Friday, December 9, 2005

Many things mentioned briefly

Things are stacking up this week...

Supportive Cancer Care has a review on oxymorphone, highlighting the new oral short & long-acting formulations. It's written by Eric Promer from UCLA, but it's unclear to me whether the oral form of oxymorphone is actually now, or is going to be, available in the US (it's implied that these are now available, but not specified where, and Eric Prommer is from the States, but for the life of me I can't find any oral formulations of oxymorphone available here). Nevertheless--if it does become available--this will be a good reference for us oxymorphone novices, as the article reviews the pharmakokinetics, supporting clinical data, and opioid conversion data for oxymorphone. Leave a comment if you know of the status of oral oxymorphone in the US.

The New England J of Medicine has published a "medical progress" article on renal cell carcinoma. It's full of molecular biology. As I've recently been keeping track of mentions of palliative/supportive care in cancer review articles in major journals, I'll note that this one doesn't mention it at all. Thus, we have sentences like these...
"The poor prognosis of advanced renal-cell carcinoma demands an aggressive search for new therapeutic agents and strategies."
True, to be sure; but this poor prognosis also demands top-notch supportive and palliative care.

Chest has published the American College of Chest Physicians statement on end of life and palliative care for people with advanced cardiopulmonary disease. For professional society statements it is quite excellent--a very thorough overview. I particularly appreciated the mention of the need for better/more education for medical trainees on end of life/palliative care. In addition it has a section on care-giver (that is--nurses/docs/etc.) support/grief. I don't recall seeing this mentioned in any professional society statements before.

And finally, December's J of the American Geriatrics Society has multiple end of life related articles, too many to review...

DNR trends in patients admitted to nursing homes under the medicare benefit (rates vary widely geographically)

Cataract surgery doesn't seem to improve cognitive function (this has nothing to do with palliative care--it's just interesting)

Racial differences in the place of death for hospice patients (African Americans are a little more likely than whites to die in an inpatient hospice)

A descriptive study on the development of DNR policies in Belgium

and...In a cohort of nursing home residents--those who died utilized more medical resources than those who didn't die. Yes, it's true.



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