The latest medical research on Palliative Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about palliative medicine gathered by our medical AI research bot.

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The COVID-19 pandemic: challenges providing supportive care to those with cardiovascular disease in a time of plague.

Opinion in supportive & palliative care

COVID-19 has permeated the very essence of human existence and society and disrupted healthcare systems. The attrition stemming from this highly contagious disease particularly affects those rendered vulnerable by age and infirmity, including those with underlying cardiovascular disease. This article critically reviews how best to integrate supportive care into the management of those affected.

Numerous studies have described the pathophysiology of COVID-19, including that specifically arising in those with cardiovascular disease. Potential treatment strategies have emerged but there is limited guidance on the provision of palliative care. A framework for implementation of this service needs to be developed, perhaps involving the training of non-specialists deliver primary palliative care in the community, bolstered by the use of telemedicine. The appropriate use of limited clinical resources has engendered many challenging discussions and complex ethical decisions. Prospective implementation of future policies requires the incorporation of measures to assuage moral distress, burnout and compassion fatigue in healthcare staff who are psychologically and physically exhausted.

Further research based on patient-centred decision making and advance care planning is required to ensure the supportive needs of COVID-19 patients with cardiovascular disease are adequately met. This research should focus on interventions applicable to daily healthcare practice and include strategies to safeguard staff well-being.

Neuromodulation techniques for cancer pain management.

Opinion in supportive & palliative care

Advanced pain management techniques may be indicated in 5-15% of cancer patients. Despite this, a recent review identified that, over the course of 1 year in England, only 458 patients received a procedure intended to provide analgesia and only 30 patients had intrathecal drug delivery (ITDD) devices implanted. This article describes the emerging evidence for ITDD in cancer pain and provides a narrative review of other neuromodulatory techniques (including spinal cord stimulation, peripheral nerve stimulation and acupuncture), approaches that might be employed to address this area of significant unmet clinical need.

Numerous studies have been published within the last year reporting positive outcomes associated with ITDD in cancer pain management. Neuromodulation represents an important strategy in the management of persistent pain. Whilst the nonmalignant pain evidence-base is rapidly growing, it remains sparse for cancer pain management. The growing cohort of cancer survivors may significantly benefit from neuromodulatory techniques.

ITDD and other neuromodulatory techniques for cancer pain management appear underutilised in the UK and offer the prospect of better treatment for cancer patients with refractory pain or intolerable side-effects from systemic analgesics.

Clinical practice guidelines for cancer pain: problems and solutions.

Opinion in supportive & palliative care

Clinical practice guidelines (CPGs) should allow practitioners to follow the best evidence-based management for patients. The increasing specialisation of medicine and pain medicine has increased the number of CPGs, but practitioners are still facing contradictory advice that can be difficult to implement and follow.

A recent comprehensive metareview of 25 reviews have highlighted that the same issues of quality, barriers to implementation and difficulties in applicability are as prevalent as they were years ago when assessment tools (e.g. AGREE II) and recommendations for CPG development were introduced. There remains a lack of consistency of recommendations and quality of evidence for CPGs in cancer pain that impedes the ability to provide the 'best' management for patients.

Even the most renowned and apparently high-quality CPGs in many specialities, including cancer pain, still are potentially deficient especially in terms of applicability, implementation, and transparency of conflicts of interest. Despite the increased scrutiny, in part related to the opioid crisis, the situation has not changed. The development of CPGs should engender collaboration with multiple stakeholder groups and focus on transparency and facilitating implementation.

Pain in Parkinson's disease: Mechanism-based treatment strategies.

Opinion in supportive & palliative care

Chronic pain, highly prevalent throughout the course of Parkinson's disease (PD), has been ranked as one of the top ten most bothersome symptoms people with Parkinson's (PwP) are experiencing. Yet, robust evidence-based treatment strategies are lacking. This unmet need is partly attributable to the multifaceted nature of PD-related pain, which results in part from a complex and poorly understood interplay involving a range of neurotransmitter pathways. Degeneration of nigrostriatal dopaminergic pathways and alterations of central nervous system extra-striatal dopaminergic, noradrenergic, serotoninergic, glutamatergic, opioidergic and endocannabinoid circuits may all promote a heightened experience of pain in PwP. Thus, the potential targets for mechanism-based pain-relieving strategies in PwP are several. These targets are discussed herein.

An increasing number of clinical trials and experimental studies in animal models of PD are being designed with the aim of addressing the pathophysiological mechanism(s) underlying PD-related pain. Overall, recent research findings highlight the analgesic effects of dopaminergic and opioidergic medication for certain subtypes of pain in PwP, whereas proposing novel strategies that involve targeting other neurotransmitter pathways.

The origin of pain in PwP remains under investigation. Although our understanding of the mechanisms underpinning persistent pain in PD has improved in recent years, this has not yet translated to clinical alleviation of this most troublesome nonmotor symptom. Patient stratification linked with evidence-based personalized pain-treatment plans for optimal analgesic relief will rely on advances in our understanding of the dopaminergic and nondopaminergic targets outlined in this review.

Cardio-oncology: rationale, aims and future directions.

Opinion in supportive & palliative care

Cardiovascular comorbidity among cancer patients is a growing clinical problem with the dramatic improvements in cancer survival. Cardio-oncology has developed as a new medical field dedicated to addressing the complex issues faced by patients who have both cancer and cardiovascular disease. This article explains to the reader what cardio-oncology services provide and the nature of cardiovascular problems caused by the growing array of modern cancer therapies.

The list of potentially cardiotoxic cancer therapeutic agents is ever growing and dedicated cardio-oncology experts are required to tackle cardiovascular complications with minimal delay to necessary cancer therapy. Cardio-oncology services originated in academic centres but are now being set up around the world in all hospitals and clinics that provide care to cancer patients. Cardio-oncology plays an increasingly active role at every stage of cancer therapy including baseline risk assessment pretreatment, surveillance and prevention during treatment, response to acute complications and assessment in survivors post cardiotoxic treatments. New treatment strategies exist to optimize cancer treatment so it can be completed safely.

In the present review, we explore the rationale, aims and roles of cardio-oncology, as well as future directions, which will certainly require multidisciplinary international collaboration.

A Narrative Literature Review on Human Resource Planning for Palliative Care Personnel.

Indian Journal of Palliative Care

A literature search was started with the objective of finding works pertaining to the use of operations research techniques in planning for human r...

Shared Decision-Making and Medicolegal Aspects: Delivering High-Quality Cancer Care in India.

Indian Journal of Palliative Care

It is often difficult for people with cancer to make decisions for their care. The aim of this review is to understand the importance of shared dec...

What is the Public Opinion of Advance Care Planning within the Punjabi Sikh Community?

Indian Journal of Palliative Care

The aim was to gain an understanding of what the United Kingdom (UK) Punjabi Sikh community understands and thinks about advance care planning (ACP). This is in response to evidence showing a lack of service usage by Black, Asian, and Minority Ethnic groups.

Surveys containing questions about the impressions of terms, advance decisions for care, do-not-attempt-resuscitation, and lasting power of attorney were taken to targeted community groups; these included community day centers, sporting groups, temples, and social media circles. Surveys were available in both Punjabi and English languages.

A total of 311 surveys were received in total. There was a 50/50 gender split and a mixed group of ages; 75% were born in the UK and 15% were born in Punjab, India. Only a third had some understanding of what ACP meant. Nearly 50% of the participants did express wishes toward the end of their life, however only a third of the respondents knew how to access services. Cardiopulmonary resuscitation was felt to be mandatory by 36%. Sixty percent thought that their decision would be legally binding in relatives who do not have capacity.

This study showed that wishes for religious rites were common, however many do not know how to make them known. If they do know about services, then people are highly likely to engage with the ACP process.

Perception and Quality of Life in Family Caregivers of Cancer Patients.

Indian Journal of Palliative Care

Cancer has been most feared among all the significantly increasing chronic diseases, and is widely assumed to be fatal. The quality of life (QOL) of the patient pertaining to physical, psychological, social, and spiritual well-being is altered, which ultimately affects the QOL of the family caregivers. The study was conducted to assess the QOL among family caregivers of cancer patients and how cancer changes and alters the vision about life for the patient as well as the family caregivers.

The objective was to assess the QOL among family caregivers of the cancer patients.

A cross-sectional, questionnaire-based study was conducted after the protocol was approved by the institutional ethics committee and obtaining written informed consent from the participants. Two sets of validated questionnaire were used to assess the awareness and QOL of the family caregivers of the cancer patients. The filled questionnaires were received from the participants, and data were analyzed using descriptive statistics.

Nearly 74% (148/200) of the participants responded, with majority of the caregivers being females (71.62%). Majority (72.9%) expressed that cancer cannot spread from one person to another and were positive (70.9%) toward cancer cure. The caregivers (76.3%) opined that the diagnosis of cancer should be informed to the family members. Approximately 50% of the participants were aware that environmental toxins and tobacco would predispose to cancer. Although most of them (87.8%) believed that the cancer treatment cause ill effects, they (93.2%) were satisfied with the hospital facilities. Among the QOL parameters, most of the participants had complaint of decreased general physical health, difficulty to cope, reduced concentration, anguish over the first treatment, disease, and interference in household activities. Among the spiritual parameters, the participants expressed sufficient support from religious activities, prayer, and general spiritual well-being.

Majority of the caregivers had awareness regarding the cancer and carcinogens from the environmental toxins. The QOL among caregivers of cancer patients is affected in all dimensions of life, with more emphasis on the social and psychological dimensions.

Experiences of Living with Intestinal Ostomy: A Qualitative Meta-Synthesis.

Indian Journal of Palliative Care

The aim and objective of the study was to identify, compare, and synthesize published qualitative evidence to have in-depth understanding of experiences of patients living with intestinal ostomy.

Over the past two decades, there have been numerous qualitative studies published depicting intense experiences of stoma patients brought about by the need to adapt with changing conditions following stoma creation. Synthesizing the findings of these studies can improve the understanding among health-care providers of needed support and care for ostomates.

This was a qualitative meta-synthesis.

Published articles were identified from the Medline, CINAHL, SciELO, PsycINFO, PubMed, WOS, Google Scholar and a hand search through selected journals published since 2000, and from references lists. Thirteen articles were selected using the predefined criteria.

A total of 222 patients, aged between 14 and 83 years from 13 studies, were identified for data collection. Ninety-seven were male and the rest of them were female. The themes identified were physical problems, psychological issues, social relations, environmental impact, and coping and adaptation to stoma.

The findings of the study identified numerous challenges and limitations in the life of patients with stoma. However, improving their skills of using problem-solving coping strategies and their interactions with other ostomates can help them to live a better and well-adjusted life.

Effect of Progressive Muscle Relaxation Therapy on Fatigue and Psychological Distress of Cancer Patients during Radiotherapy: A Randomized Controlled Trial.

Indian Journal of Palliative Care

Patients with cancer receiving radiotherapy experiences fatigue and psychological distress. Now a days there has been growing interest towards managing these symptoms with non-pharmacological treatments, But researches related to effect of progressive muscle relaxation therapy on fatigue and psychological distresses related to admitted patients are limited hence the aim of the study to evaluate the effect of progressive muscle relaxation therapy on fatigue and psychological distress in Cancer patients during Radiotherapy.

Aim of the study to evaluate the effect of progressive muscle relaxation therapy on fatigue and psychological distress in Cancer patients during Radiotherapy.

The study design was single blinded randomized control trial. Total of 50 patients, for both intervention and control group 25 patients were included. The intervention group patients received P.M.R. therapy of 20 min. given for 3 times/week of total period of 3 weeks, whereas the control group received conventional treatment with no added intervention. Fatigue symptom inventory and hospital anxiety and depression scale used as an outcome measures.

Paired t-test used for FSI to compare among intervention and control group and results were showing statistical significant difference (P < 0.05), similarly pre and post improvement was observed in both the groups for HADS. Between group comparison showed no superior improvement one over the other.

Based on the above findings, P.M.R. and conventional treatment were similarly efficacious in decreasing fatigue and psychological distress related to cancer patients who were hospitalized undergoing radiotherapy.

Impact of Prognostic Nutritional Index on Terminal Cancer Patients.

Indian Journal of Palliative Care

In terminal cancer patients (TCPs), one of the most important things is to define the survival to help the main responsible physicians, patients, and main caregivers make decisions, set goals, and work across the end-of-life strategies.

We retrospectively reviewed the medical files of TCPs, who died during September 2011 and December 2017, to recognize the correlation between prognostic nutritional indices (PNIs) and survival in those subtypes of patients. The receiver operating characteristic (ROC) curve was used to identify the cutoff value of PNI.

A total of 858 TCPs were eligible and included, the median age was 62 years (range: 18-107). The most common primary cancer sites were colorectal cancer in 151 patients (17.6%), hepatobiliary in 129 (15%), lung cancer in 115 (13.4%), breast cancer in 114 (13.3%), and genitourinary in 80 (9.3%). The mean value of PNI for all cancer types was 32.9 ± 6.7. The values showed different levels across cancer types. For patients who lived >2 weeks, PNI was 36.7 compared with that who died within 2 weeks was 29.3, which was a statistically significant (P < 0.001). By the ROC curve, the cutoff value of PNI was 32.3 and area under the curve was 0.888. The sensitivity, specificity, positive predictive value, and negative predictive value were 91.28% (95% confidence interval [CI]: 88.2-93.8), 71.09% (95% CI: 66.5-75.4), 76.5% (95% CI: 73.7-79.2), and 88.8% (95% CI: 85.3-91.5), respectively.

The PNI is an easy and an applicable biomarker to estimate life expectancy in TCPs.