EAPC - ipac

420 EAPC Abstracts
Head&Neck and Pancreas cancer, incomplete in the rest PSG. 4. UGC
incomplete in all; absent in Pancreas cancer. 5. ADC incomplete in all;
absent in Kidney and Pancreas cancer. DC and PC symptoms varied, except
for DC complete in Colorectal and Pancreas cancer. Anxiety/depression;
anorexia/early satiety; dyspnea/cough; nausea/vomiting; fatigue/lack of
energy, belching/bloating consistently clustered. Conclusions: NVC was
universal, DC complete in 2/7 PSG, NPC in Lung cancer. Primary site
determined specific clusters, did not predict general cancer clusters, except
for NVC, DC, and NPC.
69 Oral Presentation
Other symptoms
“Now that you mention it doctor…”– Symptom reporting and
the need for systematic questioning
Presenting author: Damien McMullan
Authors: Clare White Palliative Medicine Northern Ireland Hospice Care
UNITED KINGDOM
Julie Doyle Northern Ireland Hospice Care Belfast UNITED KINGDOM
Damien McMullan Northern Ireland Hospice Care Belfast UNITED
KINGDOM
Barbara Cochrane Northern Ireland Hospice Care Belfast UNITED
KINGDOM
Background: Palliative care patients may experience a wide variety of
symptoms. Some may be self-reported and some are only detected on systematic
questioning (SQ). This review aims to determine the symptoms
experienced by patients admitted to a specialist palliative care unit (SPCU),
which of these are self-reported (SR) and which are only detected with the
use of SQ. Methods: A retrospective review was performed of the charts of
50 randomly selected patients who were admitted to a SPCU over a 2 year
period. The standard admission proforma was reviewed to determine which
symptoms were present on admission, which were SR and which were only
detected upon SQ. Results: All 50 charts were included. 48 patients had
advanced malignancy and 2 had advanced non-malignant disease. An average
of 12.6 symptoms were experienced (SR+SQ) per patient on admission
(range 5–21). 42 different symptoms were SR, with an average of 4.1 per
patient (range 0 to 10). The most common SR symptoms were pain (72%),
bowel disturbance (32%), nausea or vomiting (30%), mobility problems
(30%), loss of appetite (24%) and low mood (22%). On SQ of 38 common
symptoms, there was an average of 8.5 further symptoms per patient detected
(range 1 to 18). The most common symptoms detected on SQ that were
not SR were weight loss (66%), fatigue (56%), loss of appetite (48%),
mobility problems (42%), oedema/ lymphoedema (36%), oral symptoms
(36%), confusion/ memory loss (36%), sleep problems (36%), bowel disturbance
(34%), drowsiness (32%), low mood (28%), and anxiety (26%).
Conclusions: Patients appear to have many symptoms which are not SR on
admission to a SPCU. SQ therefore plays a vital role in the detection of
symptoms that may require further assessment or treatment. We speculate
that under-reporting of symptoms may occur for several reasons e.g. if the
patient does not consider these problematic or perceives them as unimportant
to the medical team. More research is needed to further explore what
symptoms are not SR and reasons for this.
70 Oral Presentation
Other symptoms
Psychostimulants for depression: a Cochrane systematic
review
Authors: Bridget Candy Department of Mental Health Sciences, Royal Free
and University College Medical School UNITED KINGDOM
Louise Jones Royal Free and UCL Medical Scool London UNITED
KINGDOM
Rachael Williams Royal Free and UCL Medical Scool London UNITED
KINGDOM
Michael King Royal Free and UCL Medical Scool London UNITED
KINGDOM
Adrian Tookman Marie Curie Cancer Care London UNITED KINGDOM
Background: Depression is common, disabling, costly and under-treated.
There are problems in the current first-line drug treatment, antidepressants
particularly time to effect. There is little evidence to inform treatment of those
who do not respond and those, such as patients in palliative care, who would
benefit from a faster response. There is a body of research that has evaluated
effect of psycho-stimulants (PS) in the treatment of depression. This has not
been reviewed systematically. Methods: Aim: To determine the effectiveness
of PS in the treatment of depression. Eight citation databases, including
MEDLINE, and EMBASE were searched. Only randomised controlled trials
(RCTs) were included. Meta-analysis was considered for trials with comparable
characteristics. Results: Twenty-four RCTs were identified. The overall
quality was poor. Five PS were evaluated: dexamphetamine, methylphenidate,
methylamphetamine, modafinil and pemoline. PS were administered as a
monotherapy, adjunct therapy, in oral or intravenous preparation and in comparison
with a placebo or an active therapy. Effects were measured up to
24 weeks. The largest meta-analyses involved seven trials totalling 605 participants,
it demonstrated that, in comparison with a placebo, PS significantly
reduced depressive symptoms (Standardised Mean Difference –0.22, 95%
Confidence Interval –0.38, –0.06). Pooled evidence also demonstrated that PS
significantly improved daytime sleepiness, a symptom associated with
depression. The overall effect was greater in patients who had serious concomitant
medical illnesses. PS were acceptable to patients and well tolerated.
Conclusions: There is evidence that PS reduce symptoms of depression.
Whilst these reductions are statistically significant, their clinical significance
is less clear. Larger high quality trials involving longer follow-ups are needed
to explore which PS are more beneficial, in which clinical situations they are
optimal, and to evaluate further adverse events.
71 Invited Lecture
Subjective outcomes in palliative care research and their analysis
The role of patient reported outcomes in clinical research –
EMEA and FDA Guideline documents
Authors: Giovanni Apolone Lab. Tralsational Research & Outcome in
Oncology Istituto Mario Negri, ITALY
Ratings and reporting from patients are often used in clinical practice and
research to evaluate the effect of a given intervention (for example, a drug)
on relevant aspects of health, life or health care, such as pain, physical limitations
or other symptoms, self-perceived health status, quality of life, satisfaction
with care, etc. These measures, sometimess named with the term
of “subjective outcomes” or “soft endpoints”, are most of the times implemented
through self-reported questionnaires and may be used in clinical trials
as primary or secondary endpoints. Pharmas extensively use PRO measures.
A recent evaluation and preliminary analysis of the European Public
Assessment Report (EPAR) has shown that in at least 25% of the EPAR
reports there is a claim about Health Related-Quality of Life, mostly in
cancer-related products. Although the large utilization, their value are questionated
for the difficulty to document their validity, reliability and responsiveness
and for the complexity of their implementation in the studies. In
addition, most of the times it is not easy to assess the added value of their
utilization when compared to the classical clinical outcomes. Of course, in
some clinical situations where the patients’ perspective is the most relevant
or unique point-of view, the trade-off of pros (increase in the amount of relevant
information about disease, health status and satisfaction) and cons
(conceptual, methodological and logistical problems) is different. All these
measures have been recently grouped under the term of PRO (patientreported
outcomes) and both FDA and EMEA have produced and diffused
guidance documents to optimize their utilization in clinical studies designed
for registrative purposes. An analysis of the objectives, contents and recommendations
of both documents can help better understand the potential
value of these measures in palliative care and increase the quality of clinical
studies in this setting.