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Current Opinion in Supportive and Palliative Care

Alessio Molfino, Maria Ida Amabile, Maurizio Muscaritoli
PURPOSE OF REVIEW: Patients with cancer present high risk for involuntary body weight loss and reduced food intake, which, contributing to progressive tissue wasting and affecting the nutritional status, are often under-estimated in the clinical practice. In this article, we aimed at focusing on cancer-associated weight loss and investigating recent evidences on the indications of nutritional interventions to treat this condition. RECENT FINDINGS: During the last few years, increased emphasis has been addressed on the mechanisms underlying body weight loss in cancer that can be induced by either cancer metabolism and inflammation, either several side-effects of the anticancer treatments...
December 2018: Current Opinion in Supportive and Palliative Care
Vicky Wang-Wei Tsai, David A Brown, Samuel N Breit
PURPOSE OF REVIEW: To review recent finding on MIC-1/GDF15 and re-evaluate it as a potential target for the therapy of anorexia/cachexia syndromes. RECENT FINDINGS: MIC-1/GDF15 consistently induces anorexia/cachexia in animal models. Its actions on brainstem feeding centers leads to anorexia, inducing prolonged undernutrition and consequent loss of both lean and fat mass. Epidemiological studies by multiple groups have linked substantially elevated serum levels of this cytokine to anorexia/cachexia syndromes in diverse diseases such as cancer, chronic renal and cardiac failure, and chronic obstructive lung disease...
December 2018: Current Opinion in Supportive and Palliative Care
Thomas W LeBlanc, Areej El-Jawahri
PURPOSE OF REVIEW: Integrated palliative care for those with advanced solid tumors yields significant benefits in patient and caregiver outcomes. However, most palliative care clinical trials have excluded patients with hematologic malignancies. There is growing interest in whether integrated palliative care may yield similar benefits in hematologic malignancy patients and caregivers, but there has been little direct evidence of benefit in this population. This review summarizes new data on palliative care issues in hematologic malignancies, published in the preceding 12 months...
December 2018: Current Opinion in Supportive and Palliative Care
Maria Luisa Martin-Rosello, Maria Reyes Sanz-Amores, Maria Rosa Salvador-Comino
PURPOSE OF REVIEW: The growing number of patients with terminal and chronic conditions and co-morbidities constitutes a challenge for any healthcare system, to provide effective and efficient patient-centred care at the end of life. Resources are limited, and complexity is rising within patients' situations and healthcare professionals interventions. This review presents the state of art of the role of complexity in specialist palliative care provision. RECENT FINDINGS: Although studies related to complexity in palliative care are still limited, interesting reviews on complexity frameworks in co-morbidity conditions and palliative care are growing more present in current literature...
December 2018: Current Opinion in Supportive and Palliative Care
Barry J A Laird, Aminah Jatoi
No abstract text is available yet for this article.
December 2018: Current Opinion in Supportive and Palliative Care
James J McDonald, Donald C McMillan, Barry J A Laird
PURPOSE OF REVIEW: Cachexia is defined as ongoing loss of skeletal muscle mass, with or without depletion of adipose tissue and is a common syndrome in cancer patients, affecting 50% of those diagnosed. Cachexia, which cannot be fully reversed and causes significant functional impairment is caused by various mechanisms such as an altered energy balance and disruption of homeostatic control by the central nervous system. This central nervous system deregulation involves hypothalamic pituitary adrenal (HPA) axis stimulation, which can be triggered by IL-1R1 engagement on neuronal processes and endothelium in the microvasculature of the hypothalamus...
December 2018: Current Opinion in Supportive and Palliative Care
Catherine Lunt, Christopher Dowrick, Mari Lloyd-Williams
PURPOSE OF REVIEW: For older people with long-term conditions, regular structured activities within a community setting meeting others are thought to improve well being and quality of life. Historically local authority-run day care centres were widely available, but austerity measures have meant that in many areas, such provision has been markedly reduced and different models of day care services are being developed. There is little known about outcomes of day care provision for older people with long-term conditions...
December 2018: Current Opinion in Supportive and Palliative Care
Antonio Noguera, Ramón Robledano, Eduardo Garralda
PURPOSE OF REVIEW: The aim of this review is to understand how palliative care teaching (PCT) as a patient-centered learning model, influences medical undergraduate students' professional development. RECENT FINDINGS: To study PCT medical undergraduate students' learning experiences, we have employed the medical teaching concept, 'hidden curriculum,' as a way of describing attitudes and behavior conveyed implicitly by palliative care educators. Fifteen studies were selected: ten of those studies used a qualitative approach; two are theoretical explanations of the topic explored, one guideline, one review and just one quantitative study, made up the review...
December 2018: Current Opinion in Supportive and Palliative Care
Gonzalo Brito-Pons, Silvia Librada-Flores
PURPOSE OF REVIEW: Compassion has been recognized as a key aspect of high-quality healthcare, particularly in palliative care. This article provides a general review of the current understanding of compassion in palliative care and summarizes emergent compassionate initiatives in palliative care at three interdependent levels: compassion for patients, compassion in healthcare professionals, and compassionate communities at the end of life. RECENT FINDINGS: Compassion is a constructive response to suffering that enhances treatment outcomes, fosters the dignity of the recipient, and provides self-care for the giver...
December 2018: Current Opinion in Supportive and Palliative Care
Gabriela Píriz Alvarez
PURPOSE OF REVIEW: To describe how Project ECHO works and to analyze what has been published on Project ECHO Palliative Care (Project ECHO PC) over the last 18 months. RECENT FINDINGS: Only two articles on Project ECHO PC have been published over the last 18 months: a descriptive study of experiences in seven health centers of the United States, the United Kingdom, Uruguay and India; and a quantitative and qualitative study of the impact of the teleECHO clinic on physicians and nurses in Northern Ireland, which reports a significant boost in knowledge acquisition and self-efficacy...
December 2018: Current Opinion in Supportive and Palliative Care
Claire K Ankuda, Diane E Meier
PURPOSE OF REVIEW: Care near the end of life is expensive and frequently not aligned with the expressed preferences of decedents, creating an opportunity to improve value, or increase quality while lowering cost. This review examines publications from 2017 and 2018 on interventions and policies associated with high-value end-of-life care. Innovations in video and web-based advance care planning are promising to improve preference-congruent care at low cost. RECENT FINDINGS: The patterns of care within hospice and in particular increased investment in patient care in hospice are shown to improve value...
December 2018: Current Opinion in Supportive and Palliative Care
Srinivasan Narayanan
PURPOSE OF REVIEW: Anaemia is a common haematological presentation in patients with bone marrow failure, yet a challenging condition to treat. As anaemia has a direct impact on the patient's symptoms, managing anaemia in the common bone marrow failure conditions, such as myelodysplastic syndrome will help to improve the quality of life. This review discusses the available treatment options and the benefit of improving the haemoglobin level. RECENT FINDINGS: Managing anaemia effectively has shown to improve the patient outcome, yet treatment option remain limited...
December 2018: Current Opinion in Supportive and Palliative Care
Barry J A Laird, Trude R Balstad, Tora S Solheim
PURPOSE OF REVIEW: The lack of agreement and knowledge of optimal endpoints in cachexia trials have impeded progress in finding interventions counteracting the devastating effects cancer cachexia has on morbidity and mortality. An endpoint should both be sensitive enough to detect change and specific enough not to be influenced by other conditions or treatments. RECENT FINDINGS: There is a wealth of potential and applied endpoints in trials investigating cachexia...
December 2018: Current Opinion in Supportive and Palliative Care
Clare Statham, Carol Davis
PURPOSE OF REVIEW: Literature addressing the psychological impact of haematological cancers on patients and their families is sparse. New evidence might prompt a change in approach to the assessment and management of psychological burden. RECENT FINDINGS: The diagnosis, treatment and surveillance of haematological cancers often have a profound psychological impact on patients and their families and can result in clinically significant problems and increased carer stress...
December 2018: Current Opinion in Supportive and Palliative Care
Christopher Dalley
No abstract text is available yet for this article.
December 2018: Current Opinion in Supportive and Palliative Care
Laura Cannella, Fabio Efficace, Johannes Giesinger
PURPOSE OF REVIEW: The improvement of clinical outcomes in hematologic malignancies has paved the way for a more systematic patient-reported outcomes (PROs) assessment in routine clinical practice. PROs help to narrow the gap between patients' and healthcare professionals' view of patient health and treatment success. This review outlines key aspects of planning and performing PRO assessments in daily routine such as the selection of PRO instruments, electronic PRO data collection, and the presentation and interpretation of PRO results...
December 2018: Current Opinion in Supportive and Palliative Care
Santiago Rodríguez Corrêa, Julian Abel
PURPOSE OF REVIEW: Despite the historical international development of palliative care over the last 50 years, provision of equity of care and access to appropriate medication remains a major problem in many countries across the world. Interest in the public health approach to end-of-life care has grown over the last 20 years. Models of palliative care, which are affordable and provide equity of care are changing through these new concepts. We describe an existing model of practice in a primary care setting in Rio Grande in Brazil, which could act as a template for redesign of palliative care services...
December 2018: Current Opinion in Supportive and Palliative Care
Sami Antoun, Caroline Rossoni, Emilie Lanoy
PURPOSE OF REVIEW: Cachexia (CAX), a protein metabolism disorder commonly associated with cancer, can be evaluated by computed tomography (CT) scan assessment of skeletal muscle mass (SMM), a parameter associated with patient outcome. This review analyzes current barriers for using CT scans of SMM in routine management for defining prognostic risk groups, and proposes new areas of research to reach a better understanding of CAX mechanisms. RECENT FINDINGS: Current research is focused on establishing a robust and relevant CAX staging system to reach a consensual definition...
December 2018: Current Opinion in Supportive and Palliative Care
David Hui
PURPOSE OF REVIEW: To provide an evidence-based synopsis on the role of benzodiazepines in patients with agitated delirium. RECENT FINDINGS: Existing evidence supports the use of benzodiazepines in two specific delirium settings: persistent agitation in patients with terminal delirium and delirium tremens. In the setting of terminal delirium, the goal of care is to maximize comfort, recognizing that patients are unlikely to recover from their delirium. A recent randomized trial suggests that lorazepam in combination with haloperidol as rescue medication was more effective than haloperidol alone for the management of persistent restlessness/agitation in patients with terminal delirium...
December 2018: Current Opinion in Supportive and Palliative Care
Michael I Ramage, Richard J E Skipworth
PURPOSE OF REVIEW: Randomized clinical trials of cancer cachexia interventions are based on the premise that an increase in the muscle mass of patients is associated with consequent improvements in muscle function, and ultimately, quality of life. However, recent trials that have succeeded in demonstrating increases in lean body mass have been unable to show associated increases in patient physical function. In this review, we examine the potential causes for this lack of association between muscle mass and function in cancer cachexia, paying particular attention to those factors that may be at play when using body composition analysis techniques involving cross-sectional imaging...
December 2018: Current Opinion in Supportive and Palliative Care
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