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Purpose: Dry mouth is a highly prevalent and significant symptom in patients with advanced progressive diseases. It is a poorly understood area of research, and currently, there is no standardised outcome measure or assessment tool for dry mouth., Methods: To assess responses to self-reported dry mouth questions, the impact of dry mouth, methods used to reduce symptoms and relevance of the questionnaire. A cross-sectional multisite study of 135 patients with advanced progressive disease experiencing dry mouth. Participants were located in the inpatient, day care, outpatient or community setting., Results: The majority (84.4%) of patients rated their dry mouth as moderate or severe using the verbal rating scale (VRS). Seventy-five percent (74.7%) had a numeric rating scale (NRS) score of 6 or more for dry mouth severity. Patients reported that dry mouth interfered most with talking and was the most important function to assess (median score 6 out of 10) followed by eating (median 5) and taste (median 5). Taking sips of drink was the most common and most effective self-management strategy. Over half of patients (54.6%) also reported impact on swallow and sleep and associated dryness of lips, throat and nasal passages., Conclusions: This study highlights the severity of dry mouth in advanced disease. Important factors when assessing patients with dry mouth should include the functional impact on day-to-day activities including talking, dysphagia and sleep. Simple considerations for patients include provision of drinks and reviewing medications. This study could be used to develop a standardised assessment tool for dry mouth to use in clinical practice.

Background: making informed decisions about cancer care provision for older cancer patients can be challenging and complex. Evidence suggests cancer care varies by age, however the relationship between age and care experiences from diagnosis to death for cancer patients within the UK has not previously been examined in detail., Patients and Methods: retrospective cohort linking cancer registry and secondary care data for 13,499 adult cancer patients who died between January 2005 and December 2011. Cancer therapies (chemotherapy, radiotherapy, surgery), hospital palliative care referrals, hospital admissions and place of death were compared between age groups using multivariable regression models. Trends in cancer care over time, overall and within age groups were also assessed., Results: compared with adult patients under 60 years, patients aged 80 years and over were less likely to receive chemotherapy, radiotherapy, a hospital palliative care referral; or be admitted to hospital but were more likely to die in a care home. Overall, the percentage of patients receiving chemotherapy, surgery, hospital palliative care referrals and hospital admissions have increased while deaths in hospital have decreased. Deaths at home have increased for patients aged 80 years and over., Conclusion: older patients are less likely to receive cancer therapies or hospital palliative care before death. Further research is needed to identify the extent to which these results reflect unmet need.

Background: The UK National Health Service is striving to improve access to palliative care for patients with advanced cancer however limited information exists on the level of palliative care support currently provided in the UK. We aimed to establish the duration and intensity of palliative care received by patients with advanced cancer and identify which cancer patients are missing out., Methods: Retrospective cancer registry, primary care and secondary care data were obtained and linked for 2474 patients who died of cancer between 2010 and 2012 within a large metropolitan UK city. Associations between the type, duration, and amount of palliative care by demographic characteristics, cancer type, and therapies received were assessed using Chi-squared, Mann-Whitney or Kruskal-Wallis tests. Multinomial multivariate logistic regression was used to assess the odds of receiving community and/or hospital palliative care compared to no palliative care by demographic characteristics, cancer type, and therapies received., Results: Overall 64.6% of patients received palliative care. The average palliative care input was two contacts over six weeks. Community palliative care was associated with more palliative care events (p<0.001) for a longer duration (p<0.001). Patients were less likely to receive palliative care if they were: male (p = 0.002), aged 80 years or over (p<0.05), diagnosed with lung cancer (p<0.05), had not received an opioid prescription (p<0.001), or had not received chemotherapy (p<0.001). Patients given radiotherapy were more likely to receive community only palliative care compared to no palliative care (Odds Ratio = 1.49, 95% Confidence Interval = 1.16-1.90)., Conclusion: Timely supportive care for cancer patients is advocated but these results suggest that older patients and those who do not receive anti-cancer treatment or opioid analgesics miss out. These patients should be targeted for assessment to identify unmet needs which could benefit from palliative care input., Competing Interests: The authors have declared that no competing interests exist.

Objectives: This study aimed to establish the association between timing and provision of palliative care (PC) and quality of end-of-life care indicators in a population of patients dying of cancer., Setting: This study uses linked cancer patient data from the National Cancer Registry, the electronic medical record system used in primary care (SystmOne) and the electronic medical record system used within a specialist regional cancer centre. The population resided in a single city in Northern England., Participants: Retrospective data from 2479 adult cancer decedents who died between January 2010 and February 2012 were registered with a primary care provider using the SystmOne electronic health record system, and cancer was certified as a cause of death, were included in the study., Results: Linkage yielded data on 2479 cancer decedents, with 64.5% who received at least one PC event. Decedents who received PC were significantly more likely to die in a hospice (39.4% vs 14.5%, P<0.005) and less likely to die in hospital (23.3% vs 40.1%, P<0.05), and were more likely to receive an opioid (53% vs 25.2%, P<0.001). PC initiated more than 2 weeks before death was associated with avoiding a hospital death (≥2 weeks, P<0.001), more than 4 weeks before death was associated with avoiding emergency hospital admissions and increased access to an opioid (≥4 weeks, P<0.001), and more than 33 weeks before death was associated with avoiding late chemotherapy (≥33 weeks, no chemotherapy P=0.019, chemotherapy over 4 weeks P=0.007)., Conclusion: For decedents with advanced cancer, access to PC and longer duration of PC were significantly associated with better end-of-life quality indicators., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: As we age we experience many life changes in our health, personal relationships, work, or home life which can impact on other aspects of our life. There is compelling evidence that how we feel about our health influences, or is influenced by, the personal relationships we experience with friends and relatives. Currently the direction this association takes is unclear., Aim: To assess the level of published evidence available on causal links between self-rated health and personal relationships in older adults., Methods: MEDLINE, CINAHL, and PsycINFO searches from inception to June 2012 and hand searches of publication lists, reference lists and citations were used to identify primary studies utilizing longitudinal data to investigate self-rated health and personal relationships in older adults., Results: Thirty-one articles were identified. Only three articles employed methods suitable to explore causal associations between changes in self-rated health and changes in personal relationships. Two of these articles suggested that widowhood leads to a reduction in self-rated health in the short term, while the remaining article suggested a causal relationship between self-rated health and negative emotional support from family or friends, but this was complex and mediated by self-esteem and sense of control., Conclusion: While there is an abundance of longitudinal aging cohorts available which can be used to investigate self-rated health and personal relationships over time the potential for these databases to be used to investigate causal associations is currently not being recognized., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Assessing the efficacy and safety profiles of new oral direct Factor Xa (FXa) inhibiting anticoagulants compared with low-molecular-weight heparins (LMWHs) in elective total hip and knee arthroplasty (THA and TKA). The literature review only searched for randomised-controlled trials (RCTs) published before September 2011. Five eligible THA RCTs with a total of 12,184 patients and 5 eligible TKA RCTs with a total of 13,169 patients were identified. Mantel- Haenszel random-effects model was used to create meta-analyses of pooled data for each surgical group. The primary efficacy outcome was the risk of venous thromboembolism (VTE) and all-cause mortality, and the primary safety outcome was the risk of major bleeding. The THA and TKA primary efficacy outcome meta-analyses calculated relative risks (RR) of 0.55 (95% confidence interval 0.32 to 0.94) and 0.68 (95% confidence interval 0.53 to 0.87), respectively in favor of the oral direct FXa inhibitors. The primary safety outcome meta-analyses for the THA and TKA surgical groups revealed an RR of 1.27 (95% confidence interval 0.56 to 2.86) and 0.94 (95% confidence interval 0.44 to 1.98), which shows no significant difference between oral FXa inhibitors and LMWHs. This review demonstrated that oral direct FXa inhibitors have a superior efficacy to LMWHs when used as thromboprophylaxis in both THA and TKA. The safety profile of these new oral anticoagulants was not significantly different to that of LMWHs.

Background: Healthy lifestyles are an important facet of cardiovascular risk management. Unfortunately many individuals fail to engage with lifestyle change programmes. There are many factors that patients report as influencing their decisions about initiating lifestyle change. This is challenging for health care professionals who may lack the skills and time to address a broad range of barriers to lifestyle behaviour. Guidance on which factors to focus on during lifestyle consultations may assist healthcare professionals to hone their skills and knowledge leading to more productive patient interactions with ultimately better uptake of lifestyle behaviour change support. The aim of our study was to clarify which influences reported by patients predict uptake and completion of formal lifestyle change programmes., Methods: A systematic narrative review of quantitative observational studies reporting factors (influences) associated with uptake and completion of lifestyle behaviour change programmes. Quantitative observational studies involving patients at high risk of cardiovascular events were identified through electronic searching and screened against pre-defined selection criteria. Factors were extracted and organised into an existing qualitative framework., Results: 374 factors were extracted from 32 studies. Factors most consistently associated with uptake of lifestyle change related to support from family and friends, transport and other costs, and beliefs about the causes of illness and lifestyle change. Depression and anxiety also appear to influence uptake as well as completion. Many factors show inconsistent patterns with respect to uptake and completion of lifestyle change programmes., Conclusion: There are a small number of factors that consistently appear to influence uptake and completion of cardiovascular lifestyle behaviour change. These factors could be considered during patient consultations to promote a tailored approach to decision making about the most suitable type and level lifestyle behaviour change support.