Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 22 appraisals
Scandinavian journal of pain
Multimodal deep learning fusion for automatic pain detection in cancer patients
INTRODUCTION: Since pain is a multidimensional and subjective experience, pain assessment remains challenging. With advances in artificial intelligence (AI), automatic pain assessment (APA) systems offer a valuable opportunity for objective pain evaluation. However, most approaches focus on a single modality. In this proof-of-concept study, exploring multimodal fusion strategies in a controlled experimental setting, we present a deep learning framework for multimodal fusion that combines facial, acoustic, and textual information to improve APA in cancer patients. METHODS: A multimodal dataset was created from video-recorded interviews with oncologic patients. In Phase I, audio, video, and transcripts were segmented at the sentence level and temporally aligned using the Eudico Linguistic Annotator (ELAN) to ensure frame-level correspondence across modalities. In Phase II, modality-specific features were extracted: Facial Action Units from OpenFace, acoustic descriptors (MFCCs, chroma, spectral contrast, and Mel-spectrogram) from a dedicated speech-processing pipeline, and sentence-level textual embeddings from ITA-BERT. During training, the most effective analytical strategy was chosen through knowledge transfer approaches. The ELAN-assisted annotation pipeline streamlined expert labeling. Two architectures were implemented and compared: bimodal autoencoder fusion models and a transformer-based model with pairwise cross-modal attention. These models were trained and evaluated using subject-independent and stratified 5-fold cross-validation. To address the lack of independence between segments, a strictly subject-independent cross-validation strategy was adopted. RESULTS: Knowledge transfer using pretrained large-scale models outperformed traditional feature-based approaches and was applied to multimodal pain detection. Multimodal models achieved performance comparable to the strongest unimodal modality (text), while showing improved balance across modalities, suggesting potential complementary effects. Both multimodal architectures demonstrated high accuracy in distinguishing between pain and non-pain classes. The bimodal autoencoder achieved stable results across folds, with a mean accuracy of about 80 % and balanced error distribution. The pairwise transformer with cross-modal attention achieved similar performance, with smooth training and validation loss curves. No evident divergence between training and validation loss curves was observed across folds, suggesting stable behavior within the cross-validation setting. However, subject-level overfitting cannot be excluded given the limited sample size. CONCLUSION: Multimodal fusion enhances system robustness by integrating complementary signals. Despite limitations and the need for improvement, multimodal deep learning strategies can support the detection of observable pain-related expressions.
26 July 2026
Read appraisal →Current treatment options in oncology
Telemedicine and Virtual Reality Technologies in Pain Management for Cancer Patients: A Structured Narrative Review
Cancer-related pain remains a complex and persistent clinical challenge due to its multidimensional nature and the limitations of pharmacological treatments alone. In our view, telemedicine and virtual reality (VR) technologies represent complementary and increasingly relevant approaches that address different yet interconnected dimensions of pain management in oncology care. Telemedicine should be considered a key component of contemporary cancer care, particularly for continuous symptom monitoring, early detection of pain exacerbation, and timely clinical intervention. Its ability to enhance communication between patients and healthcare providers and to support continuity of care makes it especially valuable in the long-term management of cancer-related symptoms. In contrast, VR interventions offer a targeted, non-pharmacological strategy for modulating pain perception through attentional distraction, emotional regulation, and immersive engagement. Based on current evidence, VR appears particularly useful in the management of procedure-related pain and in patients experiencing persistent pain that is insufficiently controlled with standard approaches. We propose that the integration of telemedicine and VR should be considered within a coordinated, patient-centered care model, where telemedicine facilitates ongoing assessment and identification of patient needs, and VR is applied as an adjunctive intervention tailored to individual symptom profiles. Such an approach has the potential to enhance both symptom control and psychological well-being while supporting treatment adherence. However, despite their promise, the implementation of these technologies requires careful consideration of clinical context, patient characteristics, and system-level factors, including digital literacy and technological infrastructure. Future research should prioritize the development of standardized protocols and the evaluation of long-term outcomes to support the sustainable integration of these digital health strategies into routine oncology practice.
11 July 2026
Read appraisal →The Tohoku journal of experimental medicine
At-Home Deaths and Regional Factors in Japan
In Japan, at-home deaths are not always popular, yet many people hope to spend their end-of-life at home, which makes this a socio-medical issue. Regional factors are associated with at-home deaths, but their relative importance has not been known. The present study investigated the relationship between at-home deaths and regional factors and ranked their importance at the municipal level in Japan. We used national open data on at-home deaths, population, medical resources, causes of death, economic factors and geographic factors as well as built the prediction model for at-home deaths using Extreme Gradient Boosting (XGBoost) regression. The Shapley Additive Explanations (SHAP) value was applied to rank the importance of regional factors and explain the XGBoost model. As a result, the median prevalence of at-home deaths across municipalities was 12.7%. A higher prevalence of at-home deaths was observed in large metropolitan areas such as Tokyo, Osaka, and Nagoya. SHAP values revealed that latitude was the most important factor in rank, followed by the number of clinics providing end-of-life care, longitude, population density, and population change rate. In conclusion, geographic and population-related factors were ranked highly among regional factors associated with at-home deaths. These findings may be informative for community planning to realize at-home deaths nationwide.
7 July 2026
Read appraisal →Journal of medical Internet research
Attitudes and Needs of Health Care Providers Toward Artificial Intelligence-Assisted Pediatric Palliative Care: Mixed Methods Study
BACKGROUND: While artificial intelligence's (AI's) transformative potential in health care is widely acknowledged, its application in highly sensitive, humanistic domains like pediatric palliative care (PPC) remains largely unexplored. OBJECTIVE: This study aims to explore the attitudes and needs of health care providers on the PPC assisted by AI, with the goal of informing future development and implementation of AI systems in this field. METHODS: This was an explanatory sequential mixed methods study consisting of a nationwide cross-sectional questionnaire survey (March-April 2025) followed by qualitative semistructured interviews (August-October 2025). The quantitative study aimed to investigate PPC health care providers' experiences, attitudes, and needs for the application of AI. Participants included team members of all recognized PPC teams in mainland China. The qualitative study aimed to explore in greater depth the potential future roles of AI in this field, as well as the features of an ideal AI-assisted tool for PPC. Potential interviewees were recruited from the pool of quantitative survey respondents. RESULTS: Among 352 survey respondents, most (n=205, 58.24%) reported moderate familiarity with AI, with large language models being the most commonly used (n=280, 79.55%). Among large language model users, over half (161/280, 57.50%) reported using them for clinical purposes. Attitudes were generally positive: 67.05% (236/352) believed AI's benefits would outweigh drawbacks, and 75% (264/352) considered its implementation feasible. The most desired applications were patient and family education (276/352, 78.41%) and symptom management (257/352, 73.01%). Interviews with 17 providers revealed three themes: (1) clinical roles and boundaries, (2) elements for clinical integration, and (3) challenges in development and deployment. CONCLUSIONS: This study reveals that PPC providers express positive attitudes and strong demand for AI-assisted clinical work. Furthermore, the research clarifies appropriate roles for AI, outlines elements for clinical integration, and highlights potential challenges in development and integration. This study provides evidence for the feasibility of AI application in PPC and offers guidance for the future development and deployment of AI tools.
5 July 2026
Read appraisal →Journal of medical Internet research
Large Language Model Versus Multidisciplinary Team: Feasibility Study of Pancreatic Cancer Management Recommendations
Of 269 pancreatic cancer multidisciplinary team cases, 125 complete structured cases were evaluated. The chat interface model labeled ChatGPT-5.2 matched the multidisciplinary team's broad initial management category in 119 cases (95.2%, 95% CI 89.8%-98.2%). The end point was coarse, and the model was not version controlled, so findings only support supervised exploratory use.
2 July 2026
Read appraisal →BMJ supportive & palliative care
Goals of care discussions in hospitalised patients: systematic review of randomised trials.
IMPORTANCE: Structured communication tools and decision aids are recommended to facilitate goals of care discussions (GOCDs) in hospitalised patients, but their impact remains unclear. OBJECTIVE: To determine the effectiveness of communication tools and decision aids on GOCDs between healthcare providers, patients and substitute decision makers. DATA SOURCES: PubMed, Web of Science, CINAHL and ClinicalTrials.gov were searched from January 2015 to July 2025, with backward citation tracking to identify additional trials. STUDY SELECTION: Randomised trials of communication tools or decision aids for hospitalised adults or substitute decision makers were eligible, regardless of primary outcomes. DATA EXTRACTION AND SYNTHESIS: Trial characteristics, primary outcomes and methodological quality were extracted and assessed using the Core Grading of Recommendations, Assessment, Development and Evaluation framework. Random-effects meta-analyses were conducted when appropriate. RESULTS: 22 trials were included. Communication tools increased GOCD documentation (OR 1.46, 95% CI 1.04 to 2.05). Effects on resuscitation preferences were inconsistent (OR 1.84, 95% CI 0.95 to 3.60). Mixed effects were observed for concordant care, psychosocial outcomes and healthcare utilisation. Evidence certainty was moderate for most outcomes; several small pilot trials were rated low due to bias, imprecision or heterogeneity. Interventions were most effective when combining structured patient-facing or clinician-facing prompts such as videos, guides or electronic health record alerts. CONCLUSIONS AND RELEVANCE: Communication tools and decision aids improve GOCD documentation in hospitalised patients but show uncertain effects on other patient-centred outcomes or healthcare utilisation. Interprofessional training and system-level support may enhance impact, and future large trials should evaluate the effectiveness of facilitated GOCDs on important patient and health system outcomes.
1 July 2026
Read appraisal →BMJ supportive & palliative care
Time toxicity of patients with cancer enrolled in clinical trials: a systematic review and meta-analysis
PURPOSE: Time toxicity-the time patients spend receiving treatment, managing side effects, attending follow-ups and undergoing rehabilitation-is increasingly recognised as an important burden of cancer care. While time toxicity has been studied in routine clinical settings, it has rarely been quantified among patients with cancer enrolled in pharmacotherapy clinical trials. This systematic review aims to quantify time toxicity in this population. DESIGN: We searched Ovid MEDLINE, Embase and Cochrane CENTRAL from inception to 12 June 2025. Studies were included if they reported time toxicity among patients with cancer enrolled in clinical trials. Time toxicity was defined as calendar days with healthcare contact. Primary outcomes were (1) total days, (2) planned days and (3) unplanned days per month. Study quality was assessed using the Joanna Briggs Institute's (JBI) Checklist for Cohort Studies. RESULTS: Four retrospective studies reporting on an aggregate of 1809 patients were included. Two studies had low risk for bias and two had unclear risk of bias. Patients experienced time toxicity a mean of 7.6 days per month, with the highest burden in the first month of trial participation. Planned and unplanned days averaged 2.2 and 2.0 days per month, respectively. The ratio of planned to unplanned days remained consistent over time. CONCLUSIONS: Time toxicity is a substantial, under-recognised burden in cancer pharmacotherapy trials-approximately two times that experienced by non-participants. Its measurement and mitigation should be prioritised to improve patient-centred care, support shared decision-making and inform trial design, policy and consent processes. REGISTRATION: Study protocol preregistration: https://doi.org/10.17605/OSF.IO/BVY7C.
1 July 2026
Read appraisal →BMC palliative care
Factors associated with psychological distress among end-of-life care volunteers: a systematic review of quantitative and qualitative evidence
BACKGROUND: Volunteers are integral to end-of-life care, providing emotional, spiritual, and practical support. However, they often face emotionally demanding situations with limited training and supervision compared to professionals. Given the limited and fragmented literature on psychological distress experienced by end-of-life volunteers, this systematic review aimed to synthesise existing quantitative and qualitative evidence to identify factors associated with psychological distress. METHODS: We conducted a systematic literature review including qualitative and quantitative evidence. Five databases (MEDLINE, EMBASE, PsycINFO, Cochrane Database and Web of Science) were searched for original studies, complemented by citation and reference searches. Study quality was assessed using the Qualsyst tool. Quantitative findings were synthesised using an algorithm to evaluate evidence strength, and qualitative data were integrated through thematic meta-synthesis. RESULTS: Twenty-six studies (20 quantitative and 6 qualitative studies) met inclusion criteria. Quantitative research examined 49 volunteer-related, 18 service-related, and one volunteer-patient-interaction-related factor associated with anxiety, death anxiety, depression, burnout, and/or perceived stress. Moderate-strength evidence indicated that death anxiety was negatively associated with better health and well-being but unrelated to age, volunteer experience, or training. Furthermore, depression was negatively associated with volunteer training. Qualitative evidence was scarce, but highlighted additional patient-, interaction-, and service-level mechanisms. CONCLUSION: This review identifies a small, methodologically diverse evidence base on factors associated with psychological distress in end-of-life care volunteers. Quantitative evidence suggests a potential protective association between training and depression, though substantial heterogeneity limits firm conclusions. Limited qualitative evidence revealed patient-, interaction- and service-level factors that are rarely captured quantitatively. Robust theory-guided longitudinal studies are needed to better understand distress and resilience in this under-researched group.
28 June 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Structured yoga program as supportive care to enhance quality of life in head and neck cancer patients undergoing radiotherapy: a prospective matched controlled study
PURPOSE: Head and neck cancer (HNC) patients undergoing radiotherapy often experience significant deterioration in quality of life (QoL) due to physical and psychological challenges. This study evaluates the effect of a structured yoga program-including physical postures, breathing exercises, and meditation-on QoL among these patients. METHODS: A prospective matched controlled nonrandomized study was conducted at a Tertiary Care Centre in North East India. Then, 140 patients undergoing definitive or adjuvant radiotherapy were equally divided into experimental (yoga intervention) and control groups. QoL was assessed using the EORTC QLQ-C30 questionnaire at baseline, end of treatment, and two months posttreatment. The yoga intervention consisted of thrice-weekly sessions for two months. All primary statistical analysis was done using nonparametric methods. RESULTS: Statistically significant improvement was seen in the experimental group in global health status/QoL (p-value < 0.001), pain (< 0.001), financial difficulties (< 0.001), emotional functioning (0.001), and fatigue aspect (0.024). CONCLUSION: A structured yoga program significantly improved key QoL domains in head and neck cancer patients receiving radiotherapy. Yoga can be considered an effective supportive therapy in this population.
30 May 2026
Read appraisal →PloS one
Timely Integration of specialist palliative care into oncology care for patients receiving radiotherapy for bone metastases: A study protocol for the TIPZO-RT Randomized Controlled Trial
BACKGROUND: Patients living with advanced cancer often benefit from palliative care. Timely referral to specialist palliative care improves quality of life and reduces potentially inappropriate end-of-life care. Despite these benefits, specialist palliative care is frequently introduced late and inconsistently. This study evaluates whether systematically offering a consultation with the hospital palliative care consultation team (PCCT) to all patients referred for radiotherapy for symptomatic bone metastases improves satisfaction with care. PATIENTS AND METHODS: The Timely Integration of Palliative Care in Oncology care for patients referred for palliative RadioTherapy (TIPZO-RT) trial follows the Trials within Cohorts design and is embedded within the PRospective Evaluation of interventional StudiEs on boNe meTastases (PRESENT+) cohort. Following cohort enrollment, 246 patients will be randomized (1:1) to either the intervention or control group. Patients in the intervention group are offered a PCCT consultation, which they may accept or refrain from. Patients in the control group are not informed about the trial and continue to receive usual care. After four weeks, patient satisfaction with care (affective behavior, EORTC Satisfaction with Cancer Care core questionnaire (EORTC PATSAT-C33)) will be compared between the groups. Secondary outcomes include symptom burden, quality of life, overall survival, and palliative care utilization. Additionally, in the intervention group, patients' experiences with the consultation are evaluated. DISCUSSION: Integrating palliative care into oncological care for patients with advanced cancer is essential to deliver comprehensive, patient-centered care that addresses physical, psychosocial and spiritual needs. This pragmatic study may provide evidence to support timely integration of specialist palliative care for all patients with bone metastases who may benefit from specialist palliative care. Using the Trials within Cohorts design, this study generates real-world evidence on the acceptance or need for a consultation with the PCCT, while minimizing disappointment or response bias, as patients in the control group are not informed. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT06805396. Registered on 25-03-2025.
24 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
A systematic review of the assessment model for palliative care needs in cancer patients
BACKGROUND: Timely palliative care can reduce the disease burden and improve quality of life in patients with cancer. Although several studies have developed assessment models for palliative care needs in cancer patients, the quality and clinical applicability of these models remain unclear. OBJECTIVE: To systematically review existing assessment models for palliative care needs in patients with cancer, with a focus on their characteristics, predictors, risk of bias, and applicability. METHODS: A systematic search was conducted in PubMed, Cochrane Library, Embase, Web of Science, CINAHL, Scopus, China National Knowledge Infrastructure (CNKI) through September 12, 2025. Data extraction and evaluation were rigorously performed by two researchers based on the Prediction Model Risk of Bias Assessment Tool (PROBAST). RESULTS: A total of 5714 articles were identified, and eight studies were included, which covered 24 models for assessing palliative care needs. The sample size of the included studies ranged from 179 to 54,628, with areas under the curve ranging from 0.724 to 0.998. The models in all the included studies encompassed four categories of predictive factors: general demographic data, symptom/functional assessments, laboratory indicators, and treatment status. Five studies were rated as having a high risk of bias, primarily due to high risks associated with participants and conclusions, with generally low applicability. CONCLUSION: Existing models demonstrate potential for identifying patients with cancer who have increased palliative care needs using routinely collected clinical data. Commonly included predictors were symptom burden, functional status, laboratory parameters, treatment-related factors, and demographic characteristics. However, the overall body of evidence is constrained by a substantial risk of bias, particularly arising from inappropriate data sources, limited sample sizes, suboptimal handling of continuous variables, insufficient reporting of missing data, and the lack of robust internal or external validation. In addition, many models adopted mortality-based surrogate outcomes rather than clinically meaningful indicators of palliative care needs. Therefore, the currently available models should be interpreted with caution, and further high-quality model development and external validation are required before they can support broader routine clinical implementation. Future research should prioritize clinically actionable outcomes and incorporate patient-, caregiver-, and family-level factors to improve the relevance of these models for referral decisions and care planning.
12 May 2026
Read appraisal →Palliative & supportive care
Relational-temporal dignity at the end of life: Ethical foundations for the DiRePal model in the algorithmic age
OBJECTIVES: The increasing presence of artificial intelligence (AI), electronic patient-reported outcomes (ePROMs), and digital infrastructures in palliative care is transforming how clinical encounters are organized and how suffering is interpreted. These technological shifts heighten the risk of relational compression and a reduction of dignity to measurable outputs. This paper proposes the DiRePal model (Relational-Temporal Dignity in Palliative Care) as a philosophical framework to re-examine dignity beyond coherent narrative identity or autonomy-centered ethics, emphasizing relational presence, temporal sensitivity, and structural conditions of care. METHODS: A philosophical-ethical analysis informed by narrative identity (P. Ricoeur), ethics of alterity (E. Levinas), capabilities theory (M. Nussbaum), and care ethics (J. Tronto). Critical readings of dignity frameworks, AI ethics, and digital health literature were synthesized to develop a relational-temporal account of dignity and 2 operational concepts: the temporal dignity indicator and the architecture of prudence. RESULTS: While digital tools can enhance communication and support anticipatory care, they also risk reducing patients to data profiles, narrowing listening practices, and eroding opportunities for narrative, silence, and relational presence. The DiRePal model reframes dignity as a fluctuating, co-constructed achievement that depends on temporal attentiveness, ethical listening, institutional conditions, and prudent integration of AI and ePROMs. It further expands dignity to include post-biographical dimensions such as memory, grievability, and digital legacy. SIGNIFICANCE OF RESULTS: End-of-life care in the algorithmic age requires an ethics that recognizes dignity as relational, temporal, and structurally mediated. The DiRePal model offers clinicians and institutions a conceptual grammar to resist technological reductionism, protect time for presence, and safeguard the narrative and post-biographical continuity of persons whose voices may be fragmented, vulnerable, or digitally extended.
11 May 2026
Read appraisal →Palliative & supportive care
Definitional confusion in nurses' and physicians' attitudes toward euthanasia in India: A systematic review and meta-analysis
INTRODUCTION: In India, the term euthanasia is frequently used to describe a wide range of end-of-life practices, including withdrawal of life-sustaining treatment and administration of lethal drugs. Such usage diverges from more narrow definitions that restrict euthanasia to the intentional administration of lethal drugs. OBJECTIVES AND SIGNIFICANCE OF THE RESULTS: This systematic review and meta-analysis examines how euthanasia has been defined and operationalized in quantitative studies of Indian physicians' and nurses' attitudes, and estimates the prevalence of approval when euthanasia is defined narrowly. METHODS: Following PRISMA 2020 guidelines, searches were conducted in PubMed, EMBASE, PsycINFO, and CINAHL for studies published from 2010 onward. Two investigators independently screened studies, extracted data, and assessed risk of bias using the Mixed Methods Appraisal Tool (MMAT). Studies were included in the meta-analysis only if they reported attitudes toward euthanasia as narrowly defined. RESULTS: Nine studies met inclusion criteria for the systematic review. Definitions of euthanasia varied considerably, and several studies combined attitudes toward treatment withdrawal with attitudes toward the administration of lethal drugs. Four studies reporting on 519 nurses and physicians provided data suitable for meta-analysis. Approval of euthanasia, defined as the intentional administration of lethal drugs, ranged from 12% to 20%, with a pooled prevalence of 16% (95% confidence interval: 0.13-0.19). This prevalence is notably lower than in earlier reports on Indian healthcare professionals' attitudes. CONCLUSION: Definitional inconsistency substantially affects reported attitudes toward euthanasia in Indian research. When euthanasia is defined narrowly, approval among healthcare professionals is low and consistent across studies. These findings highlight the need for conceptual clarity in future research to support accurate interpretation of empirical data and to strengthen the contribution of studies on ethical attitudes to ethical and palliative care scholarship.
10 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Prevalence of antibody drug conjugated-induced nausea and vomiting (ADCINV) in patients with cancer
INTRODUCTION: Antibody-drug conjugates (ADC) have emerged as an important part of systemic treatment across disease sites. To date, there is no robust pooled prevalence estimate of nausea and vomiting induced by ADCs. Establishing such estimates is essential to determine if ADC-induced nausea and vomiting (ADCINV) represents a clinically significant problem warranting further research into antiemetic prophylaxis. Our aim is to report the prevalence of reported ADCINV across literature. METHODS: A systematic search of Medline, Embase, Cochrane CENTRAL and Web of Science was conducted from database inception until September 24, 2025. Articles were included if they reported nausea and/or vomiting due to ADCs used in cancer treatment, in the abstract. Pooled prevalence was reported. Subgroup analysis was conducted by ADC. Meta-regression was conducted by age and sex. Quality assessment was conducted. Type I error was set at 0.05. RESULTS: A total of 209 studies with 15,493 patients were included. Thirty-nine percent (95%CI, 36-42%) of patients experience any nausea, and 26% (95%CI, 23-29%) experience any vomiting. Younger patients are more likely to experience nausea; each 10-year increase in age is associated with a 12% decrease in nausea rates. Higher emetogenic ADCs include trastuzumab deruxtecan, sacituzumab govitecan, brentuximabvedotin and patritumab deruxtecan. Lower emetogenic agents include disitimab vedotin, telisotuzumab vedotin and rovalpituzumab tesirine. DISCUSSION: This is the first study to report prevalence of ADCINV across ADCs. It is a prevalent adverse effect akin to chemotherapy-induced nausea and vomiting that should be viewed as clinically relevant and further investigated to help develop optimal strategies related to antiemetics.
10 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Conducting a randomized controlled clinical trial on palliative care in patients with glioblastoma - what are the challenges?
PURPOSE: Patients with glioblastoma represent a highly vulnerable cohort as they often experience rapid health deterioration with severe symptom burden including neurological, (neuro)psychological, and psychiatric symptoms. The aim of this sub-analysis of the "Early Palliative Care for Patients with Glioblastoma" (EPCOG) trial was to investigate the specific challenges of conducting a multicenter, randomized, controlled, clinical trial in glioblastoma patients testing a specialized palliative care (PC) intervention. METHODS: We analyzed screening protocols and protocol deviations with respect to number and reasons for non-participation, skipped/delayed visits and attrition using descriptive statistics and content analysis of free-text comments. RESULTS: In total, 41.5% of 556 screened patients were enrolled. Main reasons for non-participation were lack of interest (25.7%) and low functional status (11.5%). Attrition due to death (57.6%) was higher than due to illness (5.2%) or other reasons (21.2%). Main reasons for visit deviations were structural issues (in > 50% of neurosurgical visits), health status, and patient request. Protocol deviations showed that specialized PC intervention visits were least frequently skipped (4.5%) compared to study-specific outcome assessment (10.1%) and neurosurgical (43.3%) visits. Further, only 11.0% of the specialized PC intervention visits were delayed compared to 22.3% of the outcome assessment and 56.4% of the neurosurgical visits. CONCLUSION: In this clinical trial involving glioblastoma patients, a high level of motivation among the study participants could be reached, as reflected by low protocol deviations during the specialized PC intervention and study-specific outcome assessment visits. Reasons for this might be a close guidance as well as a patient and caregiver-oriented communication, e.g., by a personal contact of the PC team in the intervention group, personal outcome assessment visits at patients' whereabouts, or the inclusion of a study nurse at each site. Considering the high vulnerability of glioblastoma patients is crucial when designing and conducting clinical trials.
2 May 2026
Read appraisal →Clinical & experimental metastasis
All-site radiotherapy for metastatic ewing's sarcoma: a short-term analysis of feasibility, response, and safety.
BACKGROUND: Metastatic Ewing sarcoma (EWS) has a poor prognosis. While metastasis-directed therapy benefits oligometastatic disease, the role of comprehensive all-site radiotherapy in widespread disease remains underexplored. This study aimed to preliminarily assess its short-term efficacy and safety. METHODS: This retrospective analysis included 21 consecutive metastatic EWS patients treated with helical tomotherapy (Aug 2024-Jun 2025). All known metastases and unresected primary tumors received radiotherapy (45-55 Gy in 20 fractions for most sites; 12-45 Gy for lung/pleural metastases). Concurrent systemic therapies included chemotherapy, tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors (ICIs), or combinations. Primary endpoints were local objective response rate (ORR, RECIST 1.1) at 2 months post-radiotherapy and acute toxicity (CTCAE 5.0). Systemic therapy subgroup analyses were exploratory. RESULTS: Median follow-up was 6 months (range 2-11). Among 77 target lesions, ORR was 61.0% (CR 48.1%), and disease control rate (DCR) was 97.4%. Soft tissue lesions had a significantly higher CR rate than bone metastases (78.3% vs 3.2%, p < 0.001), potentially influenced by RECIST 1.1 limitations and treatment heterogeneity. Median progression-free survival (PFS) was 6.0 months (95% CI: 2.30-9.70), and median overall survival (OS) was 8.0 months (95% CI: 6.69-9.31). Combination systemic therapy was associated with improved PFS (HR 3.94, 95%CI 1.32-11.78; p = 0.014), with chemotherapy-based regimens yielding the best PFS (8.5 months). TKI-containing regimens were linked to shorter PFS (4.0 vs 8.5 months, p = 0.048) due to selection bias. Acute toxicity was manageable, with grade 3 thrombocytopenia (19.0%) and pneumonitis (4.7%) resolving with treatment. CONCLUSION: All-site radiotherapy achieves promising short-term local control with manageable toxicity in metastatic EWS, demonstrating feasibility and a lesion site-specific response warranting further investigation. Systemic therapy, particularly chemotherapy, correlates with improved PFS. Given high systemic progression rates, long-term outcomes may benefit from integration with more effective systemic therapies, supporting future prospective trials.
2 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Predictive biomarkers of placebo response in patients with cancer: an exploratory analysis of the ABCD randomized clinical trial
PURPOSE: Placebo effect is commonly observed in symptom management randomized clinical trials. However, there are currently no established predictive biomarkers of placebo response. We examined the patterns of association between placebo response and baseline plasma cytokine levels for 10 symptoms in patients with cancer. METHODS: This is an exploratory analysis of the double-blind, randomized ABCD trial, which compared high-dose dexamethasone to placebo for dyspnea treatment in patients with cancer (clinicaltrials.gov; NCT03367156). The primary outcome was change in dyspnea intensity. Four plasma cytokines (TNF, IL-6, IL-8, and IL-10) and 10 Edmonton Symptom Assessment System symptoms were measured at baseline, day 7, and day 14. Generalized additive models and exploratory analyses were used to examine the patterns of association between baseline cytokine levels and symptom responses on day 7 and day 14 in placebo and dexamethasone groups. RESULTS: This analysis included data from 45 patients. In the placebo group, we observed a significant negative association (p < 0.05) between ≥ 1 of the measured cytokines' baseline levels across multiple symptoms on day 7 (5/10 symptoms) and day 14 (3/10 symptoms), including appetite, drowsiness, nausea, and pain. Exploratory analysis revealed a negative association in the placebo group in 33/40 cytokine-symptom response combinations for day 7 (p < 0.001) and 29/40 combinations for day 14 (p = 0.006). CONCLUSION: Our preliminary findings suggest patients with high baseline cytokine levels may be less likely to report placebo response for multiple symptoms. Upon further confirmation, these findings may have implications for future clinical trial design. In this exploratory analysis, we observed that patients with cancer were less likely to report placebo response for multiple symptoms if they had higher levels of baseline cytokines. These preliminary findings have important potential implications for placebo-controlled clinical trials, including patient selection, design of interventional controls, and trial interpretation. Additionally, they invite further research on possible mechanistic links between inflammation and placebo effect.
25 Apr 2026
Read appraisal →Clinical cancer research : an official journal of the American Association for Cancer Research
Becotatug Vedotin in Patients with Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck: A Multicenter, Phase IIa Trial
PURPOSE: This multicenter, phase IIa trial (NCT04868162) investigated the efficacy and safety of becotatug vedotin, an anti-epidermal growth factor receptor (EGFR) antibody-drug conjugate, in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) who have limited therapeutic options. PATIENTS AND METHODS: Patients with R/M SCCHN who progressed after platinum-based chemotherapy and/or programmed cell death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors, including those with multiple lines of prior therapy, were administered intravenous becotatug vedotin at either 2 or 2.3 mg/kg every 3 weeks. The primary endpoint was the objective response rate (ORR). RESULTS: Sixty-seven patients were enrolled (35 received 2 mg/kg and 32 received 2.3 mg/kg). The ORR was 20.9% [14/67, 95% confidence interval (CI), 11.9-32.6], with a median duration of response (DoR) of 10.9 months (95% CI, 2.6-15.1). The median progression-free survival (PFS) was 2.9 months (95% CI, 1.8-3.9), and the median overall survival (OS) was 6.7 months (95% CI, 5-8.9). Treatment-related adverse events (TRAE) were reported in 91% (61/67) patients, most commonly being rash (26.9%), pruritus (25.4%), constipation (23.9%), and anemia (20.9%). CONCLUSIONS: Becotatug vedotin demonstrated promising antitumor activity with a manageable safety profile in previously heavily treated R/M SCCHN, particularly at the recommended dose of 2.3 mg/kg, among patients who had failed platinum-based chemotherapy and PD-1/PD-L1 inhibitors (≤2 prior lines of therapy).
16 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Real-world incidence of nausea and vomiting induced by antineoplastic agents: insights and future directions from the Japanese adverse drug event report database
PURPOSE: Antineoplastic treatment commonly leads to nausea and vomiting (NV), which considerably affects the quality of life and adherence to therapy of patients. This study aimed to analyze the incidence of NV induced by antineoplastic agents using the Japanese Adverse Drug Event Report (JADER) database and to explore novel antiemetic therapies for oral antineoplastic agents. METHODS: Data from April 2004 to March 2023 were extracted from the JADER database. The analysis considered guideline-recommended antiemetics and involved the temporal evaluation of cases with NV. The onset patterns of NV were analyzed for each oral antineoplastic agent. The reported odds ratio was used to identify adjunctive medications that showed inverse associations with these symptoms. RESULTS: A large number of NV cases were reported for platinum compounds and irinotecan. Among the oral agents, a notable incidence of NV was induced by antimetabolites and tyrosine kinase inhibitors. A decreasing trend in the use of single-agent antiemetic therapy was observed from 2010. Distinct NV patterns were identified. Silodosin and meropenem emerged as potential adjunct therapies to suppress NV induced by oral agents. CONCLUSION: Although there is a trend toward improvement in NV management with increased adherence to antiemetic therapies, a substantial gap remains between guidelines and actual practice. The need for tailored management strategies based on the onset patterns of NV for specific agents has been emphasized. Investigating the mechanisms underlying the antiemetic effects of adjunctive therapies, such as silodosin and meropenem, may pave the way for new antiemetic options for oral antineoplastic agents.
9 Apr 2026
Read appraisal →J Med Internet Res
Use of Health and Welfare Technology in Palliative Care: State-of-the-Art Review
BACKGROUND: As more individuals live longer with complex conditions, the need for effective palliative care (PC) grows. It has been stated that access to PC should be integrated early and delivered in a timely manner to patients with life-threatening illnesses. Health and welfare technologies (HWTs) offer tools to enhance care delivery, particularly in home and rural settings. Although there is a profound lack of evidence regarding the impact when used in PC, it is necessary to critically assess the current state of knowledge regarding impacts and consequences of technologies, ensuring that their integration considers broader implications for patients, caregivers, and health care systems in PC. OBJECTIVE: This review explores health and welfare technology used in PC, aiming to inform practice and improve care quality. METHODS: This state-of-the-art review included empirical studies describing the use of HWT in PC for adult patients. We used a thematic synthesis approach to compare studies and provide a synthesis of the key points. RESULTS: Based on the inclusion criteria, 94 studies were included. PC is both a clinical specialty and an overall approach to care that focuses on improving quality of life and relieving suffering for patients and families facing serious illness, based on needs and not prognosis. HWT shows potential to increase access and continuity of care, for symptom management to support patients to remain at home and prevent frequent emergency visits. It can have the potential to build and remain relationships between patients, their families, and the health care team, as well as for interprofessional collaboration and support. However, there are challenges to overcome that might affect the quality of care when using technology. CONCLUSIONS: HWT shows potential as a complement to usual PC. Our findings point toward the importance of caution in choosing when to use HWT in PC, and for which patients.
1 Mar 2026
Read appraisal →BMC Palliat Care
Identification and mapping of mHealth interventions applied in palliative care in Sub Saharan Africa: a scoping review
BACKGROUND: Although palliative care is very essential for improving quality of life (QOL) by providing relief from pain and other distressing symptoms, its coverage in sub Saharan Africa remains remarkably low. Utilization of mHealth could be a fundamental healthcare system strengthening approach to enhance and promote palliative care in the region. There is paucity of evidence regarding evidence on the use of these interventions in SSA because it is a relatively new concept in the region. Therefore, there was need to identify and map the available/ applied mHealth interventions for palliative care in SSA basing on published and grey literature. AIM: To examine the nature and use of mHealth interventions for palliative care and factors influencing their use in sub Saharan Africa (SSA). METHODS: The review was based on the JBI methodology for scoping review. PUBMED, CINAHL, Embase and Google Scholar databases were searched for published articles with no time restrictions. Unpublished and grey literature was also searched for. Data was extracted from the retrieved sources and synthesized. The findings were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) in a comprehensive and transparent way. RESULTS: A total of 224 articles were identified and 35 of these met the inclusion criterion and were considered for the review. The results show use of mHealth interventions for palliative care in 12 countries of the SSA. Only 12 (35.3%) were app-based, 9(26.5%) were SMS-text-based, 4(11.8%) were telemedicine-based,5(14.7%) were phone call-based, 3(8.8%) were mixed while 1(2.9%) used wearable-sensor-based mHealth interventions. Key uses of mHealth interventions in palliative care included health strengthening, psychosocial support to patients and families, enhancement of compliance to appointments for patients, promotion of adherence to medication, health education, monitoring, evaluation and research and capacity building for palliative care health professionals. A number of influencing factors were identified and they included wide-spread telephone ownership and access, great robustness of telephone and internet connectivity, high degree of perceived usefulness and ease of use, feasibility and acceptability of mHealth. Also, vital barriers such as low levels of technological advancement/expertise, irregularity and paucity of electric power supply, high likelihood to compromise patients' privacy and confidentiality and high illiteracy rates among the population were articulated by the articles. CONCLUSION: About a quarter of SSA countries have incorporated mHealth interventions for palliative care, underscoring the need for further research and development of the technologies. These approaches are quite beneficial to SSA, where there is a disproportionate disease burden and an inadequate healthcare system.
1 Feb 2026
Read appraisal →J Pain Symptom Manage
First-Ever Global Ranking of Palliative Care: 2025 World Map Under the New WHO Framework
CONTEXT: Despite progress in policy and advocacy, global palliative care development remains highly uneven, with large segments of the population lacking access to quality services. A new WHO framework has provided an updated methodology for assessing national palliative care systems. OBJECTIVES: To assess the current state of palliative care development worldwide using the WHO framework and to produce the first global ranking of countries based on their performance across 14 indicators. METHODS: A cross-sectional, mixed-methods study was conducted across 201 countries and territories between 2023 and 2025. Trained national consultants conducted a structured survey based on WHO indicators. Scores were assigned across six domains: policy, essential medicines, service delivery, education, research, and community empowerment. Responses were validated and analyzed to produce a Global Development Score and to classify countries into four development levels: Emerging, Progressing, Established, and Advanced. RESULTS: Of the 201 countries assessed, 40% were classified as Emerging and 28% as Progressing, representing half the global population. Only 14% reached the Advanced level, and 17% were classified as Established. Significant gaps in access to essential medicines and specialized education persist-even in some high-income settings. Despite limited resources Thailand, Uganda,Chile, and Uruguay stand out as regional examples of advanced development. CONCLUSION: This study presents the first global ranking of palliative care development based on WHO indicators. The results highlight persistent disparities and offer a tool for targeted improvement. The Global Development Score enables countries to benchmark progress, identify gaps, and develop strategic responses to expand access and alleviate serious health-related suffering.
1 Nov 2025
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