BMJ Supportive & Palliative Care最新文献

Objectives: Evidence suggests that home parenteral nutrition (HPN) can prolong survival and improve quality of life in selected patients with late-stage cancer. This study aims to identify clinical characteristics associated with the survival of Taiwanese patients with late-stage cancers receiving HPN through retrospective analysis.

Methods: A retrospective study of 410 Taiwanese patients with late-stage cancer unresponsive to at least three treatment lines was performed to compare survival outcomes between those receiving HPN and those receiving palliative care alone (2010-2024), matched by sex, cancer type and treatment history. Demographic, clinical, nutritional, inflammatory, performance status (PS) and do-not-resuscitate (DNR) status data were analysed using univariate and multivariate survival analyses.

Results: Compared with those in the palliative care group, patients in the HPN group were younger, with fewer having Eastern Cooperative Oncology Group PS (ECOG PS) score >2, fewer DNR consents and were more likely to be receiving ongoing cancer treatment. Median survival was significantly longer in the HPN group (77 vs 17 days, p<0.001). ECOG PS score >2, DNR consent and modified Glasgow Prognostic Score of 2 were independently associated with shorter survival, while the use of HPN was linked to reduced mortality risk. The negative impact of DNR consent on survival was more pronounced in patients aged <65 years.

Conclusion: HPN may prolong survival in selected Taiwanese patients with late-stage cancer, with PS, nutritional and inflammatory markers and DNR status serving as key factors for identifying those most likely to benefit.

Objectives: To develop an evidence-based intervention to prevent burnout in oncology doctors.

Methods: A novel well-being intervention was developed and involved breathing and relaxation exercises, clinical debriefing, reflective practice and mindfulness. Resident doctors at a tertiary cancer centre were invited to attend weekly sessions facilitated by a clinical psychologist. Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) scores were collected at the start and end of placement.

Results: Over 12 months, 28 resident doctors in inpatient oncology participated in our optional weekly well-being sessions (average 3-6 sessions per rotation). Baseline average and median WEMWBS were 51 (SD ±5.8) and 50.5 (range 41-62). At baseline, 82.12% (n=23/28) had average well-being scores. There was a statistically significant improvement in overall WEMWBS from 51.00 (SD ±5.80) to 54.57 (SD ±7.59) (p=0.0017). 57.14% (n=16/28) of participants had an increase in three or more points (range +4 to +15) in total WEMWBS; 7.14% (n=2/28) had a decrease in three or more points (range -10 to -10). All were either 'satisfied' (n=1/28) or 'very satisfied' (n=27/28) with the session facilitation. All found the sessions either 'helpful' (n=25/28) or 'very helpful' (n=3/28).

Conclusions: In this pilot study, our novel well-being intervention preserved, and in some cases improved, mental well-being among resident doctors working in oncology.

Background: Clinical practice in palliative care points to the involvement of caregivers in the decision-making process for patient treatment and care.

Objectives: The primary objective was to explore the relational nature of decision-making between patients with advanced illness and their caregivers in palliative care. The secondary objective was to identify decision-making styles between patients and their caregivers.

Methods: Systematic review and narrative synthesis of empirical research published between January 2004 and September 2024 relevant to the topic was conducted. Databases used included EMBASE, Medline, CINAHL, PsycINFO, Web of Science and Google Scholar.

Results: 35 studies from across 20 countries were included in the review. Multiple factors intertwined with patient and caregiver decision-making processes, including patient and caregiver degree of awareness of the patient's illness, quality of communication (or lack of communication) between each other, caregiving responsibilities, the reciprocation of emotional support between the patient and caregiver, and limitations in service provision. Different approaches to and/or forms of decision-making were identified. These included patients making decisions without involving caregivers, shared decision-making between the patient and caregiver, and preference-based decision-making for both patients and caregivers. Patients and caregivers could avoid disclosure between one another, which in some cases delayed decision-making. Caregivers assumed more control in decision-making when patients became more dependent on them.

Conclusions: Mutual disclosure between patients with advanced illness in palliative care and their caregivers could be beneficial to avoid delays in decision-making. Decision-support interventions in palliative care should be designed to both protect patient autonomy and facilitate caregiver support.

Objectives: Sarcopenia, characterised by reduced skeletal muscle mass and strength, is increasingly recognised as a prognostic marker in oncology. Its role in breast cancer and its variation across molecular subtypes remains unclear. This study examined the prognostic value of sarcopenia, defined by Skeletal Muscle Index (SMI), and its association with overall survival (OS) among breast cancer subtypes.

Methods: This retrospective study included 523 women diagnosed with breast cancer at Ege University between January 2014 and January 2015. Clinical, pathological and anthropometric data were collected. Sarcopenia was evaluated using bioelectrical impedance analysis (BIA) with the TANITA SC-330 device to estimate appendicular muscle mass, and defined as SMI <5.5 kg/m². Survival outcomes were analysed using Kaplan-Meier curves and Cox regression models adjusted for age, tumour stage, molecular subtype and body mass index. Subgroup analyses were performed for luminal A, luminal B, HER2-positive and triple-negative breast cancer (TNBC) subtypes.

Results: The mean age was 57.6±13.0 years, and 9.7% were sarcopenic. Sarcopenia was significantly associated with reduced OS (HR: 1.789, p=0.025). While no significant effect was seen in luminal A or B subtypes, sarcopenia predicted markedly worse survival in HER2-positive patients (HR: 11.247, p=0.001) and TNBC patients. Recurrence rates were similar between sarcopenic and non-sarcopenic individuals.

Conclusion: Sarcopenia assessed by BIA is an independent predictor of poor survival in breast cancer, particularly in HER2-positive and TNBC subtypes. Incorporating muscle assessment into routine evaluation may help identify high-risk patients and guide supportive care.

Importance: Structured communication tools and decision aids are recommended to facilitate goals of care discussions (GOCDs) in hospitalised patients, but their impact remains unclear.

Objective: To determine the effectiveness of communication tools and decision aids on GOCDs between healthcare providers, patients and substitute decision makers.

Data sources: PubMed, Web of Science, CINAHL and ClinicalTrials.gov were searched from January 2015 to July 2025, with backward citation tracking to identify additional trials.

Study selection: Randomised trials of communication tools or decision aids for hospitalised adults or substitute decision makers were eligible, regardless of primary outcomes.

Data extraction and synthesis: Trial characteristics, primary outcomes and methodological quality were extracted and assessed using the Core Grading of Recommendations, Assessment, Development and Evaluation framework. Random-effects meta-analyses were conducted when appropriate.

Results: 22 trials were included. Communication tools increased GOCD documentation (OR 1.46, 95% CI 1.04 to 2.05). Effects on resuscitation preferences were inconsistent (OR 1.84, 95% CI 0.95 to 3.60). Mixed effects were observed for concordant care, psychosocial outcomes and healthcare utilisation. Evidence certainty was moderate for most outcomes; several small pilot trials were rated low due to bias, imprecision or heterogeneity. Interventions were most effective when combining structured patient-facing or clinician-facing prompts such as videos, guides or electronic health record alerts.

Conclusions and relevance: Communication tools and decision aids improve GOCD documentation in hospitalised patients but show uncertain effects on other patient-centred outcomes or healthcare utilisation. Interprofessional training and system-level support may enhance impact, and future large trials should evaluate the effectiveness of facilitated GOCDs on important patient and health system outcomes.

Aim and objective: This scoping review aims to explore the existing literature on occupational therapy's (OT's) role in orthopaedic oncology rehabilitation. The objectives of the review are to determine the extent of OT involvement in this area, the evaluations and interventions used and the outcomes measured, which will help identify gaps in current research.

Methods: The review followed the Joanna Briggs guidelines using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist, where all English language research articles containing qualitative or quantitative data from March 2015 to March 2025, consisting of adult patients with musculoskeletal cancers who received OT or similar rehabilitation services, were included. Five databases, PubMed, CINAHL, Embase, Scopus and Web of Science, were searched, from which 18 articles were selected for the scoping review.

Results: Only four studies clearly described the OT role in the rehabilitation team. One article provided more detailed information on the domains of OT, and five showed OT as part of a multidisciplinary team in brief. Outcomes included participation in activities of daily living, increased functional independence and return to work. The OT assessments and detailed strategies were minimal. Important aspects, such as psychosocial support, caregiver burden and environmental modifications, received little attention.

Conclusion: Detailed records on OT's role in orthopaedic cancer rehabilitation are lacking. Further studies should include roles, rehabilitation, tools, protocol development, with emphasis on emotional support, social aspects and caregiver support.

Objective: To investigate whether initiating prehabilitation during neoadjuvant chemotherapy (NAC) is associated with postoperative recovery of functional exercise capacity in patients with oesophageal cancer.

Methods: In this multicentre observational study, we classified patients with oesophageal cancer into two groups based on the timing of prehabilitation: the early prehab (initiated during NAC) and late prehab (initiated after NAC) groups. Prehabilitation consisted mainly of an exercise programme combining supervised sessions with prescribed self-exercise. Functional exercise capacity was assessed using the 6 min walk distance (6MWD) before surgery (T0) and at 3 (T1) and 6 weeks (T2) postoperatively. Secondary outcomes included muscle strength, body weight, fatigue and health-related quality of life. Between-group differences in changes in 6MWD were analysed using a linear mixed-effects model, and secondary outcomes were descriptively summarised.

Results: 51 patients were analysed (early prehab group, n=17; late prehab group, n=34). Both groups showed a decline in 6MWD at T1 with partial recovery at T2. The early prehab group showed a smaller decrease in 6MWD at T2 (-13 m) compared with the late prehab group (-27 m), though the difference was not statistically significant (p=0.70). Trends favoured the early prehab group in muscle strength, fatigue and global health status scores.

Conclusions: This study observed a modest trend towards better postoperative recovery in patients who initiated prehabilitation during NAC, although no statistically significant differences were detected between groups. Further prospective trials are needed to refine intervention quality and identify patient populations most likely to benefit.

Trial registration number: UMIN000047895.

Objectives: This study aimed to determine the frequency and characteristics of patients discharged from a specialist community palliative care service, and the incidence, timing and reasons for discharge.

Methods: This retrospective audit reviewed admissions and discharges over a 6-year period, including demographics, length of admission, discharge reason and readmission status.

Results: Of the 5149 admissions, 17% were discharged and 22% were later readmitted. 19% of readmissions were again discharged. The main reason for discharge was having no specialist palliative care needs (53%), followed by patients moving out of the service catchment area (13%). Median length of stay before discharge was 141 days, and median time from discharge to readmission was 214 days.A small group of 32 patients was referred, reviewed and immediately discharged, and most had a non-malignant diagnosis and were male. The main reasons for immediate discharge was the absence of palliative care needs or the service not being needed or wanted. A third of these patients were later readmitted.

Conclusion: These data show that a substantial proportion of community specialist palliative care service patients are discharged. It raises further research questions around flexible models of care, validated discharge criteria and implementing quality measures on discharge.

This study investigated the associations between sedentary behaviour-specifically time spent driving, watching television, and using a computer-and the risk of musculoskeletal diseases and fractures using a Mendelian randomisation (MR) approach. A two-sample MR analysis was conducted based on data from the IEU GWAS database of the UK Biobank. Single-nucleotide polymorphisms significantly associated with sedentary behaviours, musculoskeletal disorders, and fractures were selected as instrumental variables after linkage disequilibrium testing, exclusion of potential confounders, and confirmation of instrument strength (F-statistics >10). Inverse variance weighting was used as the primary analytical method, with weighted median and MR-Egger regression as complementary analyses. Sensitivity analyses included Cochran's Q test, MR-Egger intercept testing, and leave-one-out analysis. Random- and fixed-effects models were applied to synthesise results across different sedentary behaviour domains. The MR analyses identified significant associations between television viewing and ankle fractures (P = 0.0182), television viewing and musculoskeletal and connective tissue diseases (P < 0.001), and heel bone mineral density and ankle fractures (P < 0.001). In contrast, computer use was negatively associated with musculoskeletal and connective tissue diseases (P = 0.0017), suggesting a potential protective effect that warrants further investigation. Overall, these findings indicate that sedentary behaviours have heterogeneous effects on musculoskeletal health. Television viewing was associated with an increased risk of ankle fractures and musculoskeletal diseases, whereas computer use showed an inverse association with musculoskeletal disorders. This study provides genetic evidence for the role of sedentary behaviour in the development of musculoskeletal and fracture-related diseases and may inform targeted prevention and intervention strategies. The study was registered in PROSPERO (CRD42024552384).