Comment: Meeting the challenge of palliation beyond cancer
Scott A Murray
pp 213-213
Hospices provide excellent care for people with cancer, but are not set up to meet the needs of the increasing number of patients who die of other diseases. How can palliative care specialists help patients with other advanced illnesses? We can help hospital doctors and GPs identify when their non-cancer patients might benefit from a palliative care approach, and support them to provide top quality end-of-life care in hospitals, care homes and at home.
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Pain management in patients with renal impairment
Dylan Harris
pp 214-216
The World Health Organization (WHO) analgesic ladder is a well-established and validated approach to managing pain. While it can be used for patients with renal failure, or with another primary diagnosis and concurrent renal impairment, careful consideration should be given to the choice of drug at each step, and the drug dose and frequency should be adjusted accordingly.
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Bisphosphonate infusions for hypercalcaemia of malignancy
Elizabeth Brown and Kath Lambert
pp 217-220
Hypercalcaemia is the commonest life-threatening metabolic complication of malignancy, affecting approximately 10–20% of patients with advanced cancer. The incidence varies widely between cancer types, occurring most frequently in multiple myeloma, breast, renal and squamous carcinomas. It is associated with a poor prognosis, with a median survival of 30 days from presentation.
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Case study masterclass 40: A lung cancer patient with caring responsibilities making hospitalisation difficult
Jacqueline S Nicol and Isabel Dosser
pp 221-222
You are a qualified community nurse and have been asked to visit Mrs Weir, known as Meg, who was diagnosed with lung cancer three months previously. She has been attending the hospital cancer centre for investigations and, following a confirmed diagnosis of lung cancer, has been attending for chemotherapy treatment. Since her diagnosis, Mrs Weir has not required any input from the community staff. Her son, who lives a few hundred miles away, has spoken to her GP by phone, as he is concerned and believes that she is more unwell than she says. The GP has requested that you visit her to assess the situation.
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Case study masterclass 39 answers: Facing an ethical dilemma in a patient with head and neck cancer
Isabel Dosser and Jacqueline S Nicol
pp 223-223
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Evidence-based medicine and the costs of palliative care
Paul W Keeley
pp 224-227
To understand the origins of the concept of quality-adjusted life-years (QALYs), one must first understand the nature of evidence-based medicine (EBM). EBM emerged as a response to the ideas of Archie Cochrane, as expressed in his 1972 monograph, Effectiveness and Efficiency. In this slim volume, Cochrane advocated the proper assessment of the effectiveness of medical interventions, where possible through the use of well-conducted randomised controlled trials –following the methodology advocated by Sir Austin Bradford Hill and the application of the evidence thus gained to clinical practice.
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Advancing palliative care research in sub-Saharan Africa: from Venice to Nairobi
Richard A Powell, Julia Downing, Faith Mwangi-Powell, Lukas Radbruch and Richard Harding
pp 228-233
Lamenting the ponderous development of palliative care research in Europe over the preceding 25 years, in his plenary address to the European Association for Palliative Care’s (EAPC) 4th Research Forum, held in Venice in May 2006, Professor Stein Kaasa identified multiple prerequisites to successful future palliative care research: a critical mass in research groups, dedicated funding, a national strategy for palliative care research and close operational links between academics and clinicians. In sub-Saharan Africa, despite the need for methodologically robust research to inform the delivery of effective and appropriate palliative care, none of these prerequisites exist.
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Can psychedelic drugs play a role in palliative care?
Ben Sessa
pp 234-237
Psychedelic drugs are agents that may assist a person in approaching existential issues. They enjoy a rich history in ancient, non-Western cultures and, more recently, in psychiatric research of the 1960s. After a 40-year hiatus, international trials are now under way to revisit the role of psychedelic drugs in assisting patients with terminal cancer to explore – and resolve – anxiety-inducing existential issues surrounding their illness.
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Complementary medicine can benefit palliative care – part 1
Moshe Frenkel and Vaishali Shah
pp 238-243
The need for palliative and supportive care for various symptoms of cancer is increasingly being recognised, as both the incidence of cancer and the life expectancy of cancer patients increase. At the same time, the use of complementary and integrative medicine (CIM) in patients with cancer is also increasing. CIM and palliative cancer care share the goals of promoting the wellbeing and improving the quality of life of patients.
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Palliative care in long-term settings: a new web resource
Katherine Froggatt and Katharina Heimerl
pp 244-246
New and important challenges are arising with the increase of the aging population, particularly in developed countries, where a significant proportion of older people now die in long-term care settings. In the UK, for example, about 20% of those aged 65 years or more die in care homes. Similarly, in Austria, increasing numbers of deaths take place in nursing homes: in 2003, 13% of all deaths occurred in such settings.
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Monitoring quality in an acute hospital-based palliative care service in Singapore
Angel Lee, Huei Yaw Wu and Allyn Hum
pp 247-250
Audit is an important component of service provision. However, the selection of audit tools and the proper interpretation and evaluation of findings continue to be a challenge in many areas of healthcare. Common audit methods include the use of key indicators, topic review, random case review, satisfaction surveys and adverse event reporting.
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