Pub Date : 2024-09-16DOI: 10.1097/SPC.0000000000000727
Caroline Hircock, Shing Fung Lee, Srinivas Raman, Elizabeth Chuk, Adrian W Chan, Edward Chow, Henry C Y Wong
Purpose of review: This review aims to address the gap in radiation therapy (RT) care for elderly cancer patients. It will discuss the barriers to implementing effective RT in elderly and frail patients with a focus on breast cancer and metastatic settings.
Recent findings: Recent studies indicate that SBRT provides better pain control for bone metastases compared to cEBRT, but elderly patients are underrepresented in these trials. Evidence on the effectiveness of geriatric assessment tools in predicting RT tolerance and toxicity is mixed, with some studies showing a correlation while others do not. Comprehensive geriatric assessments, though promising, are often impractical due to time and resource constraints.
Summary: There is a critical need for more inclusive research to better understand the risks and benefits of RT in elderly patients. Developing streamlined geriatric assessment tools and integrating them into clinical practice can enhance treatment personalization. Future studies should prioritize elderly populations to generate robust data, thereby improving RT outcomes and quality of life for this growing patient group.
{"title":"Bridging the care gap: radiation therapy in elderly and frail cancer patients.","authors":"Caroline Hircock, Shing Fung Lee, Srinivas Raman, Elizabeth Chuk, Adrian W Chan, Edward Chow, Henry C Y Wong","doi":"10.1097/SPC.0000000000000727","DOIUrl":"https://doi.org/10.1097/SPC.0000000000000727","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to address the gap in radiation therapy (RT) care for elderly cancer patients. It will discuss the barriers to implementing effective RT in elderly and frail patients with a focus on breast cancer and metastatic settings.</p><p><strong>Recent findings: </strong>Recent studies indicate that SBRT provides better pain control for bone metastases compared to cEBRT, but elderly patients are underrepresented in these trials. Evidence on the effectiveness of geriatric assessment tools in predicting RT tolerance and toxicity is mixed, with some studies showing a correlation while others do not. Comprehensive geriatric assessments, though promising, are often impractical due to time and resource constraints.</p><p><strong>Summary: </strong>There is a critical need for more inclusive research to better understand the risks and benefits of RT in elderly patients. Developing streamlined geriatric assessment tools and integrating them into clinical practice can enhance treatment personalization. Future studies should prioritize elderly populations to generate robust data, thereby improving RT outcomes and quality of life for this growing patient group.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299217","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}
Pub Date : 2024-09-16DOI: 10.1097/SPC.0000000000000723
Naomi Takemura, Matthew Maddocks, Lisa Jane Brighton
Purpose of review: Breathlessness remains a common and distressing symptom among people with serious illness, particularly in advanced disease. This review synthesises recent advances in the development, characteristics, and outcomes of breathlessness support services.
Recent findings: The expanding body of evidence regarding breathlessness support services has broadened and strengthened our understanding of clinical and cost-effectiveness. The expansion of these services, into diverse settings and including digital delivery, has augmented their reach and accessibility to a wider population. Additionally, there is increasing attention to the psychological aspects of breathlessness and its management, including the challenges of optimising breathlessness support services for long-term benefit.
Summary: Recent studies have made substantial progress in enhancing our knowledge of breathlessness support services and their impact on people with serious illness. Innovations extending services into new countries and settings, including use of digital platforms for intervention delivery, plus increased recognition of psychological mechanisms, have the potential to support more people with serious illness to live as best as possible with breathlessness.
{"title":"Advances in breathlessness support services for people with serious illness.","authors":"Naomi Takemura, Matthew Maddocks, Lisa Jane Brighton","doi":"10.1097/SPC.0000000000000723","DOIUrl":"https://doi.org/10.1097/SPC.0000000000000723","url":null,"abstract":"<p><strong>Purpose of review: </strong>Breathlessness remains a common and distressing symptom among people with serious illness, particularly in advanced disease. This review synthesises recent advances in the development, characteristics, and outcomes of breathlessness support services.</p><p><strong>Recent findings: </strong>The expanding body of evidence regarding breathlessness support services has broadened and strengthened our understanding of clinical and cost-effectiveness. The expansion of these services, into diverse settings and including digital delivery, has augmented their reach and accessibility to a wider population. Additionally, there is increasing attention to the psychological aspects of breathlessness and its management, including the challenges of optimising breathlessness support services for long-term benefit.</p><p><strong>Summary: </strong>Recent studies have made substantial progress in enhancing our knowledge of breathlessness support services and their impact on people with serious illness. Innovations extending services into new countries and settings, including use of digital platforms for intervention delivery, plus increased recognition of psychological mechanisms, have the potential to support more people with serious illness to live as best as possible with breathlessness.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299216","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}
Pub Date : 2024-09-13DOI: 10.1097/SPC.0000000000000717
Nadiia Rykalo, Lydia Riehl, Michaela Kress
Purpose of review: The importance of the gut microbiome for human health and well-being is generally accepted, and elucidating the signaling pathways between the gut microbiome and the host offers novel mechanistic insight into the (patho)physiology and multifaceted aspects of healthy aging and human brain functions.
Recent findings: The gut microbiome is tightly linked with the nervous system, and gut microbiota are increasingly emerging as important regulators of emotional and cognitive performance. They send and receive signals for the bidirectional communication between gut and brain via immunological, neuroanatomical, and humoral pathways. The composition of the gut microbiota and the spectrum of metabolites and neurotransmitters that they release changes with increasing age, nutrition, hypoxia, and other pathological conditions. Changes in gut microbiota (dysbiosis) are associated with critical illnesses such as cancer, cardiovascular, and chronic kidney disease but also neurological, mental, and pain disorders, as well as chemotherapies and antibiotics affecting brain development and function.
Summary: Dysbiosis and a concomitant imbalance of mediators are increasingly emerging both as causes and consequences of diseases affecting the brain. Understanding the microbiota's role in the pathogenesis of these disorders will have major clinical implications and offer new opportunities for therapeutic interventions.
{"title":"The gut microbiome and the brain.","authors":"Nadiia Rykalo, Lydia Riehl, Michaela Kress","doi":"10.1097/SPC.0000000000000717","DOIUrl":"https://doi.org/10.1097/SPC.0000000000000717","url":null,"abstract":"<p><strong>Purpose of review: </strong>The importance of the gut microbiome for human health and well-being is generally accepted, and elucidating the signaling pathways between the gut microbiome and the host offers novel mechanistic insight into the (patho)physiology and multifaceted aspects of healthy aging and human brain functions.</p><p><strong>Recent findings: </strong>The gut microbiome is tightly linked with the nervous system, and gut microbiota are increasingly emerging as important regulators of emotional and cognitive performance. They send and receive signals for the bidirectional communication between gut and brain via immunological, neuroanatomical, and humoral pathways. The composition of the gut microbiota and the spectrum of metabolites and neurotransmitters that they release changes with increasing age, nutrition, hypoxia, and other pathological conditions. Changes in gut microbiota (dysbiosis) are associated with critical illnesses such as cancer, cardiovascular, and chronic kidney disease but also neurological, mental, and pain disorders, as well as chemotherapies and antibiotics affecting brain development and function.</p><p><strong>Summary: </strong>Dysbiosis and a concomitant imbalance of mediators are increasingly emerging both as causes and consequences of diseases affecting the brain. Understanding the microbiota's role in the pathogenesis of these disorders will have major clinical implications and offer new opportunities for therapeutic interventions.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299218","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}
Pub Date : 2024-09-12DOI: 10.1097/spc.0000000000000725
Caroline Hircock,Alyssa J Wang,Ethan Goonaratne,Dominic Sferrazza,Andrew Bottomley,David Cella,Shing Fung Lee,Adrian W Chan,Edward Chow,Henry C Y Wong
PURPOSE OF REVIEWTwo commonly used quality of life (QoL) questionnaires in lung cancer patients are the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Lung Cancer 13 (QLQ-LC13) and the Functional Assessment of Cancer Therapy-Lung (FACT-L). More recently, the EORTC QLQ-LC29 was developed. This systematic review compares the EORTC QLQ-LC29, EORTC QLQ-LC13 and FACT-L in terms of the content, validity and psychometric properties in assessing the QoL of lung cancer patients.RECENT FINDINGSFourteen studies were included. The EORTC QLQ-LC29 is a 29-item scale that serves as an update of the EORTC QLQ-LC13 to include symptoms from surgery and new targeted therapies. It shows validity, high internal consistency, test-retest reliability, and sensitivity. The FACT-L continues to assess general quality of life and lung cancer-specific symptoms.SUMMARYThe EORTC QLQ-LC29, EORTC QLQ-LC13, and FACT-L were reviewed to assess their validity in measuring QoL of lung cancer patients. All were found to be sufficiently validated, The choice of which to use should depend on the primary goals of the study.
{"title":"Comparing the EORTC QLQ-LC13, EORTC QLQ-LC29, and the FACT-L for assessment of quality of life in patients with lung cancer - an updated systematic review.","authors":"Caroline Hircock,Alyssa J Wang,Ethan Goonaratne,Dominic Sferrazza,Andrew Bottomley,David Cella,Shing Fung Lee,Adrian W Chan,Edward Chow,Henry C Y Wong","doi":"10.1097/spc.0000000000000725","DOIUrl":"https://doi.org/10.1097/spc.0000000000000725","url":null,"abstract":"PURPOSE OF REVIEWTwo commonly used quality of life (QoL) questionnaires in lung cancer patients are the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Lung Cancer 13 (QLQ-LC13) and the Functional Assessment of Cancer Therapy-Lung (FACT-L). More recently, the EORTC QLQ-LC29 was developed. This systematic review compares the EORTC QLQ-LC29, EORTC QLQ-LC13 and FACT-L in terms of the content, validity and psychometric properties in assessing the QoL of lung cancer patients.RECENT FINDINGSFourteen studies were included. The EORTC QLQ-LC29 is a 29-item scale that serves as an update of the EORTC QLQ-LC13 to include symptoms from surgery and new targeted therapies. It shows validity, high internal consistency, test-retest reliability, and sensitivity. The FACT-L continues to assess general quality of life and lung cancer-specific symptoms.SUMMARYThe EORTC QLQ-LC29, EORTC QLQ-LC13, and FACT-L were reviewed to assess their validity in measuring QoL of lung cancer patients. All were found to be sufficiently validated, The choice of which to use should depend on the primary goals of the study.","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264425","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}
Pub Date : 2024-09-12DOI: 10.1097/spc.0000000000000718
Richard Gordon-Williams,Clara Harris,David J Magee
PURPOSE OF REVIEWAdvances in oncological therapies have resulted in an increase in the number of patients living with and beyond cancer. The personal and societal impact of chronic pain in the survivor population represents an area of significant unmet need. Capsaicin (a TRPV1 agonist) may provide analgesia with limited systemic side effects. This review looks to summarise the most recent evidence regarding the use of capsaicin in the management of cancer pain.RECENT FINDINGSVarious international guidelines have recently endorsed the use of high concentration capsaicin patches in the treatment of chronic painful chemotherapy induced peripheral neuropathy. Numerous studies support the use of capsaicin in the treatment of peripheral neuropathic pain. This promising data is predominantly yielded from pain secondary to herpes zoster and diabetic neuropathy, with an expanding but small evidence base for its utility in other neuropathic pains. Emerging data suggests that treatments are better tolerated and provide analgesia more rapidly when compared with systemic treatments.SUMMARYWhilst randomised controlled trial data in the treatment of cancer pain are lacking, recent large cohort studies, and international guidelines, support the use of high concentration capsaicin patches in a wide variety of neuropathic pain secondary to cancer treatments.
{"title":"Is there a role for capsaicin in Cancer pain management?","authors":"Richard Gordon-Williams,Clara Harris,David J Magee","doi":"10.1097/spc.0000000000000718","DOIUrl":"https://doi.org/10.1097/spc.0000000000000718","url":null,"abstract":"PURPOSE OF REVIEWAdvances in oncological therapies have resulted in an increase in the number of patients living with and beyond cancer. The personal and societal impact of chronic pain in the survivor population represents an area of significant unmet need. Capsaicin (a TRPV1 agonist) may provide analgesia with limited systemic side effects. This review looks to summarise the most recent evidence regarding the use of capsaicin in the management of cancer pain.RECENT FINDINGSVarious international guidelines have recently endorsed the use of high concentration capsaicin patches in the treatment of chronic painful chemotherapy induced peripheral neuropathy. Numerous studies support the use of capsaicin in the treatment of peripheral neuropathic pain. This promising data is predominantly yielded from pain secondary to herpes zoster and diabetic neuropathy, with an expanding but small evidence base for its utility in other neuropathic pains. Emerging data suggests that treatments are better tolerated and provide analgesia more rapidly when compared with systemic treatments.SUMMARYWhilst randomised controlled trial data in the treatment of cancer pain are lacking, recent large cohort studies, and international guidelines, support the use of high concentration capsaicin patches in a wide variety of neuropathic pain secondary to cancer treatments.","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142186377","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}
Pub Date : 2024-09-12DOI: 10.1097/spc.0000000000000724
Alyssa J Wang,Caroline Hircock,Dominic Sferrazza,Ethan Goonaratne,David Cella,Andrew Bottomley,Shing Fung Lee,Adrian Chan,Edward Chow,Henry C Y Wong
PURPOSE OF REVIEWTwo commonly used quality of life questionnaires in breast cancer are EORTC QLQ-BR23, the FACT-B, and the extended FACT-B + 4. More recently, the EORTC EORTC QLQ-BR42 was developed. This systematic review compares the various versions of the EORTC QLQ and FACT tools for breast cancer in terms of their content, validity, and psychometric properties.RECENT FINDINGSThirty-six studies met the inclusion criteria. All questionnaires have been proven to be valid, reliable and responsive. The provisional EORTC QLQ-BR45 transitioned to the EORTC QLQ-BR42 in Phase IV of its development, which encompasses the side effects associated with the latest breast cancer treatments. Both the EORTC and FACT measures assess physical and mental dimensions of quality of life, with the EORTC measure placing relatively more emphasis on physical content and FACT placing relatively more emphasis on mental (social and emotional) content. The four additional items in the FACT-B + 4 were developed to address arm lymphoedema following axillary surgery.SUMMARYThe development and uptake of quality of life tools are essential in the evaluation of breast cancer treatments. The EORTC QLQ-BR42 and FACT-B are both valid, reliable, and responsive QoL questionnaires.
{"title":"The EORTC QLQ breast modules and the FACT-B for assessing quality of life in breast cancer patients - an updated literature review.","authors":"Alyssa J Wang,Caroline Hircock,Dominic Sferrazza,Ethan Goonaratne,David Cella,Andrew Bottomley,Shing Fung Lee,Adrian Chan,Edward Chow,Henry C Y Wong","doi":"10.1097/spc.0000000000000724","DOIUrl":"https://doi.org/10.1097/spc.0000000000000724","url":null,"abstract":"PURPOSE OF REVIEWTwo commonly used quality of life questionnaires in breast cancer are EORTC QLQ-BR23, the FACT-B, and the extended FACT-B + 4. More recently, the EORTC EORTC QLQ-BR42 was developed. This systematic review compares the various versions of the EORTC QLQ and FACT tools for breast cancer in terms of their content, validity, and psychometric properties.RECENT FINDINGSThirty-six studies met the inclusion criteria. All questionnaires have been proven to be valid, reliable and responsive. The provisional EORTC QLQ-BR45 transitioned to the EORTC QLQ-BR42 in Phase IV of its development, which encompasses the side effects associated with the latest breast cancer treatments. Both the EORTC and FACT measures assess physical and mental dimensions of quality of life, with the EORTC measure placing relatively more emphasis on physical content and FACT placing relatively more emphasis on mental (social and emotional) content. The four additional items in the FACT-B + 4 were developed to address arm lymphoedema following axillary surgery.SUMMARYThe development and uptake of quality of life tools are essential in the evaluation of breast cancer treatments. The EORTC QLQ-BR42 and FACT-B are both valid, reliable, and responsive QoL questionnaires.","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264426","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}
Pub Date : 2024-09-12DOI: 10.1097/spc.0000000000000726
Partha Patel,Carmen F Al Aadah,Lelia F Al Aadah,Henry C Y Wong,Shing Fung Lee,Muna Alkhaifi,Joel Finkelstein,Leon Rivlin
PURPOSE OF THE REVIEWPenthrox® (inhaled methoxyflurane, IMF) is an inhaled analgesic used for the treatment of moderate-to-severe acute pain. It has various advantages including the capacity for being self-administered in the presence of healthcare providers (HCPs), rapid onset and offset, and having documented evidence for minimal adverse events post-use. In a variety of non-oncological settings such as pre-hospital transport and minor outpatient procedures, amongst others, IMF has significantly reduced acute pain. As IMF has the capacity to provide appreciable pain relief but is not as widely used as other acute analgesics (i.e., opioids), this review of past and current literature hopes to explore the impact of inhaled IMF on patient outcomes, procedures where it could be used, and to inform readers about this compound.RECENT FINDINGSIn general, patients who used IMF had decreased pain, improved psychosocial factors (i.e., reduced anxiety, improved satisfaction), and minimal adverse events thereby being concluded as safe for use.SUMMARYFuture use in remote medical interventions such as military contexts, in emergency room settings, and administration under the supervision of first responders such as non-paramedic and non-HCPs further broadens the scope of settings where IMF can meaningfully be implemented.
综述目的Penthrox®(吸入式甲氧氟醚,IMF)是一种吸入式镇痛药,用于治疗中度至重度急性疼痛。它具有多种优点,包括可在医疗保健提供者(HCP)在场的情况下自行使用、起效快、药效消失快,而且有文献证明使用后的不良反应极少。在院前转运和门诊小手术等各种非肿瘤环境中,IMF 都能显著减轻急性疼痛。由于 IMF 有能力提供明显的镇痛效果,但并不像其他急性镇痛药(如阿片类药物)那样被广泛使用,因此本篇对过去和当前文献的综述希望探讨吸入式 IMF 对患者预后的影响、可使用 IMF 的程序,并向读者介绍这种化合物、总结 未来,IMF 将用于远程医疗干预(如军事环境)、急诊室环境,并在急救人员(如非护理人员和非保健医生)的监督下使用,这进一步扩大了 IMF 的使用范围。
{"title":"Managing acute pain with inhaled methoxyflurane in non-cancer patients: a review of the latest evidence.","authors":"Partha Patel,Carmen F Al Aadah,Lelia F Al Aadah,Henry C Y Wong,Shing Fung Lee,Muna Alkhaifi,Joel Finkelstein,Leon Rivlin","doi":"10.1097/spc.0000000000000726","DOIUrl":"https://doi.org/10.1097/spc.0000000000000726","url":null,"abstract":"PURPOSE OF THE REVIEWPenthrox® (inhaled methoxyflurane, IMF) is an inhaled analgesic used for the treatment of moderate-to-severe acute pain. It has various advantages including the capacity for being self-administered in the presence of healthcare providers (HCPs), rapid onset and offset, and having documented evidence for minimal adverse events post-use. In a variety of non-oncological settings such as pre-hospital transport and minor outpatient procedures, amongst others, IMF has significantly reduced acute pain. As IMF has the capacity to provide appreciable pain relief but is not as widely used as other acute analgesics (i.e., opioids), this review of past and current literature hopes to explore the impact of inhaled IMF on patient outcomes, procedures where it could be used, and to inform readers about this compound.RECENT FINDINGSIn general, patients who used IMF had decreased pain, improved psychosocial factors (i.e., reduced anxiety, improved satisfaction), and minimal adverse events thereby being concluded as safe for use.SUMMARYFuture use in remote medical interventions such as military contexts, in emergency room settings, and administration under the supervision of first responders such as non-paramedic and non-HCPs further broadens the scope of settings where IMF can meaningfully be implemented.","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264604","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}
Pub Date : 2024-09-10DOI: 10.1097/spc.0000000000000722
Jo Thompson
PURPOSE OF THE REVIEWThe original World Health Organisation (WHO) cancer pain guidelines were published in 1986 and used globally. Updated guidance was released in 2018. This review compares the 'old' with the 'new' with a closer look at the relevance of the WHO analgesic ladder in the current climate.RECENT FINDINGSThe new guidelines provide a more evidence based, rigorously developed document including recommendations relating to radiotherapeutic management. There is a more detailed focus on safe opioid prescribing, opioid stewardship and the importance of integrating pain management expertise early on in the cancer journey. There remains a lack of evidence for certain therapies despite their widespread use particularly in relation to adjuvants. The pitfalls of the original renowned analgesic ladder are highlighted including a recognition that omitting 'step 2' is safe, feasible and cost effective.SUMMARYThe new guidelines offer more detailed recommendations relevant to clinical practice with a strong focus on safety of opioid prescribing making it relevant in the current climate. The original WHO analgesic ladder is no longer recommended as a strict protocol for cancer pain management.
{"title":"The WHO guidelines: the new and the old.","authors":"Jo Thompson","doi":"10.1097/spc.0000000000000722","DOIUrl":"https://doi.org/10.1097/spc.0000000000000722","url":null,"abstract":"PURPOSE OF THE REVIEWThe original World Health Organisation (WHO) cancer pain guidelines were published in 1986 and used globally. Updated guidance was released in 2018. This review compares the 'old' with the 'new' with a closer look at the relevance of the WHO analgesic ladder in the current climate.RECENT FINDINGSThe new guidelines provide a more evidence based, rigorously developed document including recommendations relating to radiotherapeutic management. There is a more detailed focus on safe opioid prescribing, opioid stewardship and the importance of integrating pain management expertise early on in the cancer journey. There remains a lack of evidence for certain therapies despite their widespread use particularly in relation to adjuvants. The pitfalls of the original renowned analgesic ladder are highlighted including a recognition that omitting 'step 2' is safe, feasible and cost effective.SUMMARYThe new guidelines offer more detailed recommendations relevant to clinical practice with a strong focus on safety of opioid prescribing making it relevant in the current climate. The original WHO analgesic ladder is no longer recommended as a strict protocol for cancer pain management.","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142186376","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}
Pub Date : 2024-09-01Epub Date: 2024-05-15DOI: 10.1097/SPC.0000000000000707
Michael S Yule, Leo R Brown, Richard J E Skipworth, Barry J A Laird
Purpose of review: Cachexia is a devasting syndrome which impacts a large number of patients with cancer. This review aims to provide a comprehensive overview of the central mechanisms of cancer cachexia. In particular, it focuses on the role of the central nervous system (CNS), the melanocortin system, circulating hormones and molecules which are produced by and act on the CNS and the psychological symptoms of cancer cachexia.
Recent findings: A growing body of evidence suggests that a central mechanism of action underpins this multi-system disorder. Recent research has focused on the role of neuroinflammation that drives the sickness behaviour seen in cancer cachexia, with emphasis on the role of the hypothalamus. Melanocortin receptor antagonists are showing promise in preclinical studies. There are also new pharmacological developments to overcome the short half-life of ghrelin. GDF-15 has been identified as a core target and trials of compounds that interfere with its signalling or its central receptor are underway.
Summary: Understanding the central mechanisms of cancer cachexia is pivotal for enhancing treatment outcomes in patients. While emerging pharmacological interventions targeting these pathways have shown promise, further research is essential.
{"title":"Central neural mechanisms of cancer cachexia.","authors":"Michael S Yule, Leo R Brown, Richard J E Skipworth, Barry J A Laird","doi":"10.1097/SPC.0000000000000707","DOIUrl":"10.1097/SPC.0000000000000707","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cachexia is a devasting syndrome which impacts a large number of patients with cancer. This review aims to provide a comprehensive overview of the central mechanisms of cancer cachexia. In particular, it focuses on the role of the central nervous system (CNS), the melanocortin system, circulating hormones and molecules which are produced by and act on the CNS and the psychological symptoms of cancer cachexia.</p><p><strong>Recent findings: </strong>A growing body of evidence suggests that a central mechanism of action underpins this multi-system disorder. Recent research has focused on the role of neuroinflammation that drives the sickness behaviour seen in cancer cachexia, with emphasis on the role of the hypothalamus. Melanocortin receptor antagonists are showing promise in preclinical studies. There are also new pharmacological developments to overcome the short half-life of ghrelin. GDF-15 has been identified as a core target and trials of compounds that interfere with its signalling or its central receptor are underway.</p><p><strong>Summary: </strong>Understanding the central mechanisms of cancer cachexia is pivotal for enhancing treatment outcomes in patients. While emerging pharmacological interventions targeting these pathways have shown promise, further research is essential.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946127","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}
Pub Date : 2024-09-01Epub Date: 2024-07-15DOI: 10.1097/SPC.0000000000000711
Savannah A Epstein, Jason D Doles, Aneesha Dasgupta
Purpose of the review: Cancer-associated cachexia is a wasting syndrome entailing loss in body mass and a shortened life expectancy. There is currently no effective treatment to abrogate this syndrome, which leads to 20-30% of deaths in patients with cancer. While there have been advancements in defining signaling factors/pathways in cancer-induced muscle wasting, targeting the same in the clinic has not been as successful. Krüppel-like factor 10 (KLF10), a transcription factor implicated in muscle regulation, is regulated by the transforming growth factor-beta signaling pathway. This review proposes KLF10 as a potential convergence point of diverse signaling pathways involved in muscle wasting.
Recent findings: KLF10 was discovered as a target of transforming growth factor-beta decades ago but more recently it has been shown that deletion of KLF10 rescues cancer-induced muscle wasting. Moreover, KLF10 has also been shown to bind key atrophy genes associated with muscle atrophy in vitro .
Summary: There is an elevated need to explore targets in cachexia, which will successfully translate into the clinic. Investigating a convergence point downstream of multiple signaling pathways might hold promise in developing effective therapies for cachexia.
{"title":"KLF10: a point of convergence in cancer cachexia.","authors":"Savannah A Epstein, Jason D Doles, Aneesha Dasgupta","doi":"10.1097/SPC.0000000000000711","DOIUrl":"10.1097/SPC.0000000000000711","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Cancer-associated cachexia is a wasting syndrome entailing loss in body mass and a shortened life expectancy. There is currently no effective treatment to abrogate this syndrome, which leads to 20-30% of deaths in patients with cancer. While there have been advancements in defining signaling factors/pathways in cancer-induced muscle wasting, targeting the same in the clinic has not been as successful. Krüppel-like factor 10 (KLF10), a transcription factor implicated in muscle regulation, is regulated by the transforming growth factor-beta signaling pathway. This review proposes KLF10 as a potential convergence point of diverse signaling pathways involved in muscle wasting.</p><p><strong>Recent findings: </strong>KLF10 was discovered as a target of transforming growth factor-beta decades ago but more recently it has been shown that deletion of KLF10 rescues cancer-induced muscle wasting. Moreover, KLF10 has also been shown to bind key atrophy genes associated with muscle atrophy in vitro .</p><p><strong>Summary: </strong>There is an elevated need to explore targets in cachexia, which will successfully translate into the clinic. Investigating a convergence point downstream of multiple signaling pathways might hold promise in developing effective therapies for cachexia.</p>","PeriodicalId":48837,"journal":{"name":"Current Opinion in Supportive and Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11293965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617431","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}