BMJ Supportive & Palliative Care最新文献

{"title":"Long-term opioid prescribing and healthcare encounters in metastatic cancer: observational population study.","authors":"Hannah Harsanyi, Lin Yang, Jenny Lau, Winson Y Cheung, Yuan Xu, Colleen Cuthbert","doi":"10.1136/spcare-2024-005185","DOIUrl":"https://doi.org/10.1136/spcare-2024-005185","url":null,"abstract":"<p><strong>Background: </strong>Although opioids are effective for cancer pain management, long-term use may result in adverse effects which are understudied among patients with metastatic disease.</p><p><strong>Objectives: </strong>To describe long-term opioid prescribing among patients with metastatic cancer and investigate how long-term prescribing practices are associated with the incidence of opioid-related hospitalisations and emergency department visits.</p><p><strong>Methods: </strong>This retrospective cohort study included all opioid-naïve patients diagnosed with solid metastatic cancer in Alberta, Canada from 2004 to 2017 who had ≥1 year of follow-up. Patients were identified and followed using linked administrative health data. Long-term prescribing was defined as receiving a ≥90-day supply of opioids with a <30-day gap in supply within a 180-day period. The incidence rate of opioid-related healthcare encounters was compared based on characteristics of long-term prescribing (timing, dosage, duration and concurrent medications).</p><p><strong>Results: </strong>The study included 10 927 patients, 2521 (23%) of whom received long-term opioid prescribing. These practices became more common near the end of life, with 53% of cases initiated during patients' last year of life. Opioid-related healthcare encounters were experienced by 85 (3.4%) recipients of long-term prescribing. Higher dosage (p<0.001) and concurrent prescribing of anxiolytics (p=0.001), benzodiazepines (p=0.001), antidepressants (p=0.027) and neuroleptics (p<0.001) were associated with a higher incidence of opioid-related healthcare encounters.</p><p><strong>Conclusions: </strong>Long-term opioid prescribing is common, and patients receiving long-term prescriptions with high dosage or concurrent psychoactive medications may benefit from interventions aimed at reducing opioid-related adverse effects. Further research is needed to determine strategies to minimise opioid-related harms for these patients while providing appropriate pain and symptom management.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622968","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 and supportive care intervention preferences: a cross-sectional study of barriers in advanced cancer.","authors":"Megan Agnew, Lisa Cadmus-Bertram, Christian W Schmidt, Kristine Kwekkeboom, Amy Trentham-Dietz, Ronald Gangnon, Shaneda Warren Andersen","doi":"10.1136/spcare-2025-005367","DOIUrl":"https://doi.org/10.1136/spcare-2025-005367","url":null,"abstract":"<p><strong>Purpose: </strong>Physical activity may greatly benefit adults living with advanced cancer; however, barriers to physical activity and preferences for supportive care interventions are not well understood. This study investigates barriers to physical activity and differences in intervention preferences by demographic and clinical characteristics among adults with advanced cancer.</p><p><strong>Methods: </strong>Data came from a cross-sectional study of 247 adults with advanced cancer who visited the University of Wisconsin Carbone Cancer Centre from January 2021 to January 2023. The Godin-Shepard Leisure Score Index (insufficiently active, moderately active and active) was used to assess physical activity. Physical activity barriers were reported as mean scores (1-5: 'not at all' to 'a great deal'). Differences in intervention preferences were assessed using X² tests.</p><p><strong>Results: </strong>Adults living with advanced cancer were insufficiently active (53%), moderately active (21%) or active (26%). Respondents identified several barriers to physical activity spanning tiredness (x̄=3.2), winter weather concerns (x̄=3.2) and lack of motivation (x̄=2.7). Respondents were most interested in a supportive care intervention designed to increase energy (88%) and improve physical health (86%) with physical therapy (73%), walking (72%) and resistance exercises (72%). Differences in preferences emerged by demographic characteristics and to a lesser extent by clinical characteristics.</p><p><strong>Conclusions: </strong>Adults with advanced cancer reported several barriers to physical activity. Future interventions should emphasise increasing energy and physical health and include strategies to manage tiredness and winter weather concerns.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622971","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":"Inflammatory marker cut-off points and prognosis in incurable cancer: validation study.","authors":"Gabriella da Costa Cunha, Emanuelly Varea Maria Wiegert, Larissa Calixto-Lima, Livia Costa De Oliveira","doi":"10.1136/spcare-2024-005302","DOIUrl":"https://doi.org/10.1136/spcare-2024-005302","url":null,"abstract":"<p><strong>Objectives: </strong>The study aimed to determine and validate cut-off points for selected inflammatory markers to predict 30-day, 60-day and 90-day survival in patients with incurable cancer exclusively receiving palliative care.</p><p><strong>Methods: </strong>Prospective cohort study with patients referred to the palliative care unit of a national reference centre for cancer in Brazil. The sample (n=2098) was randomised into development (n=1049) and validation (n=1049) groups. C-reactive protein (CRP), CRP/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) were evaluated. Time-dependent receiver operating characteristic curves were used to define the optimal cut-off points. Kaplan-Meier curves, Cox proportional hazards models and concordance statistic (C-statistic) were used to evaluate their predictive ability.</p><p><strong>Results: </strong>The optimal cut-off points related to 30-day, 60-day and 90-day mortality were, respectively, as follows: CRP ≥6.0 mg/L, ≥4.8 mg/L and ≥4.7 mg/L; CAR ≥2.0, ≥1.7 and ≥1.5; NLR ≥6.5, ≥5.8 and ≥5.7; PLR ≥298.0, ≥286.7 and ≥281.2; LMR ≥1.9, ≥2.2 and ≥2.0; PNI ≥35.5, ≥46.8 and ≥30.5; and SII ≥2254.4, ≥1983.0 and ≥1844.1. The inflammatory markers that showed discriminatory accuracy (CRP, CAR, NLR, PLR and SII) were selected for validation. These markers demonstrated predictive ability, with good discriminatory power (C-statistic ≥0.75).</p><p><strong>Conclusions: </strong>Optimal cut-off points were validated for CRP, CAR, NLR, PLR and SII for use in the prognostic assessment of patients with incurable cancer exclusively receiving palliative care.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622965","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":"Crisis pack prescribing in terminal haemorrhage: a national survey of specialist palliative medicine physicians.","authors":"Grace Kennedy, Niall Manktelow, Ita Harnett, Camilla Murtagh","doi":"10.1136/spcare-2025-005370","DOIUrl":"https://doi.org/10.1136/spcare-2025-005370","url":null,"abstract":"<p><strong>Objectives: </strong>To establish practice among senior palliative medicine physicians regarding anticipatory prescribing to manage a terminal haemorrhage.To generate a guideline informed by data collected.</p><p><strong>Methods: </strong>An electronic questionnaire was sent to palliative medicine consultants and specialist registrars in Ireland.</p><p><strong>Results: </strong>The response rate was 50%. All respondents (100%) prescribe crisis packs. The most prescribed medications were morphine and midazolam. Over 95% prescribe medication via the subcutaneous route. Regarding indications for prescribing, about two-thirds of respondents would prescribe for a patient with a head and neck malignancy. Almost two-thirds of respondents do not follow any policy or guideline. The main area of variation is in the dose prescribed for those already on a scheduled opioid and/or benzodiazepine.</p><p><strong>Conclusions: </strong>The proposed guideline is based on the expert opinion of questionnaire respondents. The recommended medications, route of prescription and broad indications for prescribing included in the guideline were based on a clear consensus. Most respondents vary the dose of crisis medication prescribed based on whether the patient is on a baseline anxiolytic/opioid. As the calculations used for dose variation were not consistent between respondents, the most reported calculation, 1/6 of 24-hour dose, is recommended in the guideline.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555908","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":"End-of-life care in a major UK trauma centre.","authors":"Sarah Edwards, Nicola Ubayasiri","doi":"10.1136/spcare-2025-005421","DOIUrl":"https://doi.org/10.1136/spcare-2025-005421","url":null,"abstract":"<p><strong>Objectives: </strong>Death occurs within the emergency department (ED) sadly not infrequently. There is limited evidence exploring the demographics of these patients and the experience they have in the ED when they die or are approaching the end of life (EOL).</p><p><strong>Methods: </strong>A retrospective review of patients aged 18 years and over who died in our major trauma centre was conducted. Data collected included demographics, frailty scores, time of arrival, time of death, time of EOL decision, cause of death in the ED and who wrote do not attempt cardiopulmonary resuscitation (DNACPR) forms.</p><p><strong>Results: </strong>From January to December 2023, 326 patients died in the ED. 76% of patients were aged 65 years or over, with 69% having a clinical frailty score of 5 or more. The average time from arrival to death was 5 hours 56 min, with the average time from EOL decision to death being 1 hour and 53 min. 60% of all patients had a DNACPR, with 75% of those being written by ED clinicians.</p><p><strong>Conclusion: </strong>EOL is becoming ever more important in the ED. Further work is needed to see if our local experience matches other EDs.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540171","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 utilisation globally by cancer patients: systematic review and meta-analysis.","authors":"Addisu Getie, Gizachew Yilak, Temesgen Ayenew, Baye Tsegaye Amlak","doi":"10.1136/spcare-2024-005000","DOIUrl":"https://doi.org/10.1136/spcare-2024-005000","url":null,"abstract":"<p><strong>Introduction: </strong>The rising global prevalence of cancer reveals significant regional disparities in palliative care adoption. While some countries have incorporated palliative care into their systems, over half of the world lacks such services, and oncology-specific palliative care integration is sparse. This study evaluates the global prevalence of palliative care use among cancer patients.</p><p><strong>Methods: </strong>A comprehensive search across multiple databases was conducted to identify relevant studies. Data extraction and organisation were managed using Microsoft Excel, and analysis was performed with STATA/MP 17.0. A weighted inverse variance random-effects model was applied, and heterogeneity was assessed with Cochrane I² statistics. Subgroup analyses, sensitivity analyses and Egger's test were used to explore heterogeneity, publication bias and influential studies.</p><p><strong>Results: </strong>The global prevalence of palliative care among cancer patients was 34.43% (95% CI: 26.60 to 42.25). Africa had the highest utilisation rate at 55.72% (95% CI: 35.45 to 75.99), while the USA had the lowest at 30.34% (95% CI: 19.83 to 40.86). Studies with sample sizes under 1000 showed a higher utilisation rate of 47.51% (95% CI: 36.69 to 58.32). Approximately 55% (95% CI: 35.26 to 74.80) of patients had a positive attitude towards palliative care, and 57.54% (95% CI: 46.09 to 69.00) were satisfied with the services. Positive attitudes were significantly associated with higher palliative care utilisation.</p><p><strong>Conclusion: </strong>Only about one-third of cancer patients globally receive palliative care, with the highest utilisation in Africa. Nearly half of patients have a favourable attitude towards palliative care, and a similar proportion are satisfied with the services.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540172","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":"Divergence in DNACPR and resuscitation policies: institutional survey in England.","authors":"Emily Fitton, Karen Chumbley, Caroline Barry, Aneta Bartova, Ben Troke, Wayne Martin","doi":"10.1136/spcare-2024-005263","DOIUrl":"https://doi.org/10.1136/spcare-2024-005263","url":null,"abstract":"<p><strong>Objectives: </strong>Our objective was to analyse the policies of hospitals and care homes in England as regards the use of do not attempt cardiopulmonary resuscitation (DNACPR) recommendations. We sought to identify (i) variations among policies at different institutions, and (ii) divergence of local policies from national guidance, particularly with reference to decisions either (a) to initiate cardiopulmonary resuscitation (CPR) despite the presence of a DNACPR recommendation, or (b) not to initiate CPR in the absence of a DNACPR recommendation.</p><p><strong>Methods: </strong>We conducted a survey of 14 DNACPR and/or resuscitation policies, drawn from care homes, NHS trusts and hospices.</p><p><strong>Results: </strong>Many of the policies we surveyed diverge significantly from national guidance. Some require that CPR be administered in all cases where no DNACPR recommendation has been made. Others fail to specify that CPR may be appropriate even in the presence of a DNACPR recommendation.</p><p><strong>Conclusions: </strong>Local DNACPR policies currently place both patients and healthcare professionals at significant risk.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540170","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":"End of life care in paediatric settings: UK national survey.","authors":"Andre Bedendo, Andrew Papworth, Bryony Beresford, Bob Phillips, Chakrapani Vasudevan, Gabriella Lake Walker, Helen Weatherly, Richard Feltbower, Sebastian Hinde, Catherine Elizabeth Hewitt, Fliss Murtagh, Jane Noyes, Julia Hackett, Richard Hain, Sam Oddie, Gayathri Subramanian, Andrew Haynes, Lorna Fraser","doi":"10.1136/spcare-2023-004673","DOIUrl":"10.1136/spcare-2023-004673","url":null,"abstract":"<p><strong>Objectives: </strong>To describe end of life care in settings where, in the UK, most children die; to explore commonalities and differences within and between settings; and to test whether there are distinct, alternative models of end of life care.</p><p><strong>Methods: </strong>An online survey of UK neonatal units (NNUs), paediatric intensive care units (PICUs) and children/young people's cancer principal treatment centres (PTCs) collected data on aspects of service organisation, delivery and practice relevant to end of life outcomes or experiences (referred to as the core elements of end of life care) across three domains: care of the child, care of the parent and bereavement care.</p><p><strong>Results: </strong>91 units/centres returned a survey (37% response rate). There was variation within and between settings in terms of whether and how core elements of end of life care were provided. PTCs were more likely than NNUs and PICUs to have palliative care expertise strongly embedded in the multidisciplinary team (MDT), and to have the widest range of clinical and non-clinical professions represented in the MDT. However, bereavement care was more limited. Many settings were limited in the practical and psychosocial-spiritual care and support available to parents.</p><p><strong>Conclusions: </strong>Children at end of life, and families, experience differences in care that evidence indicates matter to them and impact outcomes. Some differences appear to be related to the type of setting. Subsequent stages of this research (the ENHANCE study) will investigate the relative contribution of these core elements of end of life care to child/parent outcomes and experiences.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"221-230"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749875","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":"Sedation from analgesics: patient preference survey.","authors":"Joseph Burdon, Samuel Fingas, Rachel Parry, Constantina Pitsillides, Paul Taylor","doi":"10.1136/spcare-2023-004759","DOIUrl":"10.1136/spcare-2023-004759","url":null,"abstract":"<p><strong>Background: </strong>The propensity for certain analgesics to cause sedation is well documented, yet physician-patient dialogue does not routinely include pre-emptive exploration of preferences regarding this side effect.</p><p><strong>Objectives: </strong>To investigate the extent to which palliative patients would accept sedation as a side effect of analgesia and to identify factors affecting decision-making.</p><p><strong>Methods: </strong>Patients (n=76) known to a specialist palliative care services were given hypothetical scenarios regarding pain and asked about the acceptability of varying levels of sedation occurring as an analgesic side effect. Demographic data, including diagnosis, performance status and experience of pain and sedation, were collated for evaluation of the influence of these factors on patient opinion.</p><p><strong>Results: </strong>Most patients (89.47%) would be quite or very likely to accept mild sedation. A significant minority (40.79%) would accept high levels of sedation. There is no significant association with the acceptability of sedation according to demographics. Almost half (40.79%) reported that their responses may change if the prognosis were extended, typically for less sedation with a longer prognosis.</p><p><strong>Conclusions: </strong>Increasing levels of sedation are less acceptable, although there is significant variation in views. Palliative care patients are likely to indicate preferences regarding their acceptability of sedation. Palliative physicians must explore preferences on an individualised basis.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"262-265"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930039","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 deaths in Switzerland for UK residents: diagnoses and their implications for palliative medicine and assisted dying legislation.","authors":"Colin Brewer, Marie-Claire Hopwood, Graham Winyard","doi":"10.1136/spcare-2023-004719","DOIUrl":"10.1136/spcare-2023-004719","url":null,"abstract":"<p><strong>Objective: </strong>UK campaigners for a law permitting assisted dying (AD) restricted to those with a maximum life expectancy of 6 months claim that this would largely remove the need for UK residents to seek AD in Switzerland. We wanted to discover whether this prediction was correct.</p><p><strong>Methods: </strong>We analysed the diagnoses of UK residents who had such deaths including, for the first time, data from all three of the main Swiss providers of AD to non-residents, comparing them with figures from Oregon, which has a 6-month restriction.</p><p><strong>Results: </strong>Only 22.7% of UK residents had cancer (Oregon 72.5%) while nearly half (49.6% and over half including dementias) had neurological conditions (Oregon 11.2%) and many with prognoses of much more than 6 months.</p><p><strong>Conclusion: </strong>Overall, less than half would meet a 6-month prognosis criterion. This has significant implications for patients, palliative care clinicians and legislators.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"259-261"},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139939632","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}