A recent Palliative Care digest,
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Study Type: Retrospective chart review (single-centre)

Key Question: Is rotating between, or combining, sodium channel blockers (SCBs) effective and safe for refractory neuropathic pain in palliative care patients?

Key Findings:

• 45 SCB rotations in 32 patients (81% metastatic cancer); most switches were for persistent pain (29/45), with others for poor tolerability (11/45) or route change (5/45).
• Rotation appeared beneficial in 69% of cases; lacosamide↔oxcarbazepine switches were effective in both directions, suggesting no clear superiority of either agent.
• Dual SCB therapy (7/32 patients) was well tolerated and appeared effective in 6/7, supporting a rationale for combining agents with differing channel kinetics (slow vs fast inactivators).

Clinical Relevance: Supports a pragmatic approach in UK specialist palliative care of trialling SCB rotation or combination therapy before abandoning this drug class in refractory neuropathic cancer pain, where options are often limited.

Limitations: Small, retrospective, single-centre sample without control group limits generalisability and causal inference.

Study Type: Cost-effectiveness analysis using individual patient-level data from an RCT

Key Question: Is intravenous fosaprepitant more cost-effective than oral aprepitant (both with ondansetron/dexamethasone) for antiemetic prophylaxis in children receiving highly emetogenic chemotherapy?

Key Findings:

• QALYs were nearly identical between groups (fosaprepitant 0.0116 vs aprepitant 0.0118; difference 0.0002), indicating minimal clinical difference in effectiveness.
• In India, fosaprepitant cost more ($33.94 vs $19.73) with negative incremental net monetary benefit (-$15.59), indicating it was not cost-effective.
• In the USA, fosaprepitant was cheaper ($615.92 vs $809.73) with positive iNMB (+$173.81), favouring fosaprepitant.

Clinical Relevance: While this US/India-based analysis is not directly generalisable to NHS drug pricing, it highlights that antiemetic cost-effectiveness is highly setting-dependent, relevant to UK paediatric palliative/oncology formulary and drug procurement decisions.

Limitations: Cost estimates were payer-perspective and country-specific, limiting direct applicability to NHS costing structures or drug tariffs.

Study Type: Retrospective cohort study

Key Question: Can functional status (FIM score) at PCU admission predict survival and likelihood of home discharge in patients with terminal cancer?

Key Findings:

• Median OS was significantly longer with higher FIM scores: 40 days (high), 23 days (middle), 15 days (low) (p<0.01); FIM independently predicted OS (HR 0.58, 95% CI 0.40–0.83).
• Home discharge rates were highest in the high FIM group (62.1%) vs middle (24.7%) and low (27.5%) groups.
• FIM score and number of cohabiting caregivers independently predicted home discharge; optimal FIM cut-off was 87.0.

Clinical Relevance: Standardised FIM assessment at PCU admission could support UK MDTs in prognostication and realistic goal-setting for rehabilitation and discharge planning, aiding conversations about place of care.

Limitations: Single-centre retrospective design limits generalisability and causal inference.

Study Type: Secondary analysis of longitudinal survey data (cohort study)

Key Question: Does parental satisfaction with family coping relate to depression, anxiety, and prolonged grief at different timepoints after a child's cancer death?

Key Findings:

• At 6 months–2 years post-death, satisfaction with family coping was associated with significantly lower depression (β=-4.63, 95% CI -8.5 to -0.8), anxiety (β=-4.86, 95% CI -8.7 to -1.1), and prolonged grief (β=-8.21, 95% CI -14.9 to -1.5).
• This protective association did not persist at 3–6 years when adjusting for baseline mental health.
• Baseline rates of at least moderate depression (40%), anxiety (21%), and prolonged grief (46%) were high.

Clinical Relevance: Highlights a potential early bereavement window (within 2 years) where UK paediatric palliative/bereavement services could target family coping interventions to reduce psychological morbidity, though longer-term support needs likely require additional strategies.

Limitations: Very small sample (N=47) limits statistical power and generalisability.

Study Type: Retrospective cohort study (derivation and validation cohorts)

Key Question: Can PPI, PPS, and SPS—alone or combined—accurately predict death within 3 days in cancer and non-cancer palliative care inpatients?

Key Findings:

• In 166 cancer patients, PPI+SPS performed best (AUC 0.72, 95% CI 0.64–0.80), with SPS alone nearly equivalent (AUC 0.70, 95% CI 0.62–0.77).
• In 124 non-cancer patients, SPS alone and PPI+SPS showed similar, modest discrimination (AUC 0.69 for both).
• Combining tools offered only marginal improvement over SPS alone across both groups.

Clinical Relevance: For UK palliative care teams making rapid end-of-life decisions (e.g., Fast Track CHC funding, family communication), SPS offers reasonable but imperfect short-term prognostic discrimination in both cancer and non-cancer patients, suggesting current tools should supplement rather than replace clinical judgement.

Limitations: Single-centre retrospective design with modest sample size limits generalisability and warrants prospective external validation before clinical adoption.

Study Type: Pilot study (survey-based, descriptive)

Key Question: Can palliative care physician-led debriefing sessions help haematology/oncology fellows cope with professional grief and burnout?

Key Findings:

• 83.7% of respondents reported professional grief and 46.5% personal grief in the preceding 6 months.
• 88.4% found debriefing sessions provided space to process grief; 79.1% reported benefit after just one session.
• 100% of respondents wanted sessions to continue.

Clinical Relevance: Highlights a low-cost, palliative care-led intervention that UK deaneries/training programmes could adopt to address rising burnout and grief among oncology/haematology trainees, an area of growing concern within NHS workforce wellbeing initiatives.

Limitations: Small, single-centre pilot with no comparator group or validated burnout/grief outcome measures, limiting generalisability and causal inference.

Study Type: Structured narrative review (PRISMA 2020 guidance), including one RCT, one prospective study, case reports, and reviews.

Key Question: Does inhaled or nebulized furosemide reduce dyspnea in patients with advanced cancer, end-stage heart failure, or other palliative conditions?

Key Findings:

• Only one randomized, placebo-controlled crossover trial identified; it showed no significant dyspnea benefit versus saline or no treatment.
• Uncontrolled studies (case reports, small prospective work) reported subjective improvement but carried high risk of bias and small samples.
• Overall GRADE certainty of evidence was low to very low; optimising dose/delivery technique did not resolve inconsistent responses.

Clinical Relevance: UK palliative care clinicians should not currently adopt inhaled furosemide as routine breathlessness management, as evidence does not support efficacy beyond placebo despite theoretical rationale.

Limitations: Evidence base is sparse and heterogeneous, dominated by uncontrolled or low-quality studies, limiting confidence in conclusions.

Study Type: Cross-sectional pilot survey (self-selected online sample)

Key Question: How do patterns and reasons for kratom use differ between people with and without a cancer diagnosis?

Key Findings:

• Cancer patients reported using kratom specifically in relation to their diagnosis, primarily for pain and mental health symptoms.
• Non-cancer respondents used kratom for longer durations, generally for pre-existing chronic conditions unrelated to cancer.
• Sample size was small (n=136), limiting statistical comparisons; no effect sizes or significance testing reported.

Clinical Relevance: With increasing patient-initiated use of unregulated herbal analgesics, UK palliative care clinicians should proactively ask about kratom use, particularly given potential interactions with opioids and uncertain safety data, as it is not currently regulated as a medicine in the UK.

Limitations: Self-selected, anonymous online survey design introduces significant selection and recall bias, and findings are not generalisable.