Anaesthesia
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Acute pain in cancer is an important but often overlooked feature of many patients' oncological journey. Cancer-related pain is associated commonly with more persistent pain states caused by both the disease and its treatment, but there are numerous causes of acute pain which can develop in patients with cancer. This pain is frequently severe, can be challenging to manage and its suboptimal control can directly impact on oncological outcomes. This narrative review provides an overview of several causes of acute pain in patients with cancer and management approaches. ⋯ As the oncological treatment landscape shifts and increasing numbers of novel treatments are employed, the number of causes of acute pain in patients with cancer rises. This pain is often managed by non-pain specialists and suboptimal control has a variety of deleterious effects. It is important that awareness of acute pain in the oncological population is increased and treatment approaches, which adopt a biopsychosocial structure, are optimised.
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Peri-operative allogeneic red blood cell transfusion is hypothesised to increase the risk of cancer recurrence following cancer surgery. However, previous data supporting this association are limited by residual confounding. We conducted an umbrella review (i.e. a systematic review of systematic reviews) to synthesise and evaluate the evidence between red blood cell transfusion and cancer recurrence. ⋯ Currently available evidence describes an association between peri-operative red blood cell transfusion and cancer recurrence, but this is mostly of low to critically low quality, with minimal control for residual confounding. Further research, at low risk of bias, is required to provide definitive evidence and inform practice.
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Poor wellbeing and stress in UK anaesthetic trainees impacts significantly on clinical performance, workforce retention and patient care. This study aimed to provide an overview of the evidence in this field and to explore the factors affecting wellbeing and stress in UK anaesthetic trainees. ⋯ The wide scope of phenomena of interest and measurement tools emphasises the challenge of defining and researching the concept of wellbeing. Despite these limitations, we have created a novel conceptual model of individual and external factors affecting UK anaesthetic trainees' wellbeing and stress. This supports an increased awareness and understanding of these factors, so that improvements can be made to practice and policy.
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Cancer complicates approximately 1 in 2000 pregnancies, with increasing incidence due to factors such as increased maternal age, obesity and advancements in antenatal testing. Anaesthetists play a crucial role in managing pregnant patients with cancer, both during delivery and in providing anaesthesia for oncological treatments. This review explores the challenges in anaesthetic management and specific considerations for common cancers encountered in pregnant patients. ⋯ Effective and safe anaesthetic management of cancer in pregnancy requires a multidisciplinary approach to balance maternal and fetal safety, with a focus on careful planning and individualised care.
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Peri-operative medicine is becoming increasingly relevant in the context of managing frail patients with cancer. This paper outlines how demographic shifts in populations are affecting cancer incidence and frailty rates, the relevance this holds to the management of cancer care, and the outcome measures that should be used to gauge best clinical practice to ensure patient-centred care. ⋯ There is need for a greater emphasis on quality-of-life measures alongside mortality and patient-reported outcome measures. We argue that holistic care approaches should play a greater role in enabling the measurement of outcome states beyond simply dead or alive.