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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, one review and jus...
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 conditions a...
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