I invite you to read Issue 1 Volume 17, 2023 of “Palliative Medicine in Practice”, which contains three original articles, three reviews, one short communication and a Letter to the Editor.
This Issue opens with an original article entitled “Safe practices for legitimate medical use of opioids: a study of trends in opioids prescription over a decade” by Anuja Pandit, Saurabh Vig, Shweta Bhopale, Brajesh Ratre, Balbir Kumar, Swati Bhan, Ram Singh, Prashant Sirohiya, Hari Krishna Raju Sagiraju, Seema Mishra, Rakesh Garg, Nishkarsh Gupta, Sachidanand Bharati, Vinod Kumar, and Sushma Bhatnagar. This study aimed to explore the pattern of morphine consumption and the use of safety protocols for prescribing opioids in a tertiary cancer hospital in India. Medical and pharmacy records were studied retrospectively, to investigate the pattern of oral morphine consumption and distribution from 2008 to 2020. The number of new cancer patients visiting the hospital, the number of re-visits of these patients, and inpatient admissions to palliative care services increased unswervingly from 2008 to 2019 with a sharp fall in 2020 owing to the COVID pandemic. Annual oral morphine consumption showed a steady increase from 4.89 kg in 2008 to 11.53 kg in 2019 with a fall to 5.68 kg in 2020. However, the trend for oral morphine dispensed per patient per visit showed a mild increase from 1.1 grams in 2008 to 2.06 grams in 2012, followed by a gradual decline to 0.89 grams in 2020. Opioid diversion incidence was found to be zero. The authors concluded that comprehensive interventions alongside safety protocols for prescriptions of opioids and effective integration of palliative care can help prevent opioid use disorders.
The next original article in this Issue authored by Savita Choudhary, Arvind Kumar Yadav, Anil Kumar Bhiwal, and Seema Partani is entitled “Developing competency among interns in palliative care of critically ill patients” refers to an educational interventional study conducted in the Department of Anaesthesiology of a tertiary care teaching institute. Pre-post test by standardized validated multiple choice questions for assessment of knowledge and awareness was conducted before and after the session. Interactive didactic lectures integrated with faculty narrative from the Department of Palliative Care, demonstration among small groups, and live demonstration on patients under the aegis of the Anaesthesia Department were given after the pre-test. A feedback questionnaire in the form of a Likert scale for assessment of students’ satisfaction and attitude was done at end of the session. Fifty interns participated in the study. The pre and post-test results difference was significant (p < 0.0001). The percentage gain in knowledge and awareness was 63.95%. The authors concluded that most professionals will need basic skills of various management modalities in supportive therapy in near future to fully fill the demand for palliative care which is going to be doubled within the next few decades so the need for conducting more such sessions regularly amongst young budding doctors including interns at a very early stage to develop competency for palliative care was observed.
The third original article “Development of pain management nursing care program for children with cancer” was written by Nayereh Naseri, Alireza Irajpour, and Atefeh Shamsi Naseri. The study aimed to develop a pain management nursing care program for children with cancer. Participants of the qualitative research phase included 10 children’s parents (8 mothers and 2 fathers) and 15 health providers (10 nurses, 3 oncologists, and 2 palliative medicine specialists). The study was the exploratory mixed method according to the Kern model with three phases, including two-stage qualitative stages (literature review and content analysis) in the first phase, providing a draft of the program (Phase 2) and validating the draft, using the Delphi method. Three main categories emerged from the literature review and qualitative study findings, including factors related to nursing, paediatric parents, and healthcare organizations. They were realized as the base of initial pain management nursing care obstacles that were considered in the program draft. These categories were classified into 3 domains of knowledge, attitude, and skill pain management deficiency. The contents were confirmed in 13 pain management outlines at the Delphi phase. The second phase demonstrated the final program contents, including training on items of pain concept, cancer pain, painful procedures, pain assessment, nursing care, pharmacological and non-pharmacologic interventions as the pillar outlines in pain management. The nursing care pain management program in children with cancer with an innovative view that provides professional educational opportunities for optimal pain management.
The first review manuscript is entitled “Single nucleotide polymorphisms as predictors of treatment efficacy and adverse effects of morphine in palliative medicine: a literature review” was written by Aleksander Turczynowicz, Karolina Niedźwiecka, Dominik Panasiuk, Weronika Pużyńska, Kacper Luchowski, Julia Kondracka, Piotr Jakubów. A major issue is an individual variability resulting in different degrees of response to the analgesic effects of opioids, including morphine, and the occurrence of their adverse effects. According to one of the theories of pharmacogenomics, single nucleotide polymorphisms (SNPs) are associated with opioid metabolism. A literature review of the PubMed database identified 18 scientific articles concerning SNPs that affect the analgesic effects and adverse effects of morphine or other opioids, per morphine equivalent, from which additional 22 scientific articles were retrieved. The review identified SNPs in the genes OPRM1 A118G, COMT rs4680, ABCB1 C3435T, IL-6, IL-8, TNF-α, TAOK3, HTR3B, UGT1A1/UGT1A8 and OPRM1 Arg181Cys, which were found to affect both the occurrence of potential adverse effects and the different demand in palliative care patients for a dose of morphine that will effectively relieve pain. SNPs were found to significantly affect morphine metabolism; the determination of this effect is individual based. Most studies were conducted in small groups of individuals from ethnically diverse populations, which, if mutations are present, may significantly affect the efficacy of opioid-related SNP assays and the response of patients to the analgesic treatment administered. Findings raise the prospect of the use of SNPs in clinical practice as part of personalized medicine in the future.
In the second review article entitled “Recent advances in prevention and treatment of post-radiotherapy xerostomia in patients with head and neck cancer”, Agnieszka Solarska and Zbigniew Żylicz presented this important aforementioned topic. Xerostomia or feeling of dry mouth is the most common (80%) of all complications of radiotherapy for head and neck cancer. Besides well-known artificial saliva and agents and therapies stimulating saliva production and salivary gland regeneration, new methods comprise the use of vitamins C and E, low-level laser therapy, hyperbaric oxygen therapy and thyme honey. Recently, transplantation of the mesenchymal stem cells was reported to be successful, and these may be, together with gene-transfer therapy the future therapies of xerostomia after salivary gland irradiation.
In the third review article Juan David Botero, Javier Iván Lasso entitled “Pleurodesis” presented up-to-date knowledge on this important clinical issue. Pleurodesis is a definitive management strategy in malignant pleural effusion, its history is briefly described, and a narrative review is made about its indication, patient selection, response predictors and benefits.
In a short communication Priyanka Mishra, Robina Makker, and Nishith Govil “Too much outcry about quality of life, what about the quality of death?”, consider seriously patients’ experiences. The authors are convinced that sensitizing medical health providers throughout the globe about the need to emphasize ensuring the quality of death (QOD) is really important. This article aimed to send a reminder that QOD is an equally important entity as the quality of life but is far undermined. With human civilization stepping into a revolutionary era of health, it is disappointing to witness poor QOD in most countries across the globe. QOD is becoming an increasingly popular concern amongst palliative and healthcare professionals. However, an actual improvement can only be brought about by sensitizing the common people about this concept and guiding them to achieve a “Good Death” for themselves or their families by acting early on. Authors share the belief that better health can be achieved through knowledge sharing and information dissemination.
In a Letter to Editor Tomasz Grądalski presented “Hospice and Palliative Care Evaluation Symptoms and Problems Checklist (HOPE-SP-CL): a simple tool in the eligibility process for patients in palliative and hospice care”. As discussions about the optimal model for qualifying patients for palliative and hospice care in Poland continue [1–3], the Author presented HOPE-SP-CL, which has been used in Germany for several decades, appears to be a valuable screening tool for assessing patients’ palliative and hospice care needs [4, 5].
Education is an important issue in palliative care [6, 7]. A report of the First Conference in Zielona Góra: “Palliative medicine, supportive care and pain management in patients with non-cancer diseases” held On 6–7 October 2022 has been published in Issue 4/2022 [8]. This Conference was organized by the Department of Palliative Medicine at the Institute of Medical Sciences of the Collegium Medicum of the University of Zielona Góra and Professor Jacek Łuczak Polish Association for Palliative Care. The Second Conference in Zielona Góra: “Palliative medicine, supportive care and pain management in cancer patients” is planned on ٨–٩ September ٢٠٢٣. More information can be found at: https://ptop.edu.pl/. We cordially invite you to Zielona Góra also to experience its 700th anniversary of the creation of this city and vintage celebration.
We also invite you to participate in XVI International Conference of Palliative Medicine in Practice (After the 18th World EAPC Congress 15–17th June 2023 in Rotterdam) planned on 23–24th June 2023 in Gdańsk (www.viamedica.pl/palliative_medicine_in_practice). Please find also a Supplement II, vol. 16 (2022) on a journal web: https://journals.viamedica.pl/palliative_medicine_in_practice/issue/current with all abstracts presented during XV International Conference of Palliative Medicine in Practice held on 3–4th June 2022. We also encourage students to take part in the 4th Student Conference of Palliative Medicine planned at the Medical University of Gdańsk on 29 April 2023. More information is available at: https://gumed.edu.pl/73017.html. We also invite you to Palermo for a Conference “It’s only palliative care but I like it” planned for 20–22 April 2023 (More information can be found at: https://ptop.edu.pl/).
In August 2022 Ministry of Health set up an Expert Group comprising experts in the field of palliative care together with representatives of the National Health Fund, the Agency of Evaluation of Medical Technology and Tariffication, and the Ministry of Health [9]. Preliminary work with current problem solutions has been completed and submitted to the Ministry of Health. However, as the Expert Group should elaborate on a long-term strategy for the development of palliative care in Poland, the work will be continued until the end of 2023. One of the issues discussed is the role of the physiotherapist in palliative care which has been recently comprehensively covered by WHO for the Europe Region [10].
I invite all of you to read articles published in this and archived Issues and share your knowledge and experience by sending your manuscripts (also in the Polish language) regarding broadly understood palliative, hospice and supportive care. Detailed information can be found at: https://journals.viamedica.pl/palliative_medicine_in_practice.
With cordial greetings,
Wojciech Leppert
