Substance use spans a continuum from occasional use to hazardous use and clinically defined substance use disorders, and it can shape outcomes across the cancer care continuum. This structured narrative review synthesises evidence on how alcohol, tobacco, cannabis and opioids relate to cancer outcomes relevant to supportive care, including diagnostic timing, adherence, toxicity, symptom burden and survival. Methods We searched PubMed, Scopus and Web of Science for peer-reviewed studies published between January 2010 and April 2025 and narratively synthesised findings given heterogeneity in study designs and exposure definitions. Results Heavy or hazardous alcohol use and continued tobacco use are well-established carcinogenic exposures and are associated with delayed diagnosis, poorer treatment adherence, greater toxicity and inferior survival in observational studies. Evidence for cannabis and opioids is heterogeneous and predominantly observational; interpretation is limited by variable exposure measurement, including product composition and route of administration and dose, as well as polysubstance use, confounding and reverse causation. For opioids specifically, it is essential to distinguish analgesic use for cancer pain, physiological dependence and opioid use disorder. Conclusions To improve patient-centred outcomes, supportive oncology should embed routine screening, brief interventions and clear referral pathways, while implementing integrated oncology–addiction care models tailored to symptom burden and patient-reported outcomes. Future research should prioritise standardised exposure definitions, prospective longitudinal designs and evaluation of integrated care models in supportive oncology.
BACKGROUND:Rapid population growth and urbanisation raise a critical need to better understand the burden of injuries in sub-Saharan Africa. We assessed the pattern of service demand for injuries at emergency department (ED) in urban areas of Mozambique. METHODS:This prospective, multi-centric, observational study was conducted in EDs in southern (Maputo), central (Beira) and northern (Nampula) of Mozambique. We randomly selected 7809 cases (age ≥1 years) during the seasonally distinct months of April/2016-2017 and October/2017. Data on patients' demographics, nature of injury and clinical outcomes were collected. RESULTS:Overall, 1881/7809 (26.2 %) emergency cases comprising 518 children (58.5 % male, aged 4.6 ± 2.5 years), 324 adolescents (64.8 % male, 14.7 ± 3.0 years) and 10,39 adults (60.8 % male, 34.5 ± 13.0 years) presented with injury. The arms, legs and head were most affected in both children (518 with 795 injuries) and adults (1039 with 1496 injuries). The diversity of injuries increased with older age. Injury cases predominantly presented during daylight hours (from 0900 to 1900) with age-differentials evident. There were proportionately more injury presentations in the hotter and wetter October than in colder and drier April. The most common mechanisms of injury were falls, physical violence and road traffic injuries. Overall, 9.1 % of injury cases were admitted to hospital and 0.2 % died. CONCLUSIONS:Injuries corresponded to around one-quarter of all emergency admissions in urban Mozambique, and were predominantly caused by falls, physical violence, and road traffic injuries. Understanding distinctive variations in the pattern and timing of these presentations according to the age, location and season will assist in future planning for more efficient injury prevention and health care services in Mozambique.
INTRODUCTION It is widely known that introducing palliative care at an early stage will greatly benefit patients and their families, through prevention, early identification, comprehensive assessment, and management of physical, psychological, spiritual distress and social needs. Palliative care is often underused or initiated late in the course of lifethreatening illnesses and according to the WHO, it is estimated that globally, only approximately 12% of patients who need palliative care receive it. The NECPAL CCOMSICO tool (NECessidades PALiativas Centro Colaborador da Organização Mundial da SaúdeInstitut Català d’Oncologia), developed by the Catalan Institute of Oncology, aims to identify patients in need of palliative care at an early stage, and accurately predicts mortality to facilitate endoflife care planning and hence improve quality of life. It consists of a checklist with four major categories: an intuitive question integrating comorbidity, social aspects and other factors; the request or need for palliative treatments; general clinical indicators of severity and disease progression; and finally, indicators specific to each patient’s disease. However, there are still insufficient data on its sensitivity, specificity and predictive value with further evidence needed to identify its usefulness as a screening tool for early palliative care.
