Current Opinion in Supportive and Palliative Care最新文献

Purpose of review: This review summarized current research evidence examining care needs of older patients with advanced cancer in dealing with disease, treatment, and treatment-related side effects. It also identified gaps and directions for future research and practice.

Recent findings: Older patients with advanced cancer need support from health professionals, family, friends, and other social network members in the management of physical symptoms and functioning, psychosocial and spiritual care, information provision, and practical resolution of daily problems. As older patients are affected by aging-related factors, they usually have unique patterns of care needs compared with younger patients.

Summary: Currently, insufficient research evidence hinders a comprehensive understanding of care needs of older patients with advanced cancer, as well as potential influencing factors. Future efforts are needed to develop more sophisticated assessment methods and interventions to better understand and address care needs of older patients with advanced cancer.

Purpose of the review: The aim of this review is to describe the clinical use and tolerability of immune checkpoint inhibitors in older adults with solid tumors, where there is an abundance of evidence with recent updates including subgroups of older patients.

Recent findings: Studies with updated analyses and subgroups of older patients show that in general older patients benefit as well as younger patients and tolerate immunotherapy very well. However, in some instances of combination therapies which may expose patients to more toxicity, the benefits are reduced, and careful selection of older patients, including adjunctive assessments such as geriatric assessment, can help to identify the appropriate treatment for an individual patient.

Summary: Older adults remain underrepresented in clinical trials, including those involving immunotherapy. Therefore, efforts must be made to include more older patients in trials and to assess real-world evidence to inform decision-making.

Purpose of review: Chronic cough is common in severe diseases, such as COPD, interstitial lung disease, lung cancer and heart failure, and has a negative effect on quality of life. In spite of this, patients with cough sometimes feel their cough is neglected by healthcare workers. This review aims to briefly describe cough mechanisms, highlight the burden chronic cough can be for the individual, and the clinical impact of chronic cough.

Recent findings: Chronic cough is likely caused by different mechanisms in different diseases, which may have therapeutic implications. Chronic cough, in general, has a significant negative effect on quality of life, both with and without a severe comorbid disease. It can lead to social isolation, recurrent depressive episodes, lower work ability, and even conditions such as urinary incontinence. Cough may also be predictive of more frequent exacerbations among patients with COPD, and more rapid lung function decline in idiopathic pulmonary fibrosis. Cough is sometimes reported by patients to be underappreciated by healthcare.

Summary: Chronic cough has a significant negative impact on quality of life, irrespective of diagnosis. Some differences are seen between patients with and without severe disease. Healthcare workers need to pay specific attention to cough, especially patients with severe disease.

Purpose of review: Androgen-deprivation therapy (ADT) is widely employed for treatment of advanced prostate cancer and it is considered the frontline therapy. However, the numerous adverse reactions associated with this treatment option are concerning and its potential association with cardiovascular diseases (CVD) should not be overlooked. In this review, we examine the literature on the cardiovascular side effects of ADT and the physiologic mechanisms underpinning the association with CVD. We will also specifically discuss the different findings regarding the interesting potential disparity in major cardiovascular events among GnRH agonist-treated patients compared with patients undergoing GnRH antagonist treatment.

Recent findings: Androgen-deprivation therapy increases the risk of developing CVD by altering the body composition, metabolism, vascular system, and cardiac physiology. GnRH agonists may pose a higher risk of cardiovascular mortality and morbidity than GnRH antagonists; however, this link remains to be determined. Furthermore, screening for cardiovascular risk factors before and during ADT treatment is a crucial step in preventing major adverse cardiac events in prostate cancer patients. Notably, preexisting CVD and comorbidities have been identified as major key elements predicting cardiovascular events. Early implementation of pharmacological and nonpharmacological treatment strategies is strongly suggested, and regular follow-up visits should be scheduled to continuously assess patients' cardiovascular risk under ADT.

Summary: ADT is a very powerful treatment option for advanced prostate cancer that improves survival outcomes but has the potential of considerably impacting patients' cardiovascular health. Medical optimization and close monitoring are crucial during treatment with ADT.

Purpose of review: Breathlessness is a common, distressing, and limiting symptom that many people avoid by reducing their activity. This review discusses exertional tests that can be used for uncovering and assessing breathlessness depending on the person's severity of illness, function, the setting, and aim of the assessment.

Recent findings: Standardized exertional tests are useful to uncover 'hidden' breathlessness earlier in people who may have adapted their physical activity to limit their breathing discomfort. In 'more fit' ambulatory people and outpatients, cardiopulmonary exercise testing is the gold standard for assessing symptom severity, underlying conditions, and mechanisms and treatment effects. Among field tests, the 6-min walk test is not useful for assessing breathlessness. Instead, the 3-min step test and walk test are validated for measuring breathlessness change in chronic obstructive pulmonary disease. In people with more severe illness (who are most often not breathless at rest), reported tests include upper limb exercise or counting numbers aloud, but a valid and useful test for this population is lacking.

Summary: A framework for selecting the most appropriate test to assess breathlessness validly is proposed, and research needs are identified.

Purpose of review: The purpose of this review is to highlight the demand for fertility preservation among cancer survivors and to draw attention to areas where healthcare workers need to improve. As technology advances, maximizing cryopreservation rates will be paramount to increase the ability individuals to conceive after cancer treatment.

Recent findings: Guidelines recommending discussion of fertility for those diagnosed with cancer have been shown to increase patient satisfaction and overall quality of life. Our review demonstrated that increasing counseling rates remains an ongoing challenge and should remain an area of improvement for all healthcare professionals working in the oncology field. Formal programs to improve patient and provider education and access to fertility preservation increase uptake of fertility preservation. For men, many options exist to cryopreserve sperm; a slight delay to achieve fertility preservation has not been shown to lead to worse outcomes. Cryopreservation strategies differ based on puberty status and remain an active area of clinical research.

Summary: Improving fertility outcomes for cancer survivors is possible with appropriate counseling techniques at the time of cancer diagnosis. Clinicians should challenge current barriers for patient access to fertility preservation surrounding cancer treatments.

Purpose of review: To describe the burden of post-COVID respiratory sequelae in posthospital and nonhospitalized COVID-19 survivors and to describe the priorities of clinical management.

Recent findings: Due to varying definitions of 'Long COVID' or 'Post-COVID', the prevalence of post-COVID sequelae or persisting symptoms is challenging to estimate but ranges from 2.3 to 51%. Risk factors for persistent post-COVID symptoms include age, female sex, deprivation, presence of comorbidities; and in posthospital COVID-19 survivors, the severity of acute infection. Common post-COVID respiratory symptoms include breathlessness, cough and chest pain and many individuals also experience exercise intolerance. The most common pulmonary function test abnormality is impaired diffusing capacity for carbon monoxide. In posthospital COVID-19 survivors, the prevalence of interstitial lung damage is 5-11%. Disordered breathing is common in all post-COVID patients and respiratory physiotherapy is helpful.

Summary: The vast numbers of COVID-19 infections globally implies that a large number of people will be affected by post-COVID sequelae even with conservative estimates. A significant number of people are affected for several months and up to years following acute infection. Post-COVID sequelae have a detrimental impact on quality of life and ability to work.

Purpose of review: Social wellbeing is a core component of heath. However, people with chronic respiratory disease report unmet social needs, particularly in relation to stigma, social isolation, and loneliness. This review considers recent advances in understanding these social concepts within the context of chronic respiratory disease.

Recent findings: A growing body of qualitative work illustrates the detrimental impacts of stigma in chronic respiratory disease, contributing towards poorer psychological health and self-management, and reduced engagement with professional support. Stigma, alongside physical limitations stemming from respiratory symptoms, can also contribute to social isolation and loneliness. Social isolation and loneliness are associated with poorer mental health and quality of life, declines in function, and in some cases, increased hospital admissions. Although close or cohabiting relationships can ameliorate some social challenges, isolation and loneliness can also impact informal carers of people with chronic respiratory disease.

Summary: Increasing evidence illustrates the direct and indirect influences of social dimensions on health outcomes for people living with chronic respiratory disease. Although there is increased understanding of the lived experiences of stigma, less is understood about the complexities of social isolation and loneliness in chronic respiratory disease, and optimal interventions to address social challenges.

Purpose of review: Systemic chemotherapy and second-generation androgen receptor-axis targeted therapies have been in the forefront of management for metastatic castrate-resistant prostate cancer (mCRPC) patients with low or high symptom burden. However, in the recent past, due to improvement in molecular characterization, management of mCRPC has witnessed long strides of advancement. We aim to review the novel nonhormonal and nonchemotherapeutic treatment options.

Recent findings: Poly (ADP-ribose) polymerase inhibitors (PARPis) such as olaparib and rucaparib have been recently approved by the US FDA for use in mCRPC with germline or somatic mutations in homologous recombination repair. The combination of PARPi with androgen receptor axis-targeted agents (ARAT) or dual ARAT-based therapy has shown superior radiographic progression-free survival as a first-line treatment. A combination of AKT inhibitor ipatasertib and abiraterone has shown improvement in radiographic progression-free survival as a first-line treatment. Prostate-specific membrane antigen (PSMA)-targeted radiopharmaceutical like 177Lu-PSMA-617, a beta particle emitter has demonstrated improvement in overall survival in mCRPC patients pretreated with ARAT or taxanes. Although immune checkpoint inhibitors are being tested in mCRPC, there is no robust evidence to support this premise.

Summary: These new agents have widened the treatment options for mCRPC patients. Overall treatment should be focused on improving survival while limiting the deterrent effect on the quality of life.