Annals of palliative medicine最新文献

Cirrhosis, a leading cause of death in the United States, is a result of chronic liver injury leading to progressive liver fibrosis. Initially asymptomatic, cirrhosis progresses to decompensated forms characterized by jaundice, ascites, gastroesophageal variceal bleeding, and hepatic encephalopathy (HE). Malnutrition, frailty, and sarcopenia are prevalent comorbidities in cirrhosis patients and are often used interchangeably in the clinical setting. Malnutrition is a condition marked by imbalanced nutrient intake and is closely related to the development of frailty and sarcopenia. Frailty is characterized by the decline in physiological reserve and function, while sarcopenia is the generalized loss of skeletal mass. Both are insidious complications of cirrhosis and also significantly influence morbidity, mortality, and transplant outcomes. Major contributing factors include decreased oral intake, poor nutrient uptake and deranged metabolism. Accurate assessment of frailty and sarcopenia in patients with cirrhosis is essential for predicting clinical outcomes. Interventions targeting frailty and sarcopenia could significantly improve patient prognosis. Nutritional interventions and physical activity promote muscle protein synthesis, increase muscle mass and mitigate sarcopenia. A cirrhosis-specific treatment includes ammonia-lowering agents to improve cognitive function and ultimately oral intake, and increase muscle mass. Emerging therapies, such as including L-ornithine L-aspartate, leucine-enriched branch-chained amino acids, hold promise in modulating skeletal muscle. This review explores the definitions, clinical manifestations, and consequences of malnutrition, frailty, and sarcopenia in cirrhosis, emphasizing the importance of early assessment and intervention.

Radiation therapy (RT) is a common component of breast cancer treatment. Chronic radiation dermatitis (CRD), defined as occurring after or extending beyond 90 days following the completion of RT, can be progressive and irreversible and manifest as changes in skin pigmentation, fibrosis, telangiectasia, ulceration, necrosis, and contribute to the development of cutaneous malignancy. There is limited existing research on the incidence, management approaches, and prevention strategies for CRD. The literature that does exist reports widely varying rates of CRD, reports the various manifestations individually, uses different grading scales, and has varying follow-up durations, making comparison between studies challenging. Methods that have been reported to specifically prevent CRD include massage therapy and physical activity. As increased severity of acute radiation dermatitis (ARD) may be associated with increased risk of CRD, methods to prevent ARD may also help prevent CRD. Topical corticosteroid creams currently have the greatest consensus for the prevention of ARD, but there is also evidence for barrier films such as Mepitel Film, StrataXRT, and Hydrofilm. A variety of methods have also been proposed to help manage the manifestations of CRD, including pulsed dye laser therapy for telangiectasia, flap reconstruction for ulceration, and vitamin E/pentoxifylline and fat grafting for cutaneous fibrosis. Standardization of scoring of CRD, aligning study endpoints, and further research into the prevention and management of CRD are needed, as many patients are living for years following breast RT, and CRD represents a poor cosmetic outcome that can lead to significant health problems, and can reduce quality of life. Herein, we aim to provide a comprehensive literature review of the pathophysiology, clinical manifestations, prevention and management strategies, and quality of life impact of CRD.

Background and objective: Informal caregivers are essential to home-based end-of-life (EOL) care. However, their needs are often not well-understood and described in relation to caregiving, rather than with a 'caregiver-centric' perspective. This review aimed to provide an overview of research on EOL caregiver needs, discussing the types of needs, factors that influence them, and gaps in supporting caregivers.

Methods: An unsystematic narrative review was performed to provide a broad overview of caregiver needs research. A targeted search was done on PubMed. Search terms included "caregiver needs", "concerns", "experiences", "palliative", "hospice", and "end-of-life". Qualitative and quantitative studies, reviews between January 2019 and November 2024. Selected papers were analysed to distil themes on the types of caregiver needs, as well as contextual factors and barriers that impact them. Assessment tools and processes were also included.

Key content and findings: A total of 63 papers were included. Major findings showed that caregivers often prioritize 'care-enabling needs'-such as information access and logistic support-over their personal 'direct support' needs-which encompasses the need for validation, recognition of their autonomy, and relational needs. While caregiver needs are increasingly appreciated, there remained substantial gaps in addressing them, the extent of which also varying due to contextual factors, such as patient's condition, availability of resources, and cultural norms. Barriers identified included ongoing prioritization of patient needs above self, suboptimal cultural sensitivity among providers, and general lack of needs assessment tools.

Conclusions: In EOL care, it is critical that providers acknowledge that caregivers are essential partners and a co-client to the patient. There is a need to recognize caregivers' direct support alongside care-enabling needs to ensure caregivers' well-being are also looked after. More attention can be given to increasing the visibility of caregiver needs by developing sensitivity to contextual factors and implementing assessment processes.

Pain from spinal metastases can result in significant impact to patients' quality of life. Conventional external beam radiation therapy (cEBRT) has long been shown to be effective in the pain control of patients with spinal metastases. With the advancement in radiation therapy, stereotactic body radiation therapy (SBRT) has been increasingly adopted for the treatment of spinal metastases. Multiple randomised controlled trials (RCT) have been performed to evaluate whether SBRT provides better pain relief compared to cEBRT. Previous meta-analyses showed that SBRT have significantly better complete pain response at 3 months compared to cEBRT. This report updates meta-analyses by incorporating the complete pain response data obtained from personal communication with the NRG Oncology Radiation Therapy Oncology Group (RTOG) 0631 principal investigator and the recently published RCT by Guckenberger et al. The results demonstrate that the results for complete pain response at 3 months have now changed and no longer favour SBRT. It is postulated that inconsistent definitions and reporting of study endpoints, specifically regarding vertebral compression fractures induced by radiation therapy, could be possible reasons for the difference in meta-analyses results. A consensus for standardizing study endpoints for future clinical trials in SBRT for painful bone metastases is needed to allow for better interpretation of study results.

Background: Healthcare workers in internal medicine wards often encounter challenges while providing palliative care due to a lack of training, emotional support, and organizational resources. Existing studies have explored attitudes toward palliative care in specialized teams, but less is known about internal medicine workers' perspectives. This study aims to address this gap by investigating the attitudes of internal medicine staff, analyzing demographic and professional factors, and assessing specific features, including knowledge of the legal aspects of palliative care.

Methods: A novel, 20-item questionnaire was distributed to 106 healthcare workers from six internal medicine departments at a tertiary care hospital in Israel. The questionnaire assessed participants' demographic and professional data, attitudes toward palliative care, self-perceived knowledge, emotional support needs, and organizational support. Responses were scored on a 0-10 Likert scale, with higher scores indicating stronger agreement. Data analysis included one-way analyses of variance (ANOVA), chi-square tests, and descriptive statistics.

Results: Participants included nurses (61%), medical doctors (32.4%), and other healthcare personnel (6.7%). Perceived knowledge and training were rated as moderately adequate (6.0/10 and 5.6/10, respectively), while organizational support was rated similarly (6.0/10). Emotional support from family and friends (6.5/10) was deemed higher than from institutions (4.8/10). Nurses and medical doctors reported insufficient time for palliative conversations (4.8/10 and 4.18/10). Healthcare workers disagreed that palliative care should be restricted to terminally ill patients (2.89/10). Statistically significant differences were observed in attitudes toward palliative care across professions, marital status, and years of experience. Ethnic and religious affiliations did not influence attitudes towards palliative care.

Conclusions: The findings highlight the need for targeted training, enhanced organizational support, and mentorship programs to address gaps in palliative care delivery within internal medicine departments. Addressing these needs can improve healthcare workers' preparedness and ultimately raise the quality of care for terminally ill patients.

Chemotherapy-induced peripheral neuropathy (CIPN) is a prevalent and often debilitating side effect faced by many patients undergoing chemotherapy, significantly impacting their quality of life and functional status. Psychological impact in patients with CIPN remains widely understudied and can range from symptoms of sadness, fear, depression, and anxiety, substantially impacting quality of life and daily functioning in cancer survivors. CIPN is characterized by peripheral nerve damage due to neurotoxic effects of chemotherapeutic agents. However, the pathophysiology and exact mechanism is not fully understood. Patients experience symptoms ranging from numbness, tingling, pain, and motor dysfunction. Various clinical factors [e.g., the specific chemotherapeutic agents and dosing, patient characteristics such as body mass index (BMI), age, race, genetics and co-morbid conditions] have been associated with risk of developing CIPN. The prevalence of CIPN continues to increase; however, effective preventive and treatment strategies for CIPN remain limited. Current treatment strategies are limited to dose adjustments and symptomatic relief, highlighting the need to identify evidenced-based preventive strategies and well beneficial therapeutics. Further research in CIPN is essential for improving outcomes and quality of life in patients experiencing this debilitating condition. In this review, we examine the clinical presentation, incidence and prevalence, risk factors, diagnostic evaluation, and current preventive/treatment strategies with a focus on the impact of CIPN on quality of life, patient experience and functional status.