BMJ Supportive & Palliative Care最新文献

Aim: To assess the psycho-existential distress of patients and their caregivers in a specific setting, like hospice.

Methods: Patients consecutively admitted to two hospices for a period of 8 months were enrolled. At admission (T0), patients were assessed by a routine data recording: age; gender; Edmonton Symptom Assessment Scale (ESAS); Memorial Delirium Assessment Scale (MDAS); Cut down, Annoy, Guilt, Eye-opener (CAGE); Karnofsky level; primary diagnosis; education; religiosity and comorbidities. Psycho-existential distress was assessed at T0 by the Psycho-existential Symptom Assessment Scale (PeSAS). The measurements were repeated 1 week after comprehensive palliative care treatment.

Results: 159 patients and 87 caregivers were considered. The majority of patients had a cancer diagnosis (88.7%). Non-cancer patients were older (p<0.0005), had a lower Karnofsky (p<0.0005) and higher cognitive decline (MDAS, p<0.0005). After 1 week of comprehensive palliative care treatment, significant changes were observed for most ESAS items and total ESAS in both patients and caregivers. PeSAS items were mild-moderate. All symptoms of PeSAS, except for depression, significantly decreased after 1 week of comprehensive palliative care with a significant decrease in total PeSAS. Caregivers showed similar psycho-existential distress, but total PeSAS did not significantly change. There was a positive correlation between patients and caregivers in the changes from T0 to T7 (Δ) for PeSAS (p=0<004) and total ESAS (p=0.005).

Conclusions: Admission to hospice improved both physical symptoms and psycho-existential distress in patients significantly and non-significantly in caregivers.

Objectives: As a leading cause of morbidity and mortality worldwide, cancer imposes psychological, physical and functional burdens. Recent paradigms focus on integrative treatment approaches in patients with cancer, which include psychological and spiritual care. While spirituality has been shown to have a potential role in alleviating disease burdens, both psychological and physical, this effect has not yet been fully elucidated in the Middle East. Our study examines the impact of spirituality on the quality of life (QoL), depression, anxiety and cancer symptom severity in patients with cancer within the Lebanese population.

Methods: Our cross-sectional study followed 200 adults with solid tumours in a tertiary care centre in Beirut, Lebanon. Data were mainly collected through questionnaires: Hospital Anxiety and Depression Scale, Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12 Item Scale, MD Anderson Symptom Inventory and 36-item Short Form Survey Instrument. Multivariable logistic regression analyses were conducted to predict anxiety and depression. Interaction terms between spirituality and each of symptom severity levels, physical QoL and mental QoL were assessed.

Results: Higher spirituality significantly reduced the odds of anxiety (adjusted OR (aOR)=0.89, 95% CI (0.84 to 0.94), p<0.001) and depression (aOR=0.9, 95% CI (0.85 to 0.95), p<0.001) in patients with cancer, independent of symptom severity or QoL measures.

Conclusions: Our findings shed the light on the role that spiritual care plays in alleviating cancer burden despite physical symptoms severity-and pave the way to potentially modify cancer treatment protocols in the Middle East.

Objectives: To compare a novel method of methadone rotation used in a specialist palliative care inpatient unit (SPCU) in Cork, Ireland, with rapid titration methods using Perth and Brisbane Protocols as well as the Edmonton method of methadone rotation.

Methods: A retrospective chart review was performed in March-June 2022. All patients who completed rotation to methadone during 2018-2019 in the SPCU were included. 2018-2019 was selected to study a population not affected by the coronavirus pandemic. Oral morphine equivalent (OME) was calculated using the opioid conversion chart. From the OME, the expected daily methadone dose was calculated using the Perth, Brisbane and Edmonton methods. These figures were then compared directly with the actual methadone doses achieved using our dosing schedule.

Results: A comparison of the expected doses using the Perth and Brisbane rapid titration protocols and stable daily dose achieved revealed that the stable methadone dose was significantly lower than both rapid titration protocols (p=<0.0001) and (p=0.0035, respectively). However, a comparison of the expected dose using the Edmonton method and the dose achieved did not determine any significant difference (p=0.7602).

Conclusions: This is the first evaluation of a novel Irish method of methadone rotation and demonstrates a lower overall daily methadone dose compared with established protocols.

Background: Metastatic breast cancer (MBC) is generally considered an incurable disease, and patients require continuous systematic treatment. Receiving the diagnosis and treatment of MBC is a distressing experience that may accelerate an episode of psychological disorder. This study examined the performance of the distress thermometer (DT) and identified the risk factors associated with psychological distress (PD).

Methods: We assessed 337 patients diagnosed with MBC in Henan Cancer Hospital. All patients completed the electronic DT and Hospital Anxiety and Depression Scale (HADS) online. Receiver operating characteristic (ROC) analysis compared DT accuracy against HADS-Total score (HADS-T) defined PD (HADS≥15). Multivariate regression identified PD-associated factors.

Results: DT average scores were significantly higher in HADS-T≥15 patients (4.27 vs 2.01, p<0.001). In ROC analysis, the DT showed strong discriminatory power relative to the HADS diagnosis of depression and anxiety, with an area under the curve of 0.76. A score of 4 represented the optimal trade-off between sensitivity (0.58) and specificity (0.85) characteristics for detecting distress. PD was associated with (unstandardised coefficient (B)=1.663, p=0.04) curative effect, and patients with poorer therapeutic effects experience more distress.

Conclusion: The single-item DT has been determined to be a valid tool for screening distress in patients with MBC. We recommend using a cut-off score of 4 in this population. While our analysis revealed a significant association between poor treatment response and elevated distress scores, these findings cohere with the broader clinical imperative to prioritise distress management for all cancer patients regardless of treatment outcomes.

This systematic review and meta-analysis aimed to investigate the necessity of histamine-2 antagonists (H2As) in paclitaxel premedication protocols, particularly in preventing hypersensitivity reactions (HSRs). The research question addressed whether the inclusion of H2As significantly reduces the incidence of HSRs associated with paclitaxel treatment. A comprehensive literature search of MEDLINE, Cochrane and Web of Science databases was conducted to identify studies on prophylactic H2As for paclitaxel-induced HSRs up to December 2023. Studies were included based on predefined criteria, including adult patients with cancer receiving paclitaxel infusions. Quality of included studies was evaluated using the Risk Of Bias In Non-randomised Studies-of Interventions tool and results were generated through a random effects statistical model. Six studies meeting the inclusion criteria were included in the meta-analysis. The analysis revealed no statistically significant difference in the incidence of grade III or higher HSRs (risk ratio, RR 1.04, 95% CI 0.65 to 1.67) or all-grade HSRs (RR 1.40, 95% CI 0.82 to 2.39) between patients receiving H2As as part of their premedication protocol and those without H2A blockade. Minimal heterogeneity was observed for grade III reactions (I²=0.0%, p=0.669), while high heterogeneity was noted for all-grade reactions (I²=73.4%, p=0.002). Subgroup analysis showed minimal heterogeneity with all-grade reactions once prospective studies were excluded (I²=0.0%, p=0.689). This meta-analysis supports the safe omission of H2As, particularly ranitidine, from paclitaxel premedication protocols without compromising patient safety in terms of HSRs.

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.

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.

Heart rate variability (HRV) is the variation in the time interval between consecutive heartbeats, is variable for each individual and higher or lower HRV is not always better. Despite the importance of HRV to cancer care, HRV monitoring and analysis are not standard clinical practice. In this article, we present the clinical utility of widely known recommendations for improving HRV, highlight their benefits and outline how these can provide an efficient, non-invasive and cost-effective method for identifying autonomic dysfunction through HRV. Considered together, this article can inform policy on the importance of HRV measurements and evaluation as a standard of care in supportive care guidelines.