BMJ Supportive & Palliative Care最新文献

{"title":"HCN channels: novel therapeutic targets for peripheral neuropathic pain.","authors":"Paul Howard","doi":"10.1136/spcare-2025-005509","DOIUrl":"10.1136/spcare-2025-005509","url":null,"abstract":"<p><p>Hyperpolarisation-activated cyclic nucleotide-gated (HCN) channels control neuronal firing thresholds. Together with sodium channels, they accumulate at sites of nerve injury, creating ectopic foci of action potential generation (EFAPG) that result in neuropathic pain.Their presence may explain why EFAPG do not always respond to sodium channel blockers (eg, lacosamide). Further, several current analgesics (clonidine, dexmedetomidine, ketamine and systemic lidocaine) block HCN channels in addition to their better-known actions. Future research could explore the use of ivabradine (an HCN blocker) and multichannel blockade for refractory EFAPG and develop tools to distinguish EFAPG from secondary 'upstream' pain mechanisms (eg, central sensitisation).</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"469-472"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969409","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 in practice: Australian lessons for the Terminally Ill Adults (End of Life) Bill.","authors":"Alex Hughes","doi":"10.1136/spcare-2025-005606","DOIUrl":"10.1136/spcare-2025-005606","url":null,"abstract":"<p><p>This editorial draws on clinical experience with Voluntary Assisted Dying (VAD) in Western Australia to critically examine the Terminally Ill Adults (End of Life) Bill. It compares the legislative approaches and examines the three key eligibility criteria: Terminal Illness (clause 2), Capacity (clause 3), and Coercion (clause 7). Concerns include prognostic accuracy, assessment setting, and structural coercion. Recommendations include independent life expectancy evaluations, outpatient based assessments, and early mandatory palliative care and social work involvement. Transparency about societal risks are emphasised, and the editorial draws on the UK governments recently published Impact Assessments.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"444-446"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172837","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":"Acute Mental Health Unit referrals to a Hospital Specialist and Supportive Palliative Care Liaison Team.","authors":"Despoina-Elvira Karakitsiou, Sarah Gilmour, Conn Haughey, Niall Corrigan","doi":"10.1136/spcare-2024-005359","DOIUrl":"10.1136/spcare-2024-005359","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"451-452"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514497","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":"Auriculotherapy and pain intensity and functional disability in older adults with chronic low back pain: randomised single-blind clinical trial.","authors":"Maryam Pourmohammadi, Zahra Tagharrobi, Khadijeh Sharifi, Zahra Sooki, Mohammad Zare, Fatemeh Zare Joshaghani","doi":"10.1136/spcare-2024-005170","DOIUrl":"10.1136/spcare-2024-005170","url":null,"abstract":"<p><strong>Introduction: </strong>Considering the importance of chronic low back pain in disability in older adults, the present study aimed to investigate the effect of auriculotherapy on pain intensity and functional disability in this group.</p><p><strong>Materials and methods: </strong>This single-blind clinical trial was conducted on older adults with chronic low back pain in Kashan, Iran, 2019-2020. Seventy eligible older people were allocated to the intervention and sham groups via block randomisation. In the intervention group, pressure was applied using Varcaria seeds on the Shenmen, sympathetic, nerve subcortex and low back points. The visual analogue scale was completed at the beginning (T0), weekly (T1-T4) and 1 month after intervention (T5). Functional disability was assessed using Oswestry Disability Index at T0, T4 and T5. Data were analysed in per-protocol and intention-to-treat designs using repeated measures analysis of variance and analysis of covariance.</p><p><strong>Results: </strong>There was a significant difference between the two groups regarding disease duration (p=0.012). The interaction effect of time and intervention was significant on pain intensity and functional disability (effect size (ES)=0.858 and ES=0.789, p<0.0001). The pain intensity in the intervention group was significantly lower than in the sham group at T2-T5 (p<0.0001). The functional disability score in the intervention group was significantly lower than in the sham group at T4 and T5 (p<0.0001).</p><p><strong>Conclusion: </strong>Auriculotherapy can reduce pain intensity and functional disability in older adults with chronic low back pain; it can be used as a complementary medicine in care programmes for older adults with chronic low back pain.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"480-490"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448120","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":"Untested, unlicensed, unregulated: prescribing and oversight issues in physician-assisted dying/suicide.","authors":"Sheila Hollins, Suzy Lishman, Georgina Starling, Ruslan Zinchenko","doi":"10.1136/spcare-2025-005612","DOIUrl":"10.1136/spcare-2025-005612","url":null,"abstract":"<p><p>Current lethal combinations and doses of drugs used in physician-assisted dying/suicide are untested, unlicensed and unregulated, with little pharmacological understanding of efficacy and safety at high doses. Despite this, the proposed legislation would bypass regulatory safeguards, licensing, adverse event reporting and coroner referral. In any other area of medicine, such practices would be unacceptable. Before legalisation, we recommend that a formal, prospective clinical trial should be undertaken to establish the safety, efficacy and acceptability of different practices in end-of-life care including any use of lethal drug combinations. We also suggest that prescribing, licensing and monitoring gaps should be addressed.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"447-450"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141445","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 exercise behaviour of breast cancer survivors: nationwide cross-sectional survey.","authors":"Yoichi Shimizu, Katsunori Tsuji, Tomomi Narisawa, Aya Kuchiba, Taichi Shimazu, Eisuke Ochi, Naomi Sakurai, Hiroji Iwata, Hirokazu Arai, Yutaka Matsuoka","doi":"10.1136/spcare-2024-005253","DOIUrl":"10.1136/spcare-2024-005253","url":null,"abstract":"<p><strong>Objectives: </strong>High physical activity levels have been associated with longer, healthier lifespans and improved quality of life among breast cancer survivors. The Japanese clinical guidelines for breast cancer survivors, similar to those in the USA, strongly recommend maintaining high physical activity levels. However, the extent of adherence to these guidelines among breast cancer survivors in Japan is unclear. This study aimed to assess adherence to guideline-recommended physical activities and identify associated factors.</p><p><strong>Methods: </strong>Self-administered questionnaires were distributed to breast cancer survivors without recurrence or metastasis from 34 facilities across Japan, with approximately 30 survivors per facility, between March 2019 and August 2020. The questionnaire collected information on participants' backgrounds, physical activity levels (assessed using the Global Physical Activity Questionnaire) and potential factors influencing their physical activity. Logistic regression analysis was performed to identify the factors associated with meeting the guideline recommendations.</p><p><strong>Results: </strong>In total, 791 patients (77.5%) were investigated, with 50.5% meeting the physical activity recommendations outlined in the guidelines. Factors associated with meeting the guideline recommendations included higher self-efficacy (OR 1.58, 95% CI 1.29 to 1.94), greater perceived social support (OR 1.54, 95% CI 1.26 to 1.89), lower annual household income (OR 1.58, 95% CI 1.07 to 2.33), relief from cancer-related symptoms through physical activity (OR 1.81, 95% CI 1.13 to 2.94) and urban location (OR 1.50, 95% CI 1.03 to 2.20).</p><p><strong>Conclusions: </strong>Half of the breast cancer survivors in Japan did not meet the recommended physical activity levels, and several factors influencing adherence were identified.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"498-511"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771359","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":"Voluntary-assisted dying, euthanasia and physician-assisted suicide: global perspectives-systematic review.","authors":"Graham Llewellyn Grove, Melanie R Lovell, Ian Hughes, Elise Maehler, Megan Best","doi":"10.1136/spcare-2024-005116","DOIUrl":"10.1136/spcare-2024-005116","url":null,"abstract":"<p><strong>Background: </strong>Discussions about euthanasia and physician-assisted suicide (EAS) involve various stakeholders, including patients, healthcare professionals and the general public. This review examines perspectives across different population subgroups to contribute to a broader understanding of EAS attitudes.</p><p><strong>Methods: </strong>A systematic review of literature published prior to July 2023 with quantitative data about EAS views was undertaken. Details extracted from eligible papers included data year, geography, demographic features of population subgroups and levels of support for EAS under various circumstances. Proportions in support for EAS were calculated based on these factors. Meta-analyses were conducted to estimate changes in the proportion of support for euthanasia dependent on the presence or absence of pain or terminal illness in patients.</p><p><strong>Results: </strong>The search identified 521 relevant studies. There were 1863 relevant survey questions with 1 945 945 individual responses, spanning years 1936 to 2023.478 studies explored whether EAS should be allowed, 134 examined clinician willingness to practise EAS and 78 investigated which persons might seek EAS. Clinician views were surveyed in 266 studies, public opinion in 139 and patient beliefs in 54.Support for EAS across studies and subpopulations varied widely. Mean support for EAS was lower in doctors than in the general public (25% compared with 55%). Support varied depending on access criteria to EAS with 54% support for patients in pain vs 36% for those without and 53% for terminally ill patients vs 29% for those without a terminal illness. Public support for EAS was lower in religious people, females, older people and African Americans.</p><p><strong>Conclusions: </strong>Support for EAS varies widely across studies, with numerous demographic and situational factors associated with differing levels of support. This indicates a complex interplay of elements is involved in the formation of EAS beliefs. Understanding these factors is valuable for facilitating meaningful discussions among clinicians and the community and informing policy debates and decisions.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"423-435"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771360","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":"Orthostatic hypotension in pancreatic cancer.","authors":"Siwan Seaman, Stephanie Hemmings","doi":"10.1136/spcare-2025-005399","DOIUrl":"10.1136/spcare-2025-005399","url":null,"abstract":"<p><p>Orthostatic hypotension is a relatively common medical diagnosis and can be debilitating for the patients it affects. There is a range of treatment options, though only one medication is licensed in the UK for treatment of orthostatic hypotension.We review the case of a man in his 70s with pancreatic cancer who developed orthostatic hypotension towards the latter stage of his disease that caused severe dizziness, impacting his quality of life. Multiple factors contributed to his orthostatic hypotension and various treatments, both non-pharmacological and pharmacological, were trialled, with varying degrees of success, to alleviate his symptoms and improve his quality of life. On reviewing his case, we identify that the medication options have different optimal scenarios in which they are effective.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"460-462"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954225","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":"Financial toxicity and health-related quality of life in long-term survivors of acute promyelocytic leukaemia.","authors":"Francesco Sparano, Maria Teresa Voso, Adriano Venditti, Johannes M Giesinger, Thomas Baldi, Massimo Breccia, Paola Fazi, Marco Vignetti, Fabio Efficace","doi":"10.1136/spcare-2024-004924","DOIUrl":"10.1136/spcare-2024-004924","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to investigate the association between financial toxicity (FT) and the health-related quality of life profile of long-term survivors of acute promyelocytic leukaemia (APL) treated within a universal healthcare system.</p><p><strong>Methods: </strong>We evaluated FT using the financial difficulties item of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). We also compared the prevalence of clinically important problems and symptoms between the survivors of APL with or without FT, using evidence-based thresholds for the EORTC QLQ-C30. A multivariable logistic regression analysis was performed to explore potential risk factors associated with FT.</p><p><strong>Results: </strong>Overall, 352 long-term survivors of APL, with a median age of 53.9 years and a median time since diagnosis of 12.2 years, were analysed. Of these, 71 (20.2%) reported having FT. The prevalence of clinically important problems and symptoms was generally higher across most EORTC QLQ-C30 scales for those survivors who reported FT. The three largest differences between patients with and without FT were observed for emotional functioning (+35.4 percentage points), dyspnoea (+33.1 percentage points) and physical functioning (+27.0 percentage points). The presence of FT was independently associated with having comorbidities and not receiving a salary/pension.</p><p><strong>Conclusions: </strong>These findings suggest that even many years after being diagnosed, one-fifth of long-term survivors of APL experience FT. Interventions to assist with employment may be critical to minimise the risk of FT in the most vulnerable survivors.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"530-534"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140896345","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":"Early palliative care integration in advanced cancer: two institutional quality improvement projects.","authors":"Meenakshi V Venketeswaran, Jewell Joseph, Shanthi Prasoona Thotampuri, Praveen Kumar Marimuthu, Jefrilla Nancy Joseph, Vivaan Dutt, Ramakrishnan Ayloor Seshadri, Jenifer Jeba Sundararaj","doi":"10.1136/spcare-2025-005644","DOIUrl":"https://doi.org/10.1136/spcare-2025-005644","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend early palliative care (PC) integration in advanced cancers. This remains a challenge in countries with high cancer burden and limited PC access. We report the quality improvement (QI) journey aimed at improving timely PC integration in patients with advanced gastric, colorectal and lung cancers at two centres in India.</p><p><strong>Methods: </strong>Centre A, an academic institution, and Centre B, a standalone cancer centre, used the A3 methodology for the QI process. An audit was conducted prior to August 2023 to establish the baseline PC referral rate. Process mapping, root cause analysis and Pareto chart were done, and key drivers were identified and interventions were planned. The common interventions were to increase oncologists' awareness, ensure holistic symptom assessment and establish a referral process. The proportion of patients with advanced cancer referred timely to PC was measured and recorded. Sustainability of the QI projects was assessed until September 2024.</p><p><strong>Results: </strong>There was an increase in the timely PC referral from 37% to 66% in Centre A, and from 30% to 60% in Centre B, from before August 2023 to April 2024.</p><p><strong>Conclusion: </strong>QI projects are feasible and effective when supported by good stakeholder collaboration to achieve the target of early and timely PC referral within oncology settings.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511501","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}