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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Computed tomography-derived body composition analysis in patients with advanced cancer: clinical utility and future research.Opinion in supportive & palliative care
With weight loss increasingly occurring against a background of obesity across a variety of advanced cancers, there has been increasing interest in computed tomography (CT)-derived body composition analysis. Various imaging software packages and thresholds are commonly in use in CT-derived body composition analysis. This review discusses the current research in field of body composition with emphasis on the information required for such measurements to be taken into routine clinical practice.
CT is widely used for tumour staging in patients with cancer. Over the last decade, this imaging modality has been exploited to make measurements of body composition. Using a common landmark (L3) several different thresholds have been developed to stratify adipose and muscle tissue areas according to age, sex and BMI and their relationship with survival. A significant relationship between CT-derived body composition and clinical outcomes has been shown in different tumour types and geographical locations. However, there is considerable variation with methods, thresholds and muscle groups used for analysis. Therefore, there would appear to be a need to develop reliable methodology and population-specific reference ranges to guide clinical interpretation and enable routine clinical use.
There has been an explosion of clinical research interest in CT-derived body composition analysis. Such body composition analysis provides important host phenotype information which has prognostic value. For CT-derived body composition to be fit for use in routine clinical practice, there is need for universally accepted terminology, software, muscle group selection, prognostic thresholds to standardize such body composition analysis.
CARE: A Holistic Approach Toward Patients During Pandemic: Through the Eyes of a Palliative Physician.Indian Journal of Palliative Care
Words pandemic and panic, if cannot be used synonymously, can definitely be exchanged metaphorically. Pandemics are outcome of an unanticipated cri...
Anger and Distress of a Curable Gastric Carcinoma Patient Becoming Incurable: A Dilemma of a Pandemic.Indian Journal of Palliative Care
A pandemic is a time of great distress for cancer patients with a heightened risk of infection along with fear of disease progression occurring fro...
New insights on how and where to measure muscle mass.Opinion in supportive & palliative care
This article will discuss different muscle mass assessment methods and emphasize their highlights.
Several measurement techniques can be used to evaluate muscle mass, recognized as important prognostic markers for adverse functional and clinical outcomes. Choosing the best method depends on the knowledge regarding their theoretical and practical limitations and the purpose of the assessment. Image techniques are considered the gold standards, with good accuracy and precision, but not always available in clinical settings. A new biological technique, the D3-creatinine dilution, can provide not only direct information about muscle mass but also shows a strong association with physical function. With the advancement of the use of the computed tomography (CT) images to assess skeletal muscle mass, mainly in patients with cancer, the assessment of skeletal muscle radiodensity (SMD), as a marker of muscle quality, may provide additional information regarding the association between muscle composition, muscle function and prognosis. Additional muscle function assessment can improve the risk prediction in several clinical situations.
The use of the best tool for the muscle mass assessment should be performed carefully among the various methodologies, according to their characteristics and clinical situation.
The why and how of maintaining hydration during cancer therapy.Opinion in supportive & palliative care
To provide an overview of the role hydration plays in the oncology population while providing a synopsis of recent scientifically relevant published practice advancements.
Dehydration causes substantial symptom burden in cancer patients, secondary to both disease process and treatment complications. Maintaining fluid and electrolytes balance is the key to hydration therapy. When oral intake is diminished, artificial hydration can be delivered via enteral, intravenous and subcutaneous routes. Use of artificial hydration in end-of-life care for cancer patients remains a highly debated topic with unclear benefits and lack of established standards. A holistic approach is required in the decision-making process.
Maintaining adequate hydration is important in patients receiving cancer therapy. Challenges exist, secondary to limited clinical guidelines of hydration in patients with advanced cancer. Artificial hydration may be indicated for selected patients at the end of life if used on an individualized basis as medical treatment.
Not seeing the forest for the trees: a systematic review of comprehensive distress management programs and implementation strategies.Opinion in supportive & palliative care
Clinically significant distress is common in patients with cancer and if untreated can be associated with adverse outcomes. This article offers a review of current approaches to implementing and reporting the minimum components of distress screening and management interventions in cancer services.
Twenty-two relevant published articles were identified from January 2018 to February 2020. The reporting of recommended minimum components of distress screening and management interventions in these articles was not consistent. The majority of studies used validated tools to conduct initial screening. However, recommendations were either not reported or not followed regarding subsequent pathway components, secondary assessment, referral pathways linked to screening results and rescreening. The majority of studies did not include a description of the implementation of the distress screening program. A small number of studies described a comprehensive set of implementation strategies.
Distress screening and management interventions in cancer are an important component of comprehensive cancer care. To improve patient outcomes and guide researchers and services to identify effective models, studies must include and evaluate minimum recommended components and implementation strategies. Addressing these limitations with high-quality, robust interventions is vital for advancing the implementation of effective distress management.
Affective traits, states, and breathlessness.Opinion in supportive & palliative care
Breathlessness is a prevalent and aversive symptom in various conditions and closely related to affect. Here, we review recent literature from the previous 18 months examining the interactions between affective traits and states with breathlessness.
Available studies used various qualitative, quantitative, and experimental research designs in diverse samples of patients with breathlessness and in healthy individuals. Most studies clearly demonstrated that nonspecific forms of negative affective personality traits such as anxiety and depression, disease or symptom-specific forms such as fear-of-dyspnea and fear-of-physical activity as well as short-lasting negative affective states such as experimentally induced fear were associated with greater breathlessness. Moreover, breathlessness was shown to evoke negative affect, whereas positive affect reduced breathlessness. Different treatment approaches demonstrated concurrent beneficial effects on both negative affect and breathlessness and several potential mechanisms underlying these interactions were suggested.
Negative affect is common in diverse patient groups suffering from breathlessness and is related to increased burden because of breathlessness. Future research is required to improve our understanding of the mechanisms underlying these associations together with increased clinical efforts for improved detection and treatment of negative affect in breathless patients.
The evolving options in metastatic castration-sensitive prostate cancer.Opinion in supportive & palliative care
Leading trials CHAARTED, STAMPEDE, GETUG-AFU15 and LATITUDE established docetaxel and abiraterone acetate addition to androgen deprivation therapy (ADT) as a treatment guideline for patients with metastatic castration-sensitive prostate cancer.
Two recent combinations, enzalutamide with ADT and apalutamide with ADT were tested in metastatic castration-sensitive prostate cancer in three randomized controlled trials. Both combinations provided survival gain, expanding our options of treatment. Moreover, additional evidence behind radiotherapy for the primary tumor in metastatic prostate cancer is emerging.
In this updated article, we review the data of these trials and highlight the distinctions between these therapies, in order to better personalize the care for patients with metastatic prostate cancer.
Use of short-acting opioids in the management of breathlessness: an evidence-based review.Opinion in supportive & palliative care
To provide an evidence-based review on the use of short-acting opioids for management of breathlessness in patients with advanced diseases.
We identified 28 randomized controlled trials that examined the effect of short-acting opioids on breathlessness under three study settings: as a prophylactic dose given prior to exertion; as a rescue dose for treatment of breathlessness at rest or episodic breathlessness; or as a scheduled medication for overall reduction of breathlessness. These trials varied widely in regard to patient population (opioid naive or tolerant), opioid (formulation, dose, timing of administration, and scheduling) and control intervention. Taken together, there is good evidence to support that short-acting opioids can reduce breathlessness and improve activity level when given before exertion. There is some evidence that parenteral opioids are efficacious for the as needed treatment of episodic breathlessness or breathlessness at rest. However, there is only limited evidence to support scheduled short-acting opioids for overall relief of breathlessness.
There is evidence to support that short-acting opioids have a pharmacologic effect on breathlessness. More research is needed to clarify how opioids can be prescribed to optimize breathlessness relief, function, and quality of life.
Supportive and palliative care for people with respiratory problems and preexisting serious mental illness.Opinion in supportive & palliative care
People living with serious mental illness are at a higher risk of developing respiratory problems that can lead to increased morbidity and early mortality. This review aimed to identify recent advances in care provision for people with respiratory problems and preexisting serious mental illness to ease symptom burden and reduce the risk of premature mortality.
Intervention-based studies in this area are scarce. The evidence reviewed originated from observational studies. Concluding comments from the synthesis suggest there are specific needs for proactive screening of respiratory function as part of routine physical health checks across care settings for people living with serious mental illness, more stringent monitoring of comorbid chronic lung conditions and increased attention in reducing the frequency respiratory infections. Integrated services across care settings are needed to support people with serious mental illness to limit the impact of modifiable lifestyle factors known to be detrimental to respiratory health, such as smoking.
Key priorities are identified to improve accessibility and inclusivity of respiratory care pathways for people living with serious mental illness to support early detection and proactive monitoring of respiratory problems to help reduce the risk of early mortality.
Supportive and palliative care of adults with respiratory problems experiencing structural vulnerability from homelessness, prison or other criminal justice system involvement.Opinion in supportive & palliative care
This review seeks to identify the current prevalence of potentially life-limiting respiratory conditions among those who have experienced homelessness, incarceration or had criminal justice involvement, and current developments in, and barriers to, delivery of supportive and palliative respiratory care to these populations. These structurally vulnerable populations are known to be growing, their health behaviours more risky, and their morbidity and mortality higher, with evidence of accelerated ageing.
Most studies identified investigated prevalence of respiratory conditions, which were found to be high. In contrast, only one study directly explored supportive and palliative care (in a prison population) and none considered or addressed palliative and end-of-life needs of these populations, or mechanisms to address them. There was an absence of qualitative work and studies of the impact on, or role of, family, friends or informal networks.
There is a need for evidence-based interventions to reduce the risk of communicable respiratory conditions and a greater understanding of disease trajectories and management for these vulnerable populations, including provision of accessible appropriate supportive, palliative and end-of-life care.
Schizophrenia and cancer.Opinion in supportive & palliative care
The cancer mortality rate in persons with schizophrenia is higher than it is in the general population. The purpose of this review is to determine why, and to identify solutions.
The recent literature points to three groups of reasons why mortality is high: patient reasons such as nonadherence to treatment, provider reasons such as diagnostic overshadowing, and health system reasons such as a relative lack of collaboration between medicine and psychiatry. Strategies for cancer prevention, early detection, and effective treatment are available but difficult to put into practice because of significant barriers to change, namely poverty, cognitive and volitional deficits, heightened stress, stigma, and side effects of antipsychotic medication. The literature makes recommendations about surmounting these barriers and also offers suggestions with respect to support and palliative care in advanced stages of cancer. Importantly, it offers examples of effective collaboration between mental health and cancer care specialists.
The high mortality rate from cancer in the schizophrenia population is a matter of urgent concern. Although reasons are identifiable, solutions remain difficult to implement. As we work toward solutions, quality palliative care at the end of life is required for patients with severe mental illness. VIDEO ABSTRACT.