Comment: We need more evidence on opioid use in cancer pain
Julia Riley
pp 5-5
In July 2011, the journal Palliative Medicine published a special issue, which reviewed the supporting evidence (that is, the systematic reviews) for the updated 2011 European Association for Palliative Care (EAPC) guidance on opioids for cancer pain. Previous EAPC guidelines were published in 1996 and 2001. This recent update was funded by the European Union as one of the Sixth Framework projects. So, what have we learnt and what is new?
|
Pulsed radiofrequency for glossopharyngeal neuralgia secondary to oral cancer
Muhammad Zafar Khan, Arif Jamshed, Saad ur Rehman, Haroon Hafeez, Hassan Iqbal and Raza Hussain
pp 6-9
First described in 1910, glossopharyngeal neuralgia (GPN) is a rare form of neuropathic pain with an estimated incidence of 0.8 per 100,000. GPN bears many resemblances to, and is often confused with, the more common trigeminal neuralgia; however, it is a distinct clinical syndrome presenting with its own diagnostic and treatment dilemmas.
|
The lidocaine plaster: does it have a role in palliative care?
John McGuinness, Anna Robinson and Jason Ward
pp 10-13
The lidocaine 5% plaster (LP), a medicated adhesive plaster, is licensed in the UK for the treatment of postherpetic neuralgia (PHN), but more recently, the plaster has also started to be used in palliative care for indications outside of its licence. This article outlines the use of the LP to date and discusses its developing role within the palliative care setting.
|
Case study masterclass 60: A patient struggling with motor neurone disease
Anna Hume
pp 14-15
Mathew* is a 58-year-old university lecturer who has taken early retirement from his job. He and his wife Jill have decided to sell their home and spend time travelling around South America.
|
Case study masterclass 59 answers: Managing renal failure at home near the end of life
Helen Noble and Sheila Johnston
pp 16-16
|
OPCARE9 – optimising research for cancer patient care in the last days of life
Stephen Mason, Jane Dowson,Maureen Gambles and John E Ellershaw
pp 17-19
Changing health and demographic profiles across Europe and beyond highlight the emergence of a longer-lived and increasingly aged population. Projections indicate that across Europe, mean age at the time of death will rise from 78.5 years to an estimated 84.1 years by 2050, and that the proportion of the population over the age of 60 will rise from a current 22% (161 million) to 34% (236 million). These projections highlight an emerging burden of need that may place healthcare systems across Europe under considerable strain.
|
OPCARE9 work package 1 – signs and symptoms of approaching death
Steffen Eychmüller, Massimo Costantini and Franzisca Domeisen
pp 20-23
Achieving the best care of the dying should be recognised as a core clinical proficiency and an integral part of end-of-life care – as basic as diagnosis and treatment. Patients in the dying phase should be supported properly, integrating technical expertise with a humanistic and ethical orientation. Therefore, ‘diagnosing dying’ is regarded as a core competence during this process. Current pathways, such as the Liverpool Care Pathway for the Dying Patient (LCP), provide a framework that can support clinicians in identifying the beginning of the dying phase. However, the clinical assessment process of identifying when a patient is dying can be challenging and complex
|
OPCARE9 work package 2 – end-of-life decisions in Europe: shared experiences
Natasja JH Raijmakers, Lia van Zuylen and Agnes van der Heide
pp 24-26
End-of-life care often requires difficult decisions to be made by patients, their relatives and the clinical team. Numerous challenges exist, such as making decisions about whether or not to apply potentially life-sustaining, but sometimes burdensome, treatments (such as artificial hydration, nutrition, ventilation or dialysis), about resuscitation in the event of a cardiac arrest and about appropriate symptom control.
|
Deactivation of implantable cardioverter defibrillators at the end of life
Kate Shorthose and Janice Bailey
pp 27-29
Sudden cardiac death (SCD) is a major cause of death in the UK each year and most of these deaths are related to ventricular arrhythmias. Traditionally, anti-arrhythmic drug therapy was the only treatment choice for clinicians; however, the advance in implantable cardioverter defibrillator (ICD) technology has ensured that ICDs are now more effective than antiarrhythmic medication in preventing SCD.
|
Management of carcinoma of unknown primary in a Welsh cancer centre
Angel Garcia-Alonso, Irene Logan and Nick Smith
pp 30-33
Carcinoma of unknown primary (CUP) is a histologically proven metastatic malignancy for which the anatomic origin is not detectable after intensive investigations. CUP is still one of the most common cancer causes and accounts, on average, for nearly 5% of all diagnosed cancer cases. Clinical presentation, histologic appearances and natural history are heterogeneous in this group of patients, and this has made systematic evaluation of CUP difficult. The incidence varies both between countries and between different registries within the same country. Published series have quoted incidences that range from two new cases per 100,000 to almost 20 per 100,000 people.
|
Methods of building and improving the research capacity of hospices
Sheila Payne and Mary Turner
pp 34-37
Palliative care has grown steadily throughout Europe and the importance of developing an evidence base to underpin practice has been acknowledged. To build this evidence base, professionals need skills and knowledge about a range of research methods, and an organisational culture that values and prioritises research.
|
Storytelling as palliation: narrative exchange among professional caregivers
Paul J Moon
pp 38-40
Human beings remain vulnerable to the vagaries of perceptual context, including intrapersonal, interpersonal and sociocultural dynamics. In the context of palliative (and hospice) practice, a holistic strain (biopsychosocial, existential distress) is a permeating ghost, haunting the venues of end-of-life care. This makes sense, as professional caregivers’ polymodal faculties are exercised when tending to dying and mourning persons. Indeed, palliative care cannot be employed from a posture of neutrality, as related issues/concerns demand positional perspectives. Moreover, taxing phenomena may accompany such palliative caregiving, including secondary perceived losses and secondary traumatic stress.
|
Towards a good death: creating a compassionate community
Deborah Hall and Janet Shucksmith
pp 42-44
In developed societies, deaths occur predominantly among the elderly, and from chronic diseases. Trends towards rising longevity and the elimination of death from most infectious diseases mean that death is fairly predictable in its time of coming for a majority. Despite this, as a society we still seem keen to avoid a discussion of dying, and this lack of openness has adverse consequences. People are unnecessarily frightened about the process of dying, and others are unable to make crucial decisions about place of death because clinicians lack the vocabulary and confidence to initiate such discussions.
|
European insight: Together for Short Lives: uniting children’s palliative care services
Katrina McNamara-Goodger
pp 46-48
Children’s palliative care in the UK has been established since the 1980s. There has been considerable learning in relation to the care needs of, and services providing care for, children over the past three decades, but we recognise that there are considerable challenges and opportunities for the future. International cooperation in children’s palliative care is a reality, bringing the potential to take care forward – both within the UK, and across the globe.
|