Purpose of review Neuropathic pain remains a major clinical challenge, with limited mechanism-based treatment options. This review summarizes recent advances in sensory neuron biology, with a particular focus on the transcriptomic and functional heterogeneity of nociceptive neurons and their implications for precision analgesic development. Recent findings Single-cell transcriptomics and multimodal approaches have revealed previously unrecognized sensory neuron diversity and dynamic state-dependent plasticity. Recent human dorsal root ganglion (DRG) atlases and Patch-seq studies have further demonstrated that neuronal identity arises from the interaction between transcriptional state and functional phenotype, thereby uncovering pain-relevant neuronal subtypes and novel therapeutic targets. Summary Sensory neurons emerge as transcriptionally diverse and dynamically regulated cellular states, rather than fixed neuronal classes. Recent advances in single-cell transcriptomics and multimodal profiling are refining our understanding of sensory neuron heterogeneity and providing new opportunities for mechanism-based therapeutic development in neuropathic pain.
Purpose of review Pain is a multidimensional experience emerging from the coordinated activity of distributed neural circuits that integrate sensory, emotional, and cognitive information. The purpose of this review is to highlight and synthesise current understanding of the circuit mechanisms underlying ascending nociception and descending modulation of pain, with particular emphasis on brainstem areas and their involvement in shaping pain perception. We discuss how dysregulation of these control systems may contribute to persistent pain states. Recent findings It is consistently demonstrated that pain is both a dynamic and context-dependent process, shaped by extensive bidirectional interactions within the central nervous system. In humans, nociceptive signals transmitted through spinal and trigeminal pathways engage brainstem and forebrain networks that generate protective behaviours and aversive subjective states, while descending modulatory systems exert powerful control over signal gain at early relay sites. Recent evidence asserts that this reciprocal organisation is what allows pain to be flexibly adjusted according to internal state, environmental threat, learning history, and behavioural priorities. Summary Understanding the coordinated neural and behavioural responses that lead to typical pain processing, and which components of these myriad systems become maladaptive in clinical pain settings, is critical for optimising treatment selection to individual symptom profiles.
Purpose of review Endometrial cancer is a prevalent gynecological malignancy with a rising incidence and substantial symptom burden. As treatments evolve, understanding patient-reported quality of life (QoL) has become critical. This review examines the characteristics, psychometric properties, and domain coverage of three key endometrial-cancer-specific patient-reported outcome measures to guide clinical and research applications. Recent findings The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Endometrial Cancer 24 (EORTC QLQ-EN24), the Functional Assessment of Cancer Therapy-Endometrial (FACT-En), and Functional Assessment of Cancer Therapy Endometrial Symptom Index (FEnSI-23) present varying structures, scopes, and focuses. The EORTC QLQ-EN24 provides detailed symptom assessment, particularly for treatment-induced effects, and has been validated in multinational settings. FACT-En offers a broader evaluation of physical, emotional, social, and functional well-being, supporting longitudinal and survivorship research. FEnSI-23, developed through patient-centered approaches, emphasizes disease-related symptoms and treatment side effects, taking the perspectives of underrepresented patient groups into account. Summary This review highlights significant differences in the scope, strengths, and psychometric properties of the EORTC QLQ-EN24, FACT-En, and FEnSI-23. While they demonstrate clinical research utility, gaps remain in cross-cultural validation and responsiveness. Prospective research should prioritize validation across diverse populations to further ascertain the measures’ reliability. Instrument selection should correlate with clinical requirements, with the EORTC QLQ-EN24 suited for detailed symptom assessment, the FACT-En for broader QoL evaluation, and the FEnSI-23 for patient-centered measurement of disease symptoms and treatment side effects.
PURPOSE OF REVIEW:The review aims to synthesize the current evidence on decision-making and cancer treatment planning for older adults with pre-existing cognitive impairment, Alzheimer's disease, and other related dementias. RECENT FINDINGS:Current decision-making practices are not standardized, and evidence suggests that oncology physicians conduct burden-benefit analyses to guide treatment planning. There was a consensus on the importance of involving caregivers into the decision-making process. However, caregivers experience feelings of anxiety, uncertainty, and extra burden when deciding between treatment options and providing care. Nursing home staffs were frequently excluded from the decision-making process and were perceived as unprepared to identify and manage cancer symptoms. The planning and provision of care for this population can be guided by a comprehensive geriatric assessment (CGA). CGA can inform the decision-making process based on the patient's functionality and caregiver's resources, facilitate management of cancer care, guide the identification and management of cancer symptoms, and assist communication with patients and their caregivers. SUMMARY:Decision-making and treatment planning for older adults with cancer and pre-existing cognitive impairment lacks standardization. CGA offers a standardized approach to guide treatment decisions, manage symptoms, and coordinate care by highlighting the needs and resources of patients and caregivers.
PURPOSE OF REVIEW:This review summarizes high-level evidence on clinical decision support systems, both more classical rules-based and emerging artificial intelligence-based examples. It discusses their potential and concerns, how to evaluate them and describes future directions based on published evidence, clinical experience and broader experience working with others in this space. RECENT FINDINGS:There is significant potential for CDSS to benefit elicitation and assessment of breathlessness, assist clinical decision making, improve interpretation of common diagnostic tests for breathlessness and personalize management and patient education. Even so, current evidence from trials and real-world studies in this space remains limited with multiple studies ongoing. However, evidence from studies of model development indicates that CDSS have clinically acceptable performance levels for differentiating breathlessness causative conditions such as COPD, heart failure, lower respiratory tract infection or combinations of these. The extent to which this evidence translates to real world clinical benefits remains unknown. SUMMARY:In the era of CDSS leveraging significant volumes of data, there is the potential to augment the less precise nature of clinician prediction with that of AI prediction. This, combined with clinical judgment can support better care for patients and populations. CDSS are likely to be particularly valuable in settings with workforce constraints though we must also remember that there are limitations to CDSS use and applicability. It remains important to support and undertake high quality studies testing these tools in clinical practice.
PURPOSE OF REVIEW:To summarize and critically interpret new evidence (from the last 12-18 months) on the associations between obesity and breathlessness, including epidemiology, physiological mechanisms, diagnostic challenges, and treatment approaches. RECENT FINDINGS:Multiple large cohorts confirm that obesity is one of the strongest independent predictors of exertional breathlessness. Recent work has expanded the understanding of mechanical, metabolic, and ventilatory contributors to breathlessness in obesity. Novel spirometric and oscillometric data clarify small airway dysfunction and decreased lung compliance. Obesity-related cardiac loading could be an important and potentially treatable contributor to breathlessness. Interventional studies show improvements in breathlessness following weight loss, particularly after bariatric procedures, though data on pharmacologic weight-loss therapies remain limited. SUMMARY:Obesity is strongly associated with breathlessness and likely contributes through combined mechanical, metabolic, and ventilatory factors. Treatment remains centred on weight loss, but the evidence is scarce. Future work should prioritize breathlessness-specific outcomes in obesity interventions.
PURPOSE OF REVIEW:Prostate cancer can significantly impact psychological, physical, and social well-being. This systematic review compares the development of the Functional Assessment of Cancer Therapy-Prostate (FACT-P) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Prostate Cancer (EORTC QLQ-PR25) for evaluating quality of life (QoL) in prostate cancer patients, focusing on development, characteristics, reliability, validity, and psychometric properties. RECENT FINDINGS:Thirteen studies published between 2013 and 2022 met the inclusion criteria. FACT-P and EORTC QLQ-PR25 are both validated, reliable, and responsive instruments for assessing QoL in prostate cancer patients. FACT-P emphasizes emotional, social, and functional well-being alongside prostate-specific concerns, while EORTC QLQ-PR25 focuses on prostate-specific symptoms, particularly urinary, sexual, and hormonal function. SUMMARY:The FACT-P and EORTC QLQ-PR25 are valid tools for assessing QoL in prostate cancer patients. The decision to use the FACT-P or the EORTC QLQ-PR25 instrument may depend on the population and aims of the proposed study. Given substantial advancements in treatment and patient care in prostate cancer since the initial development of the FACT-P and EORTC QLQ-PR25, these quality of life instruments should undergo comprehensive validation to ensure they remain a relevant and effective tool for contemporary prostate cancer clinical trials.
PURPOSE OF REVIEW:Patient-reported outcomes (PROs) have become increasingly important in oncology, capturing the patient perspective on symptoms, treatment effects, and health-related quality of life. Transitioning to electronic platforms (ePROs) enables real-time monitoring, efficient integration into clinical workflows, and enhanced patient-centered care. This review explores recent evidence on the clinical utility, barriers, and future directions of integrating ePROs in supportive care in oncology. RECENT FINDINGS:ePROs improve symptom control, quality of life, engagement, and in some studies, overall survival. They support earlier clinical interventions, reducing emergency visits and hospitalizations and help improve outcomes. Barriers persist at system (infrastructure, interoperability, and data security), clinician (workflow disruption, time constraints, and alert fatigue), and patient (digital literacy, access, and usability) levels. Mitigation strategies include organizational support, clinician champions, codesigned inclusive platforms, and robust privacy safeguards. Emerging opportunities involve integration with artificial intelligence, big data, and decision-support systems to advance precision oncology and population health management. SUMMARY:ePROs represent a transformative approach in supportive cancer care. Overcoming multilevel barriers and harnessing digital innovations are essential to optimize clinical outcomes, equity, and long-term sustainability.
PURPOSE OF REVIEW:Translational research is a dynamic process that aims to apply fundamental scientific discoveries into clinical practice through strong cooperation between scientists and healthcare providers. This review discusses recent advances in symptom science within palliative care, driven by translational research, and highlights the pressing need to bridge the gap between scientific innovation and clinical practice. RECENT FINDINGS:The dramatic change in the cancer landscape in the last decade has been achieved through translational research. However, the role of translational research in symptom science in palliative care for patients with cancer has been chronically neglected. Recently, initial progress has been made in symptom prediction through biomarker discovery for distressing syndromes, such as delirium or cancer-related cachexia. Other areas where translational approaches offer promise include predicting survival and identifying the dying phase in patients with advanced cancer. SUMMARY:Despite some progress in introducing translational research into palliative care, significant challenges persist, limiting the full potential of integrative and collaborative research to improve patient outcomes in cancer palliative care. Herein, key areas are discussed, including emerging themes and tools that could help bridge this gap.
PURPOSE OF REVIEW:There are many different patient-reported outcome measures to assess how patients feel or function but they vary in how they collect responses and score results. Therefore, it can be hard to know what a change in score means for a patient or whether treatments compared in a trial result in different patient experiences. Methods exist to estimate thresholds to aid interpretation, but no single method is considered the best. This review considers recent advances in efforts to improve these methods. RECENT FINDINGS:New research has been published on the choice of appropriate anchors and the methods to establish thresholds based on them. There has been increased focus on the derivation of thresholds used to compare scores between groups of patients versus those used to interpret an individual's change in scores over time. Studies are also highlighting how baseline severity and other factors affect how we estimate thresholds. SUMMARY:Consensus on the optimal methods for the derivation of score interpretation thresholds is still required, although the field continues to grow in understanding biases and impacts of treatment and population factors on estimation.
PURPOSE OF REVIEW:Two common quality of life (QoL) questionnaires for cancer-related fatigue (CRF) are the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Fatigue 12 (QLQ-FA12) and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue). This systematic review compared their content, validity, and psychometric properties. RECENT FINDINGS:Twenty-four studies were included. The QLQ-FA12 (12 items) provides physical, emotional, and cognitive subscales, while the FACIT-Fatigue (13 items) captures self-reported fatigue and its impact on daily function. Both instruments demonstrated validity, internal consistency, test-retest reliability, and sensitivity. Construct validity was supported by correlations with QoL and physical-function measures, and confirmatory factor analyses upheld their intended dimensional structures. The QLQ-FA12's 4-point question format offers distinct domain scores, whereas the FACIT-Fatigue's 5-point statement format yields a single total score. The QLQ-FA12 is preferred when a multidimensional profile is needed, such as in trials addressing specific fatigue drivers or pairing with QLQ-C30 domains. The FACIT-Fatigue suits brief screening or large-scale studies where efficiency and a single total fatigue score are priorities. SUMMARY:The EORTC QLQ-FA12 and FACIT-Fatigue are both sufficiently validated for assessing CRF-related QoL. The QLQ-FA12 is more appropriate when a multidimensional profile is required, whereas FACIT-Fatigue suits contexts needing a unidimensional total severity score.
PURPOSE OF REVIEW:Managing multimorbidity in older adults with cancer is a central, complex challenge in modern oncology. Historically, this population was underrepresented in clinical trials, leaving clinicians without practical guidance. This review synthesizes recent evidence that moves beyond simply documenting frailty to deploying targeted, evidence-based interventions to improve supportive and palliative care. RECENT FINDINGS:The literature supports a practical 2-step approach to assessment, using screening tools like the Geriatric-8 to trigger a full Comprehensive Geriatric Assessment (CGA) with management, which is proven to reduce treatment toxicity. Goal-aligned deprescribing has emerged as an active clinical skill to manage polypharmacy. In decision-making, the focus has shifted from guideline-concordant to goal-concordant care. Finally, a needs-based paradigm for integrating palliative care is replacing older, prognosis-based models, distinguishing between generalist skills for all clinicians and specialist consultation for complex cases. SUMMARY:Recent evidence provides clinicians with practical approaches. By using validated screening, CGA-led interventions, systematic deprescribing, and needs-based palliative care, clinical teams can reduce treatment toxicity, lessen medication burden, and align complex cancer care with the personal priorities and quality-of-life goals of older patients.
PURPOSE OF REVIEW:There has been a notable rise in cancer-related emergencies, especially in older patients, due to an increase in those undergoing complex therapies. In this review, we consider the management and clinical workup of the older cancer patient in the emergency department (ED). We will reflect on clinical features of older patients with cancer, as well as fall, delirium, febrile neutropenia (FN), and immune checkpoint inhibitor toxicity. RECENT FINDINGS:Older patients with cancer are more likely to require admission to hospital following ED attendance. The most common emergency presentations are fever, pain and gastrointestinal symptoms. The complexity of common presentations, such as falls and delirium, is often overlooked in older cancer patients. FN in older patients is associated with increased mortality and a higher likelihood of requiring inpatient care. Despite their therapeutic benefits in older patients, the broad spectrum of immune-related toxicities even at lower grades, can lead to functional decline and the need to discontinue therapy. SUMMARY:The number of older people with cancer presenting to emergency care is expected to rise. In response to this growing and complex demand, a comprehensive, individualised, and multi-disciplinary approach is essential. Clinicians need to be aware of the increasingly broad spectrum of diagnoses in this population and tailor their assessment and management strategies accordingly.
Two widely validated health-related quality of life (HR-QoL) tools, specifically designed for patients with advanced cancer, are the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL) and the Functional Assessment of Chronic Illness Therapy-Palliative (FACIT-Pal-14). This systematic review aims to evaluate the use of EORTC QLQ-C15-PAL and FACIT-Pal-14 in prospective studies in patients with advanced cancer, focusing on study types, clinical settings, additional HR-QoL tools used, and completion rates. Sixty studies were included in the analysis. Both EORTC QLQ-C15-PAL and FACIT-Pal-14 are used in a variety of studies. Given that EORTC QLQ-C15-PAL was developed 9 years before FACIT-Pal-14 PAL, most studies utilized the EORTC tool. Both tools were shown to be successfully used in a variety of clinical settings, including in various advanced tumour types or different study designs, depending on the investigator and study needs. This review demonstrates the wide range of utilization of EORTC QLQ-C15-PAL and FACIT-Pal-14 in prospective studies to assess the HR-QoL issues in patients with advanced cancers.
PURPOSE OF REVIEW:Adolescents and young adults (AYAs) with cancer are a vulnerable population affected by disparities in survivorship care access. These disparities are pronounced in low- and middle-income countries (LMICs) but exist even within high-income settings, affecting vulnerable and underserved groups. This expert review explores disparities in fertility preservation, psychosocial health, nutritional care, cardiovascular health, and secondary malignancies of AYA survivorship. RECENT FINDINGS:Fertility preservation services are often inaccessible due to high costs, limited provider training and knowledge, cultural stigma, and urban-centric availability, especially in LMICs. Psychosocial distress is widespread, exacerbated by structural barriers, stigma, and mental health service scarcity. Nutritional disparities lead to malnutrition and obesity, with food insecurity and limited access to high-quality diets affecting treatment outcomes. Cardiovascular complications, including physical inactivity, are usually under-monitored, despite growing recognition of exercise as an essential part of survivorship. Approaches to standardize the monitoring of secondary malignancies are needed. SUMMARY:These gaps reflect broader disparities, including limited infrastructure, lack of provider training, and absence of culturally tailored care models. Global organizations such as the Multinational Association of Supportive Care in Cancer (MASCC) can support the integration of resource-adapted, patient-centered supportive care guidelines into existing health systems. Addressing the complex and interrelated barriers faced by AYA survivors can improve survivorship outcomes and promote more equitable access to high-quality care.
PURPOSE OF THE REVIEW:The primary aim of this review was to identify and describe the tools or methods used to capture patient-reported experiences and outcomes related to palliative care provided within acute hospital settings. RECENT FINDINGS:Twenty-eight patient-reported outcome and experience measures were used across the studies. The studies mainly used the patient-reported outcome measures to assess symptom burden and distress. Only four studies used both patient-reported outcome measures and patient-reported experience measures. Most studies predominantly included patients with cancer. Only one new measure was found in the last 18 months. There was lack of use of electronic versions of patient-reported outcome and experience measures in inpatient palliative care. SUMMARY:Limited evidence was found on the use of electronic version of patient-reported outcome and patient reported experience measures in inpatient palliative care. There is a critical need to enhance understanding and routine implementation of more holistic patient-reported outcome measures in hospital-based specialist palliative care. Further research is needed to identify the most appropriate electronic version of holistic patient-reported outcome measures and patient-reported experience measures for use in these settings.
PURPOSE OF REVIEW:Low- and middle-income countries (LMICs) bear over half of the global cancer mortality but have access to only 5% of global radiotherapy resources. As the cancer burden rises and equity in palliative care gains global attention, a focused review on palliative radiotherapy access in LMICs is both timely and necessary. RECENT FINDINGS:Barriers to radiotherapy access in LMICs are multifaceted, including infrastructure gaps, workforce shortages, geographic centralization, high out-of-pocket costs, and systemic underinvestment. Palliative radiotherapy, despite its proven cost-effectiveness and impact on quality of life, is often excluded from national cancer plans and health strategies. Innovative approaches such as hypofractionation, mobile units, AI-assisted planning, and public-private partnerships are emerging to address these gaps. Efforts by the International Atomic Energy Agency and local governments have led to progress in several regions, with case studies from Africa, Asia, and Latin America showing promising results. SUMMARY:Integrating radiotherapy - particularly palliative radiotherapy - into national cancer and palliative care strategies is essential. Sustainable financing, decentralized service models, and context-specific technologies are critical to overcoming current limitations. Bridging this gap is not only a public health necessity but also a moral imperative to reduce suffering and support patients' dignity and societal contributions.
PURPOSE OF REVIEW:Accurately predicting survival in metastatic breast cancer (MBC) is essential to support personalized treatment decisions. This scoping review examines the current applications of artificial intelligence (AI) models for survival prediction in MBC and highlights their relevance in improving clinical outcomes. RECENT FINDINGS:Of 1787 records screened, 15 studies met inclusion criteria. These studies used supervised learning approaches, including random survival forests (13.3%), Naïve Bayes classifiers (13.3%), and logistic regression models (20.0%), to predict overall survival, progression-free survival, and treatment response. Input data varied widely, incorporating electronic health records, clinical data, imaging, and genomic profiles. Among included studies, 66.7% addressed all three major breast cancer subtypes, 20.0% focused on ER-positive HER2-negative cases, and 13.3% did not specify subtype. Model performance varied, with sensitivities ranging from 42% to 90%, specificities from 53% to 90%, and area under the curve values between 0.70 and 0.85. SUMMARY:AI models show promising potential for improving survival prediction in MBC, offering tools to support more individualized care. However, limitations remain, including inconsistent data quality, suboptimal model performance, and a lack of external validation. Future work should focus on refining models and ensuring clinical applicability through robust validation.
