themes; Outcomes were influenced by; the relationship with the healthcare professional, quality of services and individual preferences. Experiences of home-based palliative care can impact bereavement outcomes and financial hardship.</p><p><strong>Conclusion: </strong>Home-based care has significant implications for carers. Further work is warranted to standardise methods to enable comparisons between services and aggregate study findings.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paging Palliative Care: Barriers to Referral and Why Rheumatologists Aren't Making the Call (Yet).","authors":"Jack Kimball, Shannon Herndon, Amanda M Eudy, Ankoor Shah, Jennifer L Rogers, Maya Faison, David Leverenz, Christopher Jones","doi":"10.1016/j.jpainsymman.2025.08.010","DOIUrl":"10.1016/j.jpainsymman.2025.08.010","url":null,"abstract":"<p><strong>Paging palliative care: </strong>Barriers to Referral and Why Rheumatologists Aren't Making the Call (Yet).</p><p><strong>Context: </strong>People with serious rheumatic disease experience high morbidity and mortality, yet palliative care (PC) remains an underutilized resource for these patients. There is a lack of knowledge about the obstacles and opportunities for integrating PC into rheumatology practices.</p><p><strong>Objectives: </strong>We aim to identify provider-specific barriers to PC referral for people with serious rheumatic diseases.</p><p><strong>Methods: </strong>Rheumatology and PC providers in the United States were surveyed on barriers to PC referral for people with rheumatic diseases. Surveys were distributed via email and in-person at local and national conferences. Results were analyzed using descriptive statistics, Fisher's exact test for categorical outcomes, and two-sample t-tests for continuous outcomes.</p><p><strong>Results: </strong>201 rheumatologists and 217 palliative care providers completed the survey. Top barriers identified by rheumatologists included uncertainty about when to refer to PC (n = 100, 50%), concern that patients will think of palliative care as \"giving up\" (n = 98, 49%), and an insufficient number of people with advanced rheumatic disease who need PC (n = 80, 40%). Top barriers identified by PC providers included uncertainties about rheumatic disease prognosis (n = 143, 66%), rheumatic disease treatments and side effects (n = 132, 61%), and rheumatic disease course/complications (n = 115, 53%).</p><p><strong>Conclusion: </strong>Rheumatologists face uncertainty about who, when, and how to refer to PC, while PC providers identify inadequate knowledge about rheumatic diseases as key barriers. Ongoing efforts are needed to identify patients who would most benefit from PC and reduce hurdles to PC referral by rheumatologists.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Having a Why to Live Can Bear Almost Any How\"-Meaning-focused Interventions on Cancer-related Clinical Symptoms: Systematic Review and Meta-Analysis.","authors":"Ki Sum Samson Wong, Mu-Hsing Ho, Tianxue Hou, Chia-Chin Lin","doi":"10.1016/j.jpainsymman.2025.08.014","DOIUrl":"10.1016/j.jpainsymman.2025.08.014","url":null,"abstract":"<p><strong>Context: </strong>According to Dr Viktor Frankl's existential framework, distress in patients' spiritual dimensions could manifest as symptoms in both physical/biological and the psychological dimensions. Meaning-focused interventions (MFI) refer to the subset of spiritual care/existential interventions designed to prominently address cancer patients' loss of meaning in life.</p><p><strong>Objectives: </strong>To evaluate the effects of MFI on cancer-related physical and psychological symptoms.</p><p><strong>Methods: </strong>Search was conducted across 10 databases from inception to October 8, 2024. Primary outcomes included a list of symptoms previously reported as prevalent among cancer patients. Secondary outcome was symptom distress.</p><p><strong>Results: </strong>23 RCTs and three quasi-experimental studies, involving 2889 patients, were included. Significant effects were found on Fatigue (SMD, -2.48; 95% CI, -3.95 to -1.00; k = 6), Pain Intensity (SMD, -0.42; 95% CI, -0.74 to -0.09; k = 2), Insomnia (SMD, -0.74; 95% CI, -1.44 to -0.04; k = 4), Depressive Symptoms (SMD, -0.39; 95% CI, -0.61 to -0.18; k = 17), Anxiety (SMD, -0.51; 95% CI, -0.78 to -0.25; k = 15), Cognitive Function (MD, 1.65; 95% CI, 1.00 to 2.31; k = 2), Retrospective Memory (MD, -2.90; 95% CI, -5.35 to -0.46; k = 2) and Prospective Memory (MD, -2.22; 95% CI, -3.71 to -0.74; k = 2). Non-significant effects were found on Appetite Loss, Symptom Distress.</p><p><strong>Conclusion: </strong>Our meta-analysis could inform future integration of spiritual care into routine medical care for cancer patients. Meanwhile, findings on cognitive function and memory were based on poor-quality studies and hence should be interpreted with caution. Healthcare providers might consider (i) infusing a meaning-in-life component into physical exercise intervention for cancer patients to reduce dropout, (ii) exploring Low-intensity MFI as a cost-saving option for providing spiritual care. Future research should also work towards equitable access to MFI for brain cancer patients.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived Gaps Between Wishes and Practice in End-of-Life Sedation for Psycho-Existential Suffering.","authors":"Sayaka Maeda, Tatsuya Morita, Kengo Imai, Hiroyuki Otani, Akemi Shirado Naito, Satoru Tsuneto","doi":"10.1016/j.jpainsymman.2025.08.011","DOIUrl":"10.1016/j.jpainsymman.2025.08.011","url":null,"abstract":"<p><strong>Context: </strong>Continuous deep sedation (CDS) for psycho-existential suffering is controversial and often regarded as a last-resort option at the end of life. The frequency with which patients desire CDS for this reason remains unclear.</p><p><strong>Objectives: </strong>This study aimed to explore the prevalence of patients with cancer under palliative care in Japan who expressed a desire for CDS to alleviate psycho-existential suffering. It also sought to understand their condition at the time of expressing this desire, underlying suffering, and alternative interventions.</p><p><strong>Methods: </strong>This nationwide questionnaire survey involved all certified hospices and palliative care units (PCUs) across Japan. Participants answered a questionnaire regarding the administration of and expressed desire for CDS to relieve psycho-existential suffering, along with patients' status when such a desire was expressed.</p><p><strong>Results: </strong>Data from 306 facilities were analyzed. Approximately 0.2% of deceased patients received CDS solely for psycho-existential suffering, while 2% expressed a desire for it during the two-year study period. While only one-quarter of PCUs reported administering CDS for this purpose, three-quarters reported patients expressing a desire for it, with variation in the proportion across facilities. Patients' desire for CDS was frequently associated with existential suffering and often associated with the wish for an early death.</p><p><strong>Conclusion: </strong>A significant gap existed between patients' desire for CDS due to psycho-existential suffering and its actual implementation. Palliative care providers face the critical challenge of understanding patients' complex needs, providing appropriate care and support, and guiding ethical decisions for patients, families, and medical teams.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative Care Needs of Patients With Chronic Limb-Threatening Ischemia: A Scoping Review.","authors":"Hironori Ohinata, Naomi Akiyama, Arisa Kawashima, Hanako Nozu, Haruka Tamura, Kei Matoba, Miyuki Toda, Shintaro Togashi","doi":"10.1016/j.jpainsymman.2025.08.018","DOIUrl":"10.1016/j.jpainsymman.2025.08.018","url":null,"abstract":"<p><strong>Context: </strong>Chronic limb-threatening ischemia is associated with a high risk of limb amputation and infection and includes lower limb ischemia, rest pain and gangrene, and impaired physical function. Palliative care for patients with chronic limb-threatening ischemia and their caregivers is important. However, reports on the need for palliative care are in consistent.</p><p><strong>Objectives: </strong>To conduct a scoping review to identify the palliative care needs of patients with chronic limb-threatening ischemia and their caregivers.</p><p><strong>Methods: </strong>We adopted the methodological framework for scoping reviews outlined by Arksey and O'Malley. The protocol was registered with the Open Science Framework (https://osf.io/xc2vq/). PubMed, Ovid Embase, Web of Science, EBSCO CINAHL, Cochrane Library, PsycINFO, and Google scholar were used. Eligibility criteria were studies that described palliative care needs of patients with chronic limb-threatening ischemia and their caregivers, with no limitations on the publication year.</p><p><strong>Results: </strong>Of the 2663 articles, 14 met the eligibility criteria. The major palliative care needs were in relation to structure and process, including early intervention in palliative care and in multidisciplinary teams. Additionally, it was found that healthcare providers did not assess care needs using a comprehensive scale. Two studies used pain scales, such as the Numerical Rating Scale, and one study used a quality of life scale.</p><p><strong>Conclusion: </strong>We recommend that hospitals improve palliative care delivery systems for patients with chronic limb-threatening ischemia and their caregivers and assess their needs using comprehensive patient-reported outcome scales. Further research using existing patient-reported outcome measures that comprehensively assess palliative care needs is needed.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescents' and Young Adults' Perspectives on Decision-Making and the Emotional Experience of Having Advanced Cancer.","authors":"Nelda Itzep, Jessica Moore, Colleen Gallagher, Michael Roth, Peyton Martin, Mike Hernandez, Karen M Moody","doi":"10.1016/j.jpainsymman.2025.07.036","DOIUrl":"10.1016/j.jpainsymman.2025.07.036","url":null,"abstract":"<p><strong>Context: </strong>Adolescents and young adults (AYAs) with advanced cancer represent a unique and vulnerable population. Little is known about the optimal approach to support their medical decision-making needs.</p><p><strong>Objectives: </strong>The objective of this cross-sectional survey study was to elucidate the perspectives of AYAs with advanced cancer regarding their emotional experience of having cancer and their decision-making needs.</p><p><strong>Methods: </strong>Between April 2020 and December 2023, AYAs with advanced cancer were surveyed using the Herth Hope Index (HHI), the Peace, Equanimity, and Acceptance of Cancer Experience scale (PEACE), The Human Connection scale (THC), and the Child and Adolescent Participation in Decision Making Questionnaire (CAPDMQ). Descriptive analyses, t-tests, and Wilcoxon rank-sum tests were used to assess associations between demographic and clinic variables with patient responses.</p><p><strong>Results: </strong>Fifty-seven AYAs participated. The median age was 22 years (range: 15-29); 51% were female. Majority of participants were White (68%), non-Hispanic (61%), single (96%), and Christian (67%). The most common diagnosis was sarcoma (39%). Most participants reported acceptance and peace with their illness, yet many struggled with changes in physical appearance, the unfairness of getting cancer, and angry feelings related to their illness. Participants also reported high levels of therapeutic alliance with their doctors. These AYAs reported remaining hopeful and future oriented despite their prognosis. They also reported a strong belief that AYAs should be involved in decision-making.</p><p><strong>Conclusion: </strong>Most AYAs accepted their illness and found peace, yet many still felt the burden of disease and fear about the future. Despite this, they felt hopeful and remained future oriented. AYAs value being involved in decision-making; further work is needed to develop clinical guidelines to facilitate shared decision-making for this population.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Dose Naltrexone for Refractory Cancer Pain: Case Series of Initial Safety and Effectiveness.","authors":"Aila Malik, Alice Ye, Matthew Chung","doi":"10.1016/j.jpainsymman.2025.08.015","DOIUrl":"10.1016/j.jpainsymman.2025.08.015","url":null,"abstract":"<p><strong>Context: </strong>Low dose naltrexone (LDN) has been utilized off-label for chronic non-cancer pain; its benefits in treating cancer-related pain remain unclear.</p><p><strong>Objectives: </strong>We describe the safety and effectiveness of LDN therapy from initiation to the first two follow-up visits in treating refractory cancer-pain.</p><p><strong>Methods: </strong>Medical charts of cancer patients seen in the Pain Management Center who were prescribed LDN between 2022 and 2023 were reviewed. They were classified as \"responders\" if they attributed improvement in their primary pain complaints to LDN therapy.</p><p><strong>Results: </strong>Among the 20 cancer patients who were prescribed LDN, the most common cancer diagnosis was breast cancer (45%). There were 10 patients with cancer burden-related pain and 10 patients with therapy-related pain. Positive response rates of 80% (16/20), and 76.9% (10/13) were recorded at the first and second follow-up visits, respectively which occurred at a mean (SD) of 65.9 (53.3), and 104.8 (60.4) days following LDN initiation, respectively. The most common maximum titration dose of naltrexone was 3.0 mg daily (n = 9) (range 1.5-4.5 mg daily). Therapy-related neuropathy accounted for seven cases with a 71% positive response rate in this subset at the first follow-up. Minor adverse events were noted in two patients (insomnia, GI upset) at the first follow-up; these did not require discontinuation of LDN. The discontinuation rate by the second follow-up was 15% (3/20) (two with inadequate pain relief, one with diarrhea).</p><p><strong>Conclusion: </strong>Early follow-up indicates potential benefits for patients with refractory cancer pain with LDN being well-tolerated, with a low incidence of adverse events.</p>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}