Current Opinion in Supportive and Palliative Care最新文献

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.

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: 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 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 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: 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.