Palliative care and pain relief
The need for palliative care and effective pain relief has grown significantly over the last 3 decades. Knaul et al (2025) highlighted this issue in an updated analysis of the Lancet Commission on global access to palliative care and pain relief from 1990 to 2021.
Serious health-related suffering (SHS), a concept that was introduced in the original study, is defined as ‘suffering that cannot be alleviated without professional intervention, severely impacting physical, emotional, social or spiritual wellbeing’. Despite increasing recognition of palliative care as an essential component of universal health coverage, major disparities persist worldwide, particularly in low- and middle-income countries where 80% of the SHS burden is concentrated.
This study applied the newly published SHS 2.0 method, using data from the Global Burden of Diseases, Injuries and Risk Factors Study 2021 to estimate SHS from 1990 to 2021. Knaul et al (2025) found that the global burden of SHS rose by 74% during this period, reaching 73.5 million people by 2021, with population growth accounting for only half of this increase. SHS among non-decedents (patients living with long-term, distressing conditions) now represents 63% of the global burden, compared with 35% among those at the end of life.
Researchers improved non-decedent estimates by adjusting for double counting in conditions such as HIV, cancer, dementia and cerebrovascular diseases. They incorporated survivorship data and refined estimates for children and adults. The study categorised SHS by health condition, sex, age and income level, differentiating between decedents and non-decedents. It used country-specific disease data to assess trends and inform palliative care policies.
The findings underscore a shift in palliative care needs, with a growing proportion of SHS linked to non-communicable diseases such as cancer, cardiovascular conditions and dementia, particularly in high-income countries. While SHS from communicable diseases has declined proportionally, HIV remains a significant contributor, especially in Sub-Saharan Africa.
Additionally, SHS has shifted toward older populations, with the problem increasingly concentrated among women aged over 70 years in high-income countries, largely owing to dementia-related conditions. However, SHS remains prevalent in low-income countries among women aged 20–49 years, often linked to HIV/AIDS and other chronic conditions. The study also highlighted improvements in childhood health, with the proportion of SHS among children decreasing from 25% in 1990 to 14% in 2021. Still, the need for paediatric palliative care remains substantial in low-income regions.
The increase in SHS highlights the urgent need for health systems to expand access to palliative care services, particularly for non-decedents, who form the majority of those experiencing distress. Pain relief remains a critical issue, with millions lacking access to essential medications, such as opioids, for pain management.
The researchers called for integrated palliative care strategies that address both end-of-life needs and the growing burden of SHS, ensuring equitable access to care across all countries and income levels. Strengthening palliative care policies, improving workforce training and enhancing access to essential medicines are crucial steps toward reducing unnecessary distress and ensuring dignified care for all patients. Addressing these challenges is a pressing concern for community nurses and for all healthcare professionals committed to improving patient wellbeing.
Informal care time and dementia symptoms
Dementia affects approximately 55 million people worldwide and creates a significant economic burden. Community nurses recognise the vital role that informal caregivers play in supporting individuals with dementia. However, caring for someone with dementia is demanding and time-consuming, and the need for informal care is increasing as ageing populations continue to grow.
Handels et al (2025) carried out a secondary analysis using pooled data from 13 529 observations of 5369 individuals with dementia across nine European studies to understand how much time caregivers spend providing care and what factors influence this. The study focused on community-dwelling individuals diagnosed with dementia in clinical settings. Informal care time was measured using the resource use in dementia instrument, which captures time spent on basic and instrumental activities of daily living.
Dementia severity was assessed and the researchers applied a mixed-regression model adjusted for demographic factors. They used it to estimate informal caregiving time across dementia severities. Data were then harmonised across studies and missing values were addressed using multiple imputation techniques.
They found that informal care time varies based on the severity of dementia symptoms, including cognitive decline, functional disability and behavioural changes. According to this study, informal caregivers provided 3.3 hours of care on average per day. However, this varied significantly across countries and also depended on levels of dementia severity since cognitive decline led to increased care needs. Caregivers spent 0.5 hours more per day when a person advanced from mild to moderate dementia, and 1.3 more hours per day when the condition became severe. Functional disability was the strongest predictor of increased care time. Caregivers dedicated 1.2 extra hours per day for moderate disability and 2.7 extra hours for severe cases.
Behavioural symptoms such as aggression or anxiety also increased caregiving time, adding 0.3 hours for moderate symptoms and 0.6 hours for severe symptoms. Caregiving demands also varied by region. Caregivers in Eastern Europe and the Baltics contributed the highest number of hours, while those in Nordic countries provided the least, possibly as a result of the differences in formal healthcare support.
The study highlighted the heavy reliance on informal caregivers and the need for better support systems, such as financial aid, respite care and caregiver training programmes. Understanding how much time is spent on caregiving helps policymakers plan resources and improve dementia care services.
A prediction tool was developed from this study to estimate future caregiving needs based on disease progression. This tool can help governments and healthcare providers allocate resources efficiently. In summary, informal care is essential and demanding. The researchers suggested that as dementia cases increased, ensuring adequate support for caregivers was crucial for the wellbeing of both patients and their families. They concluded that improvements in planning and policies could help to reduce the burden on carers and improve quality of life for people living with this condition.
Healthy lifestyle and cancer mortality in Europe
Cancer remains a leading cause of mortality. Lifestyle factors such as diet, physical activity, smoking and alcohol consumption significantly influence cancer risk and overall survival (Figure 1).
Matta et al (2024) conducted a study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort that examined how changes in lifestyle impact all-cause and cancer-related mortality. Unlike previous research that assessed lifestyle factors at a single time point, this study used longitudinal data to track lifestyle changes over time, providing a more comprehensive understanding of their effects.
The study included 308 497 cancer-free adults, aged 35–70 years, from nine European countries. Participants completed detailed lifestyle questionnaires at baseline and again approximately 7 years later.
A Healthy Lifestyle Index (HLI) was developed to quantify lifestyle behaviours, incorporating smoking, alcohol consumption, body mass index (BMI) and physical activity. Each factor was scored from 0 to 4, with higher scores indicating healthier behaviours; the total HLI ranged from 0 to 16. The difference between the baseline and follow-up HLI was calculated to assess lifestyle changes. Statistical models adjusted for socioeconomic status and other potential confounders were used to analyse the relationship between lifestyle change and mortality.
Over an average follow-up period of 9.9 years after the second lifestyle assessment, 21 696 deaths were recorded, including 8407 resulting from cancer. Participants who improved their lifestyle score by more than one unit had a 16% lower risk of all-cause mortality and a 13% lower risk of cancer-related mortality compared with those whose lifestyle remained unchanged.
In contrast, those who worsened their lifestyle score by more than one unit had a 26% higher risk of all-cause mortality and a 19% higher risk of cancer mortality. The impact of lifestyle changes on mortality was observed across different socioeconomic groups, although individuals from lower socioeconomic backgrounds showed greater benefits from lifestyle improvements. The most influential factors in reducing mortality were smoking cessation and maintaining a healthy body mass index.
One limitation of the study was that diet was not included in the HLI score because of incomplete follow-up data. Additionally, some lifestyle changes may have been influenced by pre-existing health conditions, which could introduce bias. Nonetheless, this study reinforced the importance of promoting healthy lifestyle changes to reduce cancer risk and overall mortality. Even small improvements in lifestyle behaviours can have meaningful health benefits, highlighting the critical role of community nurses in patient education and health promotion. Encouraging smoking cessation, physical activity and weight management should remain key priorities in cancer prevention and long-term health strategies.