BMJ Supportive & Palliative Care最新文献

Objectives: Unnecessary hospital admissions for palliative emergencies strain resources and may not meet patients' end-of-life preferences. This study evaluates the impact of a 3-year partnership between Macmillan Cancer Support and the Scottish Ambulance Service (SAS), launched in 2022, to strengthen community-based palliative care and establish alternative referral pathways.

Methods: A retrospective comparative analysis of SAS call data linked to emergency department (ED) outcomes was conducted for 2022 and 2023. We assessed changes in key metrics: acute-care hospital admissions, ambulance conveyance rates and 7-day mortality using χ² and two-proportion z-tests. Costs were estimated using NHS data and scenario modelling of patient length of stay.

Results: A statistically significant 5.47% reduction in hospital conveyances was observed, equating to over 1600 fewer incidents conveyed to hospital. Estimated ambulance service savings totalled £570 871, with ED-related cost reductions from £3.6 to £5.6 million. A modest increase in 7-day mortality was noted, consistent with increasing acuity of patients managed in the community.

Conclusions: The SAS-Macmillan collaboration demonstrates that targeted education, alternative referral pathways and integrated community care can reduce avoidable hospital admissions and improve efficiency. The initiative offers a scalable model to enhance patient-centred, community-based palliative and end-of-life care, aligned with patient preferences.

Pain is one of the most distressing symptoms that patients experience as they approach the end of life. Opioids remain the gold standard of care, but the need for alternative options continues to grow, especially in the face of opioid unresponsive pain or opioid side effects. Clonidine, a drug initially known as a nasal decongestant and anti-hypertensive, has shown promise through its depression of the sympathetic nervous system by inhibiting norepinephrine release. It has since shown potential as an analgesic post-operatively, helping to reduce overall opioid use while providing adequate pain relief. This systematic review aimed to collate and analyse the available literature on the use of clonidine as an analgesic for palliative care patients. A comprehensive literature search was performed on CENTRAL, SCOPUS, MEDLINE, EMBASE and ClinicalTrials.gov for studies assessing the use of clonidine as analgesia for patients under palliative care. Twelve studies involving 194 patients were included. All studies were either case reports or case series. Clonidine was used as both monotherapy and as an adjunct through a variety of delivery methods, including intrathecal, perineural, subcutaneous and transdermal. Clonidine has shown initial potential to provide adequate analgesia while reducing overall opioid usage. However, further research is required to form a stronger evidence base and gain further insight into its future role in this field. Further insight is also required into more easily accessible delivery, such as oral, subcutaneous and transdermal routes.

Objective: The purpose of this study was to investigate the postoperative course of pancreatoduodenectomy (PD) and distal pancreatectomy (DP) by examining body composition, physical function, physical activity and total intake to 1 month postoperatively, and to compare the two groups.

Study design: This study is a retrospective observational study investigating.

Methods: Forty-nine patients for whom preoperative and postoperative evaluation was possible were included. Measurements included operative time, intraoperative blood loss, body weight, body fat mass, skeletal muscle mass index (SMI), grip strength, lower limb muscle strength, walking speed, physical activity, oral intake, total intake, sarcopenia and complications. Body weight, body fat mass, SMI, grip strength, muscle strength of the lower limb, walking speed and sarcopenia were measured preoperatively and 1 month postoperatively.

Results: Weight, SMI, body fat mass and grip strength were significantly lower in both groups at 1 month postoperatively compared with preoperatively (p<0.05). The per cent change in body weight, SMI, body fat mass and grip strength between preoperative and 1 month postoperatively for each group was all significantly lower for PD compared with DP (p<0.05). Postoperative activity and oral intake were significantly lower in the PD group compared with the DP group (p<0.05). The incidence of sarcopenia increased significantly in PD at 1 month postoperatively (p<0.05).

Conclusions: The present study suggests that PD is associated with lower postoperative body composition, physical function and activity than DP. Rehabilitation intervention that takes into account postoperative physical function, physical activity and nutritional status is required, especially for the PD group.

Objectives: To determine the prevalence and severity of restless legs syndrome (RLS) in patients with advanced cancer receiving palliative care.

Methods: A cross-sectional, single-centre study was conducted in a palliative oncology wars and outpatient clinics of a tertiary hospital in Spain. Adult oncology patients with palliative needs were examined by a physician, specialised in palliative care, and trained in RLS, to diagnose RLS according to established criteria of the consensus of the International RLS Study Group (IRLSSG). Subsequently, only RLS -positive patients responded to the RLS Severity-Rating Questionnaire (IRLSSG), to assess symptom severity. Functional status was evaluated using Eastern Cooperative Oncology Group performance status. Demographic variables, comorbidities, and treatments were collected, and associations between RLS and potential precipitating factors were analysed.

Results: A total of 135 patients were included. 16 patients (11.85%) met diagnostic criteria for RLS. None of them had been previously diagnosed. The mean age of RLS-positive patients was 66.4 and the most frequent cancers were digestive, respiratory and gynaecological cancers. RLS severity was mild in six patients (37.50%) and moderate in five patients (31.25%); no patients presented with severe or very severe symptoms. Sleep disturbance related to RLS was reported by a minority of affected patients. Only Alcohol consumption was the only factor significantly associated with RLS (p=0.008).

Conclusions: RLS is relatively common and underdiagnosed in patients with advanced cancer receiving palliative care, with predominantly mild to moderate symptoms. Systematic clinical assessment of RLS in palliative oncology settings may help identify a treatable contributor to impaired quality of life.

Objectives: To assess the feasibility, safety and preliminary efficacy of psilocybin-assisted therapy (PAT) for demoralisation in terminally ill patients receiving home hospice care.

Methods: In this open-label pilot trial, 4607 home hospice patients at a large community hospice were screened over 22 months; 66 were approached, 15 enrolled and 10 received psilocybin. Participants completed two home-based preparation sessions, a single 25 mg oral psilocybin session at an inpatient hospice facility, and two home-based integration sessions. Feasibility was assessed through recruitment, retention and acceptability. Safety was evaluated via adverse event monitoring, and preliminary efficacy was assessed using changes in demoralisation scores and other psychosocial measures.

Results: The intervention was well tolerated, with no serious adverse events attributed to psilocybin. At week 3, demoralisation scores significantly decreased (mean reduction: 8.8 points, p=0.0196), despite ongoing clinical decline. Grief- and peace-related themes were prominent during psilocybin sessions. While six participants rated the treatment favourably on the Reaction to Research Participation Questionnaire global evaluation factor, three rated neutral on one or more items, suggesting that the emotional intensity and demands of the intervention may influence acceptability.

Conclusion: This study provides initial evidence that PAT can be feasibly and safely integrated into hospice care for terminally ill patients. Further research is needed to optimise delivery and further assess therapeutic potential.

Objectives: To explore the level and nature of burden among primary caregivers of people with palliative care needs living in rural Nepal and to understand the sources of support available to them.

Method: An explanatory sequential mixed-method design was used. A house-to-house survey in two rural districts identified people with palliative care needs. Primary caregivers were invited to complete a structured questionnaire including a modified Caregivers' Burden Scale in End-of-Life Care. A purposive subsample then took part in semi-structured interviews exploring caregiving experiences. Quantitative data were analysed descriptively; qualitative data were analysed thematically. Finally, both data sets were integrated and triangulated to gain deeper insights.

Results: 52 caregivers of 58 people with palliative care needs participated; 42 (81%) were women, most commonly daughters-in-law (44%) and wives (23%). 83% reported high levels of emotional, physical and social burden, often feeling isolated and exhausted. Families provided most support, followed by neighbours. Only 38% reported any support from health professionals and 69% had little or no knowledge of the cared-for person's clinical condition.

Conclusions: Primary caregivers in rural Nepal are predominantly women who experience multidimensional burden, with limited information and formal support. Palliative care services should recognise and respond to caregiver needs, building on family and community resources and empowering caregivers within primary care-based models of palliative care.

Objectives: This study aims to assess the prevalence of insomnia in patients with cancer and evaluate its association with overall survival, considering related symptoms such as anxiety and pain.

Methods: A prospective cohort study was conducted at Habib Bourguiba University Hospital in Sfax, Tunisia, involving adult patients with cancer. Data were collected through validated sleep assessment tools (Insomnia Symptom Questionnaire and Insomnia Severity Index). The impact of insomnia, alongside associated symptoms, on survival was assessed using Kaplan-Meier analysis and Cox regression.

Results: Among 100 patients, 78% reported insomnia, with pain and anxiety being the most common triggers. Insomnia was significantly associated with poorer overall survival (p<0.0001). Multivariate analysis revealed insomnia (HR=2.85, p=0.02) and metastatic disease (HR=3.21, p=0.01) as independent predictors of reduced survival.

Conclusions: Insomnia, along with related symptoms like anxiety and pain, is highly prevalent among patients with cancer and significantly associated with worse survival outcomes. This highlights the need for systematic screening and management of sleep disturbances, as well as a broader focus on symptom clusters in oncology care.