BMJ Supportive & Palliative Care最新文献

Objectives: Psychological distress is a common yet under-recognised complication in cancer patients, significantly affecting quality of life, treatment adherence and clinical outcomes. Patients with oral cavity cancer are particularly susceptible due to the visible disfigurement caused by the disease, speech and swallowing impairments and associated social stigma, which contribute to heightened levels of anxiety, depression and social withdrawal. This study aimed to evaluate and compare the efficacy and safety of olanzapine and mirtazapine in managing psychological distress in patients with oral cavity cancer.

Methods: A total of 144 patients fulfilling the inclusion criteria were randomly allocated into two groups of 77 patients each. Group M received the tablet mirtazapine 15 mg/day orally; Group O received the tablet olanzapine 5 mg/day orally at bed time. All patients were assessed by using the Hospital Anxiety and Depression Score at the time of the first visit, then the follow-up visit at second and fourth weeks. Data were collected and analysed.

Results: Both mirtazapine and olanzapine led to significant reductions in anxiety and depression scores over time, with p<0.001. Mirtazapine reduced anxiety scores from 14.10 at admission to 10.28 in the fourth week, while olanzapine reduced them from 14.08 to 10.97. For depression, mirtazapine showed a decrease from 14.07 to 10.24, compared with a reduction from 14.01 to 10.98 with olanzapine. The overall drug effect was statistically significant, though no significant interaction between drug and time was observed.

Conclusion: Both mirtazapine and olanzapine effectively reduced anxiety and depression, with mirtazapine showing greater efficacy. Mirtazapine may be preferred, though olanzapine remains a viable alternative.

Objectives: The primary objective of this study was to determine the prevalence, severity and associated factors of distress among primary caregivers of patients with cancer using the National Comprehensive Cancer Network (NCCN) distress thermometer (DT). The secondary objective was to examine the demographic characteristics and cancer types associated with clinically significant distress.

Methods: A cross-sectional study was conducted at the oncology unit of B.P. Koirala Institute of Health Sciences, Dharan, Nepal, surveying 173 primary caregivers of patients with cancer between 22 September 2023 and 20 June 2024. An interview-based questionnaire, including the NCCN DT, assessed the prevalence and severity of distress. Distress levels were categorised as mild (DT 0-3), moderate (DT 4-6) and severe (DT 7-10); a score of ≥4 denoted clinically significant distress which encompasses moderate and severe distress. Secondary outcomes included domain-specific distress, sociodemographic and clinical factors.

Results: Distress was reported by all caregivers, with 91.9% experiencing clinically significant (DT≥4) and 49.7% severe distress (DT≥7); median DT score was 6 (SD=1.755). Clinically significant distress was more common in caregivers aged ≥30 years, married individuals (p=0.03) and those with lower education levels (p=0.01). Caregivers of patients with gastrointestinal/hepatobiliary (p=0.029) and breast cancers reported higher distress. Statistically insignificant (p=0.208) higher distress was observed among caregivers of patients undergoing multimodal/palliative treatment. Domain-specific analysis revealed distress across physical, emotional, practical, social and spiritual domains.

Conclusion: Distress among caregivers of patients with cancer in Nepal is significantly high. Routine screening and interventions reduce adverse outcomes and improve both caregiver well-being and patient care.

Objective: To assess psychological distress and quality of life (QoL) among patients with non-small cell lung cancer (NSCLC) receiving chemotherapy and examine the relationship between distress and QoL across treatment cycles.

Methods: This prospective observational study enrolled 105 patients with NSCLC undergoing chemotherapy. Psychological distress was assessed using the Depression Anxiety Stress Scale-21 questionnaire, and QoL was evaluated using the WHO Quality of Life-BREF questionnaire at baseline (before chemotherapy) and after three and six cycles of chemotherapy. Linear mixed models with first-order autoregressive covariance were used to account for within-patient correlation.

Results: Psychological distress worsened over time, with anxiety and stress increasing significantly. QoL declined across all domains, with physical health scores decreasing from 57.99 to 46.71 and psychological health from 54.48 to 43.00. Regression analysis demonstrated an inverse relationship between distress and QoL, with distress explaining 41.74% of QoL variance at baseline and 44.01% at the final assessment. Patients in severe and extremely severe distress categories had a two times higher risk of experiencing a ≥10-point drop in QoL than those with mild or no distress.

Conclusion: This prospective observational study confirms that patients with NSCLC receiving chemotherapy experience significant psychological distress and impaired QoL. Early identification and intervention are critical for improving patient outcomes, treatment adherence and quality of care. These findings highlight the need for integrated palliative care in NSCLC management.

Objectives: Early palliative care has driven outpatient models, yet palliative care day hospitals (PCDHs) are poorly described. Defining their core components and landscape is crucial for future evaluation.

Methods: A national cross-sectional survey (Jan-May 2024) identified adult PCDH programmes across France. A nominal group comprising high-activity and diverse centres then defined intervention components, structured via the American Heart Association taxonomy.

Results: 38 PCDH programmes were identified. Most were in urban areas (81.5%) and operated an average of 3.3 days per week, seeing 2 patients per day. Only 32.4% were part of a palliative care unit or hospice. A core team-palliative physician and nurse-managed care in 68.4% of centres. Services included symptom management, advance care planning, interventional procedures and non-pharmacological therapies. The final taxonomy described eight domains, outlining key components of PCDH structure, staffing, interventions and outcomes. It reflects the complexity and multidisciplinary nature of palliative day hospital care.

Conclusions: This first national census maps the organisational diversity and core elements of PCDHs in France, establishing a structured basis for future evaluation. These findings lay the groundwork for future evaluation, with the next step to assess how adaptable and effective current PCDH models are in palliative care.

Objectives: To describe the current provision of Breathlessness Support Services (BSS) across the UK and the Republic of Ireland (RI) and evaluate how services support equity of access for their local populations.

Methods: An online survey was disseminated to members of the Association for Palliative Medicine of Great Britain and Northern Ireland. The survey collected data on service delivery models, professionals involved, interventions offered, outcome measures used, patient demographics and resources provided to support equitable access.

Results: 38 BSS responded (32 UK, 6 RI). Most services (89%) were multidisciplinary, commonly involving physiotherapists (92%), occupational therapists (79%) and nurses (53%). Core interventions included education and breathing techniques (100%), relaxation (97%), pacing (95%) and exercise planning (89%). 12 services provided data on patient numbers and 6 services reported ethnicity data.

Conclusions: This national survey is the first to describe the way BSS are delivered in the UK and RI. Few services reported patient demographic data, limiting our assessment of equity of access. This study supports the need for more BSS across the UK and RI and highlights the need for better recording of demographic data, including ethnicity of service users.

Background: The Association for Palliative Medicine (APM) ran a national Specialist Palliative Care (SPC) service evaluation from 2013, using the Family Satisfaction with End-of-Life Care (FAMCARE-2) questionnaire to measure the satisfaction of bereaved main caregivers with SPC services.

Aim: This feature article reviews ten years of the FAMCARE-2 audit (2013-2022), summarising data from bereaved carers via SPC teams alongside a one-off survey involving the service leads.

Results: During the decade, 573 SPC teams across the UK returned 12 573 completed FAMCARE-2 questionnaires, representing 160 SPC services, with a mean of 1048 questionnaires per annum (804-1668). Responses spanned three settings: hospice (48%), home (39%) and hospital (13%).Bereaved caregivers reported highest satisfaction for patients' dignity; 92.2% of respondents were satisfied, while dissatisfaction was highest with the speed deceased patients' symptoms were treated (6.2%). There was no significant difference in satisfaction rate between different SPC teams (home, hospital, hospice) with limited year-to-year variation in responses (Kruskal-Wallis test η2: -0.17).Participation by community-based home care teams increased during the 10-year period, but reduced for hospital specialist teams. The number of questionnaires returned decreased by 40%.Notably, of those responding to the one-off survey, 90% of services found FAMCARE-2 valuable for learning, inspection or reflective practice.

Conclusion: Bereaved caregivers consistently expressed satisfaction with SPC services across settings over the 10-year period. Despite limited applicability of findings due to annual decline in participation and lack of demographic data, FAMCARE-2 remains the only nationally used tool for evaluating SPC in the UK.

Objective: To assess the desire for information regarding physical activity (PA) among patients with cancer in Tunisia and identify factors associated with this interest.

Methods: A cross-sectional study was conducted at the Medical Oncology Department of Habib Bourguiba University Hospital in Sfax, Tunisia. A structured face-to-face questionnaire was administered to adult patients with cancer. Collected data included sociodemographic variables, cancer type and stage and whether the patient desired information on PA. Associations between patient characteristics and interest in PA information were evaluated using appropriate statistical tests.

Results: Out of 135 patients, 70 (52%) expressed interest in receiving information on PA. The median age was 58 years, and 80% were under the age of 65. Females constituted 60% of respondents, and 80% were married. Among those interested in PA, the most common cancers were breast and gynaecological (59%). Interest in PA information was significantly associated with younger age (<65 years, p=0.04) and localised disease stage (p=0.03).

Conclusion: Over half of the patients demonstrated a desire for information on PA, especially younger individuals and those with non-metastatic disease. These findings support the integration of tailored educational strategies to promote PA in oncology care.

Background: Pharmacotherapy has a strategic role in palliative care (PC). Medications are prescribed in this context for various reasons, leading to polypharmacy, associated with several negative outcomes. Despite its clinical relevance, the scientific literature about pharmacological interventions in PC remains scarce and fragmented. This review aimed to explore and map the pharmacological interventions in PC.

Methods: A bibliometric review was conducted using combined data from Scopus and Web of Science. Inclusion criteria covered original articles and reviews, published between 2014 and 2024, that had terms related to PC present in the title and terms related to the use of medications present in the title, abstract or keywords. RStudio and VOSviewer were used to analyse data, focusing on publication trends, authorship, keywords and thematic evolution.

Results: A total of 2245 publications were included, mainly original articles (80%), although only 10% were clinical trials. Highest annual production was found in 2024, concentrating mainly in high-income countries. The term "symptom management" appears as a central term in keyword analysis; it also appears, along with "deprescribing" and "polypharmacy", in trending topics evolution, growing in 2019. Data indicate that pharmacotherapy is not yet a consolidated theme itself, being addressed mainly in more general references.

Conclusion: Fragmentation hinders the advancement of key issues such as the identification and management of potentially inappropriate medications, therapeutic rationalisation at the end of life and the pharmacoeconomic impact of these prescriptions and interventions. The field of palliative pharmacotherapy should be considered as a possibility for future literature development.