Showing papers in "Current Opinion in Supportive and Palliative Care in 2011"
TL;DR: The importance, clinical features, possible pathology and treatments of chemotherapy-induced neuropathic pain, and newer biological agents such as bortezomib will be considered in greater detail.
Abstract: Purpose of reviewTo discuss the importance, clinical features, possible pathology and treatments of chemotherapy-induced neuropathic pain. Newer biological agents such as bortezomib will be considered in greater detail.Recent findingsChemotherapy-induced peripheral neuropathy (CIPN) is a frequent co
116 citations
TL;DR: Recently, pharmacologic suppression of myostatin was found to counteract inflammation, increased glucocorticoids and impaired insulin/IGF-1 signaling and most importantly, prevents muscle wasting in rodent models of cancer and kidney failure.
Abstract: Purpose of reviewTo understand the mechanisms of muscle wasting and how inhibiting myostatin signaling affects them.Recent findingsMyostatin signaling is critical for the understanding of the pathogenesis of muscle wasting as blocking signaling mitigates muscle losses in rodent models of catabolic d
83 citations
TL;DR: Cross-sectional C-S imaging can reliably measure muscle and fat distribution and uniquely discriminate between intra-abdominal organ and muscle component of fat-free mass, but is less able to distinguish true differences in whole body estimates between individuals.
Abstract: Purpose of review Cross-sectional (C-S) imaging is now commonly used to measure body composition in clinical studies. This review highlights the advantages, limitations and suggested future directions for this technique. Recent findings Current understanding of C-S imaging reproducibility, tissue identification and segmentation methods, comparison between imaging techniques and estimates of whole body composition using a single image are described. Summary C-S imaging can reliably measure muscle and fat distribution and uniquely discriminate between intra-abdominal organ and muscle component of fat-free mass. It precisely tracks changes within an individual, but is less able to distinguish true differences in whole body estimates between individuals.
80 citations
TL;DR: All patients with breathlessness should learn appropriate nonpharmacological interventions, but others require specialist skills and high levels of engagement by cognitively intact and highly motivated people.
Abstract: Purpose of reviewBreathlessness is difficult to palliate and nonpharmacological interventions are effective management strategies currently available for mobile patients These are a diverse group of interventions, currently poorly defined and inconsistently used This review concentrates on identif
55 citations
TL;DR: Neuroimaging of pain and plasticity can provide a framework to understand the basic mechanisms of pain regarding function, gray and white matter structure and connectivity and this information may also guide future clinical practice.
Abstract: Purpose of review To present an overview of insights into brain mechanisms of pain perception and analgesia based on human brain imaging. Recent findings The technical advancement made in both functional and structural MRI can be used to delineate the cerebral signature of pain and analgesia, specifically, the brain responses to noxious stimuli and specific pain-related forebrain responses, as well as pain modulatory effects. Neuroimaging has revealed that the brain response to noxious stimuli shares neural resources with other systems that subserve salience detection and reward functions. Recent findings indicate that there is a wide range of individual differences in pain-related brain function and structure due to both pre-existing vulnerabilities and disease-driven factors. Furthermore, several studies now illustrate that the brain is capable of tremendous plasticity both in function and structure due to repeated and ongoing pain. However, emerging data suggest that this plasticity can be reversible after successful pain treatment. Summary Neuroimaging of pain and plasticity can provide a framework to understand the basic mechanisms of pain regarding function, gray and white matter structure and connectivity. This information may also guide future clinical practice. For instance, the time-course of disease-driven brain plasticity and capacity for reversibility may help decide the optimal time frame for chronic pain treatment. Furthermore, findings from functional and structural connectivity studies may indicate potential side effects of targeting specific brain areas in treating chronic pain. Lastly, the correlation between individual factors and functional/structural MRI data may direct individualized treatment plans.
49 citations
TL;DR: The burden of suffering that pain imposes on individuals and the enormous costs that society has to bear as a result clearly demonstrate that policy makers at governmental level and commissioners, and healthcare decision-makers alike should adopt a broad, strategic and coherent perspective in determining issues relating to service provision and resource allocation.
Abstract: Purpose of reviewThis review aims to assess the economic impact of inadequate, inappropriate and ineffective treatments of persistent pain from the perspective of the individual, their families and communities, healthcare systems, economies and societies in general.Recent findingsThe economic impact
49 citations
TL;DR: Despite growing evidence for the management of chronic pain generally, management in primary care must be largely guided by consensus, experience, and judicious extrapolation from research in other contexts or conditions.
Abstract: Purpose of reviewTo examine recent and current evidence available to guide the management of chronic pain in primary care.Recent findingsThe growing profile of chronic pain has facilitated some important consensus and guideline statements. Pharmacological management, based on available evidence and
49 citations
TL;DR: Recent progress in clinical and mechanistic studies provides some new insights into the pathogenesis of adipose atrophy in cachexia, which may lead to novel pharmacological targets to ameliorate cachexia syndrome.
Abstract: Purpose of reviewExtensive loss of body fat is considered as a hallmark of cancer cachexia which affects the quality of life and shortens survival. Evidence suggests that increased lipid mobilization has a central role in adipose tissue wasting. This review summarizes recent progress, with a particu
48 citations
TL;DR: The wide range of barriers identified all hinder conversations about the end of life with heart failure patients, and individual patient preferences for the timing and content of such conversations must be respected.
Abstract: Purpose of reviewHeart failure is a life-limiting illness, but with great uncertainty over its prognosis. Policy increasingly states the importance of discussions about end of life care between patients and their clinicians. This study reviews the extent to which there is evidence that these convers
45 citations
TL;DR: Overall, educational interventions directed at patients or professionals can result in significant but modest clinical benefit which is similar in magnitude to that achieved by some analgesics.
Abstract: Purpose of reviewTo describe the current position of educational interventions within the context of cancer pain management.Recent findingsBarriers to good cancer pain control exist within patients and professionals and centre on lack of knowledge or poor attitudes towards pain and opioid analgesia.
43 citations
TL;DR: The advantages and disadvantages of the current malnutrition assessment tools are discussed, the requirements for a comprehensive cachexia assessment instrument are described and the basis for better clinical treatment and research is described.
Abstract: Purpose of reviewCachexia is a common negative consequence of cancer and is often unrecognized To assess cachexia, malnutrition assessment tools are used This review discusses the advantages and disadvantages of the current malnutrition assessment tools and describes the requirements for a compreh
TL;DR: Therapeutic exercise may help maintain or slow down the rate of decline in muscle mass and physical function that occurs with cachexia and could include offering exercise earlier on in the course of the disease, at lower intensities and in various forms, including more novel approaches.
Abstract: Purpose of reviewTherapeutic exercise may help maintain or slow down the rate of decline in muscle mass and physical function that occurs with cachexia. This review considers recent evidence in relation to patients with cachexia as regards the rationale for the use of exercise, the challenges in its
TL;DR: In this paper, the authors reviewed updated research on end-of-life care sedation (EOLC-S) for children and aspects surrounding this issue and found that the prevalence of EOLCS for children may vary across countries on account of cultural differences, in terms of settings, legal issues an
Abstract: Purpose of reviewThis article is aimed to review updated research on end-of-life care sedation (EOLC-S) for children and aspects surrounding this issue.Recent findingsPrevalence of EOLC-S for children may vary across countries on account of cultural differences, in terms of settings, legal issues an
TL;DR: Research in spiritual care should be ongoing for all palliative care patients as well as for those with specific needs such as mental, neurological, or cognitive impairment and more work must be done on the spiritual concerns of family caregivers.
Abstract: Purpose of review This review discusses the developments in spiritual needs assessments and measurements in end-of-life care. The review considers spiritual needs assessments from the perspective of palliative care patients, their families and caregivers, and healthcare professionals. Recent findings Spiritual needs assessments vary significantly along the dimensions of content and domains. These needs assessments have the potential to deepen our insight and to identify those who are most at risk for spiritual distress, but few are practical and simple enough to use in everyday clinical practice, and for the research, few are cross-culturally validated. Spirituality is a complex construct, although 'relatedness' was recognized as a core dimension of spirituality in addition to existential beliefs and values related to meaning and purpose. Little is known about the spiritual needs in elderly patients, in the cognitively impaired, and during the dying process. The spiritual needs of family caregivers need more support and attention. Summary Spirituality is considered to be one of the patient's vital signs and should be routinely screened and assessed. Research in spiritual care should be ongoing for all palliative care patients as well as for those with specific needs such as mental, neurological, or cognitive impairment. There is also a knowledge gap concerning how spiritual needs change during the progression of the disease trajectory. More work must be done on the spiritual concerns of family caregivers.
TL;DR: Opinions and attitudes towards the use of artificial hydration at the end of life vary and communication of this imperative topic in end-of-life care is important for better care and should be research-based.
Abstract: Purpose of reviewArtificial hydration in end-of-life care is an important and emotive topic that frequently raises concerns from patients, relatives and healthcare professionals (HCPs). The aim of this review was to give an overview of currently available evidence around opinions and attitudes towar
TL;DR: Optimizing the management of BTcP requires an integrated approach, including independent assessment and better use of available treatments while taking into consideration risk management strategies, which will ultimately lead to improved outcomes and quality of life for patients.
Abstract: Purpose of reviewTo highlight the significant impact breakthrough cancer pain (BTcP) can have on patients' quality of life and to discuss potential management strategies that could improve pain control in clinical practice as well as effective strategies to manage riskRecent findingsBTcP can place
TL;DR: Pivotal clinical trial data with denosumab in advanced cancer patients across tumor types showed it was superior (breast and prostate) or noninferior trending toward superior (solid tumors/multiple myeloma) to zoledronic acid, in reducing the risk of developing an SRE and demonstrated a favorable safety profile.
Abstract: Purpose of reviewRANK ligand (RANKL) plays a central role in the cancer-induced bone destruction that results from bone metastasis. The RANKL inhibitor denosumab was recently approved for the prevention of skeletal-related events (SREs) in patients with bone metastases from solid tumors. This review
TL;DR: Intestinal permeability testing using nonmetabolized sugars may represent a tool for noninvasive objective assessment of intestinal toxicity of anticancer therapy.
Abstract: PURPOSE OF REVIEW The diagnosis and assessment of severity of intestinal mucosal damage in cancer patients treated by anticancer therapy still rely mostly on anamnestic data. We review here studies reporting on the use of intestinal permeability measurements in cancer patients before and during treatment. RECENT FINDINGS The concept of intestinal permeability is based on differential permeability of intestinal mucosa to molecular markers, including monosaccharides and disaccharides, along the crypt-villus axis. Cytotoxic drugs and/or radiation impair replacement of intestinal epithelia and induce flattening of the villi, leading to increased exposure of luminal contents to crypts and increased disaccharide absorption. Increased disaccharide/monosaccharide ratio and decreased xylose absorption have been described in patients treated by radiotherapy as well as different cytotoxic or targeted agents across a spectrum of malignant disorders. Intestinal permeability changes correlated with clinical manifestations, including diarrhea, mucositis, neutropenic enterocolitis and systemic infections. The measurement of intestinal permeability has also been used as a surrogate end-point in interventional studies. SUMMARY Intestinal permeability testing using nonmetabolized sugars may represent a tool for noninvasive objective assessment of intestinal toxicity of anticancer therapy.
TL;DR: Preclinical and clinical data illustrate the effect of several classes of chemotherapeutic agents on skeletal development and bone remodeling, including histone deacetylase inhibitors and proteasome inhibitors, which alter bone metabolism and negatively impact bone homeostasis.
Abstract: Purpose of reviewAgents used for systemic chemotherapy can alter normal bone homeostasis through mechanisms that affect both osteoblast and osteoclast function. The identification of those agents that influence maintenance of the bone-remodeling compartment is an important component of the drug deve
TL;DR: Emerging laboratory and clinical data now support the important antitumor effects of N-BPs in both solid and hematological cancers.
Abstract: Purpose of reviewThe use of bisphosphonates has focused on their antibone resorptive effects but recent studies have shown that these drugs also possess a variety of antitumor effects in the laboratory that are now being observed in clinical trials.Recent findingsIt is becoming increasingly clear th
TL;DR: VAPs are well tolerated and effective methods to provide palliative care for cancer patients with VCFs and should be offered to symptomatic patients.
Abstract: Purpose of reviewTo review the current status of vertebral augmentation procedures (VAPs) in the management of symptomatic vertebral compression fractures (VCFs) in cancer patientsRecent findingsThe natural history of VCFs in the cancer setting is presumably different from the one seen with osteopo
TL;DR: Studies characterizing the potential for nutritional support in combination with anti-inflammatory agents in defined patient groups are defined to advance the evidence base in this area.
Abstract: Purpose of review Cancer and its treatments frequently have a negative impact on the weight and nutritional status of patients. Weight loss is associated with reduced survival and poorer outcomes of treatment but is not well characterized and frequently confused with cachexia, which may complicate the interpretation of studies of nutritional support. The aims of this review were to examine the impact of cancer on nutritional status and to review the role of simple oral nutritional interventions and novel agents. Recent findings The terms weight loss, malnutrition and cachexia refer to different entities and new definitions have recently been proposed that take account of the role of the underlying inflammatory processes. Oral nutritional interventions are widely recommended for malnourished cancer patients, but the evidence for their benefits to clinical, nutritional and patient-centred outcomes is limited. Meta-analysis has highlighted the variability in response to simple nutritional interventions of different cohorts of cancer patients and suggested that improvements in nutritional endpoints and aspects of quality of life may be achieved in some patients. Recent research has largely focused on treatments aiming to modulate the inflammatory processes associated with cachexia, but to date has not identified a single treatment with clear efficacy. Summary Studies characterizing the potential for nutritional support in combination with anti-inflammatory agents in defined patient groups are defined to advance the evidence base in this area.
TL;DR: This review identified few well-designed studies that also included a robust assessment of HRQL, and high-quality trials with reliable HRQL methods are required for outcomes to inform health policy and clinical decision-making.
Abstract: Purpose of reviewThe aim of this systematic review is to scrutinize and summarize the design, conduct and reporting standards of articles recently published describing health-related quality of life (HRQL) outcomes of treatment of upper gastrointestinal cancer.Recent findingsSome 2312 abstracts were
TL;DR: Concerns about and unanswered questions in relation to opioid treatment are highlighted to provide focus for further scrutiny and evaluation of opioid treatment for pain.
Abstract: Purpose of review The prescribing of opioid medicines is increasing progressively despite a substantial body of literature identifying potential limitations and harms of therapy. Production and dissemination of best practice guidance in relation to prescribing do not yet seem to have an impact on this trend. This article highlights updated concerns about and unanswered questions in relation to opioid treatment to provide focus for further scrutiny and evaluation of opioid treatment for pain. Recent findings The literature cited in this paper confirms that opioid prescribing is prevalent despite an established evidence base spanning a decade that indicates that efficacy of opioids in long-term pain management remains uncertain and that harms of therapy are well defined. In particular, problems with treatment are more likely to occur when high doses are used and in certain patient populations and many recent high-quality studies highlight these problems. Although much is to be learned regarding clinical decision making, it is clear that current prescribing activity does not reflect the existing knowledge base. Summary Authors are unanimously agreed that the literature answers some important questions about opioid therapy but there are substantial knowledge gaps, particularly in relation to benefits and harms of long-term therapy in day-to-day clinical practice. Evidence-derived guidance clearly identifies common and important pitfalls in relation to opioid use but promotion of adherence to guidance remains a substantial challenge.
TL;DR: The routine use of palliative oxygen therapy without detailed assessment of pathogenesis and reversibility of symptoms cannot be justified and promoting self-management strategies, such as cool airflow across the face, exercise and psychological support for patients and carers, should be considered before defaulting to oxygen therapy.
Abstract: Purpose of reviewBreathlessness remains a frequent and burdensome symptom for individuals with life-limiting symptoms in both malignant and nonmalignant settings. As oxygen therapy is frequently given as part of the management of breathlessness and is associated with costs, treatment burden and pote
TL;DR: Advanced heart failure management has improved over time; however, the incorporation of a multidisciplinary care model appears to offer significant promise in dealing with complex care needs of heart failure patients towards the end of life.
Abstract: Purpose of review There has been much improvement in the treatment of heart failure over the past decade through the implementation of a multidisciplinary team approach to disease management focused on optimizing medication, the application of device-based therapy, surgical intervention and in promoting the education of patients and carers in self-management. This multidisciplinary strategy has now been extended to try and improve the care of those with advanced heart failure in the latter phases of the disease trajectory nearing the end of their lives. Recent findings A growing consensus has emerged in the literature that confirms the need to extend multidisciplinary management beyond the early targets of reducing heart failure-related mortality and morbidity to address the significant care needs of those who decline due to the often inexorable progression of this syndrome. Multidisciplinary management facilitates the development of a comprehensive care plan that is specifically tailored to accommodate the requirements of individual patients and their families and fosters a collaborative approach to care to optimize symptom management, avoid potential treatments conflicts, and to fulfil their supportive care needs. Partnership working between the three principal clinical disciplines of cardiology, specialist palliative care and general practice is central to this process and promotes coordinated care across hospital, hospice and community-based services. Summary Advanced heart failure management has improved over time; however, the incorporation of a multidisciplinary care model appears to offer significant promise in dealing with complex care needs of heart failure patients towards the end of life. Delivery of this practice requires the development of bespoke care structures that are relevant to the spectrum of healthcare service environments.
TL;DR: For the relief of chemotherapy symptoms in cancer patients, methylphenidate and modafinil were no more effective than placebo, although findings suggest that these psychostimulants may provide some benefit in patients who are suffering more severe asthenia or who are at advanced stages of the cancer.
Abstract: Purpose of reviewThis article reviews the most recent studies that examine the efficacy of psychostimulants for the relief of symptoms such as asthenia and depression in cancer patients.Recent findingsAlthough most research to date has focused on the use of methylphenidate for the relief of symptoms
TL;DR: Transdermal buprenorphine and fentanyl are now established for moderate-to-severe cancer pain, with data to suggest improved pain relief and reduced opioid side effects compared with sustained release oral morphine.
Abstract: Purpose of reviewCancer patients with moderate-to-severe pain require opioids for analgesia. Whereas early guidelines recommend oral morphine as the ‘drug of choice’, newer synthetic opioids can be given by a reliable and effective nonoral transdermal route. We examine the mode of action of transder
TL;DR: Clinical and preclinical research has progressed rapidly and this work has identified multiple plausible drug targets, which are currently being evaluated and the rationale of some of the most promising mechanisms are reviewed.
Abstract: Purpose of reviewTo inform on preclinical and early clinical advances in the effort to identify novel classes of analgesic drugs.Recent findingsHuman genetic and animal preclinical studies have identified several mechanisms that appear to make important contributions to abnormal pain states. From hu
TL;DR: A variety of successful treatments exist and outcomes can be optimized by individualizing treatment strategies in the context of a multidisciplinary package.
Abstract: Purpose of review Pelvic pain is a common complaint of women that is frequently poorly managed. This review considers the current understanding of the mechanisms of pain perception and the development of chronic pain in the context of three gynaecological pain conditions. Recent advances in the management of these conditions are then discussed. Recent findings Persistent pelvic pain is associated with central changes, reflected by alterations in psychology, brain structure and function, and dysfunction of the hypothalamic-pituitary-adrenal axis. The many similarities among the conditions support the notion that chronic pain should be treated as a symptom in its own right, however, obtaining a diagnosis remains important to patients. Few new treatments have been developed recently, however, older treatments are being subjected to more rigorous testing and improvements in phenotyping should lead to better design of clinical trials. Summary Good quality, well designed clinical trials are urgently required to improve the treatment of pelvic pain in women. However, a variety of successful treatments exist and outcomes can be optimized by individualizing treatment strategies in the context of a multidisciplinary package.