Comment: A meeting point between palliative and supportive care
Marcel Louis Viallard
pp 91-91
European professionals involved in the care of patients in the palliative phase of an illness may ask themselves: what difference can there be between the terms ‘palliative care’ and ‘supportive care’?
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Topical opioids for painful skin ulcers: do they work?
Giovambattista Zeppetella
pp 93-96
In the past, analgesics have been divided into two groups – those acting peripherally and those acting centrally. In the former group, we had non-steroidal anti-inflammatory drugs (NSAIDs), which inhibit cyclo-oxygenase in peripheral tissue, while in the latter group opioids were thought to act solely in the brain and spinal cord. Recently, advances in pharmacology have challenged this strict distinction; not only have NSAIDs been shown to act in the central nervous system but opioids have also been shown to act peripherally.
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How common are auditory hallucinations in palliative care?
Elizabeth Freshwater and Pamela Choudhury
pp 97-98
Palliative care patients present with a wide variety of symptoms, and may endure a high level of debility before the symptoms can be adequately controlled. While some symptoms are common, with a wide evidence base for treatments, some are more unusual. Here, we present the case of a patient who had continuous auditory hallucinations for four months before referral.
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Can palliative care improve the symptoms during the terminal phase of dementia?
Mari Lloyd-Williams and Marilène Filbet
pp 99-101
Dementia is a progressive terminal illness for which there is currently no cure. The incidence of the disease increases from 1 in 1,000 in those below the age of 65 to one in five over the age of 85 years. As the number of the very elderly in our population increases, dementia will become more prevalent. There are many issues in the care of patients with dementia which parallel palliative cancer care.
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Measuring quality of life in patients with advanced cancer
Jonathan Rees, Ruaraidh MacDonagh, Dympna Waldron and Ciaran O’Boyle
pp 104-106
Mr C was referred for urgent urological assessment, having noticed the gradual onset of lower urinary tract symptoms and low back pain. On examination, he had a hard irregular prostate, consistent with a T4 carcinoma. His prostate-specific antigen (PSA) was elevated at 196.7 ng/ml, and an X-ray of the lumbar spine showed sclerotic metastases. A subsequent biopsy confirmed the presence of a poorly differentiated adenocarcinoma of the prostate and he was commenced on hormonal therapy (GnRH analogue).
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What do doctors actually do in the day hospice?
Sarah White and Miriam Johnson
pp 107-109
The provision of day hospices is increasingly seen as an essential part of palliative care services in the UK,1,2 but as Noble and Hargreaves have highlighted, the debate continues as to the role of the doctor in the multidisciplinary team in this setting.3 Concerns have been voiced over the increasing medicalisation of palliative care. Traditionally, doctors have been seen as paternalistic and taught to see patient mortality as a failure,4 in direct conflict with the underlying philosophies of palliative care
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Scott’s Parabola applied to palliative care
Andrew Davies
pp 111-111
Many techniques used in surgery are not evidence-based. Scott’s Parabola is a satirical model that describes ‘the rise and fall of a surgical technique’ (see Figure 11): the technique begins as a ‘promising idea’, then following initial encouraging reports becomes a ‘standard treatment’, then following subsequent discouraging reports ‘falls into disuse’.
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The cancer care triangle
Kyriaki Mystakidou, Eleni Tsilika, Efi Parpa, Lambros Vlahos and Elizabeth Patiraki
pp 112-114
The terminal phase of care begins when medical judgement indicates that the patient’s condition is worsening, and no treatment is available to reverse or arrest the progression towards death. At this point, the palliative care team takes over. The primary task of the team is to provide care and support to patients and their families through a holistic approach. The patient, their family and the palliative care team each form a corner of the cancer care triangle. Members of the triangle depend on each other for information, assistance and co ordinated function.
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The growth of palliative care for children in Latvia
Anthea Hare and Anna Gorchakova
pp 116-118
Latvia is one of the smaller Baltic countries with a population of 2.5 million people. In May 2004, the country joined the European Union.
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Establishing a multidisciplinary model for supportive care
Ivan Krakowski, François Boureau, Roland Bugat
pp 119-123
Today, everybody acknowledges the concepts of continuity and totality of care as being inherent to modern medicine. For several years now, there has been increasing yet inadequate awareness of the diversity of needs relating to the management of symptoms and disorders of all types – somatic, psychological and social – that occur at all stages of a serious illness.
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