Comparison of two multifraction radiotherapy schedules in management of painful bone metastases: A single institution prospective study
Conclusion: A shorter treatment schedule (5 fractions) was equally efficacious as the standard schedule (10 fractions) in our setting. With the advantage of shorter overall treatment time and avoidance of re-irradiation, this schedule may be favourable for high volume centres.
Authors: Reed K Abstract The main goal of palliative care is to relieve suffering. Opioids are an essential part of the pharmacological options required to address suffering by helping to relieve the pain and chronic breathlessness that may be experienced by someone with a life-limiting illness. This paper considers the recent history and current issues of the 'opioid crisis' providing recommendations to which regulatory and peak bodies can work with the Australian government, ensuring consistent adherence to WHO guidelines maintaining access to evidence based opioid management for palliative care patients whilst a...
While palliative care (PC) continues to be integrated into pediatric oncological care, only a minority of patients with cancer receive a formal PC consult.
CONCLUSIONS: Currently, there is insufficient evidence to recommend the most appropriate management of drainage for malignant ascites among women with gynaecological cancer, as there was only very low-certainty evidence from one small RCT at overall high risk of bias. PMID: 31825525 [PubMed - in process]
A great deal of research has documented discrimination based on sexual orientation and gender identity (SOGI) against sexual and gender minority (SGM) patients in healthcare. This includes samples of oncological patients, samples of hospice and palliative care (HPC) patients, and many others. It is important to assess the progress of the HPC specialty in terms of inclusivity of SGMs for a few reasons. First, HPC is the specialty where patients coming to terms with their identity and life experience is paramount.
Palliative care aligns treatments with patients ’ values and improves quality of life, yet whether receipt of recommended elements of palliative care is associated with end-of-life outcomes is under-studied.
Abstract Individuals with terminal illness are dying behind bars and many state prison administrators have incorporated on-site hospice and palliative care services. Little is known, however, about these programs since a 2010 study of prison hospice characteristics. We provide an updated description and reflection of current hospice and palliative care programs in state prisons serving incarcerated persons with terminal illness. A cross-sectional survey was sent to representatives of all known prisons offering hospice and palliative care programs and services (N = 113). Questions were drawn from an earlier iterati...
Abstract Palliative and end of life care forms an important part of the role of any doctor in training, and an awareness of a structured approach to managing common symptoms and end of life care is essential. Common symptoms include pain, nausea and vomiting, constipation, and breathlessness. Anticipatory prescribing of the 4 A's (analgesic, anti-emetic, anxiolytic, and anti-secretory) is a proactive approach to ensure medication is available, if required, for common symptoms in the last hours to days of life, such as pain, upper airway secretions, anxiety, and agitation. Prescribing or medication errors in relati...
Pulmonary arterial hypertension (PAH) is often a progressive and ultimately fatal disease. It is characterized by an elevated mean pulmonary arterial pressure due to disease of the small pulmonary arterioles. PAH leads to a constellation of symptoms including dyspnea, fatigue, syncope, chest discomfort, and peripheral edema. Disease-targeted therapies for PAH produce symptomatic and functional improvement, but long-term survival remains uncommon without lung transplantation. Palliative care is appropriate to support patients with advanced PAH who typically have a high symptom burden.
CONCLUSION: This study highlights the challenge of opioid management in patients with serious illness, particularly when misuse or substance use disorder is present, and suggests areas for future research focus. Our next step will be to establish consensus on approaches to opioid prescribing decision-making and policy in seriously ill patients presenting to ambulatory palliative care. PMID: 31763926 [PubMed - as supplied by publisher]
Pain is one of the most feared symptoms of advanced, progressive disease and dying. It is a common but not universal experience in both advanced malignant and non-malignant conditions. A patient-centred approach involving systematic and thorough assessment, management and regular review can provide pain relief for most patients. Even in advanced disease, it is important to identify the underlying cause of the pain. Pharmacological management must be structured around the analgesic ladder, and clear guidance provided.