Thursday, December 18, 2008


Cancer recently had a review about communicating about cancer near the end of life. It's one of the best literature reviews of the topic I've read in a while, summarizes the literature, describes the knowledge gap we have, but also the practice gap between what we know about what patients want regarding communication and what actually happens. A great one for the teaching file: I've already been handing this out.

A couple from a recent NEJM which may be of interest to palliative clinicians.... First is a practical review on levodopa for Parkinson's disease - discusses history, evidence, and practical matters.  I found it to be a helpful refresher.  There's also a 'journalistic' piece about newly developed programs for primary care (NP, doc, etc.) home-visits for home bound/disabled patients (free full-text).  Apparently there have been mixed results regarding health-care costs.

A couple from Journal of Clinical Oncology....   One is a review on non-pharmacologic techniques of managing chemotherapy side effects.  Specifically, self-care/self-management strategies that patients themselves can do.  Typical systematic review of symptom research findings:  not too many good quality trials;  heterogeneous patient populations, interventions, and measurements;  urgent calls for more research.  Nausea and vomiting were the most studied with distraction, desensitization, self-hypnosis, exercise, music therapy, and relaxation having decent supporting evidence.  

The other paper explores potential quality-of-end-of-life-care markers in older cancer patients.  It looks at administrative database data for different populations, looking at opioid prescriptions as a potential marker of quality.  Basically they found that there were certain predictors of opioid prescriptions in these cancer patients (teaching hospital, exposure to a medical oncologist).  There were other similar findings - access/use of hospice varying by where you get your care, etc.  I can't say that I read this and was convinced opioid use is a helpful quality marker, although it shows some promise, and is a potentially easily measurable one.  What is striking is, again, the variations in care across the populations studied and how where you get care and by whom really has an impact of what sort of care you'll get - even basic/fundamental things like hospice utilization before you die.  This is a quality problem.  

JAMA has a systematic review of treatments for pressure ulcers.  'Little evidence' for pretty much everything.  A good literature review of the topic though.  

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