BMJ Supportive & Palliative Care最新文献

{"title":"Postoperative pain following intraoperative acupuncture: a randomized‑controlled study.","authors":"Yakir Segev, Sereen Abofol, Noah Samuels, Meirav Schmidt, Wisam Assaf, Eran Ben-Arye","doi":"10.1136/spcare-2025-005485","DOIUrl":"https://doi.org/10.1136/spcare-2025-005485","url":null,"abstract":"<p><strong>Context and objectives: </strong>This study examined the impact of an integrative oncology intervention on postoperative care, primarily postoperative pain, in patients undergoing gynaecological oncology surgery.</p><p><strong>Methods: </strong>Participants were randomised to three groups: group A, preoperative touch/relaxation modalities, followed by intraoperative acupuncture; group B, preoperative touch/relaxation only and group C, standard conventional care alone. Using an enhanced recovery after surgery (ERAS) protocol, medical personnel retrospectively assessed pain on each postoperative day (POD), using a Visual Analogue Scale (VAS; 0, no pain; 10, most severe pain). Use of analgesics, bowel movements, urination and number of days until discharge were also assessed.</p><p><strong>Results: </strong>A total of 102 patients participated, with similar baseline demographic and surgery-related characteristics among the three groups (group A, 45; group B, 25 and group C, 32). Group A patients undergoing laparoscopic surgery reported significantly lower pain scores on POD1 than group C (p=0.018). Group B patients undergoing open laparotomy were discharged earlier than group C (p=0.031). No significant between-group differences were found for VAS pain scales, use of analgesics or report of first postoperative bowel movement or urination.</p><p><strong>Conclusions: </strong>This prospective, controlled and pragmatic ERAS-based study suggests that intraoperative acupuncture may reduce postoperative pain on POD1, in patients undergoing laparoscopic gynaecological oncology surgery. The findings differ from a previous study which found no effect of acupuncture on pain-related haemodynamic parameters during laparoscopy. Further research using objective nociception parameters is needed to explore the effect of intraoperative acupuncture on postoperative pain.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov (NCT03560388).</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332389","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":"Distress thermometer and determinants of psychological distress in metastatic breast cancer.","authors":"Huihui Sun, Huimin Lv, Limin Niu, Shumin Chen, Zhiqing Zhang, Min Yan","doi":"10.1136/spcare-2025-005431","DOIUrl":"https://doi.org/10.1136/spcare-2025-005431","url":null,"abstract":"<p><strong>Background: </strong>Metastatic breast cancer (MBC) is generally considered an incurable disease, and patients require continuous systematic treatment. Receiving the diagnosis and treatment of MBC is a distressing experience that may accelerate an episode of psychological disorder. This study examined the performance of the distress thermometer (DT) and identified the risk factors associated with psychological distress (PD).</p><p><strong>Methods: </strong>We assessed 337 patients diagnosed with MBC in Henan Cancer Hospital. All patients completed the electronic DT and Hospital Anxiety and Depression Scale (HADS) online. Receiver operating characteristic (ROC) analysis compared DT accuracy against HADS-Total score (HADS-T) defined PD (HADS≥15). Multivariate regression identified PD-associated factors.</p><p><strong>Results: </strong>DT average scores were significantly higher in HADS-T≥15 patients (4.27 vs 2.01, p<0.001). In ROC analysis, the DT showed strong discriminatory power relative to the HADS diagnosis of depression and anxiety, with an area under the curve of 0.76. A score of 4 represented the optimal trade-off between sensitivity (0.58) and specificity (0.85) characteristics for detecting distress. PD was associated with (unstandardised coefficient (B)=1.663, p=0.04) curative effect, and patients with poorer therapeutic effects experience more distress.</p><p><strong>Conclusion: </strong>The single-item DT has been determined to be a valid tool for screening distress in patients with MBC. We recommend using a cut-off score of 4 in this population. While our analysis revealed a significant association between poor treatment response and elevated distress scores, these findings cohere with the broader clinical imperative to prioritise distress management for all cancer patients regardless of treatment outcomes.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332387","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":"Just-in-case drugs in the dying: home deaths retrospective chart review.","authors":"Paul Rutter, Paul Howard, Sandra Clawson, Molly Gough","doi":"10.1136/spcare-2024-005335","DOIUrl":"https://doi.org/10.1136/spcare-2024-005335","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether the Isle of Wight (IoW) Just-in-Case (JIC) scheme to supply and administer anticipatory medication to end-of-life patients was performing to an appropriate level of performance.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on patients who were considered end of life and who died at home on the IoW during 2022.</p><p><strong>Results: </strong>JIC medication was prescribed to 88% (n=70/80) of patients. Of these patients, half were administered at least four of the five medicines listed on the IoW JIC scheme. Almost three-quarters (71%, n=50/70) of patients had the standard dosage regimens amended to provide individualised treatment, and 96% (n=67/70) of patients saw some alterations to their ongoing management after initialisation of treatment. The time between prescribing and administration of JIC medication was short.</p><p><strong>Conclusions: </strong>The JIC scheme on the IoW allowed patients to receive timely and individualised care. One or more JIC drugs were administered to a higher proportion of patients than in previous studies; further work is required to establish why (eg, the use of a 24/7 home visiting palliative care nursing team in this locality) and whether this led to improved family confidence that symptoms were effectively controlled.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332388","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":"Effect of educational interventions in pain intensity and related outcomes in adults with oncological pain: a systematic review and meta-analysis.","authors":"Laura Isabel Henao Bermúdez, Lawrence Dominguez Palacios, Ilem D Rosero, Rocio Guil, Leidy Tatiana Ordoñez-Mora","doi":"10.1136/spcare-2024-005219","DOIUrl":"https://doi.org/10.1136/spcare-2024-005219","url":null,"abstract":"<p><strong>Background: </strong>Pain is the second most prevalent symptom in patients with cancer after fatigue and is highly debilitating. There is an increasing emphasis on the prescription of non-pharmacological interventions, among which pain education is a prominent option. This study aimed to determine the effects of educational interventions on pain intensity and related outcomes in patients with oncological pain.</p><p><strong>Methods: </strong>A systematic review was conducted following Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with registration in PROSPERO CRD42022343205 from searches in the main databases such as PubMed, Science Direct, Taylor and Francis, Cochrane (CENTRAL) and Scopus without language restriction, including randomised clinical trials and observational studies using the following keywords: \"Pain Education\" AND \"Cancer\". The PEDro (Physiotherapy Evidence Database scale) scale and MINORS (methodological index for non-randomised studies) criteria were used to analyse the risk of bias.</p><p><strong>Results: </strong>35 articles involving the use of educational interventions for patients with cancer pain were analysed in this study. Most protocols involved sessions implementing audiovisual aids, which the patient could easily access. The protocols showed significant results in terms of improvement in pain intensity, stress, quality of life and catastrophising in the intervened groups. Due to the heterogeneity of the interventions in the quantitative analysis, it was only possible to include six articles, which yielded significant results in improving pain (-0.65 (-1.18 to -0.12)).</p><p><strong>Conclusions: </strong>It is concluded that educational interventions can be effective in the treatment of cancer pain and should be considered as a complement to palliative care treatment.</p><p><strong>Prospero registration number: </strong>CRD42022343205.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315898","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":"Cool facial airflow hastens exertion recovery in chronic breathlessness: randomised crossover trial of different fan airflow speeds.","authors":"Thomas Burrell, Andrew Simpson, Christina Ramsenthaler, Michael G Crooks, Miriam J Johnson, Flavia Swan","doi":"10.1136/spcare-2024-005103","DOIUrl":"https://doi.org/10.1136/spcare-2024-005103","url":null,"abstract":"<p><strong>Objectives: </strong>Facial airflow from a hand-held fan (fan) hastens recovery from exertional breathlessness. We aimed to determine the effect of different airflow speeds on recovery from exertional breathlessness in patients with chronic breathlessness.</p><p><strong>Methods: </strong>A prospective, unblinded, randomised crossover trial. Participants with chronic breathlessness (modified Medical Research Council ≥3) completed five 1 min sit-to-stand (STS) tests to induce breathlessness. After each STS test, participants used a fan with one of four airflow speeds or control (no fan) during 10 min recovery. Numerical Rating Scale (NRS) breathlessness intensity, airflow pleasantness, heart rate, oxygen saturation and facial skin temperature were recorded.</p><p><strong>Results: </strong>10 participants were recruited (n=1 withdrew due to health concerns) and 9 (mean±SD age 66±14 years; 5 men; 8 chronic obstructive pulmonary disease, 1 long covid) completed the trial. Per-protocol analysis identified no difference in NRS breathlessness recovery across fan speeds (p>0.05). Sensitivity analysis (n=1 excluded due to low exertional NRS breathlessness post STS test) identified a significant interaction effect for fan speed over time (p=0.010). Fan speed 2.85 m/s reduced NRS breathlessness compared with control at minutes 4-8 during recovery (p<0.05), whereas fan speeds 1.98 m/s, 3.70 m/s and 4.91 m/s only differed from control after 7 min recovery (p<0.05). The perceived most pleasant and preferred airflow rate was 2.85 m/s. NRS pleasantness decreased with faster airflow speeds, suggesting a ceiling limit to net benefit.</p><p><strong>Conclusion: </strong>Our novel data suggest the optimal airflow speed to hasten recovery from exertional breathlessness in people with chronic breathlessness is 2.85 m/s. Net benefit reduces at higher flow rates.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293302","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":"Subcutaneous versus intravenous route switch from oral to parenteral morphine in patients with cancer: randomised controlled trial.","authors":"Eva Gravdahl, Siri Steine, Jūratė Šaltytė Benth, Knut Magne Augestad, Olav Magnus Fredheim","doi":"10.1136/spcare-2025-005593","DOIUrl":"https://doi.org/10.1136/spcare-2025-005593","url":null,"abstract":"<p><strong>Background: </strong>Subcutaneous (SC) administration is the preferred parenteral opioid route in palliative care, while intravenous infusion may allow faster titration. Comparative evidence remains limited. This study assessed whether intravenous or SC morphine, administered by continuous infusion with bolus doses, offered advantages in (1) time to stable infusion rate and (2) time to pain relief following a bolus dose.</p><p><strong>Methods: </strong>In this double-blind, double-dummy randomised controlled trial, 60 hospitalised palliative care patients with cancer requiring opioid rotation to parenteral morphine were randomised to continuous SC or intravenous infusion with bolus doses over 48 hours.</p><p><strong>Results: </strong>Mean time to final infusion rate was 20.4 hours (95% CI: 15.2 to 25.6) for SC and 16.3 hours (95% CI: 10.5 to 22.2) for intravenous (mean difference: 4.1 hours, 95% CI: -3.6 to 11.7; p=0.293). Median time to effect from bolus doses was 20 min (Q1, Q3: 15, 23) for SC and 15 min (10, 20) for intravenous (HR=1.08, 95% CI: 0.61 to 1.88; p=0.795), indicating no significant difference. NRS scores decreased from 3.9 to 2.1 (SC) and 3.3 to 2.3 (intravenous). Infusion rates increased from 2.4 to 3.3 mg/hour, bolus doses from 4.6 to 6.6 mg. Of 604 boluses, the proportion of effective doses was similar between groups. One intravenous patient developed catheter-related thrombosis and infection post-intervention.</p><p><strong>Conclusion: </strong>No statistically significant or clinically meaningful differences in effectiveness or safety were observed between SC and intravenous morphine administration. Both routes allowed similar titration patterns, supporting the use of either route in palliative care without compromising analgesic efficacy or safety.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282376","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":"Integrated home-hospital paediatric palliative care versus standard management in deceased patients with cancer: retrospective cohort study.","authors":"Iñigo de Noriega, Ricardo Martino, Raquel Jiménez, Dorleta López de Suso, Blanca Herrero","doi":"10.1136/spcare-2025-005413","DOIUrl":"https://doi.org/10.1136/spcare-2025-005413","url":null,"abstract":"<p><strong>Objective: </strong>To analyse differences in the last month of life (LMoL) of patients with paediatric cancer, classified depending on if they were included in an integrated home-hospital paediatric palliative care (PPC) programme with 24-hour assistance or received standard oncology care.</p><p><strong>Methods: </strong>Retrospective cohort study of deceased patients with cancer in HIU Niño Jesús, where the Pediatric Palliative Care Unit of Madrid (PPCUM) is located. Patients were classified based on being attended or not by the PPCUM. General epidemiological and oncological trajectory characteristics and care in LMoL were compared. A logistic regression model for PPCUM referral was established.</p><p><strong>Results: </strong>198 patients were included, with 50% of them attended by the PPCUM. In the LMoL, patients attended by the PPCUM used fewer devices, red blood cells and platelet transfusions, surgery, invasive procedures and palliative sedation. They stayed a mean of 16.8 days less at hospital and 8.6 days in the intensive care unit, with 65.7% of them dying at home, while none of the control group did. In the logistic model, relapse/recurrence events as well as having a solid tumour with long diseases trajectories were associated with being attended by the PPCUM. In patients with haematological cancer, longer trajectories were associated with less possibility of receiving PPCUM attention.</p><p><strong>Conclusion: </strong>The PPC Integrated home-hospital programmes were associated with less invasive interventions and hospital stay. Patients with haematological cancer seem to experience barriers to our intervention.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274228","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":"Omeprazole administration via short subcutaneous infusion.","authors":"Ranya Derrick, Cate Seton-Jones","doi":"10.1136/spcare-2025-005561","DOIUrl":"10.1136/spcare-2025-005561","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981014","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":"Assisted dying: are we sure the suffering is irreversible?","authors":"Wei Ming Tan","doi":"10.1136/spcare-2025-005628","DOIUrl":"https://doi.org/10.1136/spcare-2025-005628","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233189","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":"State of the science: cancer-related fatigue.","authors":"Dori Beeler, Bernadette Brady, Declan Walsh","doi":"10.1136/spcare-2025-005590","DOIUrl":"https://doi.org/10.1136/spcare-2025-005590","url":null,"abstract":"<p><p>Cancer-related fatigue (CRF) is a major clinical problem. This paper integrates the evidence-based literature and professional guidelines to support a proposed systematic approach to CRF diagnosis and management. This approach includes four diagnostic criteria, six steps for routine care and two major evidence-based treatment modalities. These comprise non-pharmacological and pharmacological interventions. This approach can reduce CRF management barriers while highlighting the illness trajectory phase when specific interventions will be most effective.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224255","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}