Researchers at the University of Technology Sydney are investigating novel approaches to treating symptoms that commonly affect patients with advanced illnesses. The Palliative Care Clinical Studies Collaborative (PaCCSC) is conducting multiple randomized clinical trials examining treatments for breathlessness, anxiety, depression, and other conditions affecting end-of-life care.
One active trial, BETTER-B, is examining whether mirtazapine, an antidepressant, can help alleviate chronic breathlessness in patients with chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD). Chronic breathlessness represents a major unmet need, as it persists despite optimal management of underlying conditions and current symptom relief measures. According to researchers, preliminary data suggests that serotonergic modulations may be beneficial, though rigorous evaluation has not yet been conducted. The study includes patients from multiple sites including Westmead Hospital, Concord Hospital, Calvary Health Care, and Barwon Health.
Another emerging trial investigates subcutaneous ketamine infusion for major depressive disorder in palliative care patients with advanced life-limiting illness. Most antidepressants have limited therapeutic benefits for patients with extremely short prognoses due to slow onset of action. Ketamine, however, shows promise as a rapid-onset antidepressant in the psychiatry literature, with high response rates for treatment-resistant depression, though effects are short-lived.
The PaCCSC also supports the Life-Space Assessment-Palliative Care (LSA-PC) study, which validates a tool to measure the degree to which home-dwelling palliative care patients can move freely and interact within their home and local community. A feasibility trial of lorazepam for anxiety in palliative care, funded by the Bethlehem Griffiths Research Foundation, aims to determine whether a larger Phase III trial is feasible. The study involves approximately 21 adult palliative care patients receiving lorazepam 2 mg twice daily or placebo for 12 weeks, with patient-reported outcomes assessed at intervals.
Additional trials address constipation, uraemic pruritus, and delirium management in palliative populations, all contributing to the evidence base for optimizing care for people with life-limiting illnesses.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.uts.edu.au/research/centres/impacct/palliative-care-clinical-studies-collaborative/paccsc-clinical-trials