Current Opinion in Supportive and Palliative Care最新文献

英文中文

Improving supportive, palliative and end of life care for teenagers and young adults with cancer in adult haematology services. 在成人血液学服务中改善对青少年和年轻成人癌症患者的支持、姑息和临终关怀。

IF 2.1 4区医学 Q2 Medicine

Current Opinion in Supportive and Palliative Care

Pub Date : 2024-04-23 DOI: 10.1097/SPC.0000000000000698

Claire Lewis-Norman, Jennifer Vidrine, Emma Thistlethwayte

PURPOSE OF REVIEWAdolescents with haematological malignancies within adult services, in the UK from 16 years old, have unique needs and require developmentally targeted services and approaches to care delivery. High-risk intensive treatments are common for this cohort and a better understanding of what individualised supportive and palliative care means in this context is required.RECENT FINDINGSBeing known and understood as an emerging adult, with particular recognition of developmental stage, is an essential component of quality measures and underpins the adolescent, and caregiver, experience when faced with an uncertain or poor cancer prognosis (UPCP). Healthcare professionals (HCPs) can experience increased emotional labour and feelings of professional inadequacy when caring for adolescents with UPCP. Therapeutic alliance improves HCPs understanding of optimum individualised care by improving communication and supported decision making. Access to training and support for HCPs is required to address the emotional impact of therapeutic alliance with teenage/adolescent and young adults (T/AYAs) with advanced cancer.SUMMARYInvestment in therapeutic alliance, alongside robust support mechanisms and targeted training, can improve the skills, confidence and wellbeing for HCPs, and can also ensure optimum individualised care for T/AYAs with UPCP. Evidence for optimum care for adolescents with advanced cancer is relatively scarce, especially for younger T/AYAs (16-24) in the UK who sit within adult services. Further evaluation of the impact of current UK expertise, services and programs are needed to inform future development.

综述目的在英国，16 岁以上的青少年血液恶性肿瘤患者在成人服务中具有独特的需求，需要有针对性的服务和护理方法。在这种情况下，需要更好地理解个体化支持性护理和姑息治疗的意义。最新研究结果当面临不确定或不良癌症预后（UPCP）时，作为新兴成年人被了解和理解，特别是对发展阶段的认识，是质量衡量标准的重要组成部分，也是青少年和照顾者体验的基础。医护人员（HCPs）在照顾患有癌症预后不良的青少年时，可能会经历更多的情感劳动，并感到专业上的不足。治疗联盟可通过改善沟通和辅助决策，提高医护人员对最佳个体化护理的理解。摘要对治疗联盟的投资，加上强有力的支持机制和有针对性的培训，可以提高医疗保健人员的技能、信心和福祉，还可以确保为患有晚期癌症的青少年提供最佳的个体化护理。为癌症晚期青少年提供最佳护理的证据相对较少，尤其是在英国，为年龄较小（16-24 岁）的 T/AYAs 提供成人服务。需要进一步评估英国目前的专业知识、服务和计划的影响，为未来的发展提供依据。

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引用次数: 0

Telemedicine in geriatric oncology - lessons learned from the COVID-19 experience. 老年肿瘤远程医疗--从 COVID-19 经验中汲取的教训。

IF 2.1 4区医学 Q2 Medicine

Current Opinion in Supportive and Palliative Care

Pub Date : 2024-04-23 DOI: 10.1097/SPC.0000000000000697

Leana Cabrera Chien, C. Uranga, V. Katheria

PURPOSE OF REVIEWTelemedicine quickly became integrated into healthcare caused by the Coronavirus 19 (COVID-19) pandemic. Rapid use of telemedicine into healthcare systems was supported by the World Health Organization and other prominent national organizations to reduce transmission of the virus while continuing to provide access to care. In this review, we explored the effect of this swift change in care and its impact on older adults with cancer.RECENT FINDINGSOlder adults are susceptible to the COVID-19 virus caused by various risk factors, such as comorbidity, frailty, decreased immunity, and cancer increases vulnerability to infection, hospitalization, and mortality. We found three major themes emerged in the literature published in the past 18 months, including access to care, telemedicine modes of communication, and the use of technology by older adults with cancer. These findings have brought insight into issues regarding healthcare disparities.SUMMARYThe utilization of telemedicine by older adults with cancer has potential future benefits with the integration of technology preparation prior to the patient's initial visit and addressing known health disparities. The hybrid model of care provides in-person and or remote access to clinicians which may allow older adults with cancer the flexibility needed to obtain quality cancer care.

审查目的由于冠状病毒 19（COVID-19）大流行，远程医疗迅速融入医疗保健领域。在世界卫生组织和其他著名国家组织的支持下，远程医疗被迅速应用到医疗保健系统中，以减少病毒传播，同时继续提供医疗服务。在这篇综述中，我们探讨了这一迅速改变的护理方式的效果及其对患有癌症的老年人的影响。最新发现老年人容易感染 COVID-19 病毒，这是由各种风险因素造成的，如合并症、虚弱、免疫力下降以及癌症增加了感染、住院和死亡的可能性。我们发现，在过去 18 个月中发表的文献中出现了三大主题，包括获得护理、远程医疗沟通模式以及癌症老年人对技术的使用。这些发现使我们对医疗保健差异问题有了更深入的了解。总结老年癌症患者使用远程医疗具有潜在的未来益处，即在患者初次就诊前整合技术准备，并解决已知的健康差异问题。混合护理模式提供了与临床医生面对面或远程接触的机会，可使老年癌症患者获得高质量癌症护理所需的灵活性。

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引用次数: 0

Role of mucositis in predicting gut microbiota composition in people with cancer. 粘膜炎在预测癌症患者肠道微生物群组成中的作用。

IF 2.1 4区医学 Q2 Medicine

Current Opinion in Supportive and Palliative Care

Pub Date : 2024-04-23 DOI: 10.1097/SPC.0000000000000700

Jacqui S Scott, Anna Li, Hannah R. Wardill

PURPOSE OF REVIEWDisruption of the precious ecosystem of micro-organisms that reside in the gut - the gut microbiota - is rapidly emerging as a key driver of adverse side effects/toxicities caused by numerous anti-cancer agents. Although the contribution of the gut microbiota to these toxicities is understood with ever increasing precision, the cause of microbial disruption (dysbiosis) remains poorly understood. Here, we discuss current evidence on the cause(s) of dysbiosis after cancer therapy, positioning breakdown of the intestinal mucosa (mucositis) as a central cause.RECENT FINDINGSDysbiosis in people with cancer has historically been attributed to extensive antibiotic use. However, evidence now suggests that certain antibiotics have minimal impacts on the microbiota. Indeed, recent evidence shows that the type of cancer therapy used predicts microbiota composition independently of antibiotics. Given most anti-cancer drugs have modest effects on microbes directly, this suggests that their impact on the gut microenvironment, in particular the mucosa, which is highly vulnerable to cytotoxicity, is a likely cause of dysbiosis. Here, we outline evidence that support this hypothesis, and discuss the associated clinical implications/opportunities.SUMMARYThe concept that mucositis dictates microbiota compositions provides two important implications for clinical practice. Firstly, it reiterates the importance of prioritising the development of novel mucoprotectants that preserve mucosal integrity, and indirectly support microbial stability. Secondly, it provides an opportunity to identify dysbiotic events and associated consequences using readily accessible, minimally invasive biomarkers of mucositis such as plasma citrulline.

综述目的肠道微生物群这一珍贵的微生物生态系统受到破坏，正迅速成为许多抗癌药物产生不良副作用/毒性的主要驱动因素。尽管人们对肠道微生物群对这些毒性的影响有了越来越精确的认识，但对微生物紊乱（菌群失调）的原因仍然知之甚少。在此，我们将讨论目前有关癌症治疗后菌群失调原因的证据，并将肠道粘膜损伤（粘膜炎）定位为核心原因。然而，现在有证据表明，某些抗生素对微生物群的影响微乎其微。事实上，最近的证据表明，所使用的癌症疗法类型可预测微生物群的组成，而与抗生素无关。鉴于大多数抗癌药物对微生物的直接影响不大，这表明它们对肠道微环境的影响，尤其是对极易受细胞毒性影响的粘膜的影响，很可能是导致菌群失调的原因。在此，我们概述了支持这一假说的证据，并讨论了相关的临床影响/机会。摘要粘膜炎决定微生物群组成的概念为临床实践提供了两个重要意义。首先，它重申了优先开发新型粘膜保护剂的重要性，这种保护剂可保持粘膜的完整性，并间接支持微生物的稳定性。其次，它提供了一个机会，利用血浆瓜氨酸等易于获取的微创粘膜炎生物标记物来识别菌群失调事件及相关后果。

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引用次数: 0

Gastrointestinal mucositis: a sign of a (systemic) inflammatory response. 胃肠道粘膜炎：（全身）炎症反应的一种表现。

IF 2.1 4区医学 Q2 Medicine

Current Opinion in Supportive and Palliative Care

Pub Date : 2024-04-23 DOI: 10.1097/SPC.0000000000000701

N. M. Blijlevens, Björn Reijnders, Eva Molendijk

PURPOSE OF REVIEWGastrointestinal mucositis (GIM) is a significant complication of cancer therapy. Whilst inflammation is a central feature of GIM, studies attempting to mitigate mucosal damage via this mechanism are scarce. This review describes the relation between GIM, local and systemic inflammation, and the microbiome and its metabolites, and explores recent research on therapeutics that target this relationship.RECENT FINDINGSRecent literature underscores the pivotal role of inflammation in GIM, elucidating its bidirectional relation with disturbance of the gut microbiota composition and intestinal permeability. These events cause a heightened risk of bloodstream infections and lead to systemic inflammation. While studies investigating risk prediction models or therapeutics targeting GIM-related inflammation remain scarce, results have shown promise in finding biomarkers and alleviating GIM and its accompanying clinical symptoms.SUMMARYThe findings underscore the important role of inflammation and the microbiome in GIM. Understanding the inflammatory pathways driving GIM is crucial for developing effective treatments. Further research is needed using genomics, epigenomics, and microbiomics to explore better risk prediction models or therapeutic strategies aimed at mitigating GIM-related inflammation.

综述目的胃肠道粘膜炎（GIM）是癌症治疗的一个重要并发症。虽然炎症是 GIM 的主要特征，但试图通过这种机制减轻粘膜损伤的研究却很少。本综述描述了 GIM、局部和全身性炎症、微生物组及其代谢物之间的关系，并探讨了针对这种关系的治疗方法的最新研究。最新发现最新文献强调了炎症在 GIM 中的关键作用，阐明了炎症与肠道微生物群组成紊乱和肠道通透性之间的双向关系。这些事件会增加血液感染的风险，并导致全身性炎症。虽然针对 GIM 相关炎症的风险预测模型或疗法的研究仍然很少，但研究结果表明，找到生物标志物和减轻 GIM 及其伴随临床症状是有希望的。了解驱动 GIM 的炎症途径对于开发有效的治疗方法至关重要。需要利用基因组学、表观基因组学和微生物组学开展进一步研究，以探索更好的风险预测模型或治疗策略，从而减轻与 GIM 相关的炎症。

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引用次数: 0

Bridging research gaps in geriatric oncology: unraveling the potential of pragmatic clinical trials. 缩小老年肿瘤学研究的差距：发掘实用临床试验的潜力。

IF 2.1 4区医学 Q2 Medicine

Current Opinion in Supportive and Palliative Care

Pub Date : 2024-03-01 Epub Date: 2023-12-22 DOI: 10.1097/SPC.0000000000000688

Carlos A Carmona-Gonzalez, Mateus T Cunha, Ines B Menjak

Purpose of review: This review examines the role of pragmatic clinical trials (PCTs) in addressing the underrepresentation of older adults with cancer (OAC) in clinical trials. Focusing on real-world evidence (RWE), it aims to provide a comprehensive overview of PCT utilization, emphasizing their potential to enhance treatment decisions and patient outcomes. Existing knowledge gaps in PCT implementation are also discussed.

Recent findings: PCTs are identified as effective tools to include OACs with comorbidities and complex conditions in research, bridging the representation gap. Despite their proven value in healthcare provision, their application in OAC contexts remains limited, hindering comprehensive understanding and inclusivity in clinical trials.

Summary: While randomized controlled trials (RCTs) are considered the gold standard in oncology research, OACs have historically been excluded, perpetuating underrepresentation. Furthermore, even in current oncology clinical development trials, this demographic continues to be underrepresented. PCTs offer a valuable avenue for the identification and evaluation of therapies within authentic RW contexts, encompassing various healthcare settings, such as hospitals, clinics, and physician practices. RCTs and PCTs complement one another, and the utilization of PCTs has the potential to inform clinical decision-making across the OACs entire treatment trajectory.

综述目的：本综述探讨了实用临床试验（PCT）在解决老年癌症患者（OAC）在临床试验中代表性不足的问题方面所起的作用。该综述以真实世界证据（RWE）为重点，旨在全面概述PCT的使用情况，强调其在改善治疗决策和患者预后方面的潜力。此外，还讨论了在实施 PCT 方面现有的知识差距：PCT 被认为是将患有合并症和复杂病症的 OAC 纳入研究的有效工具，弥补了代表性方面的差距。摘要：尽管随机对照试验（RCT）被认为是肿瘤学研究的黄金标准，但 OAC 一直被排除在外，导致其代表性长期不足。此外，即使在目前的肿瘤临床开发试验中，这一人群的代表性也仍然不足。PCT 为在真实的 RW 环境中确定和评估疗法提供了宝贵的途径，它涵盖了各种医疗环境，如医院、诊所和医生诊所。RCT 和 PCT 相辅相成，利用 PCT 有可能为 OACs 整个治疗过程中的临床决策提供信息。

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引用次数: 0

Virtual geriatric and frailty assessment for older adults with cancer. 为患有癌症的老年人提供虚拟老年病学和虚弱评估。

IF 2.1 4区医学 Q2 Medicine

Current Opinion in Supportive and Palliative Care

Pub Date : 2024-03-01 Epub Date: 2024-01-26 DOI: 10.1097/SPC.0000000000000696

Isabel Tejero, Eva Amor, Olga Vázquez-Ibar

Purpose of review: Since SARS-CoV2 pandemic, many specialties have introduced virtual assessments within clinical practice. Conducting an online geriatric assessment, or relying on self-reported questionnaires, may be more challenging than a conventional medical appointment. This review aims to discuss the state of research on virtual assessment and self-reported questionnaires in the general geriatric population and specifically in Oncology.

Recent findings: Virtual assessment of older adults has been the focus of two separate position papers. Aside from videoconferences or phone appointments, self-reported questionnaires have emerged in recent years as reliable tools to screen for frailty and triage patients who would benefit from a comprehensive in-person assessment, with adequate correlation with in-person tests, good acceptance by the respondents and being well received by healthcare providers. Although some have been tried in geriatric oncology, many still lack validation, and their widespread use may be limited by digital literacy, cognitive impairment, and social supports.

Summary: The development, validation and adoption of self-reported questionnaires and virtual assessment in the care of older adults with cancer may overcome the staffing limitations and time constrains that frequently hampers the widespread evaluation of this population to improve their care.

审查目的：自 SARS-CoV2 大流行以来，许多专科在临床实践中引入了虚拟评估。与传统的医疗预约相比，进行在线老年病评估或依赖自我报告问卷可能更具挑战性。本综述旨在讨论在普通老年医学人群中，特别是在肿瘤学中，虚拟评估和自我报告问卷的研究现状：对老年人的虚拟评估是两份独立立场文件的重点。除了视频会议或电话预约外，近年来还出现了自我报告问卷，作为筛查虚弱和分流病人的可靠工具，这些病人将受益于全面的现场评估，与现场测试有足够的相关性，被调查者接受度高，并受到医疗服务提供者的欢迎。总结：在老年肿瘤患者的护理过程中，开发、验证和采用自我报告问卷和虚拟评估可能会克服人员限制和时间限制，这些因素经常阻碍对这一人群进行广泛评估，从而改善他们的护理。

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引用次数: 0

Mitigating late effects in cancer survivors: harnessing personalised medicine and new models of care. 减轻癌症幸存者的晚期影响：利用个性化医疗和新的护理模式。

IF 2.1 4区医学 Q2 Medicine

Current Opinion in Supportive and Palliative Care

Pub Date : 2024-03-01 Epub Date: 2024-01-31 DOI: 10.1097/SPC.0000000000000693

Joanne Bird, Sara Faithfull

引用次数: 0

Supportive and palliative care for older adults with cancer; facilitating person-centred, age friendly care. 为患有癌症的老年人提供支持性和姑息治疗；促进以人为本的老年友好型护理。

IF 2.1 4区医学 Q2 Medicine

Current Opinion in Supportive and Palliative Care

Pub Date : 2024-03-01 Epub Date: 2024-01-31 DOI: 10.1097/SPC.0000000000000689

Christopher B Steer, Schroder Sattar, Ines Menjak

引用次数: 0

Age-friendly healthcare: integrating the 4Ms to enable age-friendly cancer care. 老年友好型医疗保健：整合 4Ms 以实现老年友好型癌症护理。

IF 2.1 4区医学 Q2 Medicine

Current Opinion in Supportive and Palliative Care

Pub Date : 2024-03-01 Epub Date: 2024-01-04 DOI: 10.1097/SPC.0000000000000687

Oliver Hodge, Tshepo Rasekaba, Irene Blackberry, Christopher B Steer

Purpose of review: There is a growing movement towards person-centred, age-friendly healthcare in the care of older adults, including those with cancer. The Age-Friendly Health Systems (AFHS) initiative uses the 4Ms framework to enable this change. This review documents the utility and implications of 4Ms implementation across different settings, with a particular focus on cancer care.

Recent findings: The AFHS initiative 4Ms framework uses a set of core, evidence-based guidelines (focussing on What Matters, Medication, Mentation and Mobility) to improve person-centred care. The successful implementation of the 4Ms has been documented in many different healthcare settings including orthopaedics primary care, and cancer care. Implementation of the 4Ms framework into existing workflows complements the use of geriatric assessment to improve care of older adults with cancer. Models for implementation of the 4Ms within a cancer centre are described. Active engagement and education of healthcare providers is integral to success. Solutions to implementing the What Matters component are addressed.

Summary: Cancer centres can successfully implement the 4Ms framework into existing workflows through a complex change management process and development of infrastructure that engages healthcare providers, facilitating cultural change whilst employing quality improvement methodology to gradually adapt the status quo to age-friendly processes.

审查目的：在包括癌症患者在内的老年人护理方面，以人为本、对老年人友好的医疗保健运动日益兴起。老年友好型医疗系统（AFHS）倡议采用 4Ms 框架来促成这一变革。本综述记录了在不同环境下实施 4Ms 的效用和影响，尤其关注癌症护理：AFHS 倡议的 4Ms 框架采用了一套以证据为基础的核心指南（侧重于 "重要事项"、"用药"、"指导 "和 "移动性"），以改善以人为本的护理。在许多不同的医疗机构，包括骨科初级保健和癌症护理机构，都有成功实施 4Ms 的记录。在现有的工作流程中实施 4Ms 框架是对老年评估的补充，以改善对癌症老年人的护理。介绍了在癌症中心实施 4Ms 的模式。医疗服务提供者的积极参与和教育是成功的关键。摘要：癌症中心可以通过复杂的变革管理过程和基础设施的发展，将 4Ms 框架成功应用到现有的工作流程中，让医疗服务提供者参与其中，促进文化变革，同时采用质量改进方法，逐步将现状调整为适合老年人的流程。

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引用次数: 0

Incidence, description, predictors, and consequences of persistent taxane-induced peripheral neuropathy. 持续性紫杉类药物诱发的周围神经病变的发生率、描述、预测因素和后果。

IF 2.1 4区医学 Q2 Medicine

Current Opinion in Supportive and Palliative Care

Pub Date : 2023-12-06 DOI: 10.1097/spc.0000000000000684

Daniel L Hertz

This review aims to provide insights into persistent taxane-induced peripheral neuropathy (TIPN). The primary objective is to describe the incidence, predictors, and consequences of TIPN lasting at least 1 year after the end of taxane treatment.

本综述旨在深入探讨持续性紫杉类药物诱导的周围神经病变（TIPN）。主要目的是描述在紫杉类药物治疗结束后至少持续一年的 TIPN 的发生率、预测因素和后果。

引用次数: 0

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