EDITORIAL URRENT C OPINION

The growing body of knowledge in palliative care Eduardo Bruera

Modern palliative care emerged in the 1960s in the United Kingdom with the development of the British Hospice movement. Although clinical programs developed rapidly worldwide, these clinical programs did not have access to the protected academic time and research grants that are characteristic of academic medicine. As a result, the body of knowledge in palliative care grew at a slower pace compared with other areas of academic medicine. Fortunately, during the last decade, there has been increased interest in palliative care within the universities and major academic hospitals around the world. As a result, new and exciting knowledge is now available for clinicians treating palliative care patients. In this issue of Current Opinion in Supportive and Palliative Care, I am delighted to introduce our readers to a series of innovative and very well written reviews. Egidio Del Fabbro and Sherri Rauenzahn [1] review the opioid management of pain within the context of the opioid abuse epidemic worldwide. Their review demonstrates that appropriate pain management requires regular screening for the risk of chemical coping and multidimensional interdisciplinary management of pain. Traditional teaching in the management of cancer pain in palliative care has made limited emphasis on the appropriate management of patients with a history of alcoholism and drug dependence. This chapter will be extremely useful to clinicians, particularly as palliative care is now more frequently expanding to the ambulatory care setting and patients access palliative care earlier in the trajectory of their disease. Rony Dev provides a review of the management of cachexia, with particular emphasis on two recently described problems. Hypogonadism is now accepted as a major component of cancer cachexia and it is at least partially associated with chronic opioid management. Increased resting energy expenditure has also recently been recognized as one of the complications in patients with cancer cachexia. This review emphasizes all the importance of two contributing factors to cancer cachexia that are treatable and this review points to the important areas of future research.

Peter Lawlor and Shirley Bush [2] provide a scholarly review on the screening, diagnosis, and management of delirium. Delirium is one of the most distressing syndromes we encounter in palliative care. This review stresses the importance of screening and early detection as well as the importance of identifying reversible contributors such as opioid analgesics, and the need for more aggressive symptomatic management. One of the remarkable findings of this review is the limited number of clinical trials on the pharmacological management of agitated delirium. Over the years, supportive and palliative care has extended to the pediatric population. However, contrary to the adult population, most pediatric palliative care patients do not have a diagnosis of cancer. These patients have different requirements regarding the assessment and management of their most common problems. Joanne Wolfe and Julie Hauer [3] have provided an outstanding review on palliative care in children, with specific emphasis on the metabolic and neurologic diseases. Over the last 20 years, patient-reported outcomes have become the gold standard for the assessment and management of patients and their families in palliative care. Unfortunately, both the assessment and the management of these patients are particularly challenging when there is a background of chronic mental illness. Mari Lloyd Williams, Katherine Abba, and Jacqueline Crowther [4] have reviewed the specific challenges posed by chronic mental illness including dementia on the delivery of effective supportive and palliative care. This review is useful to all palliative care specialists, especially for those practicing in geriatric facilities and nursing homes. Chaplains have had a historic role in the development of palliative care in the United Kingdom Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA Correspondence to Eduardo Bruera, MD, Professor and Chair, Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA. E-mail: ebruera @mdanderson.org Curr Opin Support Palliat Care 2014, 8:271–272 DOI:10.1097/SPC.0000000000000066

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General supportive and palliative care

and Canada. In the recent years, research has progressively demonstrated the value of spiritual assessment and management in improving the quality of life of palliative care patients and their families. Marvin Delgado-Guay [5,6] provides a very useful clinical and evidence-based review on the spiritual assessment and management in palliative care. I have found these reviews to be uniformly outstanding in quality. I am grateful to the editors for their kind invitation to edit this special issue and I hope our readers will enjoy reading each of these papers as much as I did. Acknowledgements None.

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Conflicts of interest There are no conflicts of interest.

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Rauenzahn S, Del Fabbro E. Opioid management of pain: the impact of the prescription opioid abuse epidemic. Curr Opin Support Palliat Care 2014; 8:273–278. Dev R. The assessment and management of cancer cachexia: hypogonadism and hypermetabolism among supportive and palliative care patients. Curr Opin Support Palliat Care 2014; 8:279–285. Lawlor PG, Bush SH. Delirium diagnosis, screening and management. Curr Opin Support Palliat Care 2014; 8:286–295. Hauer JM, Wolfe J. Supportive and palliative care of children with metabolic and neurological diseases. Curr Opin Support Palliat Care 2014; 8:296– 302. Lloyd-Williams M, Abba K, Crowther J. Supportive and palliative care for patients with chronic mental illness including dementia. Curr Opin Support Palliat Care 2014; 8:303–307. Delgado-Guay MO. Spirituality and religiosity in supportive and palliative care. Curr Opin Support Palliat Care 2014; 8:308–313.

Volume 8  Number 3  September 2014

Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

The growing body of knowledge in palliative care.

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