BMJ Supportive & Palliative Care最新文献

{"title":"Ambulatory palliative care and cancer symptom control: a systematic review and meta-analysis.","authors":"Rajvi Shah, Rachel Everitt, Dana Hince, David Kissane, Natasha Michael","doi":"10.1136/spcare-2024-005152","DOIUrl":"10.1136/spcare-2024-005152","url":null,"abstract":"<p><strong>Background: </strong>Ambulatory palliative care clinics are associated with improved outcomes in cancer patients, including short-term quality of life. However, their impact on individual patient-reported symptoms is not well understood.</p><p><strong>Aim: </strong>We evaluated the impact of ambulatory palliative care on individual symptoms in adult cancer patients.</p><p><strong>Design: </strong>Following a standard protocol (PROSPERO: CRD42022321909), investigators independently identified randomised and non-randomised intervention studies that assessed patient-reported symptom scores using validated symptom assessment scales longitudinally. Data were synthesised using random-effects meta-analyses.</p><p><strong>Data sources: </strong>Database of PubMed, CINAHL, EMBASE, PsycINFO and Cochrane Central was searched from inception to September 2023 for eligible studies.</p><p><strong>Results: </strong>20 studies encompassing 4 prospective cohort studies, 1 randomised control trial and 15 retrospective studies were included. Most studies focused on cohorts with advanced cancers of mixed primary tumour type, were colocated within or linked to a tertiary cancer centre and assessed symptoms using the Edmonton Symptom Assessment Scale (ESAS). The meta-analyses confirmed evidence for improvement in pain (standardised mean difference (SMD) 0.31, 95% CI 0.18 to 0.44), anxiety (SMD 0.31, 95% CI 0.12 to 0.49), fatigue (SMD 0.31, 95% CI 0.10 to 0.51), insomnia (SMD 0.29, 95% CI 0.15 to 0.42), depression (SMD 0.25, 95% CI 0.09 to 0.40), drowsiness (SMD 0.23, 95% CI 0.11 to 0.34), well-being (SMD 0.28, 95% CI 0.12 to 0.45) and overall symptom burden (SMD 0.29, 95% CI 0.22 to 0.36). There was no evidence for improvement in nausea (SMD 0.19, 95% CI -0.02 to 0.40), dyspnoea (SMD 0.16, 95% CI 0.02 to 0.29) and appetite scores (SMD 0.14, 95% CI -0.00 to 0.29).</p><p><strong>Conclusions: </strong>Ambulatory palliative care had positive effects on multiple common symptoms. The strength of this evidence however is low, largely due to the considerable heterogeneity among included studies. Further research could determine thresholds on symptom assessment scales to guide urgency of referral, timing of follow-up and optimal multidisciplinary staff involvement.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"411-422"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691074","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":"Lower physical activity and functional capacity after breast cancer neoadjuvant chemotherapy.","authors":"Clarice Gomes Chagas Teodózio, Thamyres Vitória Francisco da Silva Correia Gomes, Louise Acalantis Pereira Pires Fernandes, Raphaela Nunes de Lucena, Jessica Malena Pedro da Silva, Suzana Sales de Aguiar, Luiz Claudio Santos Thuler, Anke Bergmann","doi":"10.1136/spcare-2024-005358","DOIUrl":"10.1136/spcare-2024-005358","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to assess the levels of physical activity (PA) and functional capacity of breast cancer patients before and after neoadjuvant chemotherapy.</p><p><strong>Methods: </strong>The investigation comprises a prospective cohort study including women 18 years or older who underwent neoadjuvant chemotherapy for breast cancer at a single oncology centre between 4 April 2016 and 31 October 2018. Patients were evaluated in terms of self-reported PA levels and physical capacity using the following physical tests: handgrip strength, sitting and standing up in 30 s and stationary walking for 2 min. Variables were compared before and after neoadjuvant chemotherapy using the Wilcoxon test.</p><p><strong>Results: </strong>A total of 440 women were analysed, 88.2% of whom presented at an advanced clinical stage. The mean age of the patients was 51.0 years (±11.0), 68.0% were non-white and 53.9% were not working at the time of diagnosis. Decreased PA levels and handgrip strength (p<0.002) were observed following chemotherapy, although no changes in aerobic capacity and lower limb resistance (LLR) were noted (p=0.595 and p=0.163, respectively).</p><p><strong>Conclusion: </strong>Women with breast cancer exhibit decreased PA levels and handgrip strength following neoadjuvant chemotherapy, although no alterations in aerobic capacity and LLR were observed at the end of treatment.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"512-517"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691075","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":"Home blood pressure monitoring: technology, digitisation and future development.","authors":"Yun Shi, Oscar Onayi Mandizadza, Conghua Ji","doi":"10.1136/spcare-2025-005538","DOIUrl":"10.1136/spcare-2025-005538","url":null,"abstract":"<p><strong>Purpose: </strong>Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases, and home blood pressure monitoring (HBPM) plays a crucial role in its management. This review summarizes the current evidence on HBPM, focusing on its clinical utility, technological advancements, and future directions.</p><p><strong>Methods: </strong>We conducted a narrative synthesis of recent literature on HBPM, including its background, technological developments, and clinical applications. Key studies and guidelines were analyzed to assess the benefits, challenges, and emerging trends in HBPM adoption.</p><p><strong>Results: </strong>HBPM offers significant advantages, such as improved patient adherence, more accurate blood pressure data, and better long-term hypertension control. However, challenges remain, including standardization issues, variability in device accuracy, and integration with digital health systems. Emerging technologies, such as AI-driven analytics and smartphone-connected devices, are expected to enhance HBPM in the near future.</p><p><strong>Conclusions: </strong>HBPM represents a transformative approach to hypertension management, with emerging wearable and AI-enhanced technologies poised to revolutionize blood pressure monitoring, though wider clinical adoption requires improved standardization and validation protocols.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":"436-443"},"PeriodicalIF":2.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172838","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":"Opioid-refractory rectal tenesmus treated with burst ketamine.","authors":"David Murphy, Hannah O'Brien, Mary Jane O'Leary","doi":"10.1136/spcare-2025-005552","DOIUrl":"https://doi.org/10.1136/spcare-2025-005552","url":null,"abstract":"<p><p>Rectal tenesmus is the painful sensation of incomplete evacuation of the bowels, which is distressing and difficult to manage. Tenesmus is often caused by rectal carcinoma. It is thought there is a significant neuropathic component to tenesmus pain. Ketamine is an antagonist to the N-methyl D-aspartate receptor and has been used for neuropathic pain. We describe the case of a man with difficult-to-manage rectal tenesmus who experienced adverse effects to several medications, limiting titration. A trial of 'burst' ketamine over seven days via a continuous subcutaneous infusion, combined with midazolam and dexamethasone, resulted in a decrease in his pain, as shown by his improved self-reported pain scores and reduced PRN and background opioid requirements. To the authors' knowledge, this is the first report of using ketamine for rectal tenesmus.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504850","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 betamethasone: an alternative to out-of-stock dexamethasone.","authors":"Jonathan Hindmarsh, Mark Lee","doi":"10.1136/spcare-2025-005602","DOIUrl":"https://doi.org/10.1136/spcare-2025-005602","url":null,"abstract":"<p><p>Dexamethasone is the most widely used corticosteroid in palliative care due to its potent anti-inflammatory action. When oral administration is not feasible, dexamethasone is often administered subcutaneously. During a recent shortage of injectable dexamethasone, we were required to consider alternatives. However, evidence and clinical experience regarding the use of alternative subcutaneous corticosteroids in the palliative population remain limited. Our objective was to evaluate the clinical effectiveness and tolerability of subcutaneously administered betamethasone in the palliative demographic as an alternative to out-of-stock dexamethasone injection. Eight patients received subcutaneous betamethasone for various indications, including intracranial hypertension, liver capsule pain, superior vena cava obstruction, malignant spinal cord compression and subacute bowel obstruction. All patients tolerated the treatment at different doses (range 1-16 mg) for various periods (range 6-27 days) without developing injection-site reactions or severe adverse effects. Improvement in symptom scores and relevant clinical assessments were observed. Subcutaneously administered betamethasone was well tolerated and effective in managing various indications in palliative patients, demonstrating its potential as a viable alternative to dexamethasone during stock shortages. Further prospective studies are required to establish its utility and tolerability in this demographic.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494646","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":"Integrative medicine in modern supportive care.","authors":"Eran Ben-Arye, Noah Samuels","doi":"10.1136/spcare-2025-005545","DOIUrl":"https://doi.org/10.1136/spcare-2025-005545","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494645","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":"Why physician-assisted suicide has no place in the NHS.","authors":"Sheila Hollins, Ilora Finlay, Ruslan Zinchenko","doi":"10.1136/spcare-2025-005670","DOIUrl":"10.1136/spcare-2025-005670","url":null,"abstract":"<p><p>The UK is currently debating legislation to allow physician-assisted suicide for competent, terminally ill adults. Though not explicit, it is likely to be delivered through the National Health Service (NHS). International evidence shows that integrating assisted suicide and euthanasia into mainstream healthcare increases uptake and rate of growth as well as broadens eligibility criteria. In this editorial, we argue that it should not be part of the NHS, since it is not a medical treatment, lacks a robust evidence base and fails to meet regulatory standards. The proposed framework for assessing decision-making capacity is unsuitable, and psychiatrists are not the right clinicians to be involved.</p>","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336217","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":"Anaemia investigation and treatment in hospice inpatients: palliative medicine consultants attitudes and practices survey.","authors":"Mary Teresa Kennedy, Jessica Lee, Marie Murphy, Mary Jane O'Leary, Conal Houstoun, Oonagh Gilligan, Fiona Kiely, Aoife C Lowney","doi":"10.1136/spcare-2025-005376","DOIUrl":"10.1136/spcare-2025-005376","url":null,"abstract":"","PeriodicalId":9136,"journal":{"name":"BMJ Supportive & Palliative Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336216","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":"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":"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":"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}