The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.
GENERAL PRINCIPLES OF PALLIATIVE CARE
Delayed functional improvement after intracerebral hemorrhage (September 2022)
Functional improvement after intracerebral hemorrhage (ICH) can be slow and the temporal trajectory is often uncertain. In an analysis of individual patient data from two clinical trials in nearly 1000 patients with intracerebral or intraventricular hemorrhage, 72 percent of patients had a poor functional outcome at 30 days [1]. By one year, 46 percent had recovered further and achieved a good functional outcome, including 211 (30 percent) who were functionally independent. Acute ICH complications such as sepsis, new ischemic stroke, prolonged mechanical ventilation, hydrocephalus, and the need for a gastrostomy feeding tube were predictors of poor outcome at one year. These results support the practice of providing aggressive acute treatment of patients with ICH and sustained rehabilitation to help avoid premature withdrawal of support and improve long-term outcomes. (See "Spontaneous intracerebral hemorrhage: Secondary prevention and long-term prognosis", section on 'Functional recovery'.)
SYMPTOM MANAGEMENT
Lack of benefit of CBD oil for relief of symptoms in advanced cancer (December 2022)
Cannabidiol (CBD) is a naturally occurring molecule without psychoactive properties that can be procured by patients from legal marijuana dispensaries, online companies, or street suppliers. Although CBD oil is used by patients for a variety of conditions, there are few data on the risks and benefits in patients with cancer. A single phase II randomized trial of CBD oil for relief of symptoms in advanced cancer concluded that, compared with placebo, CBD oil did not add value to the reduction in symptom distress (including pain, nausea, vomiting, appetite loss, depression, or anxiety) provided by specialist palliative care [2]. Use of CBD oil cannot be recommended for symptom management in advanced cancer. (See "Management of poorly controlled or breakthrough chemotherapy-induced nausea and vomiting in adults", section on 'CBD oil' and "Management of cancer anorexia/cachexia", section on 'Cannabis and cannabinoids' and "Cancer pain management: Role of adjuvant analgesics (coanalgesics)", section on 'Choosing an agent for a therapeutic trial'.)
