Current Opinion in Supportive and Palliative Care最新文献

Purpose of review: This systematic review aims to evaluate how the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Brain Cancer (EORTC QLQ-BN20) and Functional Assessment of Cancer Therapy-Brain (FACT-Br) are used in prospective brain tumor studies in the past decade, particularly in assessing quality of life (QoL). It aims to assess variability in QoL outcomes across treatment types, use of supplemental tools, and assessment of data completeness and concordance with cognitive assessments.

Recent findings: A total of 100 prospective studies were included and reviewed. The EORTC QLQ-BN20 was used in 75 studies, and the FACT-Br in 27; 2 studies used both. Patient-reported outcome measures were supplemented in 98 studies, most commonly with the EORTC QLQ-C30, EQ-5D, or FACT-G. Fifteen studies included neurocognitive assessments. QoL was the primary endpoint in 39 studies. Radiotherapy and systemic therapy were the most frequently studied interventions (36 studies each), followed by surgical interventions (34 studies). QoL outcomes varied by intervention type. Seven of 15 studies using cognitive testing reported discordance between objective and self-reported cognition. Thirty-four studies reported compliance challenges, and 19 reported ≥25% missing data at final follow-up.

Summary: The QLQ-BN20 and FACT-Br are widely used tools for QoL evaluation in brain tumor research. Enhancing their usability, incorporating digital formats, and integrating cognitive testing may improve data quality and relevance in clinical practice.

Purpose of review: Low- and middle-income countries (LMICs) bear over half of the global cancer mortality but have access to only 5% of global radiotherapy resources. As the cancer burden rises and equity in palliative care gains global attention, a focused review on palliative radiotherapy access in LMICs is both timely and necessary.

Recent findings: Barriers to radiotherapy access in LMICs are multifaceted, including infrastructure gaps, workforce shortages, geographic centralization, high out-of-pocket costs, and systemic underinvestment. Palliative radiotherapy, despite its proven cost-effectiveness and impact on quality of life, is often excluded from national cancer plans and health strategies. Innovative approaches such as hypofractionation, mobile units, AI-assisted planning, and public-private partnerships are emerging to address these gaps. Efforts by the International Atomic Energy Agency and local governments have led to progress in several regions, with case studies from Africa, Asia, and Latin America showing promising results.

Summary: Integrating radiotherapy - particularly palliative radiotherapy - into national cancer and palliative care strategies is essential. Sustainable financing, decentralized service models, and context-specific technologies are critical to overcoming current limitations. Bridging this gap is not only a public health necessity but also a moral imperative to reduce suffering and support patients' dignity and societal contributions.

Purpose of review: Bereavement support in care homes is a critical aspect of end-of-life care that has gained increasing attention in recent years. The purpose of this rapid mixed-methods review is to synthesise evidence on pre- and post-bereavement support interventions as well as facilitators and barriers of bereavement for care home staff, residents, and bereaved family members in care homes.

Recent findings: Ten studies on pre- and post-bereavement support in care homes were identified. A conceptual model of bereavement support in care homes was developed and 11 measures to improve outcomes were identified: educating and training care home staff; facilitating acceptance of death; preparing for death and bereavement; building meaningful relationships; therapeutic communication; compassionate care; establishing a formal organisational culture; social support; advance care planning; and shared decision-making. The most important barriers affecting bereavement support are poor communication around death and being unprepared for death.

Summary: To facilitate higher quality person and family centred care, and to reduce the impact of negative bereavement outcomes for individuals in care homes, we recommend a formal organisational culture that prioritises preparedness for bereavement for care home staff, residents, and bereaved family members.

Purpose of review: Accurately predicting survival in metastatic breast cancer (MBC) is essential to support personalized treatment decisions. This scoping review examines the current applications of artificial intelligence (AI) models for survival prediction in MBC and highlights their relevance in improving clinical outcomes.

Recent findings: Of 1787 records screened, 15 studies met inclusion criteria. These studies used supervised learning approaches, including random survival forests (13.3%), Naïve Bayes classifiers (13.3%), and logistic regression models (20.0%), to predict overall survival, progression-free survival, and treatment response. Input data varied widely, incorporating electronic health records, clinical data, imaging, and genomic profiles. Among included studies, 66.7% addressed all three major breast cancer subtypes, 20.0% focused on ER-positive HER2-negative cases, and 13.3% did not specify subtype. Model performance varied, with sensitivities ranging from 42% to 90%, specificities from 53% to 90%, and area under the curve values between 0.70 and 0.85.

Summary: AI models show promising potential for improving survival prediction in MBC, offering tools to support more individualized care. However, limitations remain, including inconsistent data quality, suboptimal model performance, and a lack of external validation. Future work should focus on refining models and ensuring clinical applicability through robust validation.

Purpose of review: Adolescents and young adults (AYAs) with cancer are a vulnerable population affected by disparities in survivorship care access. These disparities are pronounced in low- and middle-income countries (LMICs) but exist even within high-income settings, affecting vulnerable and underserved groups. This expert review explores disparities in fertility preservation, psychosocial health, nutritional care, cardiovascular health, and secondary malignancies of AYA survivorship.

Recent findings: Fertility preservation services are often inaccessible due to high costs, limited provider training and knowledge, cultural stigma, and urban-centric availability, especially in LMICs. Psychosocial distress is widespread, exacerbated by structural barriers, stigma, and mental health service scarcity. Nutritional disparities lead to malnutrition and obesity, with food insecurity and limited access to high-quality diets affecting treatment outcomes. Cardiovascular complications, including physical inactivity, are usually under-monitored, despite growing recognition of exercise as an essential part of survivorship. Approaches to standardize the monitoring of secondary malignancies are needed.

Summary: These gaps reflect broader disparities, including limited infrastructure, lack of provider training, and absence of culturally tailored care models. Global organizations such as the Multinational Association of Supportive Care in Cancer (MASCC) can support the integration of resource-adapted, patient-centered supportive care guidelines into existing health systems. Addressing the complex and interrelated barriers faced by AYA survivors can improve survivorship outcomes and promote more equitable access to high-quality care.

Purpose of review: This review seeks to explain the impact of cultural and spiritual factors on end-of-life care decision-making from different countries to assist in the development of coherent responses for palliative care.

Recent findings: Spiritual and cultural factors shape end-of-life decision-making in the Arab Middle East and the United Kingdom. Arab cultures emphasize dignity through faith and family, leading to collective decisions, while the United Kingdom focuses on individual autonomy. Both allow withdrawal from futile treatment to alleviate suffering, but Arab approaches are more family centric. Additionally, spirituality in Arab cultures is often collective and religious, compared to the personal and secular practices common in the United Kingdom.

Summary: Western and Arab Middle East cultural beliefs influence our understanding of death, dying, and the acceptability of various care options. As people near the end of life, spiritual issues are likely to affect their values and preferences.

Purpose of review: Heart failure is a complex, progressive and life-limiting condition that affects individuals beyond physical symptoms. Psychosocial and behavioural symptoms, such as anxiety, depression, cognitive impairment, and social withdrawal, substantially impact their quality of life. Despite increasing recognition of multidimensional symptom burden across heart failure trajectory, these non-physical symptoms are often under-recognised by clinicians and researchers. This review summarises current contemporary evidence on symptom experiences from diagnosis of heart failure through to end-of-life, highlighting key features along this continuum.

Recent findings: Understanding full symptom profile including physical, psychological, social, and behavioural dimensions is essential to improving symptom management and overall care. However, limited evidence exists on symptoms experienced prior to and during formal diagnosis of heart failure. While some studies identify classic symptoms, the broader spectrum, including symptom normalisation and behavioural adaptations, remains poorly understood. Variation in symptom perception across populations underscores the need for a more individualised and culturally responsive approach.

Summary: A systematic and person-centred symptom assessment strategy is critical, particularly during advanced and end-of-life stages of heart failure. Integrating under-recognised symptoms into routine care, through multidisciplinary collaboration, can improve outcomes, enhance care quality, and better support individuals and families throughout the course of the illness.