Current Opinion in Supportive and Palliative Care最新文献

{"title":"Fan therapy for breathlessness - how do you do it and why?","authors":"Tim Luckett, Mary Roberts, Flavia Swan","doi":"10.1097/SPC.0000000000000752","DOIUrl":"10.1097/SPC.0000000000000752","url":null,"abstract":"<p><strong>Purpose of the review: </strong>This review summarises high-level evidence for fan therapy and adds a commentary on the relatively-neglected question of how to optimise benefits based on qualitative evidence, clinical experience and broader research and theory.</p><p><strong>Recent findings: </strong>Recent high-level evidence suggests the fan reduces time to recovery from episodic breathlessness rather than reduces daily levels over a longer period. Lower grade evidence suggests the fan can also help people increase their physical activity. Experimental evidence for physiological mechanisms suggests that airflow reduces inspiratory neural drive and perceived unpleasantness through facial cooling of the trigeminal and olfactory nerves. Faster airflow elicits a stronger effect, with the optimal balance between efficacy and comfort proposed to be 2.85 metres per second. Research on clinician perspectives highlights the need for targeted strategies to drive fan implementation.</p><p><strong>Summary: </strong>Fan therapy contributes to all three domains of the Breathing, Thinking, Functioning model of breathlessness management. Given it is affordable, portable, and has no known harms, the fan should be recommended as first-line therapy for anyone with breathlessness. Future research should evaluate how best to integrate fan therapy as a complex intervention alongside other strategies and supports.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"111-116"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606867","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":"Breathlessness in the general population.","authors":"Alexander Müller, Emiel F M Wouters, Daisy J A Janssen","doi":"10.1097/SPC.0000000000000751","DOIUrl":"10.1097/SPC.0000000000000751","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Breathlessness is a prevalent symptom that significantly affects physical and mental health. While commonly associated with respiratory and cardiovascular diseases, breathlessness is increasingly recognised as a concern in the general population. This review summarises recent research on the prevalence, risk factors, assessment methods, and clinical and societal impact, with a focus on findings from the past 18 months.</p><p><strong>Recent findings: </strong>Recent studies indicate that breathlessness affects a substantial proportion of adults worldwide, with prevalence varying across populations and regions. Identified risk factors include older age, female sex, high body mass index, smoking, and comorbidities such as respiratory and cardiovascular diseases. Novel approaches in assessing breathlessness are looking beyond unidimensional scales to improve diagnostic accuracy. However, breathlessness remains underdiagnosed in clinical practice. Recent publications also show that breathlessness has a substantial impact on health outcomes of the affected person, but also imposes a burden on their informal caregivers, health care systems and the economy.</p><p><strong>Summary: </strong>Despite progress in understanding chronic breathlessness, knowledge gaps persist, particularly regarding its assessment in large-population samples. Longitudinal studies are needed to understand risk factors for breathlessness and its impact on health outcomes and society.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"65-70"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558541","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}

{"title":"Evaluation of the EORTC QLQ-C15-PAL and the FACIT-PAL-14 in assessing the quality of life in patients with advanced cancer.","authors":"Paula Tur, Eva Oldenburger, Andrew Bottomley, David Cella, Shing Fung Lee, Adrian W Chan, Gustavo Nader Marta, Timothy Jacobs, Edward Chow, Henry C Y Wong, Agata Rembielak","doi":"10.1097/SPC.0000000000000750","DOIUrl":"10.1097/SPC.0000000000000750","url":null,"abstract":"<p><strong>Purpose of review: </strong>Two widely validated health-related quality of life (HR-QoL) tools, specifically designed for patients with advanced cancer, are the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL) and the Functional Assessment of Chronic Illness Therapy-Palliative (FACIT-Pal-14). This systematic review aims to evaluate the use of EORTC QLQ-C15-PAL and FACIT-Pal-14 in prospective studies in patients with advanced cancer, focusing on study types, clinical settings, additional HR-QoL tools used, and completion rates.</p><p><strong>Recent findings: </strong>Sixty studies were included in the analysis. Both EORTC QLQ-C15-PAL and FACIT-Pal-14 are used in a variety of studies. Given that EORTC QLQ-C15-PAL was developed 9 years before FACIT-Pal-14 PAL, most studies utilized the EORTC tool. Both tools were shown to be successfully used in a variety of clinical settings, including in various advanced tumour types or different study designs, depending on the investigator and study needs.</p><p><strong>Summary: </strong>This review demonstrates the wide range of utilization of EORTC QLQ-C15-PAL and FACIT-Pal-14 in prospective studies to assess the HR-QoL issues in patients with advanced cancers.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"130-137"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606840","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":"Recent advances in understanding the role of antidepressants to manage breathlessness in supportive and palliative care.","authors":"Irene J Higginson, Sabrina Bajwah, Małgorzata Krajnik, Caroline J Jolley, David Hui","doi":"10.1097/SPC.0000000000000761","DOIUrl":"10.1097/SPC.0000000000000761","url":null,"abstract":"<p><strong>Purpose of review: </strong>Breathlessness is a prevalent and distressing symptom in palliative and supportive care, with limited licensed pharmacological options once disease-directed therapies are no longer effective. Antidepressants have been proposed as a potential treatment, even in the absence of comorbid mood disorders, due to their modulation of neural circuits and serotonin pathways involved in breathlessness perception. Despite their off-label use in clinical practice for managing refractory or chronic breathlessness, robust evidence supporting their efficacy is needed. This review critically evaluates the latest evidence on their potential benefits and safety in breathlessness management.</p><p><strong>Recent findings: </strong>Breathlessness is influenced by at least three interrelated axes: lung-brain, behavioural-functional, and psycho-social-spiritual. These mechanisms operate across diseases, making them relevant in palliative and supportive care. Despite promise from early case reports and small trials, two recent large, randomised studies of mirtazapine and sertraline found no benefit in alleviating breathlessness or improving other outcomes. The mirtazapine trial also reported more adverse events than placebo. Earlier trials were small with design limitations, reducing reliability. A 2016 trial of sertraline found benefits for depression in stable COPD. Recent concerns over increased morbidity associated with antidepressant use in respiratory disease highlight the need for early detection of people at risk of worsening breathlessness or depression and a holistic, individualised approach.</p><p><strong>Summary: </strong>Current evidence does not support antidepressants for breathlessness in respiratory disease. Non-pharmacological approaches should be first line, given their proven benefits and low risk. Off-label medicine use requires caution and should ideally be offered within a trial or evaluation. Given the complex nature of breathlessness, future research should focus on innovating and then testing treatments and therapies in well-designed trials with appropriate outcome measures and reporting of adverse events, health care use and informal carer effects.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":"19 2","pages":"83-94"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005057","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}

{"title":"Real-world implementation of geriatric assessment in cancer care among older adults: the role of implementation science frameworks.","authors":"Irene Blackberry, Jennifer Boak, Tshepo Rasekaba, Christopher Steer","doi":"10.1097/SPC.0000000000000740","DOIUrl":"10.1097/SPC.0000000000000740","url":null,"abstract":"<p><strong>Purpose of review: </strong>The evidence supporting geriatric assessment (GA) in cancer care is well established, and GA is recommended by the American Society of Clinical Oncology, the International Society of Geriatric Oncology, and other oncology bodies. However, effective implementation of GA remains inadequate. Using selected papers indexed in Medline from the most recent 18 months to July 2024, including two outstanding interest papers, this review aimed to describe enablers and barriers to GA implementation in oncology and contrasts implementation with and without an implementation science framework. Finally, we make recommendations on applying an implementation science framework to facilitate integrating GA in oncology.</p><p><strong>Recent findings: </strong>Implementation science frameworks have been widely employed in health services research, but their use in geriatric oncology, particularly to guide GA implementation and evaluation, is limited. Lack of time in busy practices coupled with workforce shortages adds to the challenges of GA implementation and adoption. A variety of screening and assessment tools such as the G8, electronic rapid fitness assessment, and Eastern Cooperative Oncology Group are often used in lieu of geriatrician review and to streamline GA. When effectively implemented in oncology, GA informs care and treatment decisions for improved outcomes.</p><p><strong>Summary: </strong>Despite the benefits for older adults, embedding GA into routine clinical practice is critical yet not common practice. The variety of available GA tools, logistics, and individual beliefs are some of the identified barriers to GA adoption in oncology. Enablers include organization readiness, adaptability, communication, and the use of multidisciplinary teams. Further research is needed to examine how implementation science frameworks could provide guidance and structure for successful GA implementation in oncology.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":"19 1","pages":"12-18"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071276","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":"Buprenorphine: an old dog with new tricks.","authors":"Ai Deen Ng, Andrew Dickman","doi":"10.1097/SPC.0000000000000743","DOIUrl":"10.1097/SPC.0000000000000743","url":null,"abstract":"<p><strong>Purpose of review: </strong>The survival rate of patients with a cancer or palliative care diagnosis has improved over the years although pain remains a debilitating symptom that many patients still require treatment with opioids. Compared to full mu-opioid receptor agonists such as morphine and oxycodone, buprenorphine continues to remain a second- or third-line choice in this group of patients.We have reviewed the pharmacology and clinical utility of buprenorphine to stimulate debate around the first-line use of buprenorphine in the management of pain in cancer patients.</p><p><strong>Recent findings: </strong>Buprenorphine has a pharmacological profile that is unique and unlike any other opioid. It is associated with many immediate and long-term benefits, with lower risks of adverse effects that make it an ideal first-line choice in the management of cancer pain.</p><p><strong>Summary: </strong>Buprenorphine appears to be a promising choice of opioid for cancer patients. Studies have found that buprenorphine is a safe and effective choice for many patients, making it a suitable first-line option for the management of cancer pain.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":"19 1","pages":"59-64"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071252","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":"Social determinants of health and health outcomes in older cancer survivors.","authors":"Zachary Siegel, Ashley Smith-Nuñez, Marquita W Lewis","doi":"10.1097/SPC.0000000000000746","DOIUrl":"10.1097/SPC.0000000000000746","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Today, two-thirds of all cancer survivors are at least 65 years old. Older cancer survivors have complex care needs, and addressing their social determinants of health (SDoH) is critical for improving and managing survivorship outcomes for this uniquely vulnerable population, yet research specifically examining these associations remains limited and emergent. To this end, we describe the emergent body of evidence on the associations between SDoH domains and older cancer survivors' outcomes.</p><p><strong>Recent findings: </strong>Despite the limited investigations of SDoH on the health outcomes of older cancer survivors, there were measures representing all domains of SDoH - health care access and quality, education access and quality, neighborhood and built environment, social and community context, and economic stability. We reviewed another determinant, Digital Environment and Engagement, as they are highly relevant to older cancer survivors' care. Studies primarily investigated outcomes such as the use of or delays in treatment and variables related to care coordination. Generally, poorer access to resources such as income, social networks, and quality health care facilities predicted poorer health outcomes.</p><p><strong>Summary: </strong>We reviewed studies that revealed that SDoH significantly impacts older cancer survivors' health outcomes. Our description informs future interventions and policies to improve their care.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"19-24"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025168","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}

{"title":"The use of precision radiotherapy for the management of cancer-related pain in the abdomen.","authors":"Aisling M Glynn, Yaacov R Lawrence, Laura A Dawson, Aisling S Barry","doi":"10.1097/SPC.0000000000000738","DOIUrl":"10.1097/SPC.0000000000000738","url":null,"abstract":"<p><strong>Purpose of review: </strong>Abdominal pain due to cancer is a significant and debilitating symptom for cancer patients, which is commonly undertreated. Radiotherapy (RT) for the management of abdominal cancer pain is underused, with limited awareness of its benefit. This review presents a discussion on current precision RT options for the management of cancer pain in the abdomen.</p><p><strong>Recent findings: </strong>Precision RT focuses on delivering targeted and effective radiation doses while minimizing damage to surrounding healthy tissues. In patients with primary or secondary liver cancer, RT has been shown to significantly improve liver related cancer pain in the majority of patients. Also, symptom sequelae of tumour thrombus may be relieved with the use of palliative RT. Similarly, single dose, high precision stereotactic RT to the celiac plexus has been shown to significantly improve pain in patients with pancreatic cancer. Pain response for adrenal metastases has been less commonly investigated, but small series suggest that stereotactic body RT may reduce or alleviate pain.</p><p><strong>Summary: </strong>RT is an effective option for the treatment of abdominal cancer pain. RT should be considered within the multidisciplinary treatment armamentarium, and may be successfully integrated, alone or in conjunction with other treatment modalities, in abdominal cancer-related pain.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":" ","pages":"51-58"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820016","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":"Palliative radiotherapy for the hemostasis of bleeding tumors: an overview of the most recent literature.","authors":"Manuel Guhlich, Pieter Verschuren, Eva Oldenburger","doi":"10.1097/SPC.0000000000000741","DOIUrl":"10.1097/SPC.0000000000000741","url":null,"abstract":"<p><strong>Purpose of review: </strong>Palliative radiotherapy is frequently applied for various indications, with hemostasis being a quite common one. However, while bleeding can occur at different sites and arise from various primary tumor types, clear guidelines for administering hemostatic radiotherapy are lacking. Additionally, most available data on hemostatic radiotherapy are retrospective, and often studies do not focus on hemostasis specifically. This review provides an overview of the most recent data on hemostatic radiotherapy to identify any research trends and focus areas for this specific topic.</p><p><strong>Recent findings: </strong>This review confirms the value of radiation for tumor bleeding. Unfortunately, research in hemostatic radiotherapy predominantly continues to focus on retrospective analyses of treated patients. However, at least two prospective trials specifically investigating hemostasis have been published recently, both conducted in low-income countries.</p><p><strong>Summary: </strong>Radiotherapy is an effective and well-tolerated treatment for bleeding tumors. As the incidence of advanced cancer rises in low- and middle-income countries, where resources are limited, further research should focus on hypofractionated regimens. Additionally, there is a need for comprehensive descriptions of contouring and treatment planning to optimize outcomes in these settings.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":"19 1","pages":"33-40"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071262","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":"Blood-based biomarkers of frailty in older patients with cancer.","authors":"Baran Akagunduz, Yakup Ergün, Dig dem Dog An Akagündüz, Nergis Akbas, Dilara Akagündüz, Aziz Karaog Lu, Pinar Soysal","doi":"10.1097/SPC.0000000000000747","DOIUrl":"10.1097/SPC.0000000000000747","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to evaluate the current evidence on blood-based biomarkers for frailty detection in older cancer patients. It explores the potential of various biomarkers, including inflammatory markers and microRNAs (miRNAs), to serve as indicators of frailty and examines the limitations of existing studies. The review also highlights the need for further research to validate these biomarkers and improve their clinical applicability.</p><p><strong>Recent findings: </strong>Recent studies have examined blood biomarkers associated with frailty in older cancer patients. Findings suggest that elevated granulocyte levels and lower macrophage-derived stem cells and regulatory T cells are linked to frailty. Inflammatory biomarkers such as interleukin-6 and specific miRNAs, as well as higher neutrophil-to-lymphocyte ratios, have also been identified as potential indicators of frailty. While these biomarkers show promise, no single marker has proven sufficient, and combining them may improve frailty detection. Further research is needed to validate their clinical usefulness in this population.</p><p><strong>Summary: </strong>Blood-based biomarkers show potential for detecting frailty in older patients with cancer, but further research is needed, particularly beyond an inflammatory focus and with more robust study designs.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":"19 1","pages":"25-32"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071249","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}