had to be suspended during the coronavirus pandemic . Patients over 70 years of age , taking four or more medications were included from 12 GP practices ( 10 patients per practice ). STOPP / START criteria were used to assess medication appropriateness and quality of life ( QoL ) was assessed using the EQ5D and the MRB ( medication related burden ) QoL instruments . The study was not about the effectiveness of the intervention but about the feasibility of doing such a study , she emphasised .
The results showed that the intervention was delivered as intended and was acceptable to GPs , practice staff and patients . However , some uncertainties remain concerning patient recruitment and retention and these will need to be resolved before the full-scale trial can be launched .
Palliative care update The objective of palliative care is to increase the QoL for the patient and family in the context of life-limiting disease . In his presentation , Professor Martin Henman ( Trinity College , Dublin ) focused on four key topics – pain , breathlessness , nausea and vomiting , and fatigue . Although the palliative care movement started in hospices , it is now realised that it should start as soon as therapeutic measures have been exhausted and it can be delivered by primary care teams .
Some 30 % of patients with cancer-related pain have inadequate pain relief . Patients can have a combination of nociceptive , somatic and visceral pain and require multiple analgesics to tackle the different types of pain . The WHO pain ladder should be used to individualise treatment , he said . Ideally , analgesics should be administered orally and “ by the clock ”. It is important not to wait until pain returns before giving the next dose because then the pain is harder to control , he emphasised . Paracetamol and NSAIDs are usually insufficient to control the pain . The next step is the weak opioids , codeine and tramadol . Alternatively , low doses of strong opioids could be used , although this is not currently in the WHO guideline , he noted . Morphine is always the firstchoice opioid and has the advantage of being familiar to many prescribers , available and low-cost . In fact , 19 out of 20 patients who receive opioids will have their pain reduced within 14 days , said Professor Henman . Fentanyl patches are similarly effective but are less readily available and more costly . The most frequent opioid adverse effects are constipation , nausea and vomiting . Guidelines recommend the use of a laxative with opioids and this has to be a stimulant laxative and not a bulking agent , he emphasised .
Fentanyl and buprenorphine are the agents of choice for patients with advanced chronic kidney disease . The role of medical cannabis in cancer pain is unclear .
About 20 % of patients will experience neuropathic pain and gabapentin , pregabalin or tricyclic antidepressants may be used . For localised bone pain radiotherapy is often effective . Breathlessness can be frightening for both patients and families . Oxygen is good for hypoxia and a handheld fan can be valuable . The America Society for Clinical Oncology ( ASCO ) has clear guidelines for evidence-based management of dyspnoea , he said .
Chemotherapy-induced nausea and vomiting ( CINV ) can be acute , delayed or anticipatory . The emetogenic potential of chemotherapy needs to be taken into account when selecting treatment . A number of anti-emetic agents is available and olanzapine has now been added to the list . ASCO recommends a combination of three or four agents including treatment for the most emetogenic agent that the patient is receiving .
Fatigue can range from tiredness to exhaustion . “ Exercise is one of the best things ”, said Professor Henman , while methylphenidate and modafinil have limited effectiveness . Dexamethasone may be effective for a short time but longterm safety and efficacy are not known .
A review of prescribing in palliative care found a variety of study types . Of note , the prevalence of potentially inappropriate prescribing ranged from 6 % to 92 % and only one study reported on under-prescribing . 7 In conclusion , Professor Henman said that palliative care is ( or should be ) holistic care . Patients and families want to be cared for at home as much as possible and for this to happen coordination is critical , especially in primary care .
The 50th ESCP Symposium took place on 18 – 21 October 2022 in Prague , Czech Republic
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prevalence , relationship , and impact on mortality in a French sample of 2350 old people . Pharmacoepidemiol Drug Saf 2015 ; 24 ( 6 ): 637 – 46 . 4 Ensrud KE et al . Comparison of 2 frailty indexes for prediction of falls , disability , fractures , and death in older women . Arch Intern Med 2008 Feb 25 ; 168 ( 4 ): 382 – 9 . 5 Cudby S , Syan G . Frailty and |
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