Current Opinion in Supportive and Palliative Care最新文献

Purpose of review: The aim of this review is to discuss the relationship between cachexia in lung cancer and the role of supportive and palliative care.

Recent findings: A recent meta-analysis has shown that early supportive and palliative care improves outcome in patients with lung cancer. This includes benefits in survival, quality of life, mood and need for less aggressive end of life care. However, we examine how this is impacted by cachexia. Cachexia is a pro inflammatory syndrome causing loss of weight, muscle and function. The level of cachexia likely impacts early supportive and palliative care goals for individual patients.

Summary: It is suggested that supportive and palliative care is a key component of managing patients with lung cancer and should be routine practice.

Purpose of review: This review aims to provide a comprehensive, multidisciplinary perspective on recent advancements and future directions in spinal cord stimulation (SCS) for chronic pain management. It emphasizes the evolving science of patient selection, technological innovations, cost-effectiveness considerations, and future direction of SCS in pain medicine.

Recent findings: Significant progress has been made in optimizing patient outcomes through refined patient selection, including validated data driven predictive tool which integrated psychological profiling and standard trial stimulation protocol. Technological advancements such as closed-loop stimulation and new waveform have improved efficacy, durability, and patient satisfaction. While SCS is cost-effective in high-income countries, economic evaluations in low- and middle-income settings, such as Thailand, have not yet considered it a cost-effective treatment due to differences in willingness to pay and the cost of conservative treatment. Future direction of SCS may include, restorative SCS for spinal cord injury, new waveforms such as sub-perception stimulation, and multimodal neuromodulation.

Summary: SCS has undergone many significant transformations in recent years. The integration of clinical, psychosocial and technological knowledge are and will be the key success factors of this transformation. Multidisciplinary collaboration, ongoing research, and the adoption of advanced technologies promise to further personalize and advance therapy.

Purpose of review: Musculoskeletal pain following a road traffic crash is common and incurs substantial personal and economic costs. Current recommended treatments of reassurance and advice to stay active, exercise and simple analgesics are not very effective. This review describes the current evidence for health outcomes and potential processes involved in the persistence of pain. It also outlines promising current and future treatments aimed at the prevention of chronic pain after musculoskeletal injury.

Recent findings: Recent literature highlights a more complex clinical presentation including greater pain-related disability and nociplastic pain features of traumatic musculoskeletal pain compared to non-traumatic pain. Some studies have found evidence for the presence of neuropathic pain in a sub-group of patients. Accurate risk-prediction screening tools exist for neck pain following road traffic injury and clinical trials using these tools show promise where treatment is targeted to identified risk factors.

Summary: Traumatic musculoskeletal pain is characterised by a more complex, high-burden clinical presentation, with worse health outcomes compared to non-traumatic musculoskeletal pain. There is emerging evidence that multi-factorial stress-related processes, neuroimmune factors, and neuropathic pain may underlie these differences. Early treatments targeting risk factors for poor recovery, including stress symptoms and pro-nociceptive processes show promise in improving outcomes for injured people.

Purpose of review: Neuropathic pain affects especially older persons and this review aims at discussing neuropathic pain prevalence, evaluation and treatment and how to optimize management. Older persons are prone to develop neuropathic pain essentially because aging is associated with an increased incidence of comorbidities, immune dysfunction, higher prevalence of herpes zoster infections, higher occurrence of diabetes, surgical interventions and of central nervous system pathologies.

Recent findings: This review underlines recent publications on neuropathic pain in these different pathologies, presents a consensus focused on pharmacotherapy and an algorithm for neuropathic pain management. Combination of pharmacological and non-pharmacological approaches is suggested as essential for optimal care.

Summary: Findings underline the high neuropathic pain rate in older persons, the importance of proactively looking for the presence of pain, the adaptation and careful dosing of the pharmacotherapy in the context of adverse events and quality of life. Initiatives on neuropathic pain prevention are budding with surgical care and vaccination but need to be largely expanded to avoid the development of neuropathic pain.

Purpose of review: Time spent in nature has been shown to reduce chronic pain symptoms. However, individuals living with high impact chronic pain often face substantial accessibility barriers to nature. Recent advances in immersive virtual reality (VR) provide opportunities to deliver restorative nature-based experiences directly to patients. This review provides key insight to recent advances into nature-based analgesic mechanisms alongside the role of VR in improving access to the therapeutic benefits of nature.

Recent findings: Emerging evidence highlights that nature-based VR interventions can engage top-down cognitive, affective and autonomic mechanisms. Experimental studies demonstrate that nature VR can reduce sensitisation within central nociceptive pathways and is associated with activity within key pain-related brain regions. Qualitative research has also highlighted the therapeutic importance of nature experiences and identifies significant physical barriers that hinder access for individuals with chronic pain.

Summary: Immersive VR nature interventions present a promising strategy for the self-management of chronic pain. Integrating VR-based nature therapy into existing pain management strategies would help to expand treatment options, especially for patients restricted by physical, geographic, or socioeconomic barriers. Further research should optimise VR protocols, further explore analgesic mechanisms and investigate their efficacy in chronic pain populations.

Purpose of the review: Four commonly used quality of life (QoL) questionnaires for patients with hepatobiliary cancers are the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Liver Module (QLQ-LMC21), the Quality of Life Questionnaire Hepatocellular Carcinoma-Specific Module (QLQ-HCC18), the Quality of Life Questionnaire Biliary Tract Cancer and Gallbladder Cancer Module (QLQ-BIL21), and the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep). The objective of this systematic review is to compare the characteristics and psychometric properties of these four QoL instruments.

Recent findings: From 276 studies, 14 were included: QLQ-LMC21 (3), QLQ-HCC18 (6), QLQ-BIL21 (2), and FACT-Hep (3). All were rigorously developed using a multiphase, standardised approach and shown to be psychometrically valid. In the development/validation of the QLQ-LMC21 and QLQ-BIL21, a majority of patients were recruited from European countries, but race was not specified. In contrast, the QLQ-HCC18, despite including a greater proportion of East Asian participants, lacked representation from other regions and races. Furthermore, challenges in assessing jaundice in Asian patients were identified during the validation phase. The FACT-Hep was developed in the United States and only validated in the United States (90% Caucasian) and China. Notably, QLQ-BIL21 was limited by its small sample size ( n = 52) during the Phase III of its development.

Summary: The EORTC QLQ-LMC21, QLQ-HCC18, QLQ-BIL21, and FACT-Hep have proven to be reliable, valid, and responsive. However, additional cross-cultural validation studies may enhance global applicability.

Purpose of review: To highlight promising pre-clinical work seeking to target cancer-associated tissue/muscle wasting.

Recent findings: This narrative review explores recent innovations and emerging/understudied aspects of cancer cachexia biology, highlighting representative studies across three key areas: (a) novel strategies for targeting established wasting pathways, (b) multimodal/combinatorial therapeutic approaches, and (c) mechanisms involving inter-tissue communication.

Summary: Though not exhaustive, this review highlights three key areas of pre-clinical research with the potential to inform and inspire future clinical trials aimed at mitigating cachexia and tissue wasting in cancer patients.

Purpose of review: Cancer cachexia (CC) is a paraneoplastic syndrome (PNS) that is characterised by anorexia, weight loss, fatigue and reduced function. This review explores the molecular drivers of CC and other PNS, identifying shared pathways and highlighting unexplored gaps in research.

Recent findings: Recent studies have provided further evidence of pro-inflammatory cytokines, such as interleukin-6 and tumour necrosis factor-α, as central players in both CC and PNS, emphasising their role in systemic effects like muscle wasting, lipolysis and pyrexia. Despite these overlaps between syndromes, cytokine profiles vary across different cancer types with one study highlighting that the interplay between multiple cytokines likely plays a more significant role in cancer phenotypes than individual cytokines. Mediators, such as parathyroid hormone related peptide and vascular endothelial growth factor, which are typically associated with malignant hyperkalaemia and hypertrophic osteoarthropathy respectively, have also been linked to cachexia, suggesting a shared role.

Summary: This review highlights the overlap between CC and other PNS. Exploring these shared mechanisms can bridge research gaps and improve CC treatment strategies. Similar insights may be gained by examining other conditions which overlap with CC such as eating disorders, bariatric surgery and sepsis.

Purpose of review: The initiation/continuation of clinically assisted hydration (CAH) in patients with advanced cancer, especially those in the last days of life, remains highly controversial. The purpose of this article is to review recent developments relating to this medical intervention.

Recent findings: The volume of 'new' literature identified was relatively low, and the quality of this evidence was also relatively low. Furthermore, there are questions over the adequacy of fluid therapy administered in many of these/previous clinical studies.

Summary: Currently, there is little evidence to guide clinical practice, although the Multinational Association of Supportive Care in Cancer have produced new expert consensus guidance to support decision making in patients with advanced cancer.

Purpose: Nutritional care is consistently overlooked in oncology practice. It is a critical factor everyone acknowledges, but few actively address, leaving patients neglected. This article explores the challenges of ensuring optimal nutritional care in oncology.

Recent findings: Significant disparities have been identified among key cancer nutrition guidelines issued by the European Society for Clinical Nutrition and Metabolism (ESPEN), the European Society for Medical Oncology (ESMO) and the American Society for Clinical Oncology (ASCO). While some emphasise comprehensive nutritional assessments, others focus on pharmacological interventions. Although aligning guideline recommendations with the Global Leadership Initiative on Malnutrition (GLIM) criteria can be complex, there are shared principles that support effective identification and management of malnutrition and cachexia in clinical settings. The key barriers that oncology health professionals face are also highlighted as these are likely to impeded good nutritional care.

Summary: There is a need for a standardised, pragmatic approach in assessment and management of nutrition in patients with cancer. This will facilitate the integration of nutrition into cancer care and help overcome barriers. Emerging digital solutions may serve as a conduit to improve nutritional cancer care and enhance communication between patients and healthcare providers and streamline evidence-based nutritional care in oncology.