Comment: The death of Harold Shipman
Andrew Hoy
pp 3-3
Dr Harold Shipman died on 13 January in Wakefield Prison. He hanged himself on the day before his 58th birthday. He was convicted in January 2000 of the murder of 15 people. However, it is estimated that he killed at least 215 mainly elderly people. As well as being the UK’s most prolific serial killer, what is most shocking is that his victims were his patients. They looked up to him as a trusted GP and friend. What significance does this have for those concerned with palliative care in both the UK and beyond?
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NSAIDs: are they effective in treating cancer pain?
Abdullah Alkhenizan, Larry Librach and Joseph Beyene
pp 5-8
Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown in several randomised clinical trials to be effective analgesics in mild-to-moderate cancer pain, both when studied as a single dose and with chronic dosing. According to the analgesic ladder for the management of cancer pain proposed by the WHO, NSAIDs should be used for mild-to-moderate pain. When pain persists or increases, opioids should be added to the NSAIDs to control pain. If pain persists, opioid potency or dosage can be increased.
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Breathlessness and fatigue in cardiac failure
Paul Paes
pp 9-11
Cardiac failure accounts for approximately 60,000 deaths in the UK each year. As well as causing high mortality, patients with heart failure suffer distressing and poorly controlled symptoms. Patients with cardiac failure have multiple symptoms, often for a prolonged period of time. This paper will concentrate on two symptoms that cause considerable distress to patients: breathlessness, and the related symptoms of cachexia and fatigue. It will focus on attempting to understand the reasons why these symptoms occur and thus point the way to treatment options.
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Case study masterclass 13: A man with no evidence of recurrent acute myeloid leukaemia
Carol Davis
pp 14-15
On a Friday afternoon, the hospital palliative care team receive a referral from the haematology team requesting urgent advice about analgesia in a 52-year-old man. The consultant who telephones offers to come round to your office to explain the problem.
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Case study masterclass 12 answers: Pain from head and neck cancer that was difficult for everyone
Carol Davis
pp 15-15
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The management of cancer-related fatigue
Heather Brown
pp 16-18
Fatigue is notoriously difficult to define, as it is such an individual experience, affecting people in very diverse ways. Ream and Richardson described it as, ‘A subjective, unpleasant symptom which incorporates total body feelings ranging from tiredness to exhaustion creating an unrelenting overall condition which interferes with the individual’s ability to function to their normal capacity’.
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Palliative care for minority ethnic groups
Gurch Randhawa and Alastair Owens
pp 19-22
According to the UK government’s NHS Cancer Plan published in 2000, hospice and community palliative care services are ‘among the best in the world’. Furthermore, the report outlines a commitment by the UK government to an ‘unprecedented increase’ in funding (£50 million by 2004) to expand palliative care service provision and to even out inequalities in access. A particular concern is that there appears to be reduced access to, or uptake of, palliative care services within deprived areas and within parts of the country where there are substantial minority ethnic group populations.
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Conducting research in the palliative care population
Angélique Sentilhes-Monkam and Dominique Serrÿn
pp 23-26
Research into palliative care is essential to improve both the care provided by, and the technical and interpersonal skills of, healthcare professionals. The first step is to establish suitable assessment criteria and the population to be studied.
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Bereavement in the classroom
Karen Lowton and Irene Higginson
pp 28-31
Around 2% of all children in the UK are bereaved of a parent before the age of 18. Many more children will experience the death of a grandparent, or rarely, a sibling, classmate or teacher, yet the impact that a child’s bereavement has on their social environment, and the efficacy of services designed to alleviate problems during bereavement have not been widely studied.
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Educating the young
Kirsty Warwick
pp 32-32
As the population ages, more and more people are destined to be diagnosed with cancer. This means one thing: we are all likely to be affected by cancer, whether through direct personal experience or through knowing someone who has the disease.
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Developments in palliative care services in the Netherlands
Ria de Korte-Verhoef
pp 34-37
The Netherlands has a population of approximately 16 million and had a total death rate in 2002 of 142,355. The death rate for patients with non-acute illness in 1997 was 55,365. The largest cohort was made up of patients who died of cancer (67%).
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