{"title":"Early integration of palliative care in haemato-oncology: latest developments.","authors":"Constantina Papadopoulou, Bridget Johnston","doi":"10.1097/SPC.0000000000000728","DOIUrl":"https://doi.org/10.1097/SPC.0000000000000728","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aimed to explore recent progress made in the past five years towards early access to, and integration of palliative care services within the haemato-oncology context to address the unique needs of patients with Haematological malignancies (HMs).</p><p><strong>Recent findings: </strong>We included 14 articles in our review. We identified three themes, namely (i) disparities in the timing of referrals remain, (ii) specialist palliative care and impact on quality of life and (iii) perceptions on early integration. Patients with HM, receive less palliative care services, regardless of their higher symptom burden compared to patients with solid tumours. Structured approaches and models of early integration have shown substantial benefits, including improved pain and symptom management, shorter hospital stays and better end of life planning. Perceptions on existing barriers include the curative treatment focus, haematologists' personal perceptions on timing of palliative care and lack of palliative care training.</p><p><strong>Summary: </strong>For early integration to happen, it is crucial to address training gaps, improve communication skills, and foster interdisciplinary collaboration. Standardised organisational pathways can facilitate early and concurrent palliative care integration. System-level flexibility and supportive policies are essential to ensure that patients with HM receive comprehensive and high-quality care.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569588","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}
Anouk J L Muijsenberg, Sarah Houben-Wilke, Martijn A Spruit, Daisy J A Janssen
{"title":"Education for people with serious chronic respiratory diseases and their informal caregivers: how to address challenges that impact learning.","authors":"Anouk J L Muijsenberg, Sarah Houben-Wilke, Martijn A Spruit, Daisy J A Janssen","doi":"10.1097/SPC.0000000000000719","DOIUrl":"https://doi.org/10.1097/SPC.0000000000000719","url":null,"abstract":"<p><strong>Purpose of review: </strong>Shared decision making is crucial in palliative care for people with serious chronic respiratory diseases and their informal caregivers. Patient education is a critical component in this process, as it provides patients and their informal caregivers the necessary knowledge for informed decisions regarding symptom management, coping with breathlessness, and advance care planning. However, education does not automatically lead to acquiring knowledge. This review describes challenges for education for people with serious chronic respiratory diseases and their informal caregivers and describes how learner-centered education can address these.</p><p><strong>Recent findings: </strong>People with serious chronic respiratory diseases and their informal caregivers face diverse information needs and learning challenges, with low health literacy and cognitive problems being common. Healthcare professionals can facilitate learner-centered education by enhancing motivation for knowledge acquisition by meeting information needs and learning preferences of patients and their informal caregivers, and by ensuring that information is understandable and readable for those with low health literacy and cognitive problems. E-health applications may serve as valuable tools in this process.</p><p><strong>Summary: </strong>Learner-centered education may enhance knowledge acquisition in people with serious chronic respiratory diseases and their informal caregivers aiming to gain control over symptoms and optimize shared decision making and advance care planning.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569874","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}
Caroline Mogan, Nathan Davies, Karen Harrison Dening, Mari Lloyd-Williams
{"title":"Innovative and best models of palliative and end-of-life care - with focus on rural and remote communities.","authors":"Caroline Mogan, Nathan Davies, Karen Harrison Dening, Mari Lloyd-Williams","doi":"10.1097/SPC.0000000000000735","DOIUrl":"10.1097/SPC.0000000000000735","url":null,"abstract":"<p><strong>Purpose of review: </strong>The review aims to synthesize the most recent innovative models of palliative care being delivered in rural and remote locations.</p><p><strong>Recent findings: </strong>Worldwide, as the ageing population grows, more people will require palliative care. However, equal availability of high-quality palliative care services remains a significant challenge, particularly in rural and remote communities. Innovative models of palliative care have been developed to address the projected need of people in rural and remote areas. Models that leverage the use of digital healthcare (such as telecare and Artificial Intelligence), the non-specialized palliative care workforce (such as GPs, pharmacists, and family carers), and community driven approaches have demonstrated success in achieving positive palliative care outcomes, such as reduced physical and emotional distress, and family carers feeling more supported.</p><p><strong>Summary: </strong>There is a need to support people to remain within their rural and remote communities towards the end-of-life (EOL). While some models of care have been identified to help with this, there continues to be significant difficulties in access to health and social care in rural and remote areas. It is important we build on this research to understand more broadly the models of support for those living in remote and rural communities at the EOL.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394451","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}
Caroline Hircock,Alyssa J Wang,Ethan Goonaratne,Dominic Sferrazza,Andrew Bottomley,David Cella,Shing Fung Lee,Adrian W Chan,Edward Chow,Henry C Y Wong
{"title":"Comparing the EORTC QLQ-LC13, EORTC QLQ-LC29, and the FACT-L for assessment of quality of life in patients with lung cancer - an updated systematic review.","authors":"Caroline Hircock,Alyssa J Wang,Ethan Goonaratne,Dominic Sferrazza,Andrew Bottomley,David Cella,Shing Fung Lee,Adrian W Chan,Edward Chow,Henry C Y Wong","doi":"10.1097/spc.0000000000000725","DOIUrl":"https://doi.org/10.1097/spc.0000000000000725","url":null,"abstract":"PURPOSE OF REVIEWTwo commonly used quality of life (QoL) questionnaires in lung cancer patients are the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Lung Cancer 13 (QLQ-LC13) and the Functional Assessment of Cancer Therapy-Lung (FACT-L). More recently, the EORTC QLQ-LC29 was developed. This systematic review compares the EORTC QLQ-LC29, EORTC QLQ-LC13 and FACT-L in terms of the content, validity and psychometric properties in assessing the QoL of lung cancer patients.RECENT FINDINGSFourteen studies were included. The EORTC QLQ-LC29 is a 29-item scale that serves as an update of the EORTC QLQ-LC13 to include symptoms from surgery and new targeted therapies. It shows validity, high internal consistency, test-retest reliability, and sensitivity. The FACT-L continues to assess general quality of life and lung cancer-specific symptoms.SUMMARYThe EORTC QLQ-LC29, EORTC QLQ-LC13, and FACT-L were reviewed to assess their validity in measuring QoL of lung cancer patients. All were found to be sufficiently validated, The choice of which to use should depend on the primary goals of the study.","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264425","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}
Richard Gordon-Williams,Clara Harris,David J Magee
{"title":"Is there a role for capsaicin in Cancer pain management?","authors":"Richard Gordon-Williams,Clara Harris,David J Magee","doi":"10.1097/spc.0000000000000718","DOIUrl":"https://doi.org/10.1097/spc.0000000000000718","url":null,"abstract":"PURPOSE OF REVIEWAdvances in oncological therapies have resulted in an increase in the number of patients living with and beyond cancer. The personal and societal impact of chronic pain in the survivor population represents an area of significant unmet need. Capsaicin (a TRPV1 agonist) may provide analgesia with limited systemic side effects. This review looks to summarise the most recent evidence regarding the use of capsaicin in the management of cancer pain.RECENT FINDINGSVarious international guidelines have recently endorsed the use of high concentration capsaicin patches in the treatment of chronic painful chemotherapy induced peripheral neuropathy. Numerous studies support the use of capsaicin in the treatment of peripheral neuropathic pain. This promising data is predominantly yielded from pain secondary to herpes zoster and diabetic neuropathy, with an expanding but small evidence base for its utility in other neuropathic pains. Emerging data suggests that treatments are better tolerated and provide analgesia more rapidly when compared with systemic treatments.SUMMARYWhilst randomised controlled trial data in the treatment of cancer pain are lacking, recent large cohort studies, and international guidelines, support the use of high concentration capsaicin patches in a wide variety of neuropathic pain secondary to cancer treatments.","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142186377","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}
Alyssa J Wang,Caroline Hircock,Dominic Sferrazza,Ethan Goonaratne,David Cella,Andrew Bottomley,Shing Fung Lee,Adrian Chan,Edward Chow,Henry C Y Wong
{"title":"The EORTC QLQ breast modules and the FACT-B for assessing quality of life in breast cancer patients - an updated literature review.","authors":"Alyssa J Wang,Caroline Hircock,Dominic Sferrazza,Ethan Goonaratne,David Cella,Andrew Bottomley,Shing Fung Lee,Adrian Chan,Edward Chow,Henry C Y Wong","doi":"10.1097/spc.0000000000000724","DOIUrl":"https://doi.org/10.1097/spc.0000000000000724","url":null,"abstract":"PURPOSE OF REVIEWTwo commonly used quality of life questionnaires in breast cancer are EORTC QLQ-BR23, the FACT-B, and the extended FACT-B + 4. More recently, the EORTC EORTC QLQ-BR42 was developed. This systematic review compares the various versions of the EORTC QLQ and FACT tools for breast cancer in terms of their content, validity, and psychometric properties.RECENT FINDINGSThirty-six studies met the inclusion criteria. All questionnaires have been proven to be valid, reliable and responsive. The provisional EORTC QLQ-BR45 transitioned to the EORTC QLQ-BR42 in Phase IV of its development, which encompasses the side effects associated with the latest breast cancer treatments. Both the EORTC and FACT measures assess physical and mental dimensions of quality of life, with the EORTC measure placing relatively more emphasis on physical content and FACT placing relatively more emphasis on mental (social and emotional) content. The four additional items in the FACT-B + 4 were developed to address arm lymphoedema following axillary surgery.SUMMARYThe development and uptake of quality of life tools are essential in the evaluation of breast cancer treatments. The EORTC QLQ-BR42 and FACT-B are both valid, reliable, and responsive QoL questionnaires.","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264426","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}
Partha Patel,Carmen F Al Aadah,Lelia F Al Aadah,Henry C Y Wong,Shing Fung Lee,Muna Alkhaifi,Joel Finkelstein,Leon Rivlin
{"title":"Managing acute pain with inhaled methoxyflurane in non-cancer patients: a review of the latest evidence.","authors":"Partha Patel,Carmen F Al Aadah,Lelia F Al Aadah,Henry C Y Wong,Shing Fung Lee,Muna Alkhaifi,Joel Finkelstein,Leon Rivlin","doi":"10.1097/spc.0000000000000726","DOIUrl":"https://doi.org/10.1097/spc.0000000000000726","url":null,"abstract":"PURPOSE OF THE REVIEWPenthrox® (inhaled methoxyflurane, IMF) is an inhaled analgesic used for the treatment of moderate-to-severe acute pain. It has various advantages including the capacity for being self-administered in the presence of healthcare providers (HCPs), rapid onset and offset, and having documented evidence for minimal adverse events post-use. In a variety of non-oncological settings such as pre-hospital transport and minor outpatient procedures, amongst others, IMF has significantly reduced acute pain. As IMF has the capacity to provide appreciable pain relief but is not as widely used as other acute analgesics (i.e., opioids), this review of past and current literature hopes to explore the impact of inhaled IMF on patient outcomes, procedures where it could be used, and to inform readers about this compound.RECENT FINDINGSIn general, patients who used IMF had decreased pain, improved psychosocial factors (i.e., reduced anxiety, improved satisfaction), and minimal adverse events thereby being concluded as safe for use.SUMMARYFuture use in remote medical interventions such as military contexts, in emergency room settings, and administration under the supervision of first responders such as non-paramedic and non-HCPs further broadens the scope of settings where IMF can meaningfully be implemented.","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264604","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 WHO guidelines: the new and the old.","authors":"Jo Thompson","doi":"10.1097/spc.0000000000000722","DOIUrl":"https://doi.org/10.1097/spc.0000000000000722","url":null,"abstract":"PURPOSE OF THE REVIEWThe original World Health Organisation (WHO) cancer pain guidelines were published in 1986 and used globally. Updated guidance was released in 2018. This review compares the 'old' with the 'new' with a closer look at the relevance of the WHO analgesic ladder in the current climate.RECENT FINDINGSThe new guidelines provide a more evidence based, rigorously developed document including recommendations relating to radiotherapeutic management. There is a more detailed focus on safe opioid prescribing, opioid stewardship and the importance of integrating pain management expertise early on in the cancer journey. There remains a lack of evidence for certain therapies despite their widespread use particularly in relation to adjuvants. The pitfalls of the original renowned analgesic ladder are highlighted including a recognition that omitting 'step 2' is safe, feasible and cost effective.SUMMARYThe new guidelines offer more detailed recommendations relevant to clinical practice with a strong focus on safety of opioid prescribing making it relevant in the current climate. The original WHO analgesic ladder is no longer recommended as a strict protocol for cancer pain management.","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142186376","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}
Michael S Yule, Leo R Brown, Richard J E Skipworth, Barry J A Laird
{"title":"Central neural mechanisms of cancer cachexia.","authors":"Michael S Yule, Leo R Brown, Richard J E Skipworth, Barry J A Laird","doi":"10.1097/SPC.0000000000000707","DOIUrl":"10.1097/SPC.0000000000000707","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cachexia is a devasting syndrome which impacts a large number of patients with cancer. This review aims to provide a comprehensive overview of the central mechanisms of cancer cachexia. In particular, it focuses on the role of the central nervous system (CNS), the melanocortin system, circulating hormones and molecules which are produced by and act on the CNS and the psychological symptoms of cancer cachexia.</p><p><strong>Recent findings: </strong>A growing body of evidence suggests that a central mechanism of action underpins this multi-system disorder. Recent research has focused on the role of neuroinflammation that drives the sickness behaviour seen in cancer cachexia, with emphasis on the role of the hypothalamus. Melanocortin receptor antagonists are showing promise in preclinical studies. There are also new pharmacological developments to overcome the short half-life of ghrelin. GDF-15 has been identified as a core target and trials of compounds that interfere with its signalling or its central receptor are underway.</p><p><strong>Summary: </strong>Understanding the central mechanisms of cancer cachexia is pivotal for enhancing treatment outcomes in patients. While emerging pharmacological interventions targeting these pathways have shown promise, further research is essential.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946127","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}
Savannah A Epstein, Jason D Doles, Aneesha Dasgupta
{"title":"KLF10: a point of convergence in cancer cachexia.","authors":"Savannah A Epstein, Jason D Doles, Aneesha Dasgupta","doi":"10.1097/SPC.0000000000000711","DOIUrl":"10.1097/SPC.0000000000000711","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Cancer-associated cachexia is a wasting syndrome entailing loss in body mass and a shortened life expectancy. There is currently no effective treatment to abrogate this syndrome, which leads to 20-30% of deaths in patients with cancer. While there have been advancements in defining signaling factors/pathways in cancer-induced muscle wasting, targeting the same in the clinic has not been as successful. Krüppel-like factor 10 (KLF10), a transcription factor implicated in muscle regulation, is regulated by the transforming growth factor-beta signaling pathway. This review proposes KLF10 as a potential convergence point of diverse signaling pathways involved in muscle wasting.</p><p><strong>Recent findings: </strong>KLF10 was discovered as a target of transforming growth factor-beta decades ago but more recently it has been shown that deletion of KLF10 rescues cancer-induced muscle wasting. Moreover, KLF10 has also been shown to bind key atrophy genes associated with muscle atrophy in vitro .</p><p><strong>Summary: </strong>There is an elevated need to explore targets in cachexia, which will successfully translate into the clinic. Investigating a convergence point downstream of multiple signaling pathways might hold promise in developing effective therapies for cachexia.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11293965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617431","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}