BMJ Supportive & Palliative Care最新文献

Background: Enhanced Supportive Care (ESC) delivers multi-professional and proactive support for people with treatable but not curable cancer by addressing physical, psychological and social needs throughout the disease trajectory from the point of diagnosis. Since the dissolution of the national NHS England Commissioning for Quality and Innovation funding, ESC services in the UK have lacked standardisation, financial backing and strategic oversight.

Objectives: To create a national collaborative ESC framework by identifying evidence-based care models, mapping existing national services and informing future commissioning and research.

Methods: The ESC Steering Group was established in 2022 under the UK Association for Supportive Care in Cancer (UKASCC) and developed two workstreams in collaboration with patient and public involvement: (1) an international scoping review to define components of effective ESC models and (2) a national survey to evaluate current ESC service provision, barriers, facilitators and measurable outcomes.

Results: The UKASCC ESC National Collaborative involves over 40 professionals from 27 organisations and found considerable variation in ESC service delivery, therefore supporting the need for a standardised, evidence-informed model. The scoping review and survey distribution are in progress.

Summary: The UKASCC ESC National Collaborative demonstrates the power of collaborative working in supportive oncology. Despite challenges, this network guides national ESC development and aims to support a future research portfolio and commissioning strategy.

Background: Cannabinoid-based therapies are increasingly used in cancer care to manage symptoms such as pain, chemotherapy-induced nausea and distress in palliative settings. Despite their clinical adoption, the safety profiles of these therapies remain incomplete. This systematic review synthesises randomised controlled trials (RCTs) reporting adverse events (AEs) associated with cannabinoid-based therapies in adult patients with cancer.

Methods: We searched PubMed, CINAHL and Web of Science for studies published between January 2015 and March 2025. Eligible studies included RCTs involving adult patients with cancer receiving cannabinoid-based treatments that reported AEs. Data were extracted on study characteristics, intervention type and AEs, which were categorised by systemic disorder. Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were followed throughout.

Results: 14 RCTs were included. Studies varied in sample size (12 to 399), intervention duration (48 hours to 12 months), and cannabinoid formulations. All studies reported AEs, with the most frequent involving gastrointestinal (eg, nausea, dry mouth), neurological (eg, dizziness, somnolence) and psychiatric (eg, anxiety, hallucinations) disorders. The number of distinct AEs reported per study ranged from 1 to more than 12. Risk of bias assessments revealed that 10 studies had 'some concerns' and 2 were classified as 'high risk' due to incomplete outcome reporting or selective bias.

Conclusions: Cannabinoid therapies are associated with a broad range of AEs in adult patients with cancer, particularly affecting the gastrointestinal and nervous systems. While these therapies may offer symptomatic relief, clinicians must weigh benefits against potential harms. Further studies with larger samples, longer follow-ups and standardised AE reporting are recommended.

Objective: This study aimed to evaluate factors affecting nutrition and weight loss in patients with head and neck cancer (HNC) undergoing radiotherapy (RT) and investigate the effect of nurse-led support on symptom management.

Methods: Fifty patients with histologically confirmed HNC receiving definitive or postoperative RT were prospectively enrolled and monitored by a clinical nurse throughout treatment and follow-up (study group). Nutritional intake and bioelectrical impedance analysis (BIA) were recorded. A control group of 45 matched patients without nurse follow-up was recruited for comparison.

Results: At treatment completion, the study group had a mean weight loss of 3.0 kg (4.35%) vs 5.2 kg (6.9%) in the control group (p=0.03). Moderate dysphagia occurred in 42% of the study group and 62% of the control group (p=0.04). Grade 3 toxicities were 10% more frequent in the control group.

Conclusion: Nurse-led follow-up significantly improved nutritional outcomes and reduced treatment-related side effects in patients with HNC. These results highlight the value of nursing care in supporting treatment adherence and enhancing multidisciplinary cancer care.

Resilience-building in palliative care professionals: scoping review BACKGROUND: Burnout, demoralisation and compassion fatigue are common among palliative care professionals. Practising palliative care necessitates a quality of resilience in order to ensure constant and optimal patient care. However, there is no universal approach to prevent burnout or raise resilience among palliative care professionals. This study aims to provide an overview of interventions and explore their effectiveness in building resilience in palliative care professionals.

Methods: The search was conducted in four databases: MEDLINE, Embase, CINAHL, PsycINFO and Cochrane Database. Two independent investigators reviewed eligibility, with conflicts resolved by a third investigator. One reviewer performed data extraction, later reviewed by a second investigator. All eligible studies were manually re-reviewed. Quantitative and qualitative data synthesis were conducted.

Results: The search initially revealed 11 470 potentially eligible citations. 12 studies were included in the analysis. Most studies had a small number of participants. The studies varied in sample size, interventions and assessment tools, making it challenging to identify the most effective resilience-building interventions. However, our analysis revealed commonly found elements among these interventions: five essential elements (regularity, self-care, mindfulness, reflective practice and cognitive-behavioural therapy) and three supporting elements (peer support, educational sessions and organisational support).

Discussion: While the effectiveness of specific interventions remains inconclusive, this review highlights essential and supporting elements that should be considered in designing resilience-building programmes for palliative care professionals. Future research should focus on developing assessment tools specific to palliative care, conducting well-designed studies, and creating replicable, standardised interventions.

Introduction and aims: Circadian rest-activity rhythms describe patterns in rest and physical activity across and between 24-hour periods. Research highlights important associations between circadian disruption, including the rest-activity rhythm, and clinical outcomes in patients with cancer. This study aimed to assess the circadian rest-activity rhythms, and prevalence of circadian rest-activity rhythm disorders (CARDs), in patients with advanced cancer.

Methods: An observational study of 72 outpatients with locally advanced or metastatic cancer took place over a 1-year period, considering objective (accelerometry) and subjective (patient diary) measures of circadian rest-activity rhythms, patient-reported outcomes (Memorial Symptom Assessment Scale-Short Form, European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire, brief Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale) and clinical markers.

Results: CARDs affected up to 60% of patients with advanced cancer. Increased circadian disruption was seen in patients with more advanced disease, particularly with metastatic organ involvement (p=0.038), poorer performance status (p=0.018), higher inflammatory status (p=0.018), anaemia (p=0.007) and iron deficiency (p=0.002). The study also highlights that patients with advanced cancer and a CARD diagnosis have a higher symptom burden, particularly fatigue (p=0.003) and drowsiness (p=0.005), higher symptom-related distress (p<0.001), a poorer Global Health tatus (p=0.005) and poorer functioning subscales (p<0.014).

Conclusion: This is the first study to assess circadian rest-activity rhythms in accordance with new assessment and diagnostic guidelines. Further research is now required to validate the diagnostic criteria, standardise technical approaches to assessment and consider risk factors for the development of a CARD and additional clinical outcomes of interest.

Objectives: Mortality trends among people living in long-term care settings have been poorly understood. Linking data offers the potential to provide real-world, long-term national follow-up. Our aim was to describe patterns and associations with mortality among people moving-in to care homes in Scotland.

Methods: A retrospective cohort study was undertaken using routinely collected national social care data from the Scottish Care Home Census. These data were indexed and linked to national health data and mortality records for individuals moving- in to care homes in Scotland between 1 April 2013 and 31 March 2016. Location of death, underlying causes and time to death are reported. Survival analysis was undertaken using the Gompertz model for human mortality adjusted for key variables.

Results: Of 23 892 individuals moving-in to care homes, 20 250 (84.8%) died by 31 May 2020. Most deaths occurred in the care home setting (77.5%), with a fifth (20.5%) occurring in the hospital. 0.1% died the day they moved-in, 3.2% within a month, 24.2% within a year and 85% by 7 years. Dementia codes account for more than a third of all deaths (35.1%). Median survival time was shorter (701 vs 951 days; 23 vs 32 months) for those moving-in from the hospital, compared with the community. The adjusted HR for moving-in from the hospital was 1.19 (95% CI 1.15 to 1.22).

Conclusions: Mortality is common in Scotland's care homes but varies in timing. Dementia is the most common cause. Those moving-in from the hospital are more likely to die sooner, and this evidence provides opportunities to improve support for all involved.

Objective: Our study examines how non-small cell lung cancer (NSCLC) survivors undergoing immunotherapy can experience reduced anxiety and psychological distress, improved quality of life (QOL) and increased immunotherapy efficacy.

Methods: 133 men and 20 women with NSCLCs were enrolled. In a randomised controlled trial involving a care as usual group (CG) and a music therapy group (MTG), the researchers employed various tools such as the Self-Rating Anxiety Scale, Symptom Distress Thermometer, Functional Assessment of Cancer Therapy-General version 4 and Response Evaluation Criteria in Solid Tumours. These measures were used to evaluate anxiety, psychological distress, QOL and immunotherapy efficacy in patients undergoing immunotherapy before and after patients' completion.

Results: After the intervention, patients in the MTG demonstrated a noteworthy reduction in anxiety (t=6.272, p≤0.001) and distress (t=10.111, p≤0.001), as well as an increase in QOL (t=-7.649, p≤0.001). Moreover, compared with patients in the CG, those in the MTG demonstrated a remarkable drop in anxiety (t=-4.72, p≤0.001) and distress (t=-7.29, p≤0.001), a significant increase in QOL (t=5.363, p≤0.001) and a significant improvement in immunotherapy efficacy (z=-2.18, p≤0.05) after the intervention.

Conclusions: The use of individual music therapy sessions appears to be effective in reducing anxiety and distress, while also increasing QOL and immunotherapy efficacy in patients with NSCLCs undergoing immunotherapy.