Characteristics of the case mix, organisation and delivery in cancer palliative care: a challenge for good-quality research.

OBJECTIVES: Palliative care (PC) services and patients differ across countries. Data on PC delivery paired with medical and self-reported data are seldom reported. Aims were to describe (1) PC organisation and services in participating centres and (2) characteristics of patients in PC programmes. METHODS: This was an international prospective multicentre study with a single web-based survey on PC organisation, services and academics and patients' self-reported symptoms collected at baseline and monthly thereafter, with concurrent registrations of medical data by healthcare providers. Participants were patients ≥18 enrolled in a PC programme. RESULTS: 30 centres in 12 countries participated; 24 hospitals, 4 hospices, 1 nursing home, 1 home-care service. 22 centres (73%) had PC in-house teams and inpatient and outpatient services. 20 centres (67%) had integral chemotherapy/radiotherapy services, and most (28/30) had access to general medical or oncology inpatient units. Physicians or nurses were present 24 hours/7 days in 50% and 60% of centres, respectively. 50 centres (50%) had professorships, and 12 centres (40%) had full-time/part-time research staff. Data were available on 1698 patients: 50% females; median age 66 (range 21-97); median Karnofsky score 70 (10-100); 1409 patients (83%) had metastatic/disseminated disease; tiredness and pain in the past 24 hours were most prominent. During follow-up, 1060 patients (62%) died; 450 (44%) <3 months from inclusion and 701 (68%) within 6 months. ANOVA and χ2 tests showed that hospice/nursing home patients were significantly older, had poorer performance status and had shorter survival compared with hospital-patients (p<.0.001). CONCLUSIONS: There is a wide variation in PC services and patients across Europe. Detailed characterisation is the first step in improving PC services and research. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT01362816.

Content development for EUROPEAN GUIDELINES on the use of opioids for cancer pain: a systematic review and Expert Consensus Study.

Workpackage 3.1 (WP 3.1), within the European Palliative Research Collaborative (EPCRC), was aimed at critically revising and updating the European Association for Palliative Care recommendations on cancer pain management. The aim of this paper is to report the results of the first phase in the revision process which consists of a literature review and an expert consensus about the contents to be considered relevant in the development of the new guidelines. A systematic literature search was carried out from 2001 to 2008 through various databases including Medline, Cinahl, Cochrane Database of Systematic Reviews, Embase and Google. Through this process, guideline quality was evaluated, content was compared with EAPC recommendations and a first set of key-points was developed. A modified two-round Delphi method was applied to choose the most relevant topics for future systematic literature reviews. Fourteen guidelines on cancer pain management, published or updated after 2000, were retrieved. A comparison of these guidelines with the EAPC recommendations led to the formulation of 37 key-points, which were submitted to a panel of experts through a Delphi method. Through the responses given by the experts (25 after the first round and 19 after the second) and after a revision by the WP 3.1 local and steering committees, a final list of 22 topics was generated to answer all identified key-points. Each of these topics will be the object of systematic literature reviews. The final version of the "Evidence-based guidelines for the use of opioid analgesics in the treatment of cancer pain: the EAPC recommendations" will be based on the results of the 22 systematic literature reviews.

Prenatal diagnosis after ART success: the role of early combined screening tests in counselling pregnant patients.

First-trimester Down syndrome screening may cause a higher false positive rate in pregnant patients who have undergone ART (assisted reproductive technologies). The aim of this paper is to contribute to this analysis with the second largest series of combined biophysical and biochemical tests in the first trimester of pregnancy after ART. One hundred and forty-two singleton successful ART pregnancies were selected for this study: 50 pregnancies induced by using in-vitro fertilization (IVF), and 92 using intracytoplasmic sperm injection (ICSI). Each patient was matched with three naturally conceived pregnancies based on maternal age and gestational age. Free beta-HCG and PAPP-A were measured on dried blood spots and converted to MoMs. Nuchal translucency (NT) was measured by certified operators. Mean maternal age was 33 +/- 4. NT, free beta-HCG and PAPP-A values of the control cases were not significantly different from local standards evaluated on 3043 cases. NT between ART pregnancies and matched controls was not significantly different. PAPP-A was reduced but not significantly lower in ART pregnancies. Free beta-HCG was the only analyte that resulted in significantly higher values in ART pregnancies (1.12 MoM) versus controls (0.99 MoM). No significant differences were found for biochemical values observed between ICSI and IVF patients. The screen positive rates observed in ART and control pregnancies were 5.5 per cent and 4.6 per cent respectively. NT measurements were not affected by ART pregnancies. Our results (non-significant lower values of PAPP-A and significantly higher free beta-HCG values) were consistent with other reported series. The increase in the screen positive rate determined by these biological variations was not greater than 0.9 per cent. This higher false positive rate has a negligible impact on counselling ART patients. The algorithm used to calculate the relative risk after the combined tests should not be changed until the detection rate of trisomies in ART pregnancies is not fully disclosed by larger series.