Microsoft word - palliative care csg annual report el changed.doc
NCRI Palliative Care Clinical Studies Group 2006-7
The remit of the Group is in line with the existing Clinical Studies Groups and the primary aimis to develop a portfolio of national collaborative studies, which are clinically relevant andlikely to have an impact on day-to-day practice. The full committee is concerned withdeveloping a strategy for the Group and identifying priorities for palliative care research. The development of protocols has been devolved to subgroups where the detaileddiscussion and review of study proposals takes place. Membership The Chair was re-appointed in May 2006. Professor Chris Todd left the Group and Dr Julia Riley joined the Group in June 2006. A number of existing members successfully reapplied to the Group. Subgroups Just one of the ‘original’ Subgroups is still working; Pain. Health Services Research was dissolved, those skills being co-opted on to other groups as needed. The Pain group has met on several occasions during the past year, in addition to the twice-yearly meetings of the main Group. Two newer Subgroups, Cachexia and Palliative Care in a Primary Care Setting were set up in April and December 2005 respectively, and the newest, the Breathlessness Subgroup early Summer 2006. Progress Review The progress review in January 2006 was in the main satisfactory, but flagged up some important thoughts for the future. These included the failure of the Health Services Research (HSR) Subgroup to develop any studies to be taken forward, and the need to broaden the palliative care portfolio. “It is particularly important that studies in the important area of health service research are rapidly developed. Additionally the Group could consider developing ethics studies and work with other CS(D)Gs to develop joint studies on, for example, complementary therapies or spirituality.” As a result of the review the title of the Clinical Studies Development Group was changed, dropping the word development. This change was really an acknowledgement of the achievements of the Chairs of the Pain and Prognosis Subgroups in developing their ideas and taking them through successfully to the funding stage. The progress of the Pain Subgroup continued as the portfolio shows, and the prognosis study is ongoing. Cachexia have produced and submitted a number of proposals, and the Breathlessness Subgoup are pleasingly active, with a submission
in June 2007 to CRUK of a study titled “Phase II
feasibility study of an RCT of a Breathlessness Intervention Service (BIS) for patients withcancer versus standard care”.
More problematic was the question of how the Group should handle the sharp criticism ofHealth Services Research. At the main meeting of the PCCSDG in March 2006 the decisionwas taken to dissolve the HSR Subgroup pro tem, and to ask the chair of the disbandedsubgroup to write a new strategy document and if accepted then a new committee would beformed to take forward that work. No document was forthcoming and the HSR group wasformally dissolved at the November 2006 CSG.
The Chair attended the June 2007 Complementary Therapies Group Strategy Meeting in anadvisory capacity. Portfolio and accrual There are currently 4 open trials in the portfolio and 2 in set up, with others on the way. A summary of the open and set-up stage trials is given in Table 1 below. 70 patients were accrued to palliative care studies in 2006-07, the same as the previous year, representing 0.3% of total UK accrual. Studies in development A number of studies are in development including a study of hydrox-methyl butyrate and eicosapentaenoic acid in cancer cachexia, and a randomised double-blinded controlled parallel trial of s-ketamine, racemic ketamine and placebo in conjunction with best pain management in nueropathic pain in cancer patients. . Strategy The strategy for the Group may be summarised as:
Developing a large study which makes full use of NCRN resources and which clearly
demonstrates the added benefit of being part of NCRI
The publication of results from a national study in a high quality journal
Fully integrating palliative care research into mainstream oncology research
(palliative care outcomes built into therapeutic studies)
Agreeing and using common outcome measures in studies
A better understanding of how sponsored services can have a high positive output on
In addition there is a need to clarify the relationship between the Group and the two SUPACCollaboratives, to ease communication and prevent unnecessary competition between theCSG and the Collaboratives. The necessary cross-representation has been organised. Publications/Presentations These for the reporting year can be found in Appendix 1. Table 1. Palliative Care CSG Portfolio
preference trial of a care planningdiscussion
resistance in patients with advancedcancer - phase 1 (observational Study)
resistance in patients with advancedcancer - phase II (interventional Study).
clinicians experiences and views ofpalliative chemotherapy.
proposal for phase one of a two phasestudy
blind controlled trial to investigate the
supplementation Prosure™ containing the
omega-3 fatty acid, eicosapentaenoic acid
or EPA to stabilise weight loss andpromote weight gain in patients withspecific incurable solid tumour cancer anda history of on going weight loss(cachexia)
perceptions about the quality of end-of-lifecare (50 patient, pre-testing study)
patients: a pilot study to determine theoptimum dosage regime
strategies in older people with cancer.
measure for use in cancer cachexia trials -
stimulation in the management of cancerbone pain
An open, randomised, parallel group study
in patients with cancer pain, to compare a
oxycodone) with conventionalmanagement using a three-step approach.
NCRI-Palliative Care CSG 2006/07 Publications and Abstracts Report
Kelly L, White S and Stone P. The B12 / CRP index (BCI) as a simple prognostic indicator inpatients with advanced cancer: a confirmatory study. Annals of Oncology (in press). Stone PC and Lund S, Predicting Prognosis in patients with advanced cancer. Annals of Oncology 2007; 18: 971 – 976 Stone P. Fatigue in advanced cancer – Is it inevitable? Journal of Royal College ofPhysicians of Edinburgh 2007 (Conference proceedings)(in press)
Fernandes RJ, Stone P, Andrews PA, Morgan RE and Sharma S. Fatigue, Sleep Disturbance and Circadian Rhythm in Cancer Inpatients – A Controlled Comparison. Journal of Pain and Symptom Management 2006; 32: 245 – 254 Murphy H, Alexander S and Stone P. Investigation of diagnostic criteria for cancer-related fatigue syndrome in patients with advanced cancer: a feasibility study. Palliative Medicine 2006; 20: 413 – 418 Fernandes RJ, Stone P, Andrews PA, Morgan RE and Sharma S. Fatigue, Sleep Disturbance and Circadian Rhythm in Cancer Inpatients – A Controlled Comparison (Research abstract). Palliative Medicine 2006; 20(2): 142. Murphy H, Alexander S and Stone P. Investigation of diagnostic criteria for cancer-related fatigue syndrome in patients with advanced cancer: a feasibility study (Research abstract). Palliative Medicine 2006; 20(2): 144-145 Murray SA, Kendall M , Grant E, Barclay S, Sheikh A. Patterns of social, psychological andspiritual decline towards the end of life in lung cancer and heart failure. JPSM 2007, InPress.
Kendall M, Harris FM, Boyd K, Sheikh A, Murray SA, Brown D, Mallinson I, Kearney N,Worth A. Key challenges and ways forward in researching the “good death”: qualitative in-depth interview and focus group study. BMJ, doi:10.1136/bmj.39097.582639.55 (published28 February 2007).
Kendall M, Boyd K, Campbell C, Cormie P, Fife S, Thomas K, Weller D, Murray SA. How do people with cancer wish to be cared for in primary care? Serial discussion groups of patients and carers. Family Practice 2006; 23:644-650 Murray S, Sheikh A. Serial interviews for patients with progressive diseases. Lancet 2006; 368: 901-902. Murray S, Sheikh A, Thomas K. Advanced care planning in primary care.
2006;333: 868-869 Murray SA, Mitchell GK, Burge F, Barnard A, Nowels D, Charlton R. It’s time to develop primary care services for dying. Journal of Palliative Care 2006;22
Functional Relationships in the Nuclear and Extended Family: A 16 Culture Study James Georgas, Kostas Mylonas, & Tsabika Sophia Christakopoulou, UK Cigdem Kagitcibasi Sabiha Orung, & Diane Sunar Bogazici University Turkey Neophytos Charalambous TATA Institute of Social Sciences, India International Journal of Psychology (in press) James Georgas Department of Psychology School
Effets indésirables du baclofène dans le traitement des addictions Suivi national de Pharmacovigilance : année 2011 Comité technique de Pharmacovigilance de mars 2012 Centre Régional de Pharmacovigilance de Grenoble Résumé Le baclofène est utilisé depuis 2008 hors AMM dans le traitement des addictions, à l’alcool principalement. Les arguments neuropharmacologique sont i