Comment: Taking up the EAPC challenge
Marilène Filbet
pp 139-139
What are your hopes and aspirations for the EAPC? One of the goals of the EAPC is to promote palliative care in European countries, and one of my goals is to continue the work already started by my predecessors in this field. The level to which palliative care has been developed is very different according to the country and the model concerned.
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Spinal cord compression requires early detection
Marie Joseph and René Tayar
pp 141-143
Spinal cord compression (SCC) is always a clinical emergency. It results in considerable morbidity and mortality. More than 80% of patients present early with severe spinal pain associated with radicular pain, without sensory, motor or sphincter disturbance.
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Use of atypical antipsychotic olanzapine as an anti-emetic
Mairi-Clare Fleming and ColetteHawkins
pp 144-146
Nausea and vomiting are common symptoms in patients with advanced cancer, with about 60% suffering nausea and 30% vomiting. Some patients have symptoms that remain refractory despite treatment with a range of conventional antiemetics. Therefore, it is not surprising that within palliative care there is a great deal of interest in new anti-emetic agents. This article sets out to review the current literature on the use of olanzapine, an antipsychotic drug that seems to have the potential to act as a broad spectrum anti-emetic.
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Percutaneous nephrostomy in patients with cervical cancer
Dorothy Dulko, Jane Duffy-Weisser and Paul Sabbatini
pp 147-149
Ureteric obstruction from extrinsic compression occurs frequently in patients with advanced cervical cancer. In many cases, pelvic disease precludes the placement of internal ureteric stents and external drainage to prevent renal failure is required. Over the past two decades, percutaneous nephrostomy (PCN) insertion has effectively replaced open surgical procedures. The relative ease, convenience, low cost and improved morbidity have encouraged the use of PCNs in patients with cancer.
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Case study masterclass 21: A patient with multiple medical problems
Anjali Mullick and Caroline Lucas
pp 150-151
A 75-year-old lady with disseminated carcinoma of the colon was admitted to your hospice unit for symptom control a week ago. She has had diabetes for ten years, which has been well controlled on an insulin regimen. She suffered an ischaemic right-sided cerebrovascular accident seven years ago, following a history of transient ischaemic attacks. At that time, she was also diagnosed with atrial fibrillation and has continued on warfarin.
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Case study masterclass 20 answers: Symptom control in a patient with carcinoid tumour
Sabrina Bajwah and Bernadette Lee
pp 151-151
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The modern history of morphine use in cancer pain
Jane Seymour and David Clark
pp 152-155
Although morphine crystals were isolated from opium in the early 19th century, it was not until the mid-20th century that rigorous principles were developed to guide the clinical application of these crystals in the problem of cancer pain. The dissemination of these principles has been paralleled by the production of synthetic morphine-related substances (opioids), the emergence of adjuvant therapies, and a diversification of methods for the delivery of opioids.
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The patient–professional partnership in supportive care
Pippa Winton and Gill Thomas
pp 156-159
Over recent years, new treatments and interventions have increased the number of patients who survive cancer, which has become a chronic illness. Some patients are disabled by the illness or treatment, and most live with uncertainty about their prognosis and life expectancy. For some years, palliative care professionals at Edenhall Marie Curie centre have been aware of the shift in the emphasis of their work with cancer patients, from terminal care to both rehabilitative and terminal care.
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The ethical approach to the caress at the end of life
Eytan Ellenberg
pp 160-162
It is quite difficult to understand ‘rationally’ the importance of communication at the end of life. This phase of patient care is painful, complex and generally widely diverse. Yet to consider such matters to be beyond the duties of the healthcare professional (HCP) would be to abandon patients to their suffering, to shut them up in isolation that could only exacerbate their situation. Often considered a background issue in healthcare, communication gains new importance at the end of life. In this final phase, when technology no longer plays a primary role in relationships with patients, new opportunities are created for caring, listening and discussion.
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Minimising gate-keeping in palliative care research
Peter Hudson, Sanchia Aranda, Linda Kristjanson and Karen Quinn
pp 165-169
Research into palliative care has the same benefits as for any patient population; it aids understanding of the illness experience of patients and family members, informs clinical care and provides a foundation for evidence-based guidelines to improve practice. Unfortunately, poor recruitment and sample attrition limit the quality of research.
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Palliative day care in Belgium: first observations
Wim Distelmans, Sabien Bauwens, Guy Storme and Louis Tielemans
pp 170-173
After two decades of intensive pioneering, palliative care is now well organised in Belgium. Unlike the original ‘hospice movement’ in the UK, which focused on improvement of intramural care, palliative care in Belgium has arisen from (extramural) home care. This is because of the existence of the ‘paradox of palliative home care’ in this country, which is, that staying at home or in a ‘home-like environment’ (preferred by up to 70% of Belgians) is more expensive for patients, but cheaper for society, while hospitalisation is very costly for society but fairly inexpensive for the patient.
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Cognitive behavioural therapy in the palliative care setting
Simon Dein
pp 174-176
The past 20 years have witnessed the growth of cognitive and behavioural treatments for medical disorders. Such treatments emphasise the role of cognitive factors in the perception and behavioural response to noxious symptoms. This perspective has two basic assumptions. First, individuals actively process information rather than passively receive environmental stimuli. Second, cognitions, emotions, physiological reactions, behaviours and the social environment are, to some extent, causally related. Cognitions can elicit emotions and act as an impetus for behaviour. Emotions, in turn, can elicit specific cognitions.
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