Treatment of cancer pain Russell K Portenoy MD
The Lancet, Volume 377, Issue 9784, Pages 2236 - 2247, 25 June 2011
Link to Full Text Article
SummaryIn patients with active cancer, the management of chronic pain is an essential element in a comprehensive strategy for palliative care. This strategy emphasises multidimensional assessment and the coordinated use of treatments that together mitigate suffering and provide support to the patient and family. This review describes this framework, an approach to pain assessment, and widely accepted techniques to optimise the safety and effectiveness of opioid drugs and other treatments. The advances of recent decades suggest a future that includes increased evidence-based targeting of specific analgesic interventions within an individualised plan of care that is appropriate throughout the course of illness.
Full-text Article available at : at : http://www.sciencedirect.com/science/article/pii/S0140673611602365
What's New at Affinity Palliative Care : Dr. Nancy Homburg shares interesting new things related to Palliative Care she comes across in her reading and web surfing. Enjoy!
Monday, June 27, 2011
Friday, June 24, 2011
A Patient's Journey with Palliative Care Services
Affinity Palliative Care Nurse, Sally Marohn discovered this YouTube video that elegantly and eloquently explains what Palliative Care means to this patient. She goes through all the emotions as she explains ... Enjoy!
Wednesday, June 15, 2011
Basic Symptom Control in Pediatric Palliative Care
Below is a link to a great resource on Pediatric Palliative Care.
Fortunately pediatric end-of-life care is rare, but we all want to have the best information when the need arises.
Nancy
Basic Symptom Control in Paediatric Palliative Care is available free to download at www.act.org.uk/symptomcontrol
UK children’s palliative care charity ACT has launched a newly revised and extended key resource for all doctors and nurses providing care and support to terminally ill or life-threatened children. The resource, Basic Symptom Control in Paediatric Palliative Care aims to provide doctors and nursing staff with an ‘all in one’ reference tool for symptom management and children’s palliative care medicines.
Basic Symptom Control in Paediatric Palliative Care contains information about how to appropriately treat a wide range of symptoms and contains 28 chapters on the most common symptoms and issues within children’s palliative care. It also includes a comprehensive prescribing formulary to support those prescribing in children’s palliative medicine, covering over 90 medicines. The formulary has been adapted from the Association of Paediatric Palliative Medicine’s master formulary for children’s palliative medicine.
Caring for babies, children and young people who have a terminal or life-threatening health condition can be very daunting for GPs and paediatricians. Many GPs may only care for one or two children with life-limiting conditions in their entire working life. Basic Symptom Control in Paediatric Palliative Care has been designed to address some of the fears and challenges that these professionals may face.
Basic Symptom Control in Paediatric Palliative Care has been developed and edited by Dr Satbir Singh Jassal, GP and Medical Director at Rainbows Children’s Hospice, with contributions and peer reviews from 30 leading paediatric and palliative care specialists. The resource has been published by ACT and is funded by the Department of Health. Basic Symptom Control in Paediatric Palliative Care is available free to download at www.act.org.uk/symptomcontrol
Monday, June 13, 2011
The Last 6 Years : One Man's Experience with Palliative Care Captured on Film
The last six years: one man's experience with palliative care captured on film
This short film (13 minutes) tells the real life story of Jim Ray Cooper and his experiences during the last six years of his life with advanced lung disease. Mr. Cooper was a Navy Frogman in the Korean War. The frogmen were predecessors for the modern day Navy Seals. Frogman training requires much higher levels of fitness, and during the course there is often a high elimination rate of trainees who do not make the grade. Mr. Cooper held a record for holding his breath for five minutes! It was indeed ironic that he developed severe lung disease and was chronically breathless and oxygen dependent. In 2005, Mr. Cooper was told that he was dying of advanced lung disease and that he had less than six months to live. At that time, he was suffering with severe breathlessness and pain and was terrified that he was going to suffocate to death as his lung disease worsened. Mr. Cooper was referred to Dr. Periyakoil's Palliative Care Clinic for pain and symptom management. Dr. Periyakoil and her team began providing intensive palliative care and were able to control his pain, depression, breathlessness, PTSD and other distressing symptoms. Once his symptoms were under control, Mr. Cooper regained his desire to live and spent the last six years of his life with his family. As palliative care experts had helped him live longer and feel better, Mr. Cooper became passionately committed to increasing public awareness of this new and important medical sub-specialty. To this end, he asked Dr. Periyakoil to film his final years and use his story to teach patients, their families and health care personnel about the process of serious illness and the benefits of palliative care. Further Information
ACP Decisions Patient Education Videos
Advanced Care Planning Decisions Video Library
http://www.acpdecisions.org/videolibrary.html
* Free registration is required to preview the videos.
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Additional info from an email sent to Dr. Homburg :
ACP Decisions Patient Education Videos Featured on CBS Evening News
BOSTON, Massachusetts (June 1, 2011) – The ACP Decisions Patient Education Videos were featured on Wednesday, June 1, 2011 at 6:30 pm Eastern Standard Time on the CBS Evening News. The news segment chronicled the experience of a patient diagnosed with advanced cancer as she and her family watched an ACP video that provided information about advance care planning and end-of-life care options.
The videos were an eye-opener for the patient and allowed her to make an informed decision consistent with her values. She credited the videos for helping her better understand what occurs in the final days of an illness: “When I saw that gentleman laying there on that ventilator – that was difficult. I wouldn’t want that for me or anyone else.” The segment concluded with a comment by Dr. Jonathan LaPook, CBS Evening News Medical Correspondent:
“When a patient comes to you and says ‘Doc I’m going to beat this’ and
part of you agrees with them or wants to agree with them, it’s hard to
start [an end-of-life] conversation and I have made the mistake in my very
own practice of delaying that conversation too long and watching
one of my patients needlessly suffer at the end of their life because I
was not able to properly coordinate end-of-life care. Yes it is a tough
conversation, but we owe it to our patients to have it.”
To view the segment, click here: http://www.cbsnews.com/stories/2011/06/01/eveningnews/main20068123.shtml
About Nous Foundation, Inc.
Nous Foundation, Inc. is a non-profit organization consisting of clinicians and researchers who want to empower patients with patient-centered, culturally appropriate, and easy to use video decision aids. Our carefully crafted video support tools undergo rigorous review by leading experts in medicine, geriatrics, oncology, palliative care, ethics, and decision-making. All of our videos are first studied in the research arena and include participants who represent geographic, racial, age, and religious diversity. Our video decision aids are filmed and produced by Drs. Angelo Volandes and Aretha Delight Davis along with colleagues from Harvard Medical School, Massachusetts General Hospital, Memorial Sloan-Kettering Cancer Center, Boston Medical Center, and the University of Chicago.
Contact: Angelo Volandes, MD, MPH,
Tel: 1-866-440-5969
Email: Angelo@acpdecisions.org
Thursday, June 9, 2011
Engage with Grace : The One Slide Project
To help ensure that all of us--and the ones we love--can end our lives in the same purposeful way we lived them.
The project encourages readers to download the slide, and share it where ever we can.
Be able to answer the questions for yourself, and for your loved ones.
Get the Conversation started.
They also encourage people to come back and share your story about how you used the slide.
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This link was shared by Dr. Jim Deming at Franciscan Health care in Tomah. Thank you!
We've had only limited success working within healthcare to get these conversations going.
It's encouraging for the general public to raise these issues also. Another example is the new PBS broadcast "Consider the Conversation". To check out a 5" clip of this show: http://www.netaonline.org/5minutes.htm#CONSIDER. This film also encourages everyone to discuss these issues.
-- Nancy
Article of Interest
Longitudinal Perceptions of Prognosis and Goals of Therapy in Patients With Metastatic Non-Small-Cell Lung Cancer: Results of a Randomized Study of Early Palliative Care.
Source
Massachusetts General Hospital Cancer Center, Boston, MA; State University of New York, Buffalo, NY; and Yale Cancer Center, New Haven, CT.Abstract
PURPOSE Understanding of prognosis among terminally ill patients impacts medical decision making. The aims of this study were to explore perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer (NSCLC) and to examine the effect of early palliative care on these views over time. PATIENTS AND METHODS Patients with newly diagnosed metastatic NSCLC were randomly assigned to receive either early palliative care integrated with standard oncology care or standard oncology care alone. Participants completed baseline and longitudinal assessments of their perceptions of prognosis and the goals of cancer therapy over a 6-month period. Results We enrolled 151 participants on the study. Despite having terminal cancer, one third of patients (46 of 145 patients) reported that their cancer was curable at baseline, and a majority (86 of 124 patients) endorsed getting rid of all of the cancer as a goal of therapy. Baseline perceptions of prognosis (ie, curability) and goals of therapy did not differ significantly between study arms. A greater percentage of patients assigned to early palliative care retained or developed an accurate assessment of their prognosis over time (82.5% v 59.6%; P = .02) compared with those receiving standard care. Patients receiving early palliative care who reported an accurate perception of their prognosis were less likely to receive intravenous chemotherapy near the end of life (9.4% v 50%; P = .02). CONCLUSION Many patients with newly diagnosed metastatic NSCLC hold inaccurate perceptions of their prognoses. Early palliative care significantly improves patient understanding of prognosis over time, which may impact decision making about care near the end of life.- PMID: 21555700 [PubMed - as supplied by publisher]
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