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:
Sunday, August 3, 2014
Monday, May 5, 2014
Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Clinical Practice Guideline
[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 | ASCO.org
Sunday, April 13, 2014
"Cancer: The Emperor of All Maladies" Preview at AACR Annual Meeting 2014
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."
Wednesday, March 19, 2014
Valproic Acid Linked with Reduced Risk of Developing Head and Neck Cancer
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| 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 (PalliativeDrugs.org) 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).
URL Upon Publication: http://doi.wiley.com/10.1002/
Tuesday, March 18, 2014
Treating ‘phantom limb pain’ with mirror therapy - Mirror Box Therapy
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| A mirror box used for treating phantom limbs, developed by V.S. Ramachandran. (Photo credit: Wikipedia) |
"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
Monday, March 3, 2014
The WPCA - Global Atlas of Palliative Care
The WPCA - Global Atlas of Palliative Care:
"Published jointly by the World Health Organization and the Worldwide Palliative Care Alliance, the Atlas is the first document to map the need for and availability of palliative care globally.
Using maps, graphs and case studies, and drawing on a wealth of resources, the Atlas addresses the following questions:
- What is palliative care?
- Why is palliative care a human rights issue?
- What are the main diseases requiring palliative care?
- What is the need for palliative care?
- What are the barriers to palliative care?
- Where is palliative care currently available?
- What are the models of palliative care worldwide?
- What resources are devoted to palliative care?
- What is the way forward"
Read the full article here
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