Monday, January 19, 2015

"Palliative Care" - The Words We Use

Via Pallium Canada, who have been producing a great series of videos helping to bridge the gap with respect to some of the misconceptions surrounding palliative care.

"Supportive Care…Supportive Oncology…The Comfort Team…The Butterfly Team (as may be heard in pediatrics)…
Why is there so much resistance to the use of the “P” word – palliative? The truth is, palliative care might not be what many people think it is.
Language provides us with a tapestry of tools for communication and understanding. In palliative care, the use of poetic license is certainly no less than in any other fields of medicine. However, the words we use can be confusing."

Choose your words wisely...


Sunday, August 3, 2014

Palliative Care: Better Early Than Late

The much referred to NEJM Temel article highlighted the positive impact of early palliative care in terms of symptom management and even extending life. The Pallium group summarize this nicely:


Monday, May 5, 2014

Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Clinical Practice Guideline

ASCO has recently published guidelines for the prevention and management of CIPN. Unfortunately, but not surprisingly even after a robust medical literature search, there are no revolutionary breakthroughs for the treatment or prevention of chemotherapy-induced neuropathy (CIPN). Here is a summary of the publication:

[You will also find this web page linked on the left hand side permanently under "Useful Links"]
"Recommendations: On the basis of the paucity of high-quality, consistent evidence, there are no agents recommended for the prevention of CIPN. With regard to the treatment of existing CIPN, the best available data support a moderate recommendation for treatment with duloxetine. Although the CIPN trials are inconclusive regarding tricyclic antidepressants (such as nortriptyline), gabapentin, and a compounded topical gel containing baclofen, amitriptyline HCL, and ketamine, these agents may be offered on the basis of data supporting their utility in other neuropathic pain conditions given the limited other CIPN treatment options. Further research on these agents is warranted."
Link to the guidelines, summary, slide deck, etc. at ASCO website: click here

Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline |
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Sunday, April 13, 2014

"Cancer: The Emperor of All Maladies" Preview at AACR Annual Meeting 2014

"The American Association for Cancer Research (AACR), the world's oldest and largest professional organization dedicated to advancing cancer research and its mission to prevent and cure cancer, is proud to be an outreach partner for "CANCER: The Emperor of All Maladies," a film documentary presented by Ken Burns. Based on the book "The Emperor of All Maladies: A Biography of Cancer" by Siddhartha Mukherjee, M.D., the film will air on PBS in spring 2015. The AACR is an outreach partner for the documentary, along with Stand Up To Cancer (SU2C), a program of the Entertainment Industry Foundation (EIF) that works to accelerate innovative cancer research and to increase awareness about progress being made in the fight against the disease."
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Saturday, March 22, 2014

Video: Healthcare Professionals on Twitter: Worldwide Growth Mapped 2006-2014

"Video maps growth in doctors, nurses and healthcare professionals using Twitter since its launch in 2006 to 2014. Data sourced using Creation Pinpoint, the world's largest research tool for learning from healthcare professionals in public social media."

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Wednesday, March 19, 2014

Valproic Acid Linked with Reduced Risk of Developing Head and Neck Cancer

Sodium valproate is a common mood stabilizer
Sodium valproate is a common mood stabilizer (Photo credit: Wikipedia)
I was surprised to read this press release this morning concerning valproic acid, an antiepileptic, mood stabilizing medication that has also been used traditionally in the management of neuropathic pain.

I am interesting in seeing the doses most commonly encountered and the relevant toxicities. As PCF-4 ( notes, no single mode of action accounts for its anti-seizure activity. It is a:
  • sodium and T-type calcium channel blocker
  • an NMDA receptor-channel blocker (?helpful in hyperalgesia)
  • alters GABA (distinctively selective for midbrain), dopamine and serotonin transmission
T-type calcium channels have been implicated in thalamic burst firing (absence seizures), neuropathic pain and possibly in regulating pain excitation thresholds in a 'T-rich' subset of peripheral nociceptors. 

Beneficial effects have been reports in cancer-related neuropathic pain in Europe and Australia, but mixed results in other pain scenarios. Onset of action can often be within 24 hours for neuropathic pain.

But I digress - on to the news of the day:

Excerpt of Press Release via Wiley:

"A new study indicates that a commonly used mood stabilizing drug may help prevent head and neck cancer. The study is published early online in CANCER, a peer-reviewed journal of the American Cancer Society.

Valproic acid (VPA) is currently prescribed as an anti-seizure medication and mood stabilizer, but it is also being studied as an anticancer agent because it inhibits histone acetyl transferases, which help control gene expression by changing DNA structure.

Johann Christoph Brandes MD, PhD, of the Atlanta Veterans Affairs Medical Center and Emory University in Atlanta, led a team that assessed the anticancer effects of VPA in a study of 439,628 veterans, of whom 26,911 were taking the medication for bipolar disorder, post-traumatic stress disorder, migraines, and seizures.

Veterans who took VPA for at least one year had a 34 percent lower risk of developing head and neck cancer compared with those who did not take the medication. Higher doses and longer duration of VPA use seemed to provide additional benefits. No significant differences were observed for lung, bladder, colon, and prostate cancer incidences.

“A 34 percent risk reduction for the development of head and neck cancer with VPA use could result in the prevention of up to approximately 16,000 new cases and 3,000 to 4,000 annual deaths in the US alone,” said Dr. Brandes. “Head and neck cancer is an important global health crisis, and low cost and low toxicity prevention strategies like VPA use have a high potential impact on pain, suffering, costs, and mortality associated with this disease.”

Article: “Long-term use of valproic acid in United States Veterans associates with reduced risk of smoking related head-and neck cancer.” Hyunseok Kang, Theresa Gillespie, Michael Goodman, Seth Brodie, Mina Brandes, Maria Ribeiro, Suresh Ramalingam, Dong Shin, Fadlo Khuri, and Johann Christoph Brandes. CANCER; Published Online: March 24, 2014 (DOI: 10.1002/cncr.28479).
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Tuesday, March 18, 2014

Treating ‘phantom limb pain’ with mirror therapy - Mirror Box Therapy

A mirror box used for treating phantom limbs, ...
A mirror box used for treating phantom limbs, developed by V.S. Ramachandran. (Photo credit: Wikipedia)
Treating ‘phantom limb pain’ with mirror therapy | mirror box therapy:

"Whether the phantom is in the hand or the foot the principle of mirror box therapy is still the same. In this video soldier Bryan Wagner talk us through his phantom and how mirror box therapy help him cope with the pain."

Link to full article and video
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About Onco-PRN

Welcome and thanks for visiting Onco-P.R.N. - The oncology website with a focus on all things oncology pharmacy/pain/palliative care-related. It is intended to be an information resource for those pharmacist and relevant health care professionals involved in whatever fashion with cancer and palliative care. Stay tuned for the latest and greatest links and information with respect to: oncology medications, continuing education, pharmaceutical care initiatives, pain and symptom control, supportive care topics, and whatever else that might fit into the theme.

*Note: This website is not affiliated with Alberta Health Services (AHS) or CAPhO and the opinions expressed herewithin are that of the author(s).

Pharmacy History

"The earliest known compilation of medicinal substances was ARIANA the Sushruta Samhita, an Indian Ayurvedic treatise attributed to Sushruta in the 6th century BC. However, the earliest text as preserved dates to the 3rd or 4th century AD.
Many Sumerian (late 6th millennium BC - early 2nd millennium BC) cuneiform clay tablets record prescriptions for medicine.[3]

Ancient Egyptian pharmacological knowledge was recorded in various papyri such as the Ebers Papyrus of 1550 BC, and the Edwin Smith Papyrus of the 16th century BC.

The earliest known Chinese manual on materia medica is the Shennong Bencao Jing (The Divine Farmer's Herb-Root Classic), dating back to the 1st century AD. It was compiled during the Han dynasty and was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui tomb, sealed in 168 BC. Further details on Chinese pharmacy can be found in the Pharmacy in China article."

From Wikipedia:

Journal of Palliative Medicine - Table of Contents

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