Current Opinion in Supportive and Palliative Care最新文献

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: 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.

Purpose of the review: Pulmonary fibrosis (PF) is characterized by relentless scarring of the lungs, declining lung function, and increasing symptom burden. In PF, dyspnea and cough are the most common symptoms, severely impacting quality of life. This review highlights recent advances in understanding their mechanisms and explores evolving strategies for management of these symptoms.

Recent findings: Advances in non-pharmacologic approaches, including hand-held fans, dyspnea services and pulmonary rehabilitation are playing a vital role in dyspnea management. Opioids, while effective in reducing exertional dyspnea in controlled settings, show limited benefit for daily life breathlessness and are associated with significant adverse events, highlighting the need for cautious, individualized use. For refractory cough, promising studies are investigating the role of opioids and neuromodulatory therapies. Non-pharmacologic approaches, including speech therapy, and behavioral interventions, provide complementary approaches. A multidisciplinary approach and individualized care plans to address the multifactorial nature of dyspnea and cough are key.

Summary: Effective management of dyspnea and cough can importantly improve patients' quality of life. Further research is required to refine treatment protocols, optimize palliative care interventions, and identify and test novel therapeutics. Translation of these findings into clinical practice requires a focus on evidence-based, patient-centered care.

Purpose of review: Chronic breathlessness is distressing and debilitating, yet often under-recognised. This review summarises recent insights into the visibility of breathlessness and delineates potential contributing factors to its invisibility.

Recent findings: Chronic breathlessness' invisibility is multi-faceted and often leads to avoidance behaviour by patients. The symptom's presence, severity and impacts can be hidden from patients, caregivers, clinicians and the public due to its insidiousness, supposed subjectivity, stigma and the ability to be modulated by reducing exertion. This leads to patients' under-reporting of their breathlessness in clinic and low levels of public unawareness. Other contributing factors can include clinicians' failure to initiate conversations about breathlessness at times because of lack of knowledge about assessment and treatment, or prioritising disease management over symptom management.

Summary: There is robust evidence that chronic breathlessness is often missed, unacknowledged or misunderstood by patients, caregivers, clinicians and society. Optimised clinical recognition and response may help to reverse these trends. Longitudinal studies are needed to explore whether such perceptions can be changed. Intervention studies should address every aspect of invisibility - from clinical improvements to minimising stigma and validating the subjective experience of patients.

Purpose of review: Skeletal metastases occur in approximately 80% of advanced breast, 70% of advanced prostate, and 30% of lung cancers, and place patients at increased risk of skeletal related events (SRE). Bone modifying agents (BMAs) have been shown to prevent or delay SRE development. Our objective was to summarize the role of these agents in the management of these three cancers.

Recent findings: Total 52 studies met our inclusion criteria. These highlighted the benefit of BMAs in reducing SREs in metastatic breast and castrate resistant prostate cancer (mCRPC), with less clear impact on reducing SRE in lung cancer, or on improving progression-free and overall survival due to significant heterogeneity in trial design and outcomes. Benefits in SRE reduction occurred with bisphosphonates and denosumab, however when compared, denosumab was superior. Denosumab however is not more cost effective, and multiple trials support potential de-escalation to either 12 weekly dosing or other reduced duration.

Summary: There is a large body of evidence to support the role of BMAs in reducing SREs in metastatic breast and mCRPC. Impact on survival outcomes is heterogeneous, and future large database trials would be helpful in identifying which subgroups of patients truly have survival benefit from BMAs.

Purpose of review: Diagnosis and management of patients with suspected or confirmed cancers often require procedures which can cause significant anxiety, discomfort and pain. While intravenous sedation and strong opioids are effective, they could be risky in frail cancer patients with multiple comorbidities. Inhaled methoxyflurane (IMF) (Penthrox®) has been utilised as an analgesic for moderate to severe trauma pain for decades in emergency departments. This review article evaluates the latest evidence for the use of IMF in cancer-related procedures.

Recent findings: IMF has been recently shown to be effective in reducing pain and discomfort in patients receiving transrectal ultrasound-guided prostate biopsy and removal of gynaecological brachytherapy applicators. Side effects of IMF are mild and transient. No recent report of severe toxicities such as cardiopulmonary suppression was observed.

Summary: IMF is a safe drug device combination that can reduce discomfort and improve treatment compliance with repeat procedures in cancer patients. Real-world studies should be performed to further evaluate its safety and quality of life in diverse cancer patient populations and guide patient selection.

Purpose of review: Long COVID affects approximately 6% of the population after SARS-CoV-2 infection commonly involving persistent respiratory symptoms such as breathlessness and cough. This review provides an update on the latest evidence regarding post-COVID condition/Long COVID and respiratory sequelae, focusing on persistent symptoms, respiratory complications, and therapeutic approaches to date.

Recent findings: Post-COVID interstitial lung abnormalities are estimated to persist in approximately 11% of patients hospitalized with acute COVID-19. However, breathlessness is common in adults (non-hospitalized) with Long COVID, suggesting aetiologies beyond pneumonitis. The risk of venous thromboembolic disease in Long COVID remains uncertain and trial results of anti-coagulation in Long COVID are awaited.

Summary: Long COVID presents complex respiratory challenges, and careful assessment is crucial to differentiate Long COVID symptoms from exacerbations of pre-existing respiratory conditions. Current management includes a symptom-based multidisciplinary approach, with ongoing research into effective treatments including immune modulating agents.

Purpose of review: Two widely validated health-related quality of life (HR-QoL) tools, specifically designed for patients with advanced cancer, are the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL) and the Functional Assessment of Chronic Illness Therapy-Palliative (FACIT-Pal-14). This systematic review aims to evaluate the use of EORTC QLQ-C15-PAL and FACIT-Pal-14 in prospective studies in patients with advanced cancer, focusing on study types, clinical settings, additional HR-QoL tools used, and completion rates.

Recent findings: Sixty studies were included in the analysis. Both EORTC QLQ-C15-PAL and FACIT-Pal-14 are used in a variety of studies. Given that EORTC QLQ-C15-PAL was developed 9 years before FACIT-Pal-14 PAL, most studies utilized the EORTC tool. Both tools were shown to be successfully used in a variety of clinical settings, including in various advanced tumour types or different study designs, depending on the investigator and study needs.

Summary: This review demonstrates the wide range of utilization of EORTC QLQ-C15-PAL and FACIT-Pal-14 in prospective studies to assess the HR-QoL issues in patients with advanced cancers.

Purpose of the review: This review summarises high-level evidence for fan therapy and adds a commentary on the relatively-neglected question of how to optimise benefits based on qualitative evidence, clinical experience and broader research and theory.

Recent findings: Recent high-level evidence suggests the fan reduces time to recovery from episodic breathlessness rather than reduces daily levels over a longer period. Lower grade evidence suggests the fan can also help people increase their physical activity. Experimental evidence for physiological mechanisms suggests that airflow reduces inspiratory neural drive and perceived unpleasantness through facial cooling of the trigeminal and olfactory nerves. Faster airflow elicits a stronger effect, with the optimal balance between efficacy and comfort proposed to be 2.85 metres per second. Research on clinician perspectives highlights the need for targeted strategies to drive fan implementation.

Summary: Fan therapy contributes to all three domains of the Breathing, Thinking, Functioning model of breathlessness management. Given it is affordable, portable, and has no known harms, the fan should be recommended as first-line therapy for anyone with breathlessness. Future research should evaluate how best to integrate fan therapy as a complex intervention alongside other strategies and supports.