Wednesday, June 14, 2006

Constipation in JSO; Transitions in care; Expectations & reality with feeding tubes

A few things in brief:

The Journal of Supportive Oncology's latest issue has several articles about constipation in advanced cancer. These include one about the pathogenesis of constipation in cancer patients which asserts that direct tumor invasion of the bowel is the "most common contributor of cancer to the occurrence of cancer" which strikes me as a statement in need of some backing-up (which the author doesn't provide). Besides that it is an excellent overview of constipation's pathophysiology and I learned a lot. The other two articles are commentaries (no abstracts) which among other things mention the emerging evidence supporting opioid antagonists (methylnaltrexone & alvimopan) for opioid-induced constipation. I'm not sure of the status of these, but I am under the impression that at least methylnaltrexone was headed to the FDA (soon?) for approval. If anyone knows please leave a comment.

As always, JSO articles are available to all with a free online subscription.

BMC Palliative Care has posted a few articles of late, including one on a topic of great professional interest to me--transitions in care for dying people. That is--transitions in places of care (between home, hospital, hospice facility, etc.) and care-providers (new docs, etc.). It is a mostly descriptive study of patients enrolled at a palliative care center in Halifax. These transitions are often emotionally difficult for patients and families & represent easy opportunities for care breaking down, poor communication, care plans being lost or needlessly reinvented, etc. It's good to see this being studies.

(BMC, or BioMed Central, publishes online-only, peer-reviewed, open-access journals in multiple fields--articles are always available free online).

The American Journal of Medicine has an article about expectations and 'reality' with feeding tubes. It looks at a cohort of a few hundred mostly older adults who received feeding tubes in North Carolina hospitals; this was a mixed population including post-stroke, cancer, and dementia patients among others. Patients' families were interviewed around the time of tube placement to assess what they thought the tube would accomplish. To summarize briefly: families thought patients would get better and most of them didn't--few patients had measurable improvements in ADL's or got out of nursing homes, and mortality was high across the cohort. None of this is medically surprising, usually the receipt of a feeding tube is a marker of advanced illness and disability and high mortality risk, but this study highlights just how dismal we in medicine prepare families for this.

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