IPO Porto

Transitions from hospital to home in palliative care are emotionally and organisationally complex, influencing patients' dignity, safety, and continuity of care. Although previous studies have focused largely on professionals and informal caregivers, patients' own perspectives remain insufficiently understood. This study aimed to explore the lived experience of adults receiving palliative care during the transition from hospital to home. A descriptive phenomenological design guided by Giorgi's method was used. Twenty adults (n=20) recently discharged from hospital and receiving home-based palliative care were purposively recruited from three specialised community palliative care teams in northern Portugal and participated in in-depth individual interviews. Four essential themes described the transition experience: reconstructing home as a place of care and meaning; transforming relationships, highlighting the role of family and professionals; navigating loss and adaptation, where dependence evokes fear yet promotes acceptance; and system fragilities, including limited continuity and coordination, contributing to insecurity and distress. Overall, the transition was experienced as a tension between autonomy and vulnerability as patients reconstructed daily life in the context of serious illness. Improving transitional palliative care requires integrated and relationally attuned models that ensure continuity and timely support across care settings. Nursing practices should actively involve patients and families, strengthen home-based support, and promote dignity and safety during the transition from hospital to home.

Substance use spans a continuum from occasional use to hazardous use and clinically defined substance use disorders, and it can shape outcomes across the cancer care continuum. This structured narrative review synthesises evidence on how alcohol, tobacco, cannabis and opioids relate to cancer outcomes relevant to supportive care, including diagnostic timing, adherence, toxicity, symptom burden and survival. Methods We searched PubMed, Scopus and Web of Science for peer-reviewed studies published between January 2010 and April 2025 and narratively synthesised findings given heterogeneity in study designs and exposure definitions. Results Heavy or hazardous alcohol use and continued tobacco use are well-established carcinogenic exposures and are associated with delayed diagnosis, poorer treatment adherence, greater toxicity and inferior survival in observational studies. Evidence for cannabis and opioids is heterogeneous and predominantly observational; interpretation is limited by variable exposure measurement, including product composition and route of administration and dose, as well as polysubstance use, confounding and reverse causation. For opioids specifically, it is essential to distinguish analgesic use for cancer pain, physiological dependence and opioid use disorder. Conclusions To improve patient-centred outcomes, supportive oncology should embed routine screening, brief interventions and clear referral pathways, while implementing integrated oncology-addiction care models tailored to symptom burden and patient-reported outcomes. Future research should prioritise standardised exposure definitions, prospective longitudinal designs and evaluation of integrated care models in supportive oncology.

Metastatic urothelial carcinoma (mUC) is a lethal cancer with limited therapeutic options. Advances in genomic and transcriptomic research have deepened the understanding of mUC biology, leading to the identification of clinically relevant molecular alterations that represent potential actionable targets. This has broadened the treatment landscape of the disease to include novel agents, such as antibody-drug conjugates (e.g., enfortumab vedotin) and targeted therapies, including the pan-fibroblast growth factor receptor (FGFR) inhibitor erdafitinib. Genomic alterations in FGFR3 are well-established oncogenic drivers in bladder cancer and represent predictive biomarkers of response to FGFR-targeted therapies. The phase III THOR trial demonstrated the clinical benefit of erdafitinib in previously treated mUC patients harboring FGFR3 alterations and supported its subsequent approval by the European Medicines Agency. In this context, accurate molecular profiling is essential to guide patient selection for FGFR inhibitor therapy. Equally important is the standardization and timely implementation of FGFR3 testing in clinical practice to optimize treatment planning. This review addresses key considerations in FGFR3 testing in mUC and discusses how it can be routinely incorporated into clinical practice.

Emphysematous cystitis is a rare but underrecognized urinary tract infection characterized by gas formation within the bladder wall and lumen. It predominantly affects patients with predisposing factors such as immunosuppression and underlying urinary tract abnormalities. Delayed diagnosis may result in severe complications, including bladder necrosis, perforation, and septic shock.We describe the case of an adult female with an undifferentiated autoimmune disease under long-term corticosteroid therapy and known urinary tract dysfunction, who presented with prostration, abdominal pain, vomiting, and decreased urine output. She rapidly deteriorated into septic shock with multiorgan dysfunction involving the cardiovascular, renal, neurological, and hematological systems. Laboratory findings revealed markedly elevated inflammatory markers and severe acute kidney injury. Computed tomography (CT) of the thorax, abdomen, and pelvis demonstrated emphysematous cystitis with extensive gas tracking into the retropubic and extraperitoneal spaces. A contrast-enhanced study excluded bladder rupture. Broad-spectrum antimicrobial therapy and intensive supportive care were initiated and later tailored based on microbiological cultures isolating Klebsiella pneumoniae and Enterococcus faecalis. The patient showed progressive clinical, laboratory, and radiological improvement with prolonged conservative management, avoiding surgical intervention.This case illustrates an unusually extensive radiological presentation of emphysematous cystitis in an immunosuppressed patient with structural urinary tract abnormalities. CT played a pivotal role in diagnosis, exclusion of bladder rupture, and guidance of therapeutic strategy. Despite a severe initial presentation, early multidisciplinary management enabled a favorable outcome without surgical intervention.Emphysematous cystitis should be considered in septic patients with urinary symptoms and relevant risk factors. Prompt imaging, early targeted antimicrobial therapy, and close multidisciplinary follow-up are crucial to reduce morbidity and mortality, even in severe presentations.