Current Opinion in Supportive and Palliative Care最新文献

Purpose of review: There has been a notable rise in cancer-related emergencies, especially in older patients, due to an increase in those undergoing complex therapies. In this review, we consider the management and clinical workup of the older cancer patient in the emergency department (ED). We will reflect on clinical features of older patients with cancer, as well as fall, delirium, febrile neutropenia (FN), and immune checkpoint inhibitor toxicity.

Recent findings: Older patients with cancer are more likely to require admission to hospital following ED attendance. The most common emergency presentations are fever, pain and gastrointestinal symptoms. The complexity of common presentations, such as falls and delirium, is often overlooked in older cancer patients. FN in older patients is associated with increased mortality and a higher likelihood of requiring inpatient care. Despite their therapeutic benefits in older patients, the broad spectrum of immune-related toxicities even at lower grades, can lead to functional decline and the need to discontinue therapy.

Summary: The number of older people with cancer presenting to emergency care is expected to rise. In response to this growing and complex demand, a comprehensive, individualised, and multi-disciplinary approach is essential. Clinicians need to be aware of the increasingly broad spectrum of diagnoses in this population and tailor their assessment and management strategies accordingly.

Purpose of review: Two common quality of life (QoL) questionnaires for cancer-related fatigue (CRF) are the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Fatigue 12 (QLQ-FA12) and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue). This systematic review compared their content, validity, and psychometric properties.

Recent findings: Twenty-four studies were included. The QLQ-FA12 (12 items) provides physical, emotional, and cognitive subscales, while the FACIT-Fatigue (13 items) captures self-reported fatigue and its impact on daily function. Both instruments demonstrated validity, internal consistency, test-retest reliability, and sensitivity. Construct validity was supported by correlations with QoL and physical-function measures, and confirmatory factor analyses upheld their intended dimensional structures. The QLQ-FA12's 4-point question format offers distinct domain scores, whereas the FACIT-Fatigue's 5-point statement format yields a single total score. The QLQ-FA12 is preferred when a multidimensional profile is needed, such as in trials addressing specific fatigue drivers or pairing with QLQ-C30 domains. The FACIT-Fatigue suits brief screening or large-scale studies where efficiency and a single total fatigue score are priorities.

Summary: The EORTC QLQ-FA12 and FACIT-Fatigue are both sufficiently validated for assessing CRF-related QoL. The QLQ-FA12 is more appropriate when a multidimensional profile is required, whereas FACIT-Fatigue suits contexts needing a unidimensional total severity score.

Purpose of review: There are many different patient-reported outcome measures to assess how patients feel or function but they vary in how they collect responses and score results. Therefore, it can be hard to know what a change in score means for a patient or whether treatments compared in a trial result in different patient experiences. Methods exist to estimate thresholds to aid interpretation, but no single method is considered the best. This review considers recent advances in efforts to improve these methods.

Recent findings: New research has been published on the choice of appropriate anchors and the methods to establish thresholds based on them. There has been increased focus on the derivation of thresholds used to compare scores between groups of patients versus those used to interpret an individual's change in scores over time. Studies are also highlighting how baseline severity and other factors affect how we estimate thresholds.

Summary: Consensus on the optimal methods for the derivation of score interpretation thresholds is still required, although the field continues to grow in understanding biases and impacts of treatment and population factors on estimation.

Purpose of review: Translational research is a dynamic process that aims to apply fundamental scientific discoveries into clinical practice through strong cooperation between scientists and healthcare providers. This review discusses recent advances in symptom science within palliative care, driven by translational research, and highlights the pressing need to bridge the gap between scientific innovation and clinical practice.

Recent findings: The dramatic change in the cancer landscape in the last decade has been achieved through translational research. However, the role of translational research in symptom science in palliative care for patients with cancer has been chronically neglected. Recently, initial progress has been made in symptom prediction through biomarker discovery for distressing syndromes, such as delirium or cancer-related cachexia. Other areas where translational approaches offer promise include predicting survival and identifying the dying phase in patients with advanced cancer.

Summary: Despite some progress in introducing translational research into palliative care, significant challenges persist, limiting the full potential of integrative and collaborative research to improve patient outcomes in cancer palliative care. Herein, key areas are discussed, including emerging themes and tools that could help bridge this gap.

Purpose of review: Managing multimorbidity in older adults with cancer is a central, complex challenge in modern oncology. Historically, this population was underrepresented in clinical trials, leaving clinicians without practical guidance. This review synthesizes recent evidence that moves beyond simply documenting frailty to deploying targeted, evidence-based interventions to improve supportive and palliative care.

Recent findings: The literature supports a practical 2-step approach to assessment, using screening tools like the Geriatric-8 to trigger a full Comprehensive Geriatric Assessment (CGA) with management, which is proven to reduce treatment toxicity. Goal-aligned deprescribing has emerged as an active clinical skill to manage polypharmacy. In decision-making, the focus has shifted from guideline-concordant to goal-concordant care. Finally, a needs-based paradigm for integrating palliative care is replacing older, prognosis-based models, distinguishing between generalist skills for all clinicians and specialist consultation for complex cases.

Summary: Recent evidence provides clinicians with practical approaches. By using validated screening, CGA-led interventions, systematic deprescribing, and needs-based palliative care, clinical teams can reduce treatment toxicity, lessen medication burden, and align complex cancer care with the personal priorities and quality-of-life goals of older patients.

Purpose of review: Prostate cancer can significantly impact psychological, physical, and social well-being. This systematic review compares the development of the Functional Assessment of Cancer Therapy-Prostate (FACT-P) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Prostate Cancer (EORTC QLQ-PR25) for evaluating quality of life (QoL) in prostate cancer patients, focusing on development, characteristics, reliability, validity, and psychometric properties.

Recent findings: Thirteen studies published between 2013 and 2022 met the inclusion criteria. FACT-P and EORTC QLQ-PR25 are both validated, reliable, and responsive instruments for assessing QoL in prostate cancer patients. FACT-P emphasizes emotional, social, and functional well-being alongside prostate-specific concerns, while EORTC QLQ-PR25 focuses on prostate-specific symptoms, particularly urinary, sexual, and hormonal function.

Summary: The FACT-P and EORTC QLQ-PR25 are valid tools for assessing QoL in prostate cancer patients. The decision to use the FACT-P or the EORTC QLQ-PR25 instrument may depend on the population and aims of the proposed study. Given substantial advancements in treatment and patient care in prostate cancer since the initial development of the FACT-P and EORTC QLQ-PR25, these quality of life instruments should undergo comprehensive validation to ensure they remain a relevant and effective tool for contemporary prostate cancer clinical trials.

Purpose of review: Patient-reported outcomes (PROs) have become increasingly important in oncology, capturing the patient perspective on symptoms, treatment effects, and health-related quality of life. Transitioning to electronic platforms (ePROs) enables real-time monitoring, efficient integration into clinical workflows, and enhanced patient-centered care. This review explores recent evidence on the clinical utility, barriers, and future directions of integrating ePROs in supportive care in oncology.

Recent findings: ePROs improve symptom control, quality of life, engagement, and in some studies, overall survival. They support earlier clinical interventions, reducing emergency visits and hospitalizations and help improve outcomes. Barriers persist at system (infrastructure, interoperability, and data security), clinician (workflow disruption, time constraints, and alert fatigue), and patient (digital literacy, access, and usability) levels. Mitigation strategies include organizational support, clinician champions, codesigned inclusive platforms, and robust privacy safeguards. Emerging opportunities involve integration with artificial intelligence, big data, and decision-support systems to advance precision oncology and population health management.

Summary: ePROs represent a transformative approach in supportive cancer care. Overcoming multilevel barriers and harnessing digital innovations are essential to optimize clinical outcomes, equity, and long-term sustainability.

Purpose of the review: The primary aim of this review was to identify and describe the tools or methods used to capture patient-reported experiences and outcomes related to palliative care provided within acute hospital settings.

Recent findings: Twenty-eight patient-reported outcome and experience measures were used across the studies. The studies mainly used the patient-reported outcome measures to assess symptom burden and distress. Only four studies used both patient-reported outcome measures and patient-reported experience measures. Most studies predominantly included patients with cancer. Only one new measure was found in the last 18 months. There was lack of use of electronic versions of patient-reported outcome and experience measures in inpatient palliative care.

Summary: Limited evidence was found on the use of electronic version of patient-reported outcome and patient reported experience measures in inpatient palliative care. There is a critical need to enhance understanding and routine implementation of more holistic patient-reported outcome measures in hospital-based specialist palliative care. Further research is needed to identify the most appropriate electronic version of holistic patient-reported outcome measures and patient-reported experience measures for use in these settings.

Purpose of the review: Social isolation and loneliness are common in people with advanced illness. This leads to reduced quality of life and all-cause mortality. The aim of this review is to identify the causes of social isolation in those with serious illness and consider the role of Public Health Palliative Care (PHPC) and Compassionate Communities in reducing these insidious issues.

Recent findings: Recent studies have expanded the evidence base around the causes of social isolation in those with serious illness. While there has been a plethora of research on the outcomes of Compassionate Communities initiative recent research has identified that more needs to be done to evidence their effectiveness and efficiency.

Summary: Social isolation and loneliness in those with serious illness have a negative effect on the quality of life. However, much still needs to be done to improve this situation in an effective and efficient way that meet the needs of individuals. It would appear that PHPC, and in particular Compassionate Communities, have a key role to play in this endeavour.