David C Currow

• University of Technology Sydney

Background Long-term pathological breathlessness is a life-limiting symptom that risks taking control of the individual's life. We aimed to evaluate how locus of control (LOC), an individual's perceived control of present and past life events, relates to breathlessness in a middle-aged general population. Methods A population-based, cross-sectiona...

Introduction Optimally measuring improvements in chronic breathlessness in clinical practice and research continues to evolve. The aim of this study was to consider the performance of uni-dimensional measures in chronic breathlessness limiting exertion . Methods We report five measures of breathlessness (intensity: worst, best and average in the p...

Background Despite a strong basic science rationale, the effectiveness of opioids for chronic breathlessness and exercise endurance seen in laboratory-based studies has not been replicated in clinical trials. Methods Multicentre, Phase-3, parallel-group, double-blind, randomised placebo-controlled titration trial (5–10mg twice-daily oral long-acti...

Purpose The EQ-5D has been used to assess health related quality of life (HRQoL) in respiratory conditions. However, the core descriptive system may not be sensitive to all the HRQoL impacts of these conditions. To increase the sensitivity of the descriptive system, two respiratory specific bolt-ons, have been developed. Psychometric assessment of...

Background: Impaired health states can limit a person's mobility, often progressively for people with life-limiting illnesses. Quantifying mobility changes is crucial for individual clinical care and service planning. Objective: To explore any correlation between EQ-5D-5L's mobility dimension ratings and Life-Space Assessment (LSA) from a populatio...

Background: Sleep disturbance has a prevalence of 30-78% in patients with advanced cancer. While pharmacotherapy is common, randomized controlled studies (RCTs) investigating available agents are limited. This study examines the efficacy and safety of temazepam or melatonin versus placebo for sleep in advanced cancer. Methods: This is a multicenter...

Background: Long-term oxygen supplementation for at least 15 hours per day prolongs survival among patients with severe hypoxemia. On the basis of a nonrandomized comparison, long-term oxygen therapy has been recommended to be used for 24 hours per day, a more burdensome regimen. Methods: To test the hypothesis that long-term oxygen therapy used...

Background Adverse events of continuous subcutaneous infusion of lidocaine in people with neuropathic cancer pain have rarely been collected in a systematic way despite its use in clinical practice. The LiCPAIN trial aimed to determine the feasibility of conducting a double-blind randomized controlled trial of continuous subcutaneous lidocaine for...

Background Lidocaine infusions are used variably around Australia to treat people with neuropathic cancer pain. The LiCPAIN trial aimed to determine the feasibility of conducting a double-blind randomised controlled trial of continuous subcutaneous lidocaine for neuropathic cancer pain. The primary objective was Methods Palliative care inpatients...

Background The Stop Cancer PAIN Trial was a phase III pragmatic stepped wedge cluster randomised controlled trial which compared effectiveness of screening and guidelines with or without implementation strategies for improving pain in adults with cancer attending six Australian outpatient comprehensive cancer centres (n = 688). A system for pain sc...

Introduction Population cancer registries record primary cancer incidence, mortality and survival for whole populations, but not more timely outcomes such as cancer recurrence, secondary cancers or other complications that disrupt event-free survival. Nonetheless, indirect evidence may be inferred from treatment data to provide indicators of recurr...

Introduction Disability, resulting from altered interactions between individuals and their environment, is a worldwide issue causing inequities and suffering. Many diseases associated with breathlessness cause disability but the relationship between disability and the severity of breathlessness itself is unknown. This study evaluated associations b...

Introduction Little is known about replacement costs of care provided by informal carers during the last year of life for people dying of cancer and non-cancer diseases. Aim To estimate informal caregiving costs and explore the relationship with carer and decedent characteristics. Design National observational study of bereaved carers. Questions...

Aims The aim of this work is to describe opioid initiation and long‐term use after emergency department (ED) visits or hospitalizations in New South Wales, Australia, by patient, admission and clinical characteristics. Methods This is a population‐based cohort study, including all hospitalizations and ED visits between 2014 and 2020, linked to med...

There are no known estimates of the prevalence, severity and impacts from breathlessness in low- and middle-income countries. This study aimed to explore the prevalence, severity, self-attributed underlying conditions and impacts of breathlessness limiting exertion in community-dwelling adults in India. This exploratory, population-based online sur...

Objectives Family involvement in the lives of people who have dementia and live in long-term care is important, but family members may face challenges communicating and connecting with their loved one as dementia progresses. A type of therapeutic humor (Laughter Care) delivered by trained specialists aims to engage people with dementia who reside i...

Background Older adults with cancer are a growing population requiring tailored care to achieve optimum treatment outcomes. Their care is complicated by under-recognised and under-treated wasting disorders: malnutrition, sarcopenia, and cachexia. We aimed to investigate the prevalence, overlap, and patients’ views and experiences of malnutrition, s...

Aims Oxycodone is the most commonly prescribed strong opioid in Australia. This study describes health service antecedents and sociodemographic factors associated with oxycodone initiation. Methods Population‐based new user cohort study linking medicine dispensings, hospitalizations, emergency department visits, medical services and cancer notific...

Background Breathlessness is a troublesome and prevalent symptom in the population, but knowledge of related factors is scarce. The aim of this study was to identify the factors most strongly associated with breathlessness in the general population and to describe the shapes of the associations between the main factors and breathlessness. Methods...

Rationale: Regular, low-dose, sustained-release morphine is frequently prescribed for persistent breathlessness in chronic obstructive pulmonary disease (COPD). However, effects on daytime sleepiness, perceived sleep quality and daytime function have not been rigorously investigated. Objectives: Determine the effects of regular, low-dose, sustai...

Background: Sleep disturbances, including insomnia, sleep-disordered breathing, and circadian rhythm disorders with potential consequences including excessive daytime somnolence and worsening fatigue, are prevalent yet largely under-measured and therefore under-managed problems in people receiving palliative care. This has the potential to negative...

Background Palliative care is characterised by heterogeneous patient and caregiver populations who are provided care in different health systems and a research base including a large proportion of observational, mostly retrospective studies. The inherent diversity of palliative care populations and the often inadequate study descriptions challenge...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Supportive and palliative care continues to evolve rapidly because of the increasing understanding of the pathophysiology of bodies under stress and the ability to intervene with less catabolic stress or other harms. This opens new ways of providing palliation for what were previously intractable problems. As such, there is a need to understand the...

Aim This study aimed to estimate the proportion of acute care nurses witnessing end‐of‐life dreams and visions or having these reported by a patient or relative, and to canvass their related attitudes and beliefs. Design A cross‐sectional survey study was conducted from February 2023 to May 2023. Setting/Participants Participants were medical and...

Background Patients are frequently admitted to hospital in the last year of life. Actively recognising patients at this stage gives the opportunity to plan future care. Methods We performed a cross-sectional survey of all acute medical and surgical inpatients at one tertiary hospital. Two simple screening tools, the indicators for a palliative app...

Background Breathlessness and fatigue are common symptoms in older people. We aimed to evaluate how different breathlessness dimensions (overall intensity, unpleasantness, sensory descriptors, emotional responses) were associated with fatigue in elderly men. Methods This was a cross-sectional analysis of the population-based VAScular disease and C...

Background Measuring health related quality-of-life (HRQoL) of the general population is essential to establish a reference for health outcome evaluations. This study sought to establish EQ-5D-5L population norms in Australia and to investigate the heterogeneity of HRQoL between sociodemographic variables. Methods A cross-sectional study comprisin...

Background The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed. Objective Th...

Preference-based outcome measures are commonly applied in economic analyses to inform healthcare resource allocation decisions. Few preference-based outcome measures have been specifically developed for palliative and end-of-life settings. This study aimed to identify which quality-of-life domains are most important to Australians receiving special...

Background Chronic breathlessness adversely impacts people with chronic obstructive pulmonary disease and their caregivers (family and friends), who may, in turn, experience significant burden due to their caregiving role. Sustained-release morphine may reduce chronic breathlessness in some patients, which may have an impact on caregivers’ perceive...

Background Ketamine at subanaesthetic dosages (≤0.5mg/kg) exhibits rapid onset (over hours to days) antidepressant effects against major depressive disorder in people who are otherwise well. However, its safety, tolerability and efficacy are not known for major depressive disorder in people with advanced life-limiting illnesses. Objective To deter...

Introduction Health-related quality of life (HRQoL) is essential for human wellbeing, influenced by a complex interplay of factors, and is reported lower in women than men. We aimed to evaluate which factors were the most important for HRQoL in a middle-aged general population. Methods This was a cross-sectional, multi-centre study of 29,212 men (...

Background Breathlessness that persists despite treatment of causal disease(s) is disabling, associated with high therapy-related costs and poor socioeconomic outcomes. Low resource countries bear a disproportionate burden of respiratory problems, often characterised by disabling breathlessness. Low-cost self-management breathlessness-targeted inte...

Introduction This study aimed to explore the relationship between breathlessness (severity and chronicity) and poor sleep quality. Methods Analysis of an Australia-wide, online cross-sectional survey carried out between 12 July - 2 August 2021. Community-dwelling adults were recruited from a web-based survey panel, with recruitment based on age, g...

Objective: To describe the harms in all arms of six consecutive multi-site, double-blind, placebo-controlled randomised clinical trials. Background: Controversies surround conduct of phase III clinical trials in palliative care. Concerns include risks to participants' safety, use of placebo arms, participants' burden, and justification when therapi...

Opioids (e.g. morphine) are affordable, effective interventions for cancer-related pain. However, equity of access to this key medication remains a global challenge, particularly in low- and middle-income countries. We aimed to explore views of palliative care providers and public-representatives about opioid analgesia access in two States in India...

Background Night eating syndrome (NES) is a unique eating disorder characterised by evening hyperphagia and nocturnal ingestions which cause significant distress and/or impairment in functioning. Despite the growing literature, NES remains poorly understood and under diagnosed. As such, this study aims to compare the prevalence of physical health c...

Introduction Long-term breathlessness is more common with age. However, in the oldest old (>85 years), little is known about the prevalence, or impact of breathlessness. We estimated breathlessness limiting exertion prevalence and explored (i) associated characteristics; and (ii) whether breathlessness limiting exertion explains clinical and social...

Background Malignant bowel obstruction is experienced by 15% of people with advanced cancer, preventing them from eating and drinking and causing pain, nausea and vomiting. Surgery is not always appropriate. Management options include tube or stent drainage of intestinal contents and symptom control using medication. Published literature describing...

Introduction Dying and death are public health concerns, but little is known about public health interventions that target populations living with life-limiting illnesses. This gap makes it difficult to identify best-practice public health interventions for this population and to achieve public health objectives. The study aimed to describe a publi...

Importance: There are known risks of using opioids for extended periods. However, less is known about the long-term trajectories of opioid use following initiation. Objective: To identify 5-year trajectories of prescription opioid use, and to examine the characteristics of each trajectory group. Design, setting, and participants: This populati...

Purpose Older age, risks from pre-existing health conditions and socio-economic disadvantage are negatively related to the prospects of an early-stage cancer diagnosis. With older Aboriginal Australians having an elevated prevalence of these underlying factors, this study examines the potential for the mitigating effects of more frequent contact wi...

Chronic breathlessness, a persistent and disabling symptom despite optimal treatment of underlying causes, is a frightening symptom with serious and widespread impact on patients and their carers. Clinical guidelines support the use of morphine for the relief of chronic breathlessness in common long-term conditions, but questions remain around clin...

There is increased awareness of palliative care needs in people with chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD). This European Respiratory Society (ERS) task force aimed to provide recommendations for initiation and integration of palliative care into the respiratory care of adult people with COPD or ILD. The ER...

TPS12146 Background: Management of neuropathic cancer pain (NCP) refractory to regular opioids remains an important challenge. The efficacy of pregabalin for NCP except chemotherapy-induced peripheral neuropathy has already been confirmed in two randomised controlled trials (RCTs) compared with placebo. Duloxetine offers the potential of analgesia...

Anorexia is experienced by most people with lung cancer during the course of their disease and treatment. Anorexia reduces response to chemotherapy and the ability of patients to cope with, and complete their treatment leading to greater morbidity, poorer prognosis and outcomes. Despite the significant importance of cancer-related anorexia, current...

Purpose The POPPY II cohort is an Australian state-based cohort linking data for a population of individuals prescribed opioid medicines, constructed to allow a robust examination of the long-term patterns and outcomes of prescription opioid use. Participants The cohort includes 3 569 433 adult New South Wales residents who initiated a subsidised...

Introduction: Prescriber behaviour is important for understanding opioid use patterns. We described variations in practitioner-level opioid prescribing in New South Wales, Australia (2013-2018). Methods: We quantified opioid prescribing patterns among medical practitioners using population-level dispensing claims data, and used partitioning arou...

Background: Emerging digital health approaches could play a role in better personalized palliative care. Aim: We conducted a feasibility study testing wearable sensor (WS)-triggered ecological momentary assessments (EMAs) and electronic patient-reported outcomes in community palliative care with patient-caregiver dyads. Design: All wore consumer-gr...

Healthcare innovations often represent important improvements in population welfare, but at what cost, and to whom? Health technology assessment (HTA) is a multidisciplinary process to inform resource allocation. HTA is conventionally anchored on health maximization as the only relevant output of health services. If we accept the proposition that h...

Introduction: Persistent breathlessness (breathlessness persisting despite optimal treatment for the underlying condition and resulting in disability) is a prevalent syndrome associated with chronic and life-limiting conditions. Improving the clinical recognition and assessment of persistent breathlessness is essential to ensure people are provide...

BACKGROUND The routine measurement of patient-reported outcomes in clinical cancer care using electronic patient-reported outcomes measures (ePROM) is gaining momentum worldwide. However, a deeper understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed. OBJECTIVE...

Background: Persistent breathlessness is debilitating and increases in prevalence with advanced age and at end of life. This study aimed to evaluate any relationship between self-reported global impressions of change (GIC) in perceived health and breathlessness in older men. Design: Cross-sectional study of 73-year-old Swedish men in the VAScular a...