BMJ Supportive & Palliative Care最新文献

{"title":"Neutropenic event incidence in women with early-stage breast cancer receiving neoadjuvant or adjuvant chemotherapy: a retrospective study.","authors":"Elin Englund, Michael Strandéus, Kristina Engvall, Delmy Oliva","doi":"10.1136/spcare-2024-005329","DOIUrl":"10.1136/spcare-2024-005329","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the incidence of neutropenia, febrile neutropenia, documented infection with neutropenia and fever associated with early-stage breast cancer (BC) in a real-life setting.</p><p><strong>Methods: </strong>A retrospective study that includes 88 women with BC who received a first dose of Epirubicin plus Cyclophosphamide with or without 5-Fluorouracil, in the county hospital of Ryhov, Sweden. The patients were included continuously from May 2017 to November 2020 and were ≥18 years old. All data was collected in a form and the G-CSF prophylaxis was checked to ensure that it was given during the treatments.</p><p><strong>Results: </strong>The median age among the patients was 59 (min 27-82max) years. 79 patients were treated with primary prophylaxis with Granulocyte-colony stimulating factor (G-CSF) support. Seven (8.0%) patients were affected by a neutropenic episode, including one (1.1%) patient with FN and two (2.3%) patients with documented infection (online supplemental table 1).</p><p><strong>Conclusion: </strong>The incidence of neutropenic events in this study is relatively low. A higher incidence of neutropenic episodes is observed in patients ≥ 60 years old compared with younger patients, despite lower doses of chemotherapy for the elderly. The use of G-CSF in the elderly, regardless of the dose of chemotherapy, may be needed to decrease the incidence of neutropenia and its consequences. The adverse effects of G-CSF and its cost-effectiveness are important perspectives which should be included in the treatment.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963883","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":"Pharmacogenomics and symptom management in palliative and supportive care: A scoping review.","authors":"Caroline Barry, Martyn Patel","doi":"10.1136/spcare-2024-005205","DOIUrl":"https://doi.org/10.1136/spcare-2024-005205","url":null,"abstract":"<p><strong>Context: </strong>Pharmacogenomics (PGx) is an area of expanding research, which could indicate whether an individual is likely to benefit from a symptom control medication. Palliative and supportive care (PSC) could be an area that benefits from PGx, however, little is known about the current evidence base for this.</p><p><strong>Objective: </strong>To determine how PGx can be applied in PSC, whether there is any evidence of benefit, and to understand the extent and type of evidence that supports the use of PGx in PSC.</p><p><strong>Methods: </strong>A search of six databases up to July 2024. Reference snowballing from review articles and screened papers was used to identify any missed articles.</p><p><strong>Results: </strong>11 articles were reviewed. A total of 550 patients had a PGx test across 8/11 studies. Up to half of the patients had an actionable PGx result, and in one study there were 4.6 drug-gene interactions per patient. Implementation of PGx was found to be feasible. Clinician adherence to advice given was under-reported. No studies reported health economics analysis, or was designed to definitively answer whether PGx was better than standard care.</p><p><strong>Conclusions: </strong>It is both feasible and acceptable to conduct PGx testing in a supportive and palliative care setting. Many supportive care medications are amenable to PGx. Clinician adherence to recommendations is variable and there is no clear evidence that PGx enhances palliative/supportive care patient outcomes. Prospective, clinical trials are needed to establish whether PGx can improve symptom management for people receiving PSC.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977584","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":"Transcutaneous electrical acupoint stimulation for upper limb spasticity after stroke: effect andd feasibility-a randomised pilot study.","authors":"Yuting Wang, Lili Zhang, Rui Yin, Yuqing Zhang, Zifeng Dai, Min Wang, Jiali Song, Xiaonong Fan, Yanan Zhang, Sha Yang, Yan Shen, Chen Yang, Qian Song, Sihan Sun, Jian Liu","doi":"10.1136/spcare-2024-005174","DOIUrl":"https://doi.org/10.1136/spcare-2024-005174","url":null,"abstract":"<p><strong>Importance: </strong>Limb spasticity is a common issue among stroke patients. Transcutaneous electrical acupoint stimulation (TEAS) is recommended as an alternative therapy for managing upper limb spasticity after stroke; however, its potential effects and feasibility remain uncertain.</p><p><strong>Objective: </strong>To investigate the potential effects and feasibility of TEAS on motor function in patients with upper limb spasticity after stroke.</p><p><strong>Methods: </strong>This randomised controlled, double-blined pilot study was conducted in two phases. All the patients were randomly divided into two groups: the TEAS group and the sham TEAS group. The intervention period for both TEAS and sham TEAS was 6 weeks, with each session lasting 30 min and conducted thrice weekly. The outcomes measured were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score, the effective improvement rate, the modified Ashworth Scale (MAS), the Wolf Motor Function Test (WMFT), the visual analogue scale (VAS), the Barthel index (BI) and the surface electromyography (sEMG).</p><p><strong>Results: </strong>All participants completed the course of therapy. Baseline characteristics were comparable across the two groups. Compared with the sham TEAS group, the TEAS group showed significant increases in FMA-UE score (P value=0.013), WMFT score (P value=0.001) and BI score (P value=0.008) at week 6. For integrated electromyogram (p=0.048) and root mean square of the biceps (p=0.033), lower scores were identified in the TEAS group compared with the sham TEAS group with a significant difference at week 6.</p><p><strong>Conclusion: </strong>TEAS was acceptable and feasible in participants with upper limb spasticity after stroke. A pivotal study of this therapy is justified.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969668","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":"Preoperative frailty in oesophageal cancer: postoperative outcomes and overall survival - meta-analysis and systematic review.","authors":"Bingyan Zhao, Min Wu, Leilei Bao, Si-Ai Zhang, Chunmei Zhang","doi":"10.1136/spcare-2024-005073","DOIUrl":"https://doi.org/10.1136/spcare-2024-005073","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the prevalence of preoperative frailty in patients with oesophageal cancer and its impact on postoperative outcomes and overall survival.</p><p><strong>Methods: </strong>A comprehensive computer-based search of the CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library, Web of Science and CINAHL databases was conducted for articles related to preoperative frailty in patients with oesophageal cancer. The search was carried out from the time of the construction of the database to 20 April 2024. Data related to the prevalence of preoperative frailty in patients with oesophageal cancer and their postoperative outcomes and overall survival were extracted.</p><p><strong>Results: </strong>A total of 13 studies were included, including 12 cohort studies and 1 cross-sectional study involving 53 485 patients. Meta-analysis showed that the prevalence of preoperative frailty in patients with oesophageal cancer was 29.6% (95% CI 24.5% to 34.8%). Preoperative frailty increased the risk of postoperative mortality (HR 1.80, 95% CI 1.51 to 2.14, p<0.001), complications (HR 1.32, 95% CI 1.16 to 1.49, p<0.001) and 30-day readmission (HR 1.24, 95% CI 1.18 to 1.31, p<0.001), in patients with oesophageal cancer, but had no significant effect on overall survival (HR 1.28, 95% CI 0.97 to 1.68, p=0.08).</p><p><strong>Conclusions: </strong>The prevalence of preoperative frailty is high in patients with oesophageal cancer, and preoperative frailty is strongly associated with increased adverse outcomes after surgery. Healthcare providers should identify preoperative frailty in patients with oesophageal cancer at an early stage and develop targeted intervention strategies to reduce the incidence of postoperative adverse outcomes.</p><p><strong>Prospero registration number: </strong>CRD42024541051.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944666","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":"Challenges with cancer pain management: novel opioid shortages and cancer trials restrictions.","authors":"Aaron Bak Ong Wong, Benjamin Crock, Myles Wright, Aaron Kee Yee Wong","doi":"10.1136/spcare-2024-005279","DOIUrl":"https://doi.org/10.1136/spcare-2024-005279","url":null,"abstract":"<p><p>Patients with advanced cancer often experience bothersome symptoms requiring specialist palliative care input. Oncology clinical trials commonly include a list of prohibited medications while on trial, to avoid potential drug interactions with the investigational product. This case series illustrates how recent opioid shortages combined with prohibited opioids in clinical trials significantly impacted cancer pain control and quality of life. These cases highlight the need for cancer trial protocols to closely consider the potential impact of prohibited medication lists on optimal pain management for patients with cancer.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944713","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":"Sleep quality and coping styles among nurses working in tertiary cancer institutions: a mixed-method study.","authors":"Shubha Pai, Praneeth Suvvari, Praveen Kumar Kodisharapu, Basanth Kumar Rayani, Gayatri Palat","doi":"10.1136/spcare-2024-005315","DOIUrl":"https://doi.org/10.1136/spcare-2024-005315","url":null,"abstract":"<p><strong>Introduction: </strong>Providing nursing care is a challenging job which may lead to serious effects on sleep quality, thereby leading to lower work productivity and reduced job satisfaction. Therefore, it becomes increasingly important to adopt effective and adaptive coping strategies to deal with day-to-day stress and to improve sleep.</p><p><strong>Aim: </strong>This study aimed to assess the sleep quality of nurses and the coping styles employed by them to deal with the stressors at the workplace.</p><p><strong>Methods: </strong>This cross-sectional study included (n=125) nurses working across different wards and intensive care units in two cancer hospitals. The sleep quality was assessed using the Pittsburgh Sleep Quality Index, while brief COPE was used to assess the coping styles. Stress was assessed using a Likert scale.</p><p><strong>Results: </strong>The results indicated that the majority of the nurses (59.2%) had poor sleep quality. However, most nurses employed problem-focused coping (70.4%) compared with emotion-focused (21.6%) and avoidant coping (8%). Poor sleep quality was found to have significant association with problem-focused coping (r<i>=</i>0.27), emotion-focused coping (r<i>=</i>0.25) and stress (r<i>=</i>0.42). A thematic analysis of the responses resulted in the emergence of eight major themes causing stress including management issues, novelty of job, family stress, health, work-life balance, workload, interpersonal relations and career growth.</p><p><strong>Conclusion: </strong>Poor sleep quality was observed in more than half of the nurses who participated in this study. This can be attributed to several reasons mostly relating to work stress. Thus, it becomes increasingly important to address these issues and provide adequate support on an organisational level to improve their psychological well-being.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944733","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":"Family voices from the bedside: National Audit of Care at the End of Life (England and Wales).","authors":"Mary Miller","doi":"10.1136/spcare-2024-005287","DOIUrl":"https://doi.org/10.1136/spcare-2024-005287","url":null,"abstract":"<p><strong>Introduction: </strong>The National Audit of Care at the End of Life reports the quality of care provided to people dying in hospital. This paper reports the bereavement (quality) survey data about the families' view of care provided to the patient and support provided to the family.</p><p><strong>Methods: </strong>Anonymised summary data were retrieved from 'Key findings for patients and carers on the quality of end of life care in acute and community hospitals' reports 2019-2022 and the summary report 2018.</p><p><strong>Results: </strong>9089 respondents provided feedback about care received. In more than 70% of the cases, care provided to the dying person was described as good, excellent or outstanding. At least 66% of respondents reported that care provided to them was good, excellent or outstanding. At least 76% of respondents felt that staff communicated sensitively, and more than 70% felt they were happy with the level of involvement in decisions about the patient's care.</p><p><strong>Conclusion: </strong>The voices of dying patients and those at the bedside are critical in helping understand and improve care at the end of life. Co-ordinating our ask and focusing on agreed key outcomes are important to achieve the pragmatic principle of 'one death one review'.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944662","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 care needs in cystic fibrosis: hospital survey.","authors":"Geana Paula Kurita, Inge Eidemak, Tacjana Pressier, Sille Larsen, Per Sjøgren, Camilla Lykke","doi":"10.1136/spcare-2024-005318","DOIUrl":"https://doi.org/10.1136/spcare-2024-005318","url":null,"abstract":"<p><strong>Background: </strong>Cystic fibrosis (CF) is an incurable, progressive disease that affects multiple organs, causing burdensome symptoms. This study aimed to explore the palliative care needs in patients with CF, focusing on health-related quality of life (HRQOL), fatigue, anxiety and depression.</p><p><strong>Methods: </strong>From October 2019 to March 2020, a cross-sectional questionnaire survey was conducted with outpatients with CF at the Infectious Medicine Clinic in a Danish University Hospital.</p><p><strong>Results: </strong>130 patients completed at least one questionnaire. Mean age was 35.5 years (SD 11.5), with 51.7% males. Charlson's comorbidity index mean score was 1.3 (SD 1.6). Patients with CF had significantly lower scores in general health, vitality, social functioning, role emotional and mental health compared with the Danish population. Mean fatigue score of patients was 50.9 (SD 16.2), with the highest scores in general fatigue, physical fatigue and reduced activity. Additionally, 33% indicated anxiety and 19.5% depression. 51.6% were treated with Tezacaftor/Ivacaftor or Lumacaftor/Ivacaftor.</p><p><strong>Conclusion: </strong>This study found poor HRQOL and burdensome symptoms of fatigue, anxiety and depression in patients with CF compared with the general Danish population. The results suggest that systematic assessments and palliative care interventions should be integrated into routine CF care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909105","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":"Postcancer rehabilitation: multidisciplinary exercise - programme organisation and feasibility.","authors":"Chloé Drozd, Quentin Jacquinot, Sophie Paget-Bailly, Laura Mansi, Marie-Justine Paillard, Fernando Bazan, Loic Chaigneau, Erion Dobi, Julien Viot, Guillaume Meynard, Morgan Goujon, Lorraine Dalens, Victor Pereira, Edgar Robin, Jean Farret, Carole Gagnepain, Ophélie Simon, Christine Fagnoni-Legat, Fabienne Mougin, Nathalie Meneveau, Elsa Curtit","doi":"10.1136/spcare-2024-005068","DOIUrl":"https://doi.org/10.1136/spcare-2024-005068","url":null,"abstract":"<p><strong>Background: </strong>Although the benefit of supportive care in the postcancer period is now well demonstrated, its implementation in the patient journey remains challenging. This article describes the development, since 2015 and in routine care, of supportive postcancer care comprising a multidisciplinary rehabilitation programme (MRP) based on exercise for patients with early breast cancer.</p><p><strong>Methods: </strong>As part of quality control, we reviewed all patient files since the programme was implemented. Patient data regarding the type of cancer, clinical and pathological factors, and treatment were recorded in a computerised database.</p><p><strong>Results: </strong>From April 2015 to January 2024, 655 patients participated in the MRP. The programme lasts for 14 weeks, totalling 126 hours of face-to-face programme, with a maximum of 8 patients per group, in 5 different centres. A multidisciplinary professional team provide supportive care. The MRP is mainly based on supervised physical exercise and patients also participate in social, psychological, dietary support and educational sessions. Supervised physical exercise includes cardiorespiratory endurance work through specific sessions on ergometers or outdoor walking and adapted physical activity sessions to improve muscular capacities (endurance, strength and flexibility).</p><p><strong>Conclusion: </strong>We describe here the practical implementation of a routine multidisciplinary supportive care programme, based mainly on physical activity, for post-treatment breast cancer patients. We report almost 9 years of experience with the programme. We show that offering this programme in the postcancer setting and in clinical routine practice is feasible and can be maintained in the long term.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909135","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":"Physical activity, fatigue, kinesiophobia and quality of life: comparative study of prostate cancer survivors with healthy controls.","authors":"Emine Cihan, Ilknur Karalezli, Cansu Sahbaz Pirincci, Omer Faruk Cavdar, Yunus Emre Goger, Aydan Aytar, Giray Karalezli","doi":"10.1136/spcare-2024-005239","DOIUrl":"https://doi.org/10.1136/spcare-2024-005239","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the distribution of prostate cancer (PCa) patients between physical activity and kinesiophobia, fatigue and quality of life, and to what extent PCa persists compared to healthy males.</p><p><strong>Methods: </strong>Total of 118 males participated in the study. These participants were allocated into two groups: PCa group (n:59) and control group (n:59). The International Physical Activity Questionnaire Short Form was used to assess physical activity levels, Functional Assessment of Chronic Illness Therapy-Fatigue Questionnaire (FACIT-F) was used for measuring fatigue, kinesiophobia was evaluated with the Kinesiophobia Causes Scale, and Functional Assessment of Cancer Treatment-Prostate Version questionnaire (FACT-P) was used to assess quality of life.</p><p><strong>Results: </strong>PCa had significantly lower scores in moderate activity (p=0.005) and total physical activity (p=0.010) compared with the control. Scores for kinesiophobia in both biological (p=0.045) and psychological subparameters (p=0.001), as well as the total kinesiophobia score (p=0.003), were higher in PCa. The FACIT-F (p<0.001) and total FACT-P (p<0.001) score were significantly lower in PCa than the control.</p><p><strong>Conclusion: </strong>Kinesiophobia in PCa is significantly influenced by both biological and psychological factors. Kinesiophobia negatively affects patients' functional status and overall quality of life. Their well-being is shaped not only by their physical and emotional conditions but also by the quality of their family relationships. This multifaceted impact highlights the complex interaction between physical activity, functional abilities, emotional health and social dynamics in PCa. In addition to routine treatments for PCa patients, the development and implementation of a comprehensive rehabilitation programme may lead to significant improvements in their quality of life.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909109","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}