Palliverse loves a bit of #SoMe interacting with palliative care discussions.
If we have not converted you to tweet chats yet, check out this transcript of the healthcare leaders weekly tweet chat which comes out of North America on a Wednesday 1130 AEDT. This week it was on Palliative Care (yay) but it’s often about change, innovation and patient experience in heath.
It highlighted again for me the differences between palliative care in the USA and in Australia and New Zealand. I know from hanging out on tweet chats out of the USA that often you must sign up to forgo all active treatments in order to qualify for hospice care.
I gave NZ a plug as an example of a country with a good palliative care system (ahead of Aus cos I think NZ is better with community palliative care integration.) Was I right or wrong? What do you think?
The International Association for Hospice and Palliative Care (IAHPC) is pleased to announce 15 scholarships from the IAHPC Traveling Scholarship Program, to help support the travel of palliative care workers in developing countries to the VIII Congress of the Latin American Association for Palliative Care (Asociacion Latinoamericana de Cuidados Paliativos – ALCP).
The ALCP Congress will take place at the Hotel Royal Pedregal in Mexico City, Mexico, April 14-16, 2016.
Applicants must be living in a developing country, be active members of IAHPC and of ALCP, and actively working in palliative care. Applications from physicians, nurses, psychologists and other disciplines are welcome.
If you wish to apply for the Traveling Scholarship and are not member of IAHPC or ALCP, you may join through the corresponding websites:
Applications to the IAHPC Traveling Scholarship are available through the IAHPC website
Preference will be given to individuals who have not received an IAHPC grant in the past three years with accepted poster or oral presentations in the Congress and to individuals living and working in developing countries in the Latin American and Caribbean Region. If applicable, please send proof of acceptance of the poster or oral presentation, along with a copy of your current CV. Selected grantees will also be eligible to receive a discounted registration fee from the Congress.
Deadline to apply is December 31st, 2015. Results will be announced by January 2016.
Additional information about the ALCP Congress can be found in the congress website.
Malignant psoas syndrome is said to be extremely rare, but I keep seeing it. Admittedly, working in the pain and palliative care service in a specialist cancer centre, if anyone was going to see it, you would think it would be my team.
I have had three patients with MPS this year and because each time it’s something that the clinical staff are not familiar with, I thought I would share a short summary with the Palliverse.
The original description of MPS in 1990 (1) described patients with:
Metastatic cancer involving the psoas major muscle either intrinsically (direct intramuscular metastasis), or extrinsically from metastatic retroperitoneal lymph- adenopathy infiltrating into the muscle.
Painful flexion of the ipsilateral hip with positive psoas stretch test (‘‘reverse’’ straight leg raise) related to psoas muscle spasm or irritation.
Clinical evidence of proximal (L1–L4) lumbar plexopathy with spontaneous, burning and lancinating pain associated with hyperalgesia (allodynia and hyperesthesia).
Absence of osseous lumbar vertebral metastases and/or concomitant lumbar polyradiculopathy due to other causes (e.g., malignant neuraxial dissemination, chemotherapy-associated or radiation-induced neurotoxicity).
In 2010, Stevens et al wrote a helpful review (2) of MPS with a case review, mechanisms and theories. Five years ago, according to the paper, there had only been 28 cases reported in the English speaking literature.
I will leave interested readers to explore the papers themselves, but it describes polymodal pharmacotherapy (aka throw everything at it), plus some novel strategies like local anaesthetic block of psoas sheath.
What has encouraged me to put fingers to keyboards tonight though is the referral of yet another patient with psoas syndrome, plus this Japanese case series by Takase et al (3). It describes three patients with MPS who had excellent results with methadone (15-30 mg/day). Their average pain scores were reduced by an astounding 7 points with greatly improved function.
I am pretty keen to try adjuvant methadone for my new referral.
Have you seen any malignant psoas syndrome cases before?Were they recognised and treated as such? How did it go? Particularly keen to hear whether anyone has tried methadone.
1. Stevens MJ, Gonet YM: Malignant psoas syndrome: Recognition of an oncologic entity. Australas Radiol 1990; 34:150–154.
2. Mark John Stevens, Charlotte Atkinson, and Andrew M. Broadbent. Journal of Palliative Medicine. February 2010, 13(2): 211-216. doi:10.1089/jpm.2009.0193.
3. Takase Naoto, Ikegaki Junichi, Nishimura Harumi, Yuasa Sayoko, Ito Yumiko, and Kizawa Yoshiyuki. Journal of Palliative Medicine. July 2015, 18(7): 645-652. doi:10.1089/jpm.2014.0387.
Sadly, I am not actually AT ASCO, the annual meeting of the American Society for Clinical Oncology which is taking place in Chicago this year.
However thanks to the modern day marvels of social media I was able to watch this lecture by Dr Riedel and a team at Duke University Medical Centre.
Dr Riedel introduced a model where palliative physicians ( “palliatricians”. What do you think? I love a neologism, myself….) co-rounded with the oncologists in the inpatient oncology unit.
Statistically significant reductions in length of stay (LOS), 7 and 30 day readmissions, and ICU admissions were demonstrated. Nurse and doctor satisfaction was increased. Nurses felt the quality of care was improved.
All the medical oncologists surveyed felt that the palliatricians added to the care of the patient and that they learned some stuff about symptom management. I know I learn heaps when I round with medical oncologists! Communication and collaboration was improved.
It was a shame they didn’t look at patient satisfaction, but hopefully that might happen in future.
Seen anything interesting coming out of ASCO this year?
How would you choose to live, if you were diagnosed with a life-threatening illness?
What are the most important things in your life? What can’t you live without?
Pal and Carey – #NPCW15 mascots #dyingtotalk
The theme of National Palliative Care Week (24-30th May) this year is “Dying to talk; talking about dying won’t kill you”. In fact, talking about how you want to live and die can be empowering and bring you closer to those who matter most to you. On the other hand, not talking about it can lead to regret – both for you but also for those you leave behind.
As part of National Palliative Care Week, the Palliative Care Service at Alfred Health hosted a public forum on Monday, discussing the topic: “The Top Five Regrets of the Dying”, based on a book by Australian palliative care nurse Bronnie Ware.
Hospice New Zealand is once again presenting a lecture series on palliative care this year. The lectures are held on the first Thursday of every month at 7:30am NZDT/NZST and are available by teleconference at various sites across New Zealand. The first lecture on nausea and vomiting was delivered last week by Dr Michael Downing.
You can also listen to lectures from the previous series by simply registering here. Awesome!