JOURNAL OF PALLIATIVE MEDICINE Volume 18, Number 2, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2015.0011
Recent Literature Feature Editor: Paul C. Rousseau
patients (n = 17) tolerated the subcutaneous infusion well. Nineteen patients (95%) received levetiracetam in combination with other drugs. These were mainly metamizol (80%), midazolam (75%), and morphine (45%). The median dose of levetiracetam was 95.8 mg/h (SD 37 mg/h), median osmolarity of the infusion solution was 2203 mOsmol/L (SD 717 mOsmol/L), and infusion rate was 2 mL/h (SD 2.4 ml/h). In 16 patients (80%), seizures were controlled and status epilepticus were interrupted, respectively. The authors conclude that SC levetiracetam is an effective treatment and well tolerated in the palliative care setting.
Chow E, Meyer RM, Chen BE, et al.: Impact of reirradiation of painful osseous metastases on quality of life and function: A secondary analysis of the NCIC CTG SC.20 randomized trial. J Clin Oncol 2014;32:3867–3873. The authors of this article previously demonstrated that 48% of patients with pain at sites of previously irradiated bone metastases benefit from reirradiation. However, it was unknown whether alleviating pain also improves patient perception of quality of life (QOL). In this study, the authors used the database of a randomized trial comparing radiation treatment dose fractionation schedules to evaluate whether response, determined using the International Consensus Endpoint (ICE) and Brief Pain Inventory pain score (BPIPS), was associated with patient perception of benefit, as measured using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and functional interference scale of the BPI (BPI-FI). Evaluable patients completed baseline and two-month follow-up assessments. Results demonstrated that among 850 randomly assigned patients, 528 were evaluable for response using the ICE and 605 using the BPI-PS. Using the ICE, 253 patients experienced a response and 275 did not. Responding patients had superior scores on all items of the BPI-FI (i.e., general activity, mood, walking ability, normal work, relations with other people, sleep, and enjoyment of life) and improved QOL, as determined by scores on the EORTC QLQ-C30 scales of physical, role, emotional and social functioning, global QOL, fatigue, pain, and appetite. Similar results were obtained using the BPI-PS; observed improvements were typically of lesser magnitude. The authors conclude that patients responding to reirradiation of painful bone metastases experience superior QOL scores and less functional interference associated with pain. Consequently, patients should be offered re-treatment for painful bone metastases in the hope of reducing pain severity as well as improving QOL and pain interference.
Evans N, Pasman HR, Deeg D, Onwuteaka-Philipsen B: How do general end-of-life treatment goals and values relate to specific treatment preferences? A population-based study. Palliat Med 2014;28:1206–1212. As noted by the authors, there is a lack of research on the relationship between general end-of-life goals and values and preferences for specific life-sustaining treatments. In this study the authors attempted to examine agreement between Dutch older people’s general end-of-life goals and specific life-sustaining treatment preferences. Participants identified general end-of-life goals in an interview and preferences for four life-sustaining treatments in hypothetical cancer and dementia scenarios in a separate questionnaire. Agreement between general goals and specific treatment preferences was calculated. From 11 representative Dutch municipalities, 1818 older people participated in the study. Results demonstrated that in total, 1168 (response rate 73%) answered questions on general end-of-life and specific treatment preferences. Agreement between a desire to live as long as possible, irrespective of health problems, and a preference for life-sustaining treatments ranged from 51% to 76% in cancer and 41% to 60% in dementia scenarios, depending on the treatment. Agreement between a desire for a shorter life, if without major health problems, and a preference to forgo treatments ranged from 61% to 79% in cancer and 75% to 88% in dementia scenarios. The authors conclude that for a sizable minority of participants, specific treatment preferences did not agree with their general end-of-life goals. The more frequent desire to forgo treatments in case of dementia compared to cancer suggests that physical deterioration is more acceptable than cognitive decline. The findings underline the importance of discussing general care goals, end-of-life scenarios, and the risks and burdens of treatments in order to frame discussions of specific treatment preferences.
Remi C, Lorenzl S, Vyhnalek B, et al.: Continuous subcutaneous use of levetiracetam: A retrospective review of tolerability and clinical effects. J Pain Palliat Care Pharmacother 2014;28:371–377. The authors of this study attempted to evaluate the tolerability and clinical effects of subcutaneous (SC) levetiracetam for the treatment of epileptic seizures in a palliative care setting via a retrospective chart review of patients treated with subcutaneous levetiracetam in the Department of Palliative Medicine at the University Munich, between September 2006 and March 2013. The following parameters were extracted from the charts: reason for antiepileptic drug treatment, daily dose, concentration, infusion rate, coadministration of other drugs, and clinical effects. Furthermore, the charts were screened for signs of adverse drug reactions (e.g., irritation or pain at the infusion site). Twenty patients that were treated with levetiracetam SC in the inpatient (n = 7) and outpatient (n = 13) settings were identified. Most
Yopp JM, Park EM, Edwards T, et al.: Overlooked and underserved: Widowed fathers with dependent-age children. Palliat Support Care 2014. (E-pub ahead of print.) Widowed fathers and their children are at heightened risk for poor coping and maladaptive psychosocial outcomes. This exploratory study explicitly examined the psychological characteristics of this population of fathers. Some 259 fathers 1
(mean age = 46.81; 90% Caucasian) with dependent-age children and whose wives had died from cancer within the previous five years completed a web-based survey that consisted of demographic questions, the Center for Epidemiologic Studies Depression Scale (CES–D), the Texas Inventory of Grief–Revised (TRIG–R), the Psychological Adaptation Scale (PAS), the Kansas Parental Satisfaction Scale (KPSS), and items assessing perceived parental efficacy. Results demonstrated that fathers were found to have elevated depressive and grief symptomatology, and low adaptation and high levels of stress related to their parenting role. However, they reported being satisfied with their parenting and having met their own parental expectations. Multivariate analyses revealed an association between father’s age and depression ( p £ 0.01), with younger fathers reporting greater depressive symptoms. Psychological adaptation was positively correlated with being in a romantic relationship ( p = 0.02) and age of oldest child ( p = 0.02). The authors conclude that the results of their exploratory study suggest that, while widowed fathers perceive themselves as meeting their parental responsibilities, it comes at a substantial psychological cost, with particularly high stress related to being a sole parent. These findings may help guide interventions for this neglected population and underscore the importance of developing targeted therapies and research protocols to address their needs. Fishbain DA, Lewis JE, Gao J: The pain suicidality association: A narrative review. Pain Med 2014;15:1835–1849. The objective of this narrative review was to examine recent evidence and, when necessary, past evidence on the association between pain and suicidality. Fifty-eight research reports were found on this topic, which had not previously been reviewed. These reports were divided into groups based on whether they addressed suicide ideation (SI), suicide attempts (SAs), or suicide completion (SC); what population they represented (acute pain patients [APPs], chronic pain patients [CPPs], other than APPs/CPPs); and whether they controlled for relevant confounders. Information as to whether the results of these studies supported/did not support the association of pain and suicidality was abstracted. For each group of studies (above), a vote counting method was utilized to determine the overall percentage of studies supporting/not supporting the association of pain and suicidality. Based on this percentage, the consistency of the data supporting the association was rated according to Agency for Healthcare Research and Quality guidelines. The following groups of studies received an A consistency rating (consistent evidence from multiple studies): SI, SA, and SC for other than APPs/
CPPs; and SI, SA, and SC for CPP prevalence greater than an appropriate control group. A subgroup of the SI, SA, and SC studies for other than APPs/CPPs had controlled for behavioral issues (potential confounders); these three subgroups received an A consistency rating. The 58 studies identified a number of new predictor variables for SI, SA, and SC in CPPs. The authors conclude that these studies solidify the evidence for an association between pain and SI, SA, and SC in both CPPs and other than APPs/CPPs. Te Boldveldt N, Vernooij-Dassen M, Leppink I, et al.: Patient empowerment in cancer pain management: An integrative literature review. Psychooncology 2014;23:1203–1211. More than 50% of patients with cancer experience pain. Patient empowerment has been highlighted as central to success in pain management. Up to now, no clear model for this patient group exists, yet several strategies to empower patients have been used in clinical practice. This review examines how empowerment or related concepts have been described in relation to pain management in patients with cancer. An integrative review was conducted, using the databases PubMed, CINAHL, and PsycINFO. Papers were evaluated discussing empowerment or related concepts in relation to pain management in patients with cancer. The authors analyzed the term ‘empowerment’ semantically. From a total of 5984 identified papers, 34 were included for analysis. Empowerment has been described with the concepts self-efficacy, active patient participation, increasing abilities, and control of life. Most papers focus on pain treatment induced by the professional caregiver or on the active involvement of the patient, and not on the combination of both. The following elements of empowerment can be identified: role of the patient, role of the professional, resources, selfefficacy, active coping, and shared decision making. The authors on the basis of these findings propose a conceptual model to empower patients in controlling cancer pain. They recommend focusing on pain treatment given by the professional, on the active involvement of the patient, and on the interaction of both. They suggest their model might also be useful for other patient groups or specific contexts, especially in symptom management.
Address correspondence to: Paul C. Rousseau, MD 81 On The Harbor Drive Mt. Pleasant, SC 29464 E-mail: [email protected]