{"title":"Respiratory complications of systemic autoimmune diseases: the emerging and important role of palliative care.","authors":"Laura Ross, Julie McDonald, Elizabeth R Volkmann","doi":"10.1097/SPC.0000000000000797","DOIUrl":"10.1097/SPC.0000000000000797","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Respiratory disease is a major cause of morbidity and mortality for patients with systemic autoimmune diseases. Chronic exertional fatigue, breathlessness, and cough all cause significant impairment of quality of life. In this review, we summarize the major respiratory complications of systemic autoimmune diseases and consider the evidence supporting the role that palliative care can play in the management of systemic autoimmune disease.</p><p><strong>Recent findings: </strong>The symptom burden suffered by patients with systemic autoimmune diseases is equivalent to that of patients with active malignancy. Recent studies have explored how palliative care could be integrated with rheumatology care to improve symptom control and address the high psychosocial burden associated with living with a systemic autoimmune disease. Both rheumatologists and palliative care providers are uncertain as to the role of palliative care in the management of systemic autoimmune diseases, with the optimal model of integrated palliative care yet to be defined.</p><p><strong>Summary: </strong>Emerging evidence supports the acceptability and value of palliative care to patients living with a systemic autoimmune disease and their caregivers. However, there are both patient and physician associated barriers to the integration of palliative care with rheumatology care. Studies are required to demonstrate the efficacy of palliative care in the management of systemic autoimmune diseases.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"80-87"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dysphagia, aspiration, and respiratory problems in people with chronic respiratory illness.","authors":"Phyllis M Palmer, Paula Leslie","doi":"10.1097/SPC.0000000000000803","DOIUrl":"10.1097/SPC.0000000000000803","url":null,"abstract":"<p><strong>Purpose: </strong>Dysphagia, aspiration, and respiratory dysfunction are interlinked with shared neural control and biomechanical demands. Recent respiratory-swallow coordination research and scrutiny of long-standing dysphagia interventions necessitate reappraisal of aspiration risk, airway protection, and clinical decision making. These issues are particularly relevant in chronic respiratory illness and palliative care, where dyspnoea, frailty, and quality-of-life considerations strongly influence eating and drinking decisions.</p><p><strong>Recent findings: </strong>Breathing and swallowing are coordinated by overlapping brainstem pattern generators, a fundamental neural relationship in airway protection with important implications for eating and drinking across health and disease. Chronic respiratory disease disrupts this coordination through heightened respiratory drive and reduced physiologic reserve. Evidence increasingly demonstrates that aspiration alone does not predict adverse pulmonary outcomes; rather the consequences depend on aspirate characteristics, bacterial burden, and host defences. Traditional interventions such as thickened liquids, non-oral feeding, and the use of chin tuck show limited evidence for preventing pulmonary complications and may increase dyspnoea or distress.</p><p><strong>Summary: </strong>Current evidence supports moving beyond aspiration as a binary outcome toward individualized, person-centred risk-benefit assessment. Good oral health care is a significant and underused approach to reducing respiratory complications. Expiratory muscle strength training and motor imagery show promise in supporting impaired swallow and respiratory function. Frameworks integrating host factors, respiratory status, and lived experience better support ethical, informed clinical decision making, particularly in chronic respiratory disease and palliative care.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"88-97"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical decision support system for breathlessness.","authors":"Anthony Sunjaya, Christine R Jenkins","doi":"10.1097/SPC.0000000000000801","DOIUrl":"10.1097/SPC.0000000000000801","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes high-level evidence on clinical decision support systems, both more classical rules-based and emerging artificial intelligence-based examples. It discusses their potential and concerns, how to evaluate them and describes future directions based on published evidence, clinical experience and broader experience working with others in this space.</p><p><strong>Recent findings: </strong>There is significant potential for CDSS to benefit elicitation and assessment of breathlessness, assist clinical decision making, improve interpretation of common diagnostic tests for breathlessness and personalize management and patient education. Even so, current evidence from trials and real-world studies in this space remains limited with multiple studies ongoing. However, evidence from studies of model development indicates that CDSS have clinically acceptable performance levels for differentiating breathlessness causative conditions such as COPD, heart failure, lower respiratory tract infection or combinations of these. The extent to which this evidence translates to real world clinical benefits remains unknown.</p><p><strong>Summary: </strong>In the era of CDSS leveraging significant volumes of data, there is the potential to augment the less precise nature of clinician prediction with that of AI prediction. This, combined with clinical judgment can support better care for patients and populations. CDSS are likely to be particularly valuable in settings with workforce constraints though we must also remember that there are limitations to CDSS use and applicability. It remains important to support and undertake high quality studies testing these tools in clinical practice.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"98-105"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oscar Y Franco Rocha, Michelle C Janelsins, Allison Magnuson
{"title":"Decision-making and treatment planning for older adults with pre-existing cognitive impairment and cancer.","authors":"Oscar Y Franco Rocha, Michelle C Janelsins, Allison Magnuson","doi":"10.1097/SPC.0000000000000804","DOIUrl":"10.1097/SPC.0000000000000804","url":null,"abstract":"<p><strong>Purpose of review: </strong>The review aims to synthesize the current evidence on decision-making and cancer treatment planning for older adults with pre-existing cognitive impairment, Alzheimer's disease, and other related dementias.</p><p><strong>Recent findings: </strong>Current decision-making practices are not standardized, and evidence suggests that oncology physicians conduct burden-benefit analyses to guide treatment planning. There was a consensus on the importance of involving caregivers into the decision-making process. However, caregivers experience feelings of anxiety, uncertainty, and extra burden when deciding between treatment options and providing care. Nursing home staffs were frequently excluded from the decision-making process and were perceived as unprepared to identify and manage cancer symptoms. The planning and provision of care for this population can be guided by a comprehensive geriatric assessment (CGA). CGA can inform the decision-making process based on the patient's functionality and caregiver's resources, facilitate management of cancer care, guide the identification and management of cancer symptoms, and assist communication with patients and their caregivers.</p><p><strong>Summary: </strong>Decision-making and treatment planning for older adults with cancer and pre-existing cognitive impairment lacks standardization. CGA offers a standardized approach to guide treatment decisions, manage symptoms, and coordinate care by highlighting the needs and resources of patients and caregivers.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"106-111"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Impact of increasing overweight and obesity on breathlessness: a review.","authors":"Jacob Sandberg","doi":"10.1097/SPC.0000000000000798","DOIUrl":"10.1097/SPC.0000000000000798","url":null,"abstract":"<p><strong>Purpose of review: </strong>To summarize and critically interpret new evidence (from the last 12-18 months) on the associations between obesity and breathlessness, including epidemiology, physiological mechanisms, diagnostic challenges, and treatment approaches.</p><p><strong>Recent findings: </strong>Multiple large cohorts confirm that obesity is one of the strongest independent predictors of exertional breathlessness. Recent work has expanded the understanding of mechanical, metabolic, and ventilatory contributors to breathlessness in obesity. Novel spirometric and oscillometric data clarify small airway dysfunction and decreased lung compliance. Obesity-related cardiac loading could be an important and potentially treatable contributor to breathlessness. Interventional studies show improvements in breathlessness following weight loss, particularly after bariatric procedures, though data on pharmacologic weight-loss therapies remain limited.</p><p><strong>Summary: </strong>Obesity is strongly associated with breathlessness and likely contributes through combined mechanical, metabolic, and ventilatory factors. Treatment remains centred on weight loss, but the evidence is scarce. Future work should prioritize breathlessness-specific outcomes in obesity interventions.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"63-70"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The prevalence of persisting breathlessness despite treatment in chronic conditions.","authors":"Hayley Lewthwaite, Naomi Takemura","doi":"10.1097/SPC.0000000000000799","DOIUrl":"10.1097/SPC.0000000000000799","url":null,"abstract":"<p><strong>Purpose of review: </strong>Breathlessness impairs all aspects of daily life and places substantial burden on healthcare systems. This review explores the prevalence of breathlessness that persists despite optimal treatment in chronic conditions. Defining its scale is essential to ensure recognition and provision of evidence-based, breathlessness-specific interventions alongside disease management. Despite advances in breathlessness management research over the past decade, persistent breathlessness remains unacceptably common, reflecting implementation gaps and limited access to effective therapies.</p><p><strong>Recent findings: </strong>Recent systematic reviews report breathlessness in 35-87% of people with cancer, with episodic breathlessness affecting up to 80% of those with persistent symptoms. Across primary studies in COPD, asthma, pulmonary fibrosis, pulmonary vascular and neurological conditions, and cancer, prevalence ranges from 9% to 91%. Even among people receiving guideline-based disease treatment, 38-53% report clinically relevant breathlessness. The mMRC dyspnea scale may underestimate prevalence compared with exercise testing and multidimensional questionnaires.</p><p><strong>Summary: </strong>Persistent breathlessness remains common across major chronic diseases, often despite optimal disease therapy. Clinicians across all sectors of healthcare should routinely ask people about their breathlessness, and evidence-based strategies should be offered as part of routine, integrated symptom management to help reduce the high burden of persistent breathlessness in clinical populations.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"71-79"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute oncology: the care of older patients in the emergency department.","authors":"Jason den Duijn, Christian H Nickel, Tim Cooksley","doi":"10.1097/SPC.0000000000000789","DOIUrl":"10.1097/SPC.0000000000000789","url":null,"abstract":"<p><strong>Purpose of review: </strong>There has been a notable rise in cancer-related emergencies, especially in older patients, due to an increase in those undergoing complex therapies. In this review, we consider the management and clinical workup of the older cancer patient in the emergency department (ED). We will reflect on clinical features of older patients with cancer, as well as fall, delirium, febrile neutropenia (FN), and immune checkpoint inhibitor toxicity.</p><p><strong>Recent findings: </strong>Older patients with cancer are more likely to require admission to hospital following ED attendance. The most common emergency presentations are fever, pain and gastrointestinal symptoms. The complexity of common presentations, such as falls and delirium, is often overlooked in older cancer patients. FN in older patients is associated with increased mortality and a higher likelihood of requiring inpatient care. Despite their therapeutic benefits in older patients, the broad spectrum of immune-related toxicities even at lower grades, can lead to functional decline and the need to discontinue therapy.</p><p><strong>Summary: </strong>The number of older people with cancer presenting to emergency care is expected to rise. In response to this growing and complex demand, a comprehensive, individualised, and multi-disciplinary approach is essential. Clinicians need to be aware of the increasingly broad spectrum of diagnoses in this population and tailor their assessment and management strategies accordingly.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"11-17"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145821774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Britney Zhang, Amari Randhawa, Ayush Patel, Eduardo Bruera, Nicolas H Hart, Andrew Bottomley, David Cella, Muna Al-Khaifi, Partha Patel, Edward Chow, Henry C Y Wong
{"title":"Comparing FACIT-fatigue and EORTC QLQ-FA12 for assessing the quality of life in people with cancer-related fatigue.","authors":"Britney Zhang, Amari Randhawa, Ayush Patel, Eduardo Bruera, Nicolas H Hart, Andrew Bottomley, David Cella, Muna Al-Khaifi, Partha Patel, Edward Chow, Henry C Y Wong","doi":"10.1097/SPC.0000000000000791","DOIUrl":"10.1097/SPC.0000000000000791","url":null,"abstract":"<p><strong>Purpose of review: </strong>Two common quality of life (QoL) questionnaires for cancer-related fatigue (CRF) are the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Fatigue 12 (QLQ-FA12) and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue). This systematic review compared their content, validity, and psychometric properties.</p><p><strong>Recent findings: </strong>Twenty-four studies were included. The QLQ-FA12 (12 items) provides physical, emotional, and cognitive subscales, while the FACIT-Fatigue (13 items) captures self-reported fatigue and its impact on daily function. Both instruments demonstrated validity, internal consistency, test-retest reliability, and sensitivity. Construct validity was supported by correlations with QoL and physical-function measures, and confirmatory factor analyses upheld their intended dimensional structures. The QLQ-FA12's 4-point question format offers distinct domain scores, whereas the FACIT-Fatigue's 5-point statement format yields a single total score. The QLQ-FA12 is preferred when a multidimensional profile is needed, such as in trials addressing specific fatigue drivers or pairing with QLQ-C30 domains. The FACIT-Fatigue suits brief screening or large-scale studies where efficiency and a single total fatigue score are priorities.</p><p><strong>Summary: </strong>The EORTC QLQ-FA12 and FACIT-Fatigue are both sufficiently validated for assessing CRF-related QoL. The QLQ-FA12 is more appropriate when a multidimensional profile is required, whereas FACIT-Fatigue suits contexts needing a unidimensional total severity score.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"52-61"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Defining thresholds for meaningful interpretation of patient-reported outcome scores.","authors":"Kim Cocks, Johannes M Giesinger","doi":"10.1097/SPC.0000000000000788","DOIUrl":"10.1097/SPC.0000000000000788","url":null,"abstract":"<p><strong>Purpose of review: </strong>There are many different patient-reported outcome measures to assess how patients feel or function but they vary in how they collect responses and score results. Therefore, it can be hard to know what a change in score means for a patient or whether treatments compared in a trial result in different patient experiences. Methods exist to estimate thresholds to aid interpretation, but no single method is considered the best. This review considers recent advances in efforts to improve these methods.</p><p><strong>Recent findings: </strong>New research has been published on the choice of appropriate anchors and the methods to establish thresholds based on them. There has been increased focus on the derivation of thresholds used to compare scores between groups of patients versus those used to interpret an individual's change in scores over time. Studies are also highlighting how baseline severity and other factors affect how we estimate thresholds.</p><p><strong>Summary: </strong>Consensus on the optimal methods for the derivation of score interpretation thresholds is still required, although the field continues to grow in understanding biases and impacts of treatment and population factors on estimation.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"18-23"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Juan J Fierro, Seamus Coyle, Barry J A Laird, Lia van Zuylen
{"title":"Driving innovation in cancer symptom science through translational research: bridging science and practice.","authors":"Juan J Fierro, Seamus Coyle, Barry J A Laird, Lia van Zuylen","doi":"10.1097/SPC.0000000000000792","DOIUrl":"10.1097/SPC.0000000000000792","url":null,"abstract":"<p><strong>Purpose of review: </strong>Translational research is a dynamic process that aims to apply fundamental scientific discoveries into clinical practice through strong cooperation between scientists and healthcare providers. This review discusses recent advances in symptom science within palliative care, driven by translational research, and highlights the pressing need to bridge the gap between scientific innovation and clinical practice.</p><p><strong>Recent findings: </strong>The dramatic change in the cancer landscape in the last decade has been achieved through translational research. However, the role of translational research in symptom science in palliative care for patients with cancer has been chronically neglected. Recently, initial progress has been made in symptom prediction through biomarker discovery for distressing syndromes, such as delirium or cancer-related cachexia. Other areas where translational approaches offer promise include predicting survival and identifying the dying phase in patients with advanced cancer.</p><p><strong>Summary: </strong>Despite some progress in introducing translational research into palliative care, significant challenges persist, limiting the full potential of integrative and collaborative research to improve patient outcomes in cancer palliative care. Herein, key areas are discussed, including emerging themes and tools that could help bridge this gap.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"45-51"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12851542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}