Current Opinion in Supportive and Palliative Care最新文献

Purpose of review: Diagnosis and management of patients with suspected or confirmed cancers often require procedures which can cause significant anxiety, discomfort and pain. While intravenous sedation and strong opioids are effective, they could be risky in frail cancer patients with multiple comorbidities. Inhaled methoxyflurane (IMF) (Penthrox®) has been utilised as an analgesic for moderate to severe trauma pain for decades in emergency departments. This review article evaluates the latest evidence for the use of IMF in cancer-related procedures.

Recent findings: IMF has been recently shown to be effective in reducing pain and discomfort in patients receiving transrectal ultrasound-guided prostate biopsy and removal of gynaecological brachytherapy applicators. Side effects of IMF are mild and transient. No recent report of severe toxicities such as cardiopulmonary suppression was observed.

Summary: IMF is a safe drug device combination that can reduce discomfort and improve treatment compliance with repeat procedures in cancer patients. Real-world studies should be performed to further evaluate its safety and quality of life in diverse cancer patient populations and guide patient selection.

Purpose of review: Long COVID affects approximately 6% of the population after SARS-CoV-2 infection commonly involving persistent respiratory symptoms such as breathlessness and cough. This review provides an update on the latest evidence regarding post-COVID condition/Long COVID and respiratory sequelae, focusing on persistent symptoms, respiratory complications, and therapeutic approaches to date.

Recent findings: Post-COVID interstitial lung abnormalities are estimated to persist in approximately 11% of patients hospitalized with acute COVID-19. However, breathlessness is common in adults (non-hospitalized) with Long COVID, suggesting aetiologies beyond pneumonitis. The risk of venous thromboembolic disease in Long COVID remains uncertain and trial results of anti-coagulation in Long COVID are awaited.

Summary: Long COVID presents complex respiratory challenges, and careful assessment is crucial to differentiate Long COVID symptoms from exacerbations of pre-existing respiratory conditions. Current management includes a symptom-based multidisciplinary approach, with ongoing research into effective treatments including immune modulating agents.

Purpose of the review: Pulmonary fibrosis (PF) is characterized by relentless scarring of the lungs, declining lung function, and increasing symptom burden. In PF, dyspnea and cough are the most common symptoms, severely impacting quality of life. This review highlights recent advances in understanding their mechanisms and explores evolving strategies for management of these symptoms.

Recent findings: Advances in non-pharmacologic approaches, including hand-held fans, dyspnea services and pulmonary rehabilitation are playing a vital role in dyspnea management. Opioids, while effective in reducing exertional dyspnea in controlled settings, show limited benefit for daily life breathlessness and are associated with significant adverse events, highlighting the need for cautious, individualized use. For refractory cough, promising studies are investigating the role of opioids and neuromodulatory therapies. Non-pharmacologic approaches, including speech therapy, and behavioral interventions, provide complementary approaches. A multidisciplinary approach and individualized care plans to address the multifactorial nature of dyspnea and cough are key.

Summary: Effective management of dyspnea and cough can importantly improve patients' quality of life. Further research is required to refine treatment protocols, optimize palliative care interventions, and identify and test novel therapeutics. Translation of these findings into clinical practice requires a focus on evidence-based, patient-centered care.

Purpose of review: Two widely validated health-related quality of life (HR-QoL) tools, specifically designed for patients with advanced cancer, are the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL) and the Functional Assessment of Chronic Illness Therapy-Palliative (FACIT-Pal-14). This systematic review aims to evaluate the use of EORTC QLQ-C15-PAL and FACIT-Pal-14 in prospective studies in patients with advanced cancer, focusing on study types, clinical settings, additional HR-QoL tools used, and completion rates.

Recent findings: Sixty studies were included in the analysis. Both EORTC QLQ-C15-PAL and FACIT-Pal-14 are used in a variety of studies. Given that EORTC QLQ-C15-PAL was developed 9 years before FACIT-Pal-14 PAL, most studies utilized the EORTC tool. Both tools were shown to be successfully used in a variety of clinical settings, including in various advanced tumour types or different study designs, depending on the investigator and study needs.

Summary: This review demonstrates the wide range of utilization of EORTC QLQ-C15-PAL and FACIT-Pal-14 in prospective studies to assess the HR-QoL issues in patients with advanced cancers.

Purpose of the review: This review summarises high-level evidence for fan therapy and adds a commentary on the relatively-neglected question of how to optimise benefits based on qualitative evidence, clinical experience and broader research and theory.

Recent findings: Recent high-level evidence suggests the fan reduces time to recovery from episodic breathlessness rather than reduces daily levels over a longer period. Lower grade evidence suggests the fan can also help people increase their physical activity. Experimental evidence for physiological mechanisms suggests that airflow reduces inspiratory neural drive and perceived unpleasantness through facial cooling of the trigeminal and olfactory nerves. Faster airflow elicits a stronger effect, with the optimal balance between efficacy and comfort proposed to be 2.85 metres per second. Research on clinician perspectives highlights the need for targeted strategies to drive fan implementation.

Summary: Fan therapy contributes to all three domains of the Breathing, Thinking, Functioning model of breathlessness management. Given it is affordable, portable, and has no known harms, the fan should be recommended as first-line therapy for anyone with breathlessness. Future research should evaluate how best to integrate fan therapy as a complex intervention alongside other strategies and supports.

Purpose of the review: Breathlessness is a prevalent symptom that significantly affects physical and mental health. While commonly associated with respiratory and cardiovascular diseases, breathlessness is increasingly recognised as a concern in the general population. This review summarises recent research on the prevalence, risk factors, assessment methods, and clinical and societal impact, with a focus on findings from the past 18 months.

Recent findings: Recent studies indicate that breathlessness affects a substantial proportion of adults worldwide, with prevalence varying across populations and regions. Identified risk factors include older age, female sex, high body mass index, smoking, and comorbidities such as respiratory and cardiovascular diseases. Novel approaches in assessing breathlessness are looking beyond unidimensional scales to improve diagnostic accuracy. However, breathlessness remains underdiagnosed in clinical practice. Recent publications also show that breathlessness has a substantial impact on health outcomes of the affected person, but also imposes a burden on their informal caregivers, health care systems and the economy.

Summary: Despite progress in understanding chronic breathlessness, knowledge gaps persist, particularly regarding its assessment in large-population samples. Longitudinal studies are needed to understand risk factors for breathlessness and its impact on health outcomes and society.

Purpose of the review: Today, two-thirds of all cancer survivors are at least 65 years old. Older cancer survivors have complex care needs, and addressing their social determinants of health (SDoH) is critical for improving and managing survivorship outcomes for this uniquely vulnerable population, yet research specifically examining these associations remains limited and emergent. To this end, we describe the emergent body of evidence on the associations between SDoH domains and older cancer survivors' outcomes.

Recent findings: Despite the limited investigations of SDoH on the health outcomes of older cancer survivors, there were measures representing all domains of SDoH - health care access and quality, education access and quality, neighborhood and built environment, social and community context, and economic stability. We reviewed another determinant, Digital Environment and Engagement, as they are highly relevant to older cancer survivors' care. Studies primarily investigated outcomes such as the use of or delays in treatment and variables related to care coordination. Generally, poorer access to resources such as income, social networks, and quality health care facilities predicted poorer health outcomes.

Summary: We reviewed studies that revealed that SDoH significantly impacts older cancer survivors' health outcomes. Our description informs future interventions and policies to improve their care.

Purpose of review: The survival rate of patients with a cancer or palliative care diagnosis has improved over the years although pain remains a debilitating symptom that many patients still require treatment with opioids. Compared to full mu-opioid receptor agonists such as morphine and oxycodone, buprenorphine continues to remain a second- or third-line choice in this group of patients.We have reviewed the pharmacology and clinical utility of buprenorphine to stimulate debate around the first-line use of buprenorphine in the management of pain in cancer patients.

Recent findings: Buprenorphine has a pharmacological profile that is unique and unlike any other opioid. It is associated with many immediate and long-term benefits, with lower risks of adverse effects that make it an ideal first-line choice in the management of cancer pain.

Summary: Buprenorphine appears to be a promising choice of opioid for cancer patients. Studies have found that buprenorphine is a safe and effective choice for many patients, making it a suitable first-line option for the management of cancer pain.

Purpose of review: The evidence supporting geriatric assessment (GA) in cancer care is well established, and GA is recommended by the American Society of Clinical Oncology, the International Society of Geriatric Oncology, and other oncology bodies. However, effective implementation of GA remains inadequate. Using selected papers indexed in Medline from the most recent 18 months to July 2024, including two outstanding interest papers, this review aimed to describe enablers and barriers to GA implementation in oncology and contrasts implementation with and without an implementation science framework. Finally, we make recommendations on applying an implementation science framework to facilitate integrating GA in oncology.

Recent findings: Implementation science frameworks have been widely employed in health services research, but their use in geriatric oncology, particularly to guide GA implementation and evaluation, is limited. Lack of time in busy practices coupled with workforce shortages adds to the challenges of GA implementation and adoption. A variety of screening and assessment tools such as the G8, electronic rapid fitness assessment, and Eastern Cooperative Oncology Group are often used in lieu of geriatrician review and to streamline GA. When effectively implemented in oncology, GA informs care and treatment decisions for improved outcomes.

Summary: Despite the benefits for older adults, embedding GA into routine clinical practice is critical yet not common practice. The variety of available GA tools, logistics, and individual beliefs are some of the identified barriers to GA adoption in oncology. Enablers include organization readiness, adaptability, communication, and the use of multidisciplinary teams. Further research is needed to examine how implementation science frameworks could provide guidance and structure for successful GA implementation in oncology.

Purpose of review: Abdominal pain due to cancer is a significant and debilitating symptom for cancer patients, which is commonly undertreated. Radiotherapy (RT) for the management of abdominal cancer pain is underused, with limited awareness of its benefit. This review presents a discussion on current precision RT options for the management of cancer pain in the abdomen.

Recent findings: Precision RT focuses on delivering targeted and effective radiation doses while minimizing damage to surrounding healthy tissues. In patients with primary or secondary liver cancer, RT has been shown to significantly improve liver related cancer pain in the majority of patients. Also, symptom sequelae of tumour thrombus may be relieved with the use of palliative RT. Similarly, single dose, high precision stereotactic RT to the celiac plexus has been shown to significantly improve pain in patients with pancreatic cancer. Pain response for adrenal metastases has been less commonly investigated, but small series suggest that stereotactic body RT may reduce or alleviate pain.

Summary: RT is an effective option for the treatment of abdominal cancer pain. RT should be considered within the multidisciplinary treatment armamentarium, and may be successfully integrated, alone or in conjunction with other treatment modalities, in abdominal cancer-related pain.