Current Opinion in Supportive and Palliative Care最新文献

Purpose of the review: Respiratory disease is a major cause of morbidity and mortality for patients with systemic autoimmune diseases. Chronic exertional fatigue, breathlessness, and cough all cause significant impairment of quality of life. In this review, we summarize the major respiratory complications of systemic autoimmune diseases and consider the evidence supporting the role that palliative care can play in the management of systemic autoimmune disease.

Recent findings: The symptom burden suffered by patients with systemic autoimmune diseases is equivalent to that of patients with active malignancy. Recent studies have explored how palliative care could be integrated with rheumatology care to improve symptom control and address the high psychosocial burden associated with living with a systemic autoimmune disease. Both rheumatologists and palliative care providers are uncertain as to the role of palliative care in the management of systemic autoimmune diseases, with the optimal model of integrated palliative care yet to be defined.

Summary: Emerging evidence supports the acceptability and value of palliative care to patients living with a systemic autoimmune disease and their caregivers. However, there are both patient and physician associated barriers to the integration of palliative care with rheumatology care. Studies are required to demonstrate the efficacy of palliative care in the management of systemic autoimmune diseases.

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.

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.