Thursday, May 11, 2006

Neoplastic meningitis review; Palliative care & liver transplantation; Communicating prognosis

Lancet Neurology has a review of neoplastic meningitis in their May issue. Good for us non-oncologists. Despite this usually being a highly lethal 'complication' of cancer, only a vague mention of 'supportive care' is given in the paper's final paragraph.

JAMA has a "Clinician's Corner" piece about palliative care for those awaiting liver transplantation. It is a cased-based discussion of palliative care and end stage liver disease/transplantation (much like JAMA's Perspectives on the Close of Life series) that is well worth the read. Among other things it has a focused discussion of prognosis in liver failure and symptom management in end stage liver disease. More importantly though, the piece is a powerful advocate of the palliative-care-early/palliative-care-alongside-curative-care paradigm, and directly addresses the emotional difficulties for patient and clinician alike of the "hoping for the best/planning for the worst" paradigm. Ugh--I just used 'paradigm' twice in a single sentence.

I also found this nugget buried in the middle of the article of note--I'm looking forward to seeing this paper: "Preliminary results of an ongoing qualitative study of 30 patients with cancer and 30 patients with oxygen-dependent chronic obstructive pulmonary disease suggests that most patients do not associate honest prognostic information with the loss of hope, provided that information is delivered in a sensitive and caring way (J.R.C., unpublished data, 2006)."

Journal of Supportive Oncology has a review of communicating prognosis to cancer patients (free full text .pdf link here; html link of the issue's table of contents here). It is crap. Ok, that is a joke, which I made because it is authored by my friend and blog collaborator Dr. Christian Sinclair, who is apparently too modest to mention this on the blog himself. It is excellent, and what I really appreciated about it is that it is very much about the art of communicating prognosis, and is clearly written by someone who does it a lot and pays attention to what he is doing. Congratuations Christian! My one question, which I'm sure he'll answer, is that he uses the language "communicating a prognosis." I usually say "communicating prognosis"--no "a." Is "a prognosis" the preferred usage?

The same issue also has a preliminary (only a few patients; completely uncontrolled) report about nitric oxide-donating aspirin which may or may not turn out to be an effective and much safer NSAID-type analgesic.

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