Palliative Care (PC) aims to improve the quality of life for patients with cancer and their families and its benefits have been demonstrated by several studies. The objective of this systematic ...review is to assess the integration of PC in the content of guidelines/pathways of adult cancer patients in Europe.
We included studies of adult patients with cancer published from 01/01/1995 and 31/12/2013 in Europe in six languages. We searched nine electronic databases, hand-searched six journals and also performed citation tracking. Studies were ranked using Emanuel's Integrated Palliative Care (IPC) criteria, a tool containing 11 domains to assess PC content in guidelines. Two reviewers screened the results and narrative synthesis has been employed.
We identified a total of 28,277 potentially relevant articles from which 637 were eligible for full-text screening. The final review included 60 guidelines and 14 pathways. Eighty percent (80%) of the guidelines/pathways emphasize a holistic approach and 66% focus on PC interventions aimed at reducing suffering. Fifty seven percent (57%) did not discuss referral criteria for PC. Of all studies, five fulfilled at least 10/11 IPC criteria. Differences existed with regard to the referral criteria for bereavement care and the continuous adjustment of goals of care.
Overall, most of the identified guidelines/pathways highlighted the importance of the holistic approach of IPC. The studies that were found to fulfil at least 10/11 Emanuel's IPC criteria could serve as benchmarks of IPC.
Integrated palliative care (IPC) involves bringing together administrative, organisational, clinical and service aspects in order to achieve continuity of care between all actors involved in the care ...network of patients receiving palliative care (PC) services. The purpose of this study is to identify literature on IPC in the Spanish context, either in cancer or other advanced chronic diseases.
Systematic review of the literature about IPC published in Spain between 1995 and 2013. Sources searched included PubMed, Cochrane Library, Cinahl, the national palliative care Journal (Medicina Paliativa), and Google. Evidence on IPC in care models, pathways, guidelines and other relevant documents were searched. Additionally, data were included from expert sources. Elements of IPC were considered based on the definition of IPC and the Emmanuel´s IPC tool. The main inclusion criterion was a comprehensive description of PC integration.
Out of a total of 2,416 titles screened, 49 were included. We found two models describing IPC interventions achieving continuity and appropriateness of care as a result, 12 guidelines or pathways (most of them with a general approach including cancer and non-cancer and showing a theoretical IPC inclusion as measured by Emmanuel's tool) and 35 other significant documents as for their context relevance (17 health strategy documents, 14 analytical studies and 4 descriptive documents). These last documents comprised respectively: regional and national plans with an IPC inclusion evidence, studies focused on IPC into primary care and resource utilisation; and descriptions of fruitful collaboration programmes between PC teams and oncology departments.
The results show that explications of IPC in the Spanish literature exist, but that there is insufficient evidence of its impact in clinical practice. This review may be of interest for Spanish-speaking countries and for others seeking to know the status of IPC in the literature in their home nations.
Cellular senescence is a stress response that activates innate immune cells, but little is known about its interplay with the adaptive immune system. Here, we show that senescent cells combine ...several features that render them highly efficient in activating dendritic cells (DC) and antigen-specific CD8 T cells. This includes the release of alarmins, activation of IFN signaling, enhanced MHC class I machinery, and presentation of senescence-associated self-peptides that can activate CD8 T cells. In the context of cancer, immunization with senescent cancer cells elicits strong antitumor protection mediated by DCs and CD8 T cells. Interestingly, this protection is superior to immunization with cancer cells undergoing immunogenic cell death. Finally, the induction of senescence in human primary cancer cells also augments their ability to activate autologous antigen-specific tumor-infiltrating CD8 lymphocytes. Our study indicates that senescent cancer cells can be exploited to develop efficient and protective CD8-dependent antitumor immune responses.
Our study shows that senescent cells are endowed with a high immunogenic potential-superior to the gold standard of immunogenic cell death. We harness these properties of senescent cells to trigger efficient and protective CD8-dependent antitumor immune responses. See related article by Chen et al., p. 432. This article is highlighted in the In This Issue feature, p. 247.
Since the approval of anti-EGFR and anti-PD1 monoclonal antibodies in head and neck squamous cell carcinoma, there is an increased interest in developing novel therapeutics in head and neck ...malignancies. The purpose of this study is to analyze all phase I clinical trials conducted at the Vall d'Hebron Institute of Oncology for head and neck cancers since 2010. We aimed to evaluate the proportion of phase I studies with dedicated cohorts for head and neck cancers, assessing the types of agents in development and tumor types included, as well as analyzing the patient characteristics participating in these trials.
We have reviewed all the phase 1 clinical trials conducted in the Early Drug Development Unit, from Vall d'Hebron Institute of Oncology from January 2010 to June 2023, and identify which of these studies have cohorts for head and neck cancers. We use descriptive statistics to describe the tumor types and drug types included in these cohorts. We have also collected data from all the patients with head and neck cancers, included in phase I clinical trials from January 2010 to December 2022 and describe tumor types and agents used to identify potential opportunities for development in head and neck tumors.
Among the 634 phase I clinical trials activated from 2010 to 2023, 151 clinical trials had at least one cohort for patients with head and neck malignancies. Most of these studies include other solid tumors, and only 2 studies were tumor-specific. The majority of the 151 studies with dedicated head and neck cohorts were focused on head and neck squamous cell carcinoma (84%), while only 21% and 2.8% included salivary gland cancers or nasopharyngeal carcinomas (7.5% of studies include two or more histologies). Sixty-two studies evaluated agents in monotherapy, while 38% evaluated combinations. The anticancer agents evaluated included: targeted therapy 131 (87%), immunotherapy 61 (40%), chemotherapy 17 (11%), and hormone therapy 1 (0.7%). The proportion of studies evaluating immunotherapies was higher in the studies with dedicated head and neck cohorts, in comparison to the global pool of phase I studies conducted in the unit (32.5%). Although the absolute number of phase I studies with dedicated head and neck cohorts has progressively increased (29 studies in 2022), the proportion compared to the global pool of phase I studies remained stable since 2016 ranging from 25-30% of the total.
From January 2010 to December 2022 we have included 275 patients in phase I clinical trials: 63% had HNSCC, 28% had salivary gland cancers, 8% had nasopharyngeal carcinomas, and 1% had other tumor types. The new agents evaluated included: immunotherapies (52%), targeted agents (41%), novel chemotherapies or antibody-drug conjugates (6%), and other therapies such as nanoparticles (1%).
There is an increasing interest in developing novel drugs for head and neck cancers. In recent years, 25-30% of the phase clinical trials conducted in our institution have at least one cohort dedicated to head and neck malignancies, especially HNSCC. Despite these positive trends, clinical trial opportunities for rare/less frequent head and neck cancers remain limited.
ABSTRACT Background: A suitable environment can encourage the practice of physical activity, being an easy option for the population, for this reason the main objective was to determine the influence ...of the urban environmental characteristics relate with the physical activity on adult people living on the Pamplona Area. Methods: Cross-sectional study based on the International Physical Activity and the Environment Network (IPEN Adult). Participants were selected in random and stratified from the Basic areas of health attached to resident's population in the Pamplona area, aged ranged between 18-65years old. A self-administered questionnaire was used, including a complete version of the Neighborhood Environment Walkability Scale scale, to evaluate the perception of the urban environmental factors. In addition, the extended version of International Physical Activity Questionnaire for the physical activity data collection was employed. Chi2 test was calculated and a multi variable analysis using non-conditional logistic regression. Results: The representative sample was composed of 905 subjects, 54,70% female. The perception of having footpaths near to their place of resident or workplace was greater in the group that practice moderated physical activity OR: 3,86 CI95% 1.70-8.74 and greater total physical activity (the summary of vigorous, moderated physical activity and walking) (OR: 2,61 CI95% 1.24-5.45). The people perception of having many places for walk in the neighborhood was associated with major habit of taking a walk (OR: 1,26 IC95% 1.01-1.58. Having sport spaces close to the workplace or place of resident was associated with major practice of vigorous physical s activity, OR: 1,46 CI95% 1.01-2.12. Conclusions: There is association between the most active participants and the urban environmental factors such as the trails or sport facilities.
RESUMEN Fundamentos: Un entorno adecuado puede favorecer la práctica de la actividad física, siendo una opción fácil para la población. El objetivo fue determinar la influencia de la percepción de los factores urbanísticos ambientales en el nivel de actividad física de las personas adultas. Métodos: Estudio transversal basado en el International Physical Activity and the Environment Network. Las personas participantes fueron seleccionadas de forma aleatoria y estratificada de la población de las zonas básicas de salud del Área Metropolitana de Pamplona entre las que tenían edad de 18 a 65 años. Se utilizó un cuestionario autoadministrado que incluyó la versión completa de la escala Neighborhood Environment Walkability Scale para valorar la percepción de los factores urbanísticos ambientales y la versión larga del International Physical Activity Questionnaire para recoger datos de actividad física. Se calculó la chi2 y se realizó un análisis multivariable mediante regresión logística no condicional Resultados: Participaron 905 sujetos (54,70% mujeres). Tener sendas de paseo próximas al domicilio o lugar de trabajo se relacionó con practicar actividad física moderada OR: 3,86 (IC 95% 1,70-8,74) y actividad física total (suma de actividad física vigorosa, moderada y caminar) OR: 2,61 (IC 95% 1,24-5,45). La presencia en el barrio de lugares a los que podían ir caminando se asoció con dedicar más tiempo a caminar OR: 1,26 (IC 95% 1,01-1,58) y disponer cerca del domicilio o lugar de trabajo de espacios deportivos se asoció conpracticar más actividad física vigorosa OR: 1,46 (IC 95% 1,01 - 2,12)*. Conclusiones: Existe asociación directa entre las personas que se declaran más activas y los factores urbanísticos ambientales, como sendas de paseo o instalaciones deportivas.
A suitable environment can encourage the practice of physical activity, being an easy option for the population, for this reason the main objective was to determine the influence of the urban ...environmental characteristics relate with the physical activity on adult people living on the Pamplona Area.
Cross-sectional study based on the International Physical Activity and the Environment Network (IPEN Adult). Participants were selected in random and stratified from the Basic areas of health attached to resident's population in the Pamplona area, aged ranged between 18-65years old. A self-administered questionnaire was used, including a complete version of the Neighborhood Environment Walkability Scale scale, to evaluate the perception of the urban environmental factors. In addition, the extended version of International Physical Activity Questionnaire for the physical activity data collection was employed. Chi square test was calculated and a multi variable analysis using non-conditional logistic regression.
The representative sample was composed of 905 subjects, 54,70% female. The perception of having footpaths near to their place of resident or workplace was greater in the group that practice moderated physical activity OR: 3,86 CI95% 1.70-8.74 and greater total physical activity (the summary of vigorous, moderated physical activity and walking) (OR: 2,61 CI95% 1.24-5.45). The people perception of having many places for walk in the neighborhood was associated with major habit of taking a walk (OR: 1,26 IC95% 1.01-1.58. Having sport spaces close to the workplace or place of resident was associated with major practice of vigorous physical s activity, OR: 1,46 CI95% 1.01-2.12.
There is a direct association between the practice of physical activity and environmental urban characteristics, such as the existence of paths of walk or sports facilities.
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