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Palliative and supportive care

These pages are being developed in collaboration with Phil Wiffen and Frances Fairman of the Cochrane Pain, Palliative and Supportive Care SRG (PaPaS). PaPaS has been supported by a generous grant from ther Marie Curie Cancer Care. This site has been possible because we had sponsorship from the BUPA Foundation. The aim is to try and gather together information of interest in palliative care. Some may come from systematic reviews, but we are aware that this is an area with few RCTs even, so reviews will frequently not be available for those things to which we most want answers. There may be lower levels of evidence that can still be useful, and even these will often be difficult to find, because information about palliative care is published in so many different places.

Palliative and supportive care is not just for cancer, but extends to all chronic diseases, and affects carers and professionals, and not only patients. Often it will be not just what we do but how we do it, so we would love to hear from groups which have found that through better organisation they can deliver a better quality of care. And we would like to develop links to help all of us find better information quickly on the internet. If you have special Internet sites that you find helpful, or papers or reports that have influenced you, please email Frances.

Cochrane Review Group

Advice on setting out to perform a Cochrane review Cochrane PaPaS reviews - progress reports Quality of evidence in palliative care


Factors affecting the ratio of morphine to its glucuronides Peak plasma morphine after oral administration Nebulised morphine for dyspnoea

Nausea and vomiting

Overview of chemotherapy nausea and vomiting Dexamethasone and chemotherapy nausea and vomiting 5-HT3 receptor antagonists for chemotherapy-induced nausea and vomiting Cannabinoids for chemotherapy-induced nausea and vomiting 5-HT3 receptor antagonists for radiotherapy-induced nausea and vomiting

Some issues around cancer

Cancer-related fatigue Death rattle Depression in advanced disease Erythropoietin for anaemia with cancer therapy Intracerebroventricular opioids Neurolytic coeliac plexus block Nilutamide plus orchidectomy for metastatic prostatic cancer NSAIDs for cancer pain Opioids for management of dyspnoea Radiotherapy for bone metastases Strontium for bone metastases

Complementary and other therapies

Abdominal massage for chronic constipation Cannabis for spasticity and multiple sclerosis Cognitive behavioural therapy for distress and pain in breast cancer Complementary and alternative therapies at the end of life Complementary AIDs therapies Prayer Relaxation ineffective for acute and chronic pain Psychological coping and cancer Therapeutic touch Thymus therapy for cancer

Management matters

Audit flags for better management Breast cancer care pathway Breast cancer: specialist centres do best Do-it-yourself pain control Improving stroke services Palliative care delivery systems Nutritional assessment tools NNTs used in decision-making in Chronic Pain Management Quality improvement by audit: Pain relief after day surgery Reducing laxatives in nursing homes by systematic review of repeat prescribing


Breaking bad news to patients Developing role of therapy assistants Exploring the role of therapy assistants


Baths are major problem for older people Different ways of helping the elderly Fight it together for cancer patients Treating fatigue in multiple sclerosis What happens after prostate cancer surgery

Drug issues

The gastroduodenal toxicity of nonsteroidal anti-inflammatory drugs


Glutamine supplementation in serious illness Cognitive behaviour therapy for chronic fatigue Ranking quality of life in chronic disease

From the Agency for Healthcare Research and Quality in the USA

Note that these reports are too big to precis. If you click on the title you will link into the report Chronic Obstructive Pulmonary Disease Management of Cancer Pain Swallowing Disorders in Stroke Patients Urinary Tract Infections in Paralyzed Persons Weaning from Mechanical Ventilation


The National Council for Palliative Care