Methods of assessing late radiotherapy effects on bowel function
Purpose of review Pelvic radiation disease in the form of chronic radiation-induced consequences of treatment is under recognized by healthcare professionals and under reported by patients. Gastrointestinal symptoms are not routinely assessed, and may not be causally associated with previous radiotherapy. These symptoms are therefore often under treated. Recent findings A literature search was conducted in Ovid Medline, which included Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Ovid Embase for articles published between 2016 and April 2018. A total of 11 articles were selected for review. A w...
Source: Current Opinion in Supportive and Palliative Care - May 3, 2019 Category: Palliative Care Tags: GASTROINTESTINAL SYMPTOMS: Edited by Nicole Blijlevens and Andrea M. Stringer Source Type: research

Animal models of mucositis: critical tools for advancing pathobiological understanding and identifying therapeutic targets
Purpose of review Mucositis remains a prevalent, yet poorly managed side effect of anticancer therapies. Mucositis affecting both the oral cavity and gastrointestinal tract predispose to infection and require extensive supportive management, contributing to the growing economic burden associated with cancer care. Animal models remain a critical aspect of mucositis research, providing novel insights into its pathogenesis and revealing therapeutic targets. The current review aims to provide a comprehensive overview of the current animal models used in mucositis research. Recent findings A wide variety of animal models o...
Source: Current Opinion in Supportive and Palliative Care - May 3, 2019 Category: Palliative Care Tags: GASTROINTESTINAL SYMPTOMS: Edited by Nicole Blijlevens and Andrea M. Stringer Source Type: research

The role of mucins in mucositis
This article aims to review current studies involving mucin and mucositis. Recent findings Mucins have been shown to alter mucositis severity and key targets associated with mucositis. First, interventions increasing mucin content has been associated with reduce damage associated with mucositis. Second, mucins have also been shown to protect microbiota from radiation-induced damage. Finally, mucins have also been shown to be involved in lumen epithelial barrier interactions altering signalling for cell proliferation, motility, and the inhibition of apoptosis. Summary The current studies suggest that mucin expression ...
Source: Current Opinion in Supportive and Palliative Care - May 3, 2019 Category: Palliative Care Tags: GASTROINTESTINAL SYMPTOMS: Edited by Nicole Blijlevens and Andrea M. Stringer Source Type: research

Editorial: Knowledge of gastrointestinal toxicity mechanisms is paving the way for improved assessment and management of patient supportive care
No abstract available (Source: Current Opinion in Supportive and Palliative Care)
Source: Current Opinion in Supportive and Palliative Care - May 3, 2019 Category: Palliative Care Tags: GASTROINTESTINAL SYMPTOMS: Edited by Nicole Blijlevens and Andrea M. Stringer Source Type: research

Issues in the future development of new analgesic drugs
Purpose of review There is a clear unmet need for either the development of new drugs for the treatment of painful pathologies or the better use of the existing agents denoted by the lack of efficacy of many existing drugs in a number of patients, limitations of their use due to severity of side effects, and by the high number of drugs that fail to reach clinical efficacy from preclinical development. This account considers the efforts being made to better validate new analgesic components and to improve translational efficacy of existing drugs. Recent findings A better use of the available models and tools can improv...
Source: Current Opinion in Supportive and Palliative Care - May 3, 2019 Category: Palliative Care Tags: PAIN: NON-MALIGNANT DISEASES: Edited by Anthony H. Dickenson and Kirsty Bannister Source Type: research

Assessment of conditioned pain modulation in healthy participants and patients with chronic pain: manifestations and implications for pain progression
Purpose of review The purpose of this review is to summarize recent findings on conditioned pain modulation (CPM) in humans with a focus on methodology, factors modulating CPM, and the potential for CPM as a clinical marker for pain progression. Recent findings CPM can be evoked by combining different stimulus modalities with good reliability; sequential CPM effects are stable over time with limited carryover effects. Optimism and pain catastrophizing might influence pain inhibition. Further, studies suggest that the CPM effect can be improved by gabapentinoids, transcranial direct current stimulation to cortical stru...
Source: Current Opinion in Supportive and Palliative Care - May 3, 2019 Category: Palliative Care Tags: PAIN: NON-MALIGNANT DISEASES: Edited by Anthony H. Dickenson and Kirsty Bannister Source Type: research

Where has the ‘bio’ in bio-psycho-social gone?
Purpose of review Current definitions of pain do not necessitate tissue damage. This is important because it does justice to the pain patient in whom a nociceptive source is not detectable. However, in conjunction with exciting findings regarding supraspinal pain modulation and a (perceived) failure of identifying nociceptive sources in individual patients, this might have led to a devaluation of the role of nociception for chronic pain. In this review, the relative importance of nociception versus psychological factors for chronic pain is examined by scrutinizing the example of pain present several months following surg...
Source: Current Opinion in Supportive and Palliative Care - May 3, 2019 Category: Palliative Care Tags: PAIN: NON-MALIGNANT DISEASES: Edited by Anthony H. Dickenson and Kirsty Bannister Source Type: research

Opioids and breast cancer recurrence
Purpose of review Breast cancer survival has improved motivating the need for better understanding of the sequelae of the disease and its treatments. Lab studies suggest opioids modify cancer cell growth but the association of opioids with cancer progression in humans is not clear. This review aims to summarize recent findings related to opioid use and breast cancer progression. Recent findings Opioid-sparing analgesia may be associated with better survival in cancer patients. In-vitro research suggests that treatment with μ-opioid receptor antagonists inhibits cancer proliferation, and shows some promise for atten...
Source: Current Opinion in Supportive and Palliative Care - May 3, 2019 Category: Palliative Care Tags: PAIN: CANCER: Edited by Anthony H. Dickenson and Paul Farquhar-Smith Source Type: research

Mindfulness-based interventions for cancer-related pain and depression: a narrative review of current evidence and future potential
Purpose of review People with cancer commonly experience persistent pain and psychological distress. Interventions are needed which address the multifactorial nature of pain and depression, yet few studies have examined the impact of mindfulness-based interventions (MBIs) for cancer-related pain and depression. Recent findings MBIs for cancer-related pain and depression can be effectively delivered across a range of modalities and show promise for alleviating mood and some physical health symptoms, although not always pain. There is some evidence for the cost-effectiveness of MBIs. Summary The field of MBIs would b...
Source: Current Opinion in Supportive and Palliative Care - May 3, 2019 Category: Palliative Care Tags: PAIN: CANCER: Edited by Anthony H. Dickenson and Paul Farquhar-Smith Source Type: research

Intrathecal therapy for pain in cancer patients
Purpose of review Intrathecal drug delivery systems (IDDS) for cancer pain remain little employed despite a high level of efficiency even though the technique is widely recommended. This review aims to summarize recent advances in IDDS for cancer patients. Recent findings The respective roles of catheter positioning, volume and flow rate in diffusion of intrathecal treatments, as well as the individual roles of blood pressure, heart rate, and amplitude of the respiratory movements in cerebrospinal fluid (CSF) treatment dispersion, are now well established. Models are available using MRI data. Morphine has long been th...
Source: Current Opinion in Supportive and Palliative Care - May 3, 2019 Category: Palliative Care Tags: PAIN: CANCER: Edited by Anthony H. Dickenson and Paul Farquhar-Smith Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Supportive and Palliative Care)
Source: Current Opinion in Supportive and Palliative Care - May 3, 2019 Category: Palliative Care Tags: EDITORIAL INTRODUCTIONS Source Type: research

Best practices on team communication: interprofessional practice in oncology
Purpose of review Good communication is the cornerstone of interprofessional care teams providing optimized quality patient care. Over the last decade, advances in technology have provided tools to improve communication; however, opportunities still exist for innovation and implementation. Recent findings The literature suggests that interprofessional education and assessment of team communication are fundamental in supporting collaborative care. The literature favours an interactive, team-based approach (e.g. simulation) to learning about communication, in which communication competencies and behaviours are practiced...
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: COMMUNICATION IN CANCER: ITS IMPACT ON THE EXPERIENCE OF CANCER CARE: Edited by Elie Isenberg-Grzeda and Janet Ellis Source Type: research

Communication involving special populations: older adults with cancer
The objective of this article is to summarize current literature about communication between older adults and medical professionals in cancer care. Our article addresses four categories related to communication: first, ageism; second, screening; third, treatment; and fourth, end of life (EoL) care. Recent findings Current literature suggests that cancer treatment for older patients may be influenced by ageist biases. Older patients prefer that clinicians incorporate health status to individualize screening decisions although some patients don’t consider life expectancy to be an important factor in screening. Patie...
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: COMMUNICATION IN CANCER: ITS IMPACT ON THE EXPERIENCE OF CANCER CARE: Edited by Elie Isenberg-Grzeda and Janet Ellis Source Type: research

Oncologists communicating with patients about assisted dying
Purpose of review Across all jurisdictions in which assisted dying is legally permissible, cancer is the primary reported underlying diagnosis. Therefore, oncologists are likely to be asked about assisted dying and should be equipped to respond to inquiries or requests for assisted dying. Because Medical Assistance in Dying was legalized in Canada in 2016, it is a relatively new end-of-life practice and has prompted the need to revisit the academic literature to inform communication with patients about assisted dying. Recent findings We reviewed applicable literature published in the past 5 years, pertaining to assist...
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: COMMUNICATION IN CANCER: ITS IMPACT ON THE EXPERIENCE OF CANCER CARE: Edited by Elie Isenberg-Grzeda and Janet Ellis Source Type: research

Cancer and fertility: optimizing communication between patients and healthcare providers
This article reviews the status of guidelines and recommendations for communication between patients with cancer and healthcare providers (HCPs) concerning fertility issues. Recent findings The timing, the type of information provided, and the openness of HCPs can all affect how patients with cancer perceive discussions regarding fertility concerns and preservation. In addition, whether such discussions occur is associated with intrinsic factors, such as age and sex of the patients as well as HCP's knowledge level. It has also been found that the patients have different needs for information regarding fertility preserva...
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: COMMUNICATION IN CANCER: ITS IMPACT ON THE EXPERIENCE OF CANCER CARE: Edited by Elie Isenberg-Grzeda and Janet Ellis Source Type: research

Communication in cancer: its impact on the experience of cancer care: communicating with the angry patient and the patient in denial
Purpose of review This review aims to describe the recent literature on communication between cancer care clinicians and angry patients and patients in denial. Recent findings Clinicians had improved perceived self-efficacy in responding to patient anger after completing anger management training, with a focus on reframing anger as a normative response to unmet needs. Psychosocial and mindfulness programmes for cancer patients were found to be useful for modifying anger response to stressors. Existing clinician communication guidelines may not meet the complex needs of adolescents and individuals with anger-prone pers...
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: COMMUNICATION IN CANCER: ITS IMPACT ON THE EXPERIENCE OF CANCER CARE: Edited by Elie Isenberg-Grzeda and Janet Ellis Source Type: research

Communication skills training for healthcare professionals in oncology over the past decade: a systematic review of reviews
Purpose of review Effective communication in cancer care requires complex communication skills of healthcare professionals (HCPs), which can be advanced by communication skills training (CST). The number of empirical studies on CST has grown steadily over the last decade. However, controversies on CST abound. The aim of this review of reviews is to summarize evidence for the effectiveness of CST in oncology as well as for effective CST features (intensity, format and content) and to synthesize the current opinion on CST. Recent findings The evidence synthesized from multiple reviews supported the effect of CST on HCPs...
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: COMMUNICATION IN CANCER: ITS IMPACT ON THE EXPERIENCE OF CANCER CARE: Edited by Elie Isenberg-Grzeda and Janet Ellis Source Type: research

Editorial: Communication in cancer
No abstract available (Source: Current Opinion in Supportive and Palliative Care)
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: COMMUNICATION IN CANCER: ITS IMPACT ON THE EXPERIENCE OF CANCER CARE: Edited by Elie Isenberg-Grzeda and Janet Ellis Source Type: research

The role of splanchnic congestion and the intestinal microenvironment in the pathogenesis of advanced heart failure
Purpose of review Right-sided heart failure, which is often present in the setting of advanced heart failure, is associated with cardiac cachexia, the cardiorenal syndrome, and adverse outcomes. Improved understanding of venous congestion of the splanchnic circulation, which may play a key role in the pathogenesis of right-sided heart failure, could lead to novel therapeutics to ameliorate heart failure. Here we provide an overview of right-sided heart failure, splanchnic hemodynamics, fluid homeostasis, and the intestinal microenvironment. We review recent literature to describe pathophysiologic mechanisms and possible ...
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: CARDIAC AND CIRCULATORY PROBLEMS: Edited by James M. Beattie Source Type: research

The lived experience of breathlessness for people diagnosed with heart failure: a qualitative synthesis of the literature
Purpose of review The experience of breathlessness in patients with heart failure is understudied. This review was aimed at evaluating the most recent qualitative findings regarding the experience of breathlessness in persons diagnosed with heart failure. Recent findings A literature search was conducted using Pubmed, Psycinfo, BNI, Cinahl and Google Scholar including studies on breathlessness experience in patients with heart failure, published between 2017 and 2018. Only three studies were identified, and findings were categorized into five themes: acknowledgment of breathlessness, prevailing consequences of breathl...
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: CARDIAC AND CIRCULATORY PROBLEMS: Edited by James M. Beattie Source Type: research

Structural heart disease: one valve does not fit all
This article highlights the work that has been done to facilitate decision-making in this challenging patient population. Recent findings Patient selection is of paramount importance as TAVR remains a costly intervention. Currently, our gold standards for preprocedural patient evaluation are inadequate. Apropos, several objective tools are being developed to help clinicians evaluate frailty. Giving patients a more accurate postprocedure prognosis allows them to make informed decisions on whether this intervention is appropriate for their respective goals. Summary In order for us to fully embrace shared decision-makin...
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: CARDIAC AND CIRCULATORY PROBLEMS: Edited by James M. Beattie Source Type: research

Can a complex adaptive systems perspective support the resiliency of the heart failure patient – informal caregiver dyad?
Purpose of review A holistic palliative approach for heart failure care emphasizes supporting nonprofessional informal caregivers. Informal caregivers play a vital role caring for heart failure patients. However, caregiving negatively affects informal caregivers’ well being, and in turn heart failure patients’ health outcomes. This opinion article proposes that complex adaptive systems (CAS) theory applied to heart failure models of care can support the resiliency of the heart failure patient – informal caregiver dyad. Recent findings Heart failure care is enacted within a complex system composed of ...
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: CARDIAC AND CIRCULATORY PROBLEMS: Edited by James M. Beattie Source Type: research

Māori: living and dying with cardiovascular disease in Aotearoa New Zealand
This article provides an informed perspective on cardiovascular disease (CVD) and palliative care need among Māori New Zealanders. High Māori CVD risk factors will contribute to a sharp increase in older Māori deaths which has implications for health and palliative care service provision. Recent findings CVD is New Zealand's leading cause of premature deaths and disability among Māori. A projected rise in older Māori deaths within the next 30 years will require increased palliative care. However, accessing palliative care and obtaining and understanding information can be challenging for families who are already of...
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: CARDIAC AND CIRCULATORY PROBLEMS: Edited by James M. Beattie Source Type: research

Editorial: Culture, treatment paradigms, and advanced heart failure
No abstract available (Source: Current Opinion in Supportive and Palliative Care)
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: CARDIAC AND CIRCULATORY PROBLEMS: Edited by James M. Beattie Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Supportive and Palliative Care)
Source: Current Opinion in Supportive and Palliative Care - January 29, 2019 Category: Palliative Care Tags: EDITORIAL INTRODUCTIONS Source Type: research

Managing anaemia in bone marrow failure syndromes
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. Recently, activin inhibitors such as Luspatercept have sh...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: BLOOD, BONE MARROW AND LYMPHATICS: Edited by Christopher Dalley Source Type: research

Hemato-oncology and palliative care teams: is it time for an integrated approach to patient care?
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. Recent findings Most newly published evi...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: BLOOD, BONE MARROW AND LYMPHATICS: Edited by Christopher Dalley Source Type: research

How should we assess patient-reported outcomes in the onco-hematology clinic?
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. Recent findings A substantial body of literature has demonstrated that ...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: BLOOD, BONE MARROW AND LYMPHATICS: Edited by Christopher Dalley Source Type: research

Psychological burden of haematological cancer on patient and family: is it time for a multisystem approach?
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. These may manifest at any stage from diagnosis to death or living as a survivor. Some high-risk subgroups have been identified. Summary The range of...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: BLOOD, BONE MARROW AND LYMPHATICS: Edited by Christopher Dalley Source Type: research

We all need support but can our patients help us to help them?
No abstract available (Source: Current Opinion in Supportive and Palliative Care)
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: BLOOD, BONE MARROW AND LYMPHATICS: Edited by Christopher Dalley Source Type: research

The role of day care in supporting older people living with long-term conditions
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. Recent findings This review has critically examined the recent evidence on outcomes of day care provis...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston Source Type: research

Palliative care for all? How can Brazil develop a palliative care service founded on principles of equity and access for all?
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. Recent findings Traditional models of palliative care have focussed on the physical, social, psychological and spiritual domains. Abel and Kellehear have proposed a new model, uniting specialist and generalist palliative care with compassionate communities and the civic component encapsulated in the compassionate city charter. This model is more comprehensive, emphasizing both harm reduction and health and well being promotion, and is currently being rolled ...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston Source Type: research

Palliative care teaching shapes medical undergraduate students’ professional development: a scoping review
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, on...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston Source Type: research

Benzodiazepines for agitation in patients with delirium: selecting the right patient, right time, and right indication
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 per...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston Source Type: research

Instruments to evaluate complexity in end-of-life care
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 conditio...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston Source Type: research

Compassion in palliative care: a review
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. Patients and healthcare professionals value compassion and perceive a general lack of compassion in healthcare systems. Compassion fo...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston Source Type: research

Technology for improving accessibility of end-of-life care: Extension for Community Healthcare Outcomes Project
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. Summary Project ECHO is an innovati...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston Source Type: research

Predictors of reliably high-value end-of-life care
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. A meta-analysis de...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: END OF LIFE MANAGEMENT: Edited by Gustavo De Simone and Bridget Johnston Source Type: research

Targeting IL-1α in cancer cachexia: a narrative review
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 microvascul...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Barry J.A. Laird Source Type: research

Endpoints in clinical trials in cancer cachexia: where to start?
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. As of today, there is no generally acknowledged consensus, but assessments of key factors such as body composition should continue to be applied. However, the...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Barry J.A. Laird Source Type: research

The relationship between muscle mass and function in cancer cachexia: smoke and mirrors?
We report similar confirmatory findings in other studies, and describe potential reasons for these observations. Summary The relationship between muscle mass and muscle function is complex and unlikely to be linear. Furthermore, the relationship is influenced by the techniques used to assess nutritional endpoints [e.g. computed tomography (CT)]; the nature of the chosen physical function outcome measures; and the sex and severity of the recruited cachectic patients. Such factors need to be considered when designing intervention trials for cancer cachexia with functional endpoints. (Source: Current Opinion in Supportive and Palliative Care)
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Barry J.A. Laird Source Type: research

Nutrition support for treating cancer-associated weight loss: an update
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 in...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Barry J.A. Laird Source Type: research

What's next in using CT scans to better understand cachexia?
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. Previous biomarkers of CAX are poorly associate...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Barry J.A. Laird Source Type: research

Preservation of muscle mass as a strategy to reduce the toxic effects of cancer chemotherapy on body composition
Purpose of review Cancer patients undergoing chemotherapy often experience very debilitating side effects, including unintentional weight loss, nausea, and vomiting. Changes in body composition, specifically lean body mass (LBM), are known to have important implications for anticancer drug toxicity and cancer prognosis. Currently, chemotherapy dosing is based on calculation of body surface area, although this approximation does not take into consideration the variability in lean and adipose tissue mass. Recent findings Patients with depletion of muscle mass present higher chemotherapy-related toxicity, whereas patient...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Barry J.A. Laird Source Type: research

How much does reduced food intake contribute to cancer-associated weight loss?
Purpose of review An international consensus group defined cancer cachexia as a syndrome of involuntary weight loss, characterized by loss of skeletal muscle (with or without fat loss), which is driven by a variable combination of reduced food intake and altered metabolism. This review presents recent studies that evaluated the contribution of reduced food intake to cancer-associated weight loss. Recent findings Four studies examined food intake in relation to weight loss. Heterogeneity among studies rendered aggregation and interpretation of results challenging. Despite these limitations, reduced food intake had con...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Barry J.A. Laird Source Type: research

Targeting the divergent TGFβ superfamily cytokine MIC-1/GDF15 for therapy of anorexia/cachexia syndromes
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. Thes...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Barry J.A. Laird Source Type: research

Understanding sex differences in the regulation of cancer-induced muscle wasting
Purpose of review We highlight evidence for sexual dimorphism in preclinical and clinical studies investigating the cause and treatment of cancer cachexia. Recent findings Cancer cachexia is unintended bodyweight loss occurring with cancer, and skeletal muscle wasting is a critical predictor of negative outcomes in the cancer patient. Skeletal muscle exhibits sexual dimorphism in fiber type, function, and regeneration capacity. Sex differences have been implicated in skeletal muscle metabolism, mitochondrial function, immune response to injury, and myogenic stem cell regulation. All of these processes have the potenti...
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Barry J.A. Laird Source Type: research

‘The shoulders, clavicles, chest and thighs melt away’: a compilation of reviews on cachexia
No abstract available (Source: Current Opinion in Supportive and Palliative Care)
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Barry J.A. Laird Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Supportive and Palliative Care)
Source: Current Opinion in Supportive and Palliative Care - November 2, 2018 Category: Palliative Care Tags: EDITORIAL INTRODUCTIONS Source Type: research

Exercise and movement in musculoskeletal pain: a double-edged problem
Purpose of review Exercise and movement are increasingly used in pain management and in palliative care, outside the traditional context of physical medicine and rehabilitation. This critical review aims to provide specialists in pain and palliative medicine with recent insights into the use of exercise and movement in the approach to musculoskeletal disorders when pain and disability are the major complaints. Recent findings If there is a common sense linking pain and movement in both directions, that is pain influencing movement – as a withdrawal movement or a reduction of mobility as a defense reaction &ndash...
Source: Current Opinion in Supportive and Palliative Care - August 3, 2018 Category: Palliative Care Tags: MUSCULOSKELETAL PROBLEMS: Edited by Roberto Casale Source Type: research