Current Opinion in Supportive and Palliative Care最新文献

Purpose of review: The evidence supporting geriatric assessment (GA) in cancer care is well established, and GA is recommended by the American Society of Clinical Oncology, the International Society of Geriatric Oncology, and other oncology bodies. However, effective implementation of GA remains inadequate. Using selected papers indexed in Medline from the most recent 18 months to July 2024, including two outstanding interest papers, this review aimed to describe enablers and barriers to GA implementation in oncology and contrasts implementation with and without an implementation science framework. Finally, we make recommendations on applying an implementation science framework to facilitate integrating GA in oncology.

Recent findings: Implementation science frameworks have been widely employed in health services research, but their use in geriatric oncology, particularly to guide GA implementation and evaluation, is limited. Lack of time in busy practices coupled with workforce shortages adds to the challenges of GA implementation and adoption. A variety of screening and assessment tools such as the G8, electronic rapid fitness assessment, and Eastern Cooperative Oncology Group are often used in lieu of geriatrician review and to streamline GA. When effectively implemented in oncology, GA informs care and treatment decisions for improved outcomes.

Summary: Despite the benefits for older adults, embedding GA into routine clinical practice is critical yet not common practice. The variety of available GA tools, logistics, and individual beliefs are some of the identified barriers to GA adoption in oncology. Enablers include organization readiness, adaptability, communication, and the use of multidisciplinary teams. Further research is needed to examine how implementation science frameworks could provide guidance and structure for successful GA implementation in oncology.

Purpose of review: The survival rate of patients with a cancer or palliative care diagnosis has improved over the years although pain remains a debilitating symptom that many patients still require treatment with opioids. Compared to full mu-opioid receptor agonists such as morphine and oxycodone, buprenorphine continues to remain a second- or third-line choice in this group of patients.We have reviewed the pharmacology and clinical utility of buprenorphine to stimulate debate around the first-line use of buprenorphine in the management of pain in cancer patients.

Recent findings: Buprenorphine has a pharmacological profile that is unique and unlike any other opioid. It is associated with many immediate and long-term benefits, with lower risks of adverse effects that make it an ideal first-line choice in the management of cancer pain.

Summary: Buprenorphine appears to be a promising choice of opioid for cancer patients. Studies have found that buprenorphine is a safe and effective choice for many patients, making it a suitable first-line option for the management of cancer pain.

Purpose of the review: Today, two-thirds of all cancer survivors are at least 65 years old. Older cancer survivors have complex care needs, and addressing their social determinants of health (SDoH) is critical for improving and managing survivorship outcomes for this uniquely vulnerable population, yet research specifically examining these associations remains limited and emergent. To this end, we describe the emergent body of evidence on the associations between SDoH domains and older cancer survivors' outcomes.

Recent findings: Despite the limited investigations of SDoH on the health outcomes of older cancer survivors, there were measures representing all domains of SDoH - health care access and quality, education access and quality, neighborhood and built environment, social and community context, and economic stability. We reviewed another determinant, Digital Environment and Engagement, as they are highly relevant to older cancer survivors' care. Studies primarily investigated outcomes such as the use of or delays in treatment and variables related to care coordination. Generally, poorer access to resources such as income, social networks, and quality health care facilities predicted poorer health outcomes.

Summary: We reviewed studies that revealed that SDoH significantly impacts older cancer survivors' health outcomes. Our description informs future interventions and policies to improve their care.

Purpose of review: Abdominal pain due to cancer is a significant and debilitating symptom for cancer patients, which is commonly undertreated. Radiotherapy (RT) for the management of abdominal cancer pain is underused, with limited awareness of its benefit. This review presents a discussion on current precision RT options for the management of cancer pain in the abdomen.

Recent findings: Precision RT focuses on delivering targeted and effective radiation doses while minimizing damage to surrounding healthy tissues. In patients with primary or secondary liver cancer, RT has been shown to significantly improve liver related cancer pain in the majority of patients. Also, symptom sequelae of tumour thrombus may be relieved with the use of palliative RT. Similarly, single dose, high precision stereotactic RT to the celiac plexus has been shown to significantly improve pain in patients with pancreatic cancer. Pain response for adrenal metastases has been less commonly investigated, but small series suggest that stereotactic body RT may reduce or alleviate pain.

Summary: RT is an effective option for the treatment of abdominal cancer pain. RT should be considered within the multidisciplinary treatment armamentarium, and may be successfully integrated, alone or in conjunction with other treatment modalities, in abdominal cancer-related pain.

Purpose of review: Palliative radiotherapy is frequently applied for various indications, with hemostasis being a quite common one. However, while bleeding can occur at different sites and arise from various primary tumor types, clear guidelines for administering hemostatic radiotherapy are lacking. Additionally, most available data on hemostatic radiotherapy are retrospective, and often studies do not focus on hemostasis specifically. This review provides an overview of the most recent data on hemostatic radiotherapy to identify any research trends and focus areas for this specific topic.

Recent findings: This review confirms the value of radiation for tumor bleeding. Unfortunately, research in hemostatic radiotherapy predominantly continues to focus on retrospective analyses of treated patients. However, at least two prospective trials specifically investigating hemostasis have been published recently, both conducted in low-income countries.

Summary: Radiotherapy is an effective and well-tolerated treatment for bleeding tumors. As the incidence of advanced cancer rises in low- and middle-income countries, where resources are limited, further research should focus on hypofractionated regimens. Additionally, there is a need for comprehensive descriptions of contouring and treatment planning to optimize outcomes in these settings.

Purpose of review: Globally, breast cancer is the most commonly diagnosed cancer in women. Locally advanced breast cancers (LABCs) may necessitate palliative radiation therapy (RT) due to the severity of the patients' symptoms, inoperability, or other reasons precluding curative-intent treatment such as poor performance status and patient comorbidities. This review aims to discuss current evidence on palliative RT in LABC.

Recent findings: Advanced targeted RT techniques have led to improvements in local control with reduced treatment-related toxicities. Emerging short-course palliative RT prescriptions offer feasible options that avoid delay in systemic therapy. Additionally, recent studies also highlight approaches for integrating palliative RT with systemic therapies.

Summary: Palliative RT plays a vital role in managing symptoms and enhancing quality of life for LABC patients. However, there is currently no consensus on the optimal prescriptions for palliative RT in these patients. Standardized reporting of palliative RT studies is needed for robust comparison of efficacy and toxicity between various treatment regimens. Furthermore, future research on the optimal integration of RT with novel systemic agents is needed.

Purpose of review: This review raises awareness regarding the lack of data available for healthcare professionals caring for older adults with cancer when using supportive care medications.

Recent findings: Guidelines for supportive cancer care lack concrete recommendations on the appropriate use of medications in older adults with cancer. Some guidelines, such as the National Comprehensive Cancer Network Older Adult Oncology guideline, contain vital information for prescribers to consider when choosing a supportive care medication. Information at present in most guidelines is generally vague, identifying areas where caution is required in older adults, without specific details.

Summary: Research is needed to assess the efficacy and safety of supportive cancer care medications in older adults.

Purpose of review: This review aims to evaluate the current evidence on blood-based biomarkers for frailty detection in older cancer patients. It explores the potential of various biomarkers, including inflammatory markers and microRNAs (miRNAs), to serve as indicators of frailty and examines the limitations of existing studies. The review also highlights the need for further research to validate these biomarkers and improve their clinical applicability.

Recent findings: Recent studies have examined blood biomarkers associated with frailty in older cancer patients. Findings suggest that elevated granulocyte levels and lower macrophage-derived stem cells and regulatory T cells are linked to frailty. Inflammatory biomarkers such as interleukin-6 and specific miRNAs, as well as higher neutrophil-to-lymphocyte ratios, have also been identified as potential indicators of frailty. While these biomarkers show promise, no single marker has proven sufficient, and combining them may improve frailty detection. Further research is needed to validate their clinical usefulness in this population.

Summary: Blood-based biomarkers show potential for detecting frailty in older patients with cancer, but further research is needed, particularly beyond an inflammatory focus and with more robust study designs.

Purpose of review: The impacts of early palliative care for patients with advanced cancer are well described. This has led to endorsement of early palliative care, alongside cancer treatment, by leading cancer organisations. The aim of this review is to consider how best to adopt and integrate the learning from studies of early palliative care into an effective, sustainable service that is offered as part of routine cancer care.

Recent findings: 'Timely', 'targeted' and 'precision' approaches have been proposed to ensure that limited palliative care resources are available to those who are most likely to benefit. Triage and referral based on individual patients' needs has been shown to be both efficient and effective. Standardised referral criteria and the use of tools to assess complexity may support equitable service development. A specialist multidisciplinary approach is a common factor underpinning successful integration between palliative care and oncology but does not negate the importance patient-centred considerations such as advance care planning, which can be facilitated by non-specialist teams.

Summary: The challenge is no longer whether early palliative care should be provided, but how. Evidence-based strategies about how best to implement early palliative care are needed to inform appropriate resourcing, funding, and delivery.