Comment: Finding the best management for breakthrough cancer pain
Julia Riley
pp 57-57
Last year, the European Journal of Palliative Care (EJPC) carried a supplement on the treatment of breakthrough cancer pain. It provoked all sorts of comments. In the main, concerns were expressed regarding the influence that the pharmaceutical industry may have had on the content: there is good documentation that the main element of bias in medical literature is the source of funding. Could this bias have extended to the novel medications for breakthrough pain mentioned in the EJPC supplement?
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Breakthrough pain in cancer patients: the need for evidence
David Hui and Eduardo Bruera
pp 58-67
Cancer breakthrough pain is frequent, rapid in onset, intense in nature and short-lasting. It is associated with significant functional impairment and has a negative effect on a patient’s quality of life. When managing breakthrough pain, it is first necessary to ensure that the background pain is under control. Breakthrough pain should then be minimised using pharmacological and non-pharmacological measures.
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Case study masterclass 49: Rapidly progressive carcinomatous meningitis following breast cancer
Carol Davis
pp 68-69
Emma is a 48-year-old primary school teacher. She is married and has two daughters aged 17 and 15. A year ago, she developed a breast lump, which grew quickly over several weeks. A biopsy confirmed breast cancer and Emma went on to undergo a mastectomy followed by adjuvant chemotherapy. She remained well until very recently. Three weeks ago, she was seen urgently in the oncology clinic after complaining of intermittent severe headaches. She explained that the headaches were mainly in the back of her head and upper neck and that, when they were bad, they were excruciating. Usually a stoical woman who would ‘carry on regardless’, she needed to lie down in a darkened room when she had a headache. Neurological examination was normal. She was admitted to the oncology ward for further investigation.
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Case study masterclass 48 answers: Complex clinical decision-making: a duty of care
Anna Hume and Carol Davis
pp 70-70
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The need for advance care planning documentation
Jackie Richardson and Louise Watson
pp 72-74
Anumber of strategies and national frameworks have advocated advance care planning (ACP) in support of good end-of-life care; the most recent of these is the Department of Health’s End of Life Care Strategy. This advocates a patient-held ACP document that records the patient’s choices and wishes. The document should allow for reviews at different points in the patient’s disease trajectory and should be adaptable enough to be implemented in a variety of health- and social care settings. The information in it should be disseminated to all the healthcare professionals involved in the patient’s care.
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Research in palliative care – a four-principle justification
Vinnie Nambisan
pp 76-79
There is increasing awareness of the importance of research in palliative care. Despite this, there is a lack of evidence-based research in several important areas. Even with the recent focus on research as a means of improving patient care, given added weight by UK policy documents such as the National Institute for Health and Clinical Excellence guidance manual on palliative care for adults with cancer and the Department of Health’s End of Life Care Strategy, it seems likely that it will take some time to reverse the paucity of robust, high-quality research involving patients at the end of life.
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The use of emergency boxes for children with advanced cancer
Anna-Karenia Anderson, Maggie Breen, Nishanthiny Sebastian and Julie Mycroft
pp 80-83
Childhood cancer is rare. In the UK, only one in 600 children under the age of 15 develops a cancer, resulting in approximately 1,700 new cases each year. More than 70% of these children can now be cured. The most common childhood malignancies are leukaemias, brain and spinal tumours, and lymphomas. In the UK, children suffering from cancer are treated at one of 21 paediatric oncology centres (POCs). About 300 deaths a year from cancer in children under 15 were recorded on death certificates in the UK in the three-year period 2000–02. Most were due to recurrent or uncontrollable disease.
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The EAPC Task Force on Education for Psychologists in Palliative Care
Saskia Jünger, Sheila A Payne, Anna Costantini, Christine Kalus and James L Werth Jr
pp 84-87
It is argued that psychological aspects of care and psychosocial problems are essential components of palliative care. However, the provision of appropriate services remains somewhat arbitrary. Unlike medical and nursing care, which are clearly delivered by doctors and nurses respectively, psychological and psychosocial support in palliative care are not assigned exclusively to psychologists. It is generally expected that all professionals working in palliative care should have some knowledge of the psychological dynamics in terminal illness, as well as skills in communication and psychological risk assessment. On the one hand, palliative care education programmes for nurses and doctors comprise a considerable amount of psychological and psychosocial content. On the other hand, only a few palliative care associations provide explicit information on the role and tasks of psychologists in palliative care. Psychologists’ associations do not deal much with this issue either. If they refer to it at all, it is in the context of the care of the aged, end-of-life care or how to deal with grief.
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The role of rapid-onset fentanyl in clinical practice
Adam Burkey and Jane Ballantyne
pp 88-90
Fentanyl is a synthetic opioid that has a high lipid solubility. This drug and its many derivatives have expanded the indications and use of opioid drugs, in part because their high lipid solubility allows for new ways of administration. While transdermal preparations delay and extend fentanyl’s central activity, transmucosal fentanyl preparations achieve an onset that approaches the rapidity of effect of an intravenous injection. In theory, this makes transmucosal preparations better suited than traditional opioids, such as morphine, to treating a flare of pain that is both transient and intense.
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Palliative care and dementia: consensus in North Tyneside
Julian C Hughes, Alice Jordan, Pam Ransom, Eva Joanna Alexjuk, Isabel Quinn and Paul Paes
pp 92-95
As palliative care has sought to embrace conditions beyond cancer, the issue of palliative care in patients with dementia has come increasingly to the fore. In North Tyneside, an interdisciplinary team has been formed to look at ways in which palliative care might be implemented within the field of dementia. In this article, the members of this team review their work and the potential difficulties and areas of concern.
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European insight: HPPA: the rise of Hungarian hospice and palliative care
Katalin Hegedus
pp 98-100
The Hungarian Hospice Palliative Association (HHPA) was set up in 1995, when 19 hospices got together to form a national association. By 2009, it had grown to include 65 member associations. In 2006, the HHPA became a member of the Hungarian National Health Council. In 2007, it hosted the 10th Congress of the European Association for Palliative Care (EAPC) in Budapest. It is thanks to the HHPA that hospice care in Hungary is now financed by the national health insurance fund and that recommendations for hospice care have been included in the 2005 national programme for cancer control.
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