Articles of interest in other scholarly journals

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Undetected Cognitive Impairment and Decision-Making Capacity in Patients Receiving Hospice Care.

Burton CZ, Twamley EW, Lee LC, Palmer BW, Jeste DV, Dunn LB, Irwin SA.

This study examined the prevalence of cognitive impairment and its impact on decision-making abilities in 110 hospice patients without a diagnosis of a cognitive disorder or clinical recognition of cognitive impairment. Using neuropsychological tests, assessment of decisional capacity, and interviews, it was found that 54% of patients had significant, previously undetected, cognitive impairment and performed worse on all neuropsychological and decisional measures. Verbal ability and cognitive function predicted decision-making capacity. This shows the need for cognitive assessment of hospice patients as this may enable interventions to improve decision making and patient autonomy.

Evaluation of the comparative analgesic effectiveness of transdermal and oral opioids in cancer patients: A propensity score analysis.

Apolone G, Deandrea S, Montanari M, Corli O, Greco MT, Cavuto S.

In an observational study of 266 patients starting strong opioids, the propensity score (to reduce selection bias) was used to compare the effectiveness of oral and transdermal opioids over 28 days, using pain intensity, dose increases, need for switching and safety. Adjusting for the propensity score, transdermal opioids were reported to give better pain control than oral opioids. No differences were reported in the frequency of most side effects, but cases of nausea and vomiting were more common in the transdermal opioid group.

Information of imminent death or not: does it make a difference?

Lundquist G, Rasmussen BH, Axelsson B.

Nearly 14,000 cancer deaths from a national end-of-life register were reviewed to assess if patients with cancer who were informed about imminent death had different end-of-life care from patients who were not informed. Over 90% of patients had been given information about imminent death. Samples were matched to minimise bias, with nearly 1200 patients being analysed in each group. Compared with uninformed patients, informed patients more frequently had pre-emptive parenteral drugs prescribed, died in their preferred place, and had family who were offered bereavement support. There was no difference in pain, anxiety, confusion, nausea, and respiratory tract secretions between the groups.

Laxative management in ambulatory cancer patients on opioid therapy: a prospective, open-label investigation of polyethylene glycol, sodium picosulphate and lactulose.

Wirz S, Nadstawek J, Elsen C, Junker U, Wartenberg HC.

In a prospective, open-label randomised trial of 348 outpatients with cancer and opioid induced constipation, the laxatives polyethylene glycol, sodium picosulphate and lactulose were compared. Outcomes included the number of patients with a stool-free interval greater than 72h, numerical rating scale for constipation and quality of life questionnaire scores. In spite of opioid therapy, the incidence of constipation was low (5.7%) and laxative use correlated to the opioid dose. For prevention of constipation, polyethylene glycol and sodium picosulphate had a lower stool-free interval greater than 72h and lower numerical rating scale for constipation compared with lactulose.

By Jason Boland, Consultant in Palliative Medicine, Barnsley Hospice, United Kingdom

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