Palliative care – the key facts

In September 2011, the United Nations hosted its second only Heads of State summit on health. The topic was non-communicable diseases. The four major disease streams were cardiovascular disease, respiratory disease, cancer and diabetes.

Each of these diseases has a group of people who will experience progressive disease with an increasing symptom burden. This burden will be seen in resource poor countries in increasing numbers in the decades ahead.

The Union for International Cancer Control (UICC) was active in advocating for good palliative care as part of the key planning that needs to be done. There was a small committee with representatives from around the globe who put together key fact sheets. Sadly the final communiqué of the summit only mentioned palliative once, but the resources developed are now being made widely available. They can be downloaded here and here, and focus on the practical things that can be done at a policy level to improve palliative care at a jurisdictional level.

Posted by David Currow, Professor, Flinders University, Australia.

Another eventful year for ATOME

Another eventful year for ATOME

After having achieved several important milestones last year, 2012 will be another eventful year for the Access To Opioid Medication in Europe (ATOME) project.

The overall goal of this project is to undertake applied research into the reasons why opioid medicines for moderate to severe pain and for the treatment of opioid dependence are often not available where needed and not used adequately in twelve European countries.

2011 – analysis, foundation, preparation

Last autumn, two six-country workshops were successfully realised in Bucharest (Romania) with delegations from all twelve target countries and a guest delegation from the Ukraine participating and developing national action plans for improving access to opioid medications. By the end of 2011, the “quick scan” of legislation had been performed with the aim to detect aspects that are a potential barrier to the access and availability of opioids in the respective country.

2012 – dissemination, intensification, implementation

This year, a series of national 1-day conferences will be started aiming at sensitisation of key stakeholders towards opioid availability in their country. The results of the quick scan of legislation will be followed up by a more in-depth analysis of the legislation in the target countries.

For more information, visit the ATOME session at the next EAPC World Research Congress in Trondheim (Thursday 7^th June 2012, 18:00 – 19:00) and the ATOME website.

Posted by Saskia Jünger, Dr. rer. medic., University Hospital Bonn, Germany.

Inflammation: important in cancer, important in symptoms

Mantovani described inflammation as the 7^th hallmark of cancer, citing its importance both for tumour development but also maintenance of the cancer state (Nature 2008). What is becoming clear is that inflammation has implications for symptom management as well.

Cancer cachexia is well recognised to have systemic inflammation at its core and possible therapies to treat this underlying inflammation are currently being investigated (preMENAC Study-PRC). Pain is also related to inflammation. This has been described as early as the 1^st Century AD by the roman encyclopaedist Celcus. Recently the specific link between pain and inflammation in cancer has been described (Laird et al, Pain 2011).

In addition to pain and cachexia, inflammation has been suggested as a cause of some symptom clusters (pain, depression, fatigue) in cancer. This cluster is similar to animal models of cytokine induced sickness behaviour and further examination of this in human studies would be of interest.

In treating cancer symptoms, we treat from the front; once symptoms have developed symptoms are attenuated, where possible, with medication. As our understanding of inflammation in symptom development increases, inflammation may provide a target in treating cancer symptoms at their genesis.

Such an approach would be of interest and potentially therapeutic value. Studies fully exploiting the pro-inflammatory response as a target in the treatment of cancer symptoms are eagerly awaited.

Posted by Barry Laird, MD, University of Edinburgh, UK and NTNU, Norway.

The making of guidelines

Pain is the most prevalent and feared symptom of all cancer patients, and studies show that a lot of patients are not sufficiently treated. This makes research on use of opioid analgesics crucial.

This week the European Association for Palliative Care (EAPC) guidelines for use of opioid analgesics in treatment of cancer pain, authored by PRC researchers, were published in Lancet Oncology. The guidelines are updates of previous recommendations, giving health care providers state-of-the-art evidence-based ways to treat cancer pain.

So how did these guidelines come to be?

1. Previous guidelines

The last version of the EAPC guidelines were reviewed and compared with other available guidelines, and consensus recommendations were created by an international expert panel. The content was divided into 22 topics.

2. Systematic reviews

Each topic was assigned to collaborators who developed systematic literature reviews, all using the same methodology when performing the reviews.

3. Writing recommendations

A writing committee combined the evidence derived from the reviews with the evaluations of the expert panel, and the results where endorsed by the EAPC Board of Directors. The outcome was 16 recommendations for use of opioid analgesics when treating cancer pain.

Posted by Ragnhild Green Helgås.

Health care versus health technology

Health care depends on health technology in almost everything we do.  We read and examine CT and MR scans on the screen, e-mail each other using the electronic health record system (EHR) within the hospital, request blood tests and read the result on the screen. We use technology in order to make things go faster and be more accurate.

It is a paradox that when communicating with people outside the hospital we depend in most cases on telephone and letters per post. Dealing with patients in early stages of their palliative care cancer disease trajectory, the communication might be random and infrequent. As the symptom burden increases, both the patient and the healthcare provider will have to speed up the conversation frequency and let more personnel take part.

The locations of the different health care providers responsible for the care of patients with palliative needs are scattered and spread-out, which in turn make analog communication ineffective and slow. This change of need makes the technological adjustment especially urgent.  We need a fast, easy, secure and inclusive way of communicating, especially in our field of medicine.

Painful areas marked on a CPBM

Like most areas of medicine, technology and health go hand in glove. This is one of the reasons why we in palliative care do research in the field of medical technology. One of the target areas of the Ministry of Health and the local health authority is to make safe electronic communication between health care providers and patients possible. The pilot program of a computerized pain body map (CPBM) is one of our contributions to the patients when the security and judicial problems are solved.

Posted by Ellen Jaatun.

Four vacant researcher positions

Through the Marie Curie Initial Training Networks project EURO IMPACT (European Intersectorial and Multi-disciplinary Palliative Care Research Training) 4 full-time senior researcher positions are available.

EURO IMPACT is a pan-European network project that aims to develop a multi-disciplinary, multi-professional and intersectorial educational and research training framework in Europe, aimed at monitoring and improving the quality of palliative care in Europe

The positions are based in Brussels, Lancaster, London and Amsterdam.

Please read more at the EURO IMPACT website, and if you have general questions please e-mail Koen Meeussen.

Posted by Patrick Reurink.

Oncology or palliative care?

In a recent interview with the magazine Cancer World, professor Stein Kaasa explains

why he thinks palliative care should be more integrated with “mainstream” oncology.

- About 60 % of cancer patients receive non-curative care. When you are giving chemo-and radiotherapy as part of life-prolonging treatment, where someone may live two to three years or more, they will have many symptoms and may often be needed to be supported at home.

Kaasa is a strong believer in that both oncology and palliative care will benefit from tighter integration.

- Patients deserve to have palliative care specialists as part of the oncology team during their cancer journey. It is better to have the voice of palliative care firmly integrated in the healthcare system.

An important argument in this matter is symptom control.

- Pain is a major problem for many patients when they are not diagnosed and followed-up appropriately. This calls for closer collaboration between specialists, e.g. on opioids and radiotherapy. We have to avoid patients falling into gaps, Kaasa says.

Posted by Ragnhild Green Helgås.