European Palliative Care Research Centre

The updated EAPC guidelines on use of opioid analgesics in the treatment of cancer pain are outcomes of the EU collaborative EPCRC.

The content of the guidelines was defined by topics, and a systematic review was conducted within each topic. The recommendations were thereafter developed by a writing committee, resulting in 16 evidence-based guidelines for using opiods when treating cancer pain.

The article is published online at Lancet Oncology.

EURO IMPACT is a pan-European network project that aims to develop a multi-disciplinary, multi-professional and intersectorial educational and research training framework in Europe, aimed at monitoring and improving the quality of palliative care in Europe.

Researcher 1 and 2: Developing a handbook on palliative care for older people

•  R1: 2 year position based in Brussels (Belgium), expected to reside in Switzerland for 3 months. Deadline for application is 15 March, 2012.
• R2: 1,5 year position based in Amsterdam (the Netherlands), expected to reside in Belgium for 3 months. Deadline for application is 1 June, 2012.

Researcher 3: Developing a guideline on symptom assessment and clinical applicability of computer symptom assessment

• R3: 1,5 year position based in London (UK), expected to reside in Trondheim for 3 months. Deadline for application is 15 March, 2012.

Researcher 4: Developing a guideline on palliative sedation

• R4: 1,5 year position based in Lancaster (UK), expected to reside in Amsterdam for 3 months. Deadline for application is 31 January, 2012.

These positions will be based in Belgium, the Netherlands, and the UK (London and Lancaster), and during the appointment period the researcher will have a period of residency at other collaborating sites.

Please read more at the EURO IMPACT website, and if you have general questions please e-mail Koen Meeussen.

- To be physical active does not mean to participate in the Birkebeiner (a long-distrance Norwegian cross-country ski race). All type of activity and exercise contributes, like carrying the groceries or walking to and from work, Kaasa emphasises in the interview.

HUNT data

Kaasa has led a research project that has studied the effect of physical activity on chronic pain, mental health and cancer. The project has been financed by the NRC's program for public health, and used data from the Nord-Trøndelag Health Survey (HUNT), a follow-up study including more than 3500 voluntary participants over a period of 5 years.

- Pain can be reduced and possibly prevented by exercise, but can also prevent people exercising. Therefore, it is important to include pain in the evaluation when we are talking about increasing the physical activity in the whole Norwegian population, he says.

All exercise matters

The greatest difference is between those who do not exercise at all and those who exercise a little. The increase is much smaller in the group who exercise a little compared to the groups who exercise a lot. Also here, the difference is most evident for women above 65 years of age.

- This means that physical activity can prevent many common illnesses in the population, not only pain, but that it also contributes toward better wellbeing. That even cancer patients benefit of exercise, indicates that it is never too late to start exercising. And the older you get, the more important training is.

The entire interview can be found at NRC's website (text is in Norwegian).

The 1st International Seminar of the PRC and EAPC RN took place at Rigshospitalet, Copenhagen, Denmark. 184 participants from all over the world attended, and all in all there were 27 plenary talks in 10 plenary sessions. The plenary sessions were on: classification and pain, patophysiology, diagnosis and treatment, status and progress on projects, danish research projects, the PRC international PhD programme, the European pharmacogenetic opioid study, opioids, and challenges and perspectives.

For most of the presentations and some information on the Copenhagen seminar, please visit www.pallres.org.

Next year, the 2nd International Seminar of the PRC and EAPC RN will be in Ghent, Belgium on 18-19 October. Please read more about this at www.pallres.org.

The themed session part of the scientific programme is already finalised. Two of the themed sessions are as follows:

Cancer cachexia

- Definition and classification of cancer cachexia: heading for an international consensus? Ken Fearon (UK)

- The evidence for nutritional support in multimodal therapy for cancer cachexia. Ingvar Bosaeus (Sweden)

- Pathophysiology of cachexia. Common features in cancer and COPD? Annemie Schols (Netherlands)

Studying palliative care in dementia patients

- How to assess pain in end-of-life patients suffering from advanced dementia? Ladislav Vollicer (USA)

- End-of-life care and quality of dying of people with dementia: a nationwide study. Lieve Van den Block (Belgium)

- Retrospective versus prospective assessment and process versus outcome measures in studying palliative care needs in patients with dementia. Jenny van der Steen (The Netherlands)

Among eight meet-the-experts sessions you will find:

- Does opioid addiction play a role in advanced cancer? (Sebastiano Mercadante/Eduardo Bruera)

- How to write and read a paper (Geoffrey Hanks/Luc Deliens)

Further details of the scientific programme are available at the congress website. There you will also find the link to the registration system, which is open. Deadline for early bird registration is 1 March 2012.

Everyone with an interest in palliative care research is encouraged to participate in this landmark congress.

The congress unites a variety of professions, such as doctors, nurses, nutritionists, physiotherapists, social workers, clergymen and others who work with patients in a palliative phase of their disease. 1400 participants from all over the world are expected to attend in Trondheim, which makes the congress one of the most important of its kind.

Abstract driven

The scientific programme is mainly based on submitted abstracts, and we hope that as many as possible will come and present their research in Trondheim. Popular abstract categories are pain, dyspnea, cachexia, fatigue, symptom treatment, psychology, communication, ethics, palliative care for older people, and organisation of palliative care. Abstract submission deadline is 31 October.

- Unique opportunity

Professor Stein Kaasa, director of the Cancer Clinic at Trondheim University Hospital and leader of the palliative research community at NTNU and the EAPC Research Network, has been the initiator behind next year's congress.

- This is a unique opportunity to meet world leading researchers within palliative care, and to present your own results, Kaasa says. He stresses that the congress is multi-disciplinary.

- All professions within palliative care will profit from the congress as a meeting point, and as a forum for exchanging knowledge across professional borders.

You can submit your abstract at: www.eapcnet.eu/research2012.

Cancer pain

Classification of cancer pain in a palliative phase of the disease trajectory is a specific concern in cancer care, as pain is one of the most prevalent symptoms for cancer patients. Despite the attention given to cancer pain, studies show that 50 % of patients on opioid treatment are unsatisfactorily treated.

Guidelines evolution

EAPC guidelines on the use of opioid analgesics for the management of cancer pain have been seen as an evolution of WHO recommendations, and were published twice, in 1996 and 2001. The previous versions of the guidelines had some weaknesses with regards to methodology and the number of experts contributing to them. When the European Palliative Care Research Collaborative (EPCRC) – the first major EU-funded cancer palliative care research collaborative – started in 2006, an important part of the project became to revise and update the guidelines.

"Call to arms"

23 systematic reviews were performed, and the results of them are now to be found in the special issue of Palliative Medicine. The reviews revealed difficulties in finding suitable studies for inclusion, which made them unable to provide robust evidence-based recommendations. This represents a "call to arms" for the palliative care research community, which needs to aim towards a practice that is evidence-based, not merely expert opinion-based. The systematic reviews, however striking the low level of evidence found by them, constitute an important platform for future research.

The article, Associations between Physical Activity and Physical and Mental Health - A HUNT3 Study, by Gro Bertheussen, Pål Romundstad, Tormod Landmark, Stein Kaasa, Ola Dale and Jorunn Helbostad, was published in the journal Medicine and science in sports and exercise in July 2011.

The study found that people who engaged in exercise - even small amounts - reported improved mental health compared to Norwegians who do not exercise.

The article was quoted in a news article in the New York Times on 6 July, under the heading: "Why Exercise Makes Us Feel Good".

You can meet world leading experts in these three major symptoms at this pre-congress seminar, which takes place at Jægtvolden Fjordhotell in the county Nord-Trøndelag.

The seminar will be CME accredited and participants are invited to attend parallel group activities and lectures by invited guest speakers presenting and discussing cutting edge knowledge and sharing insights on the latest research developments. This will also be discussed in relation to the future research agenda of the PRC and EAPC RN, making this the place to be if you want to influence and take part in some large and high quality research projects on these symptoms in the coming years.

This event will allow time for both scientific and leisure activities, combining a cutting edge scientific programme and possibilities to explore the beautiful nature and countryside surrounding Jægtvolden.

For more information on the specific programme, price, registration and other practicalities, please visit the EAPC Research congress website at: www.eapcnet.eu/research2012

The Union for International Cancer Control is working to ensure that the issues relating to cancer are well represented at this once in a generation summit. They are also working with cardiac and respiratory groups to represent the major chronic and progressive morbidities associated with palliative care.

The UICC commissioned a number of committees to work on particular areas to improve access including palliative care.  The output of that group was presented to the Health Ministers meeting in Moscow in April 2011 and will be part of the UICC submissions for the UN Summit in New York in September.

The sheets can be downloaded here and here.

By David Currow

PALC8001 is a two-week course covering theoretical, practical, ethical and methodological aspects of palliative care research, with main emphasis on biomedical research.

This is an open PhD-course, and is part of the international PhD programme in palliative care which is hosted by the PRC.

• Module I: Trondheim, week 38 (19 - 23 September)
• Module II: Edinburgh, week 44 (31 October - 4 November)

The program consists of lectures, group work and plenary discussions during the two separate  weeks at NTNU and the University of Edinburgh, respectively. The students will be given a home assignment in the period between the two weeks. A final home exam after the two-week course must be passed. The course language is English.

Overview week 1 in Trondheim
Responsible: Stein Kaasa and Dagny F. Haugen

Monday

• Palliative care and future challenges
• How to define a palliative care population
• Outcome measurements

Tuesday

• Litterature search
• How to read a scientific paper

Wednesday

• Research methods and study design
• PhD education

Thursday

• Ethical and legal regulation in research
• Organisational aspects of palliative care research

Friday

• Systematic reviews

Overview week 2 in Edinburgh
Responsible: Marie Fallon and Barry Laird

Monday

• Reviewing and writing abstracts

Tuesday

• Clinical trials management
• Statistics in clinical trials

Wednesday

• Protocol writing
• Qualitative research

Thursday

• Protocol writing

Friday

• How to write a paper
• Dissemination and the publication process

All students must have a Master's degree or equivalent education. This course will replace SMED8004 (Introduction to Research) and SMED8005 (Communication of Science); for those of you who already have these courses, PALC8001 will give a reduced number of study points. Please read more about the course by clicking here.

Registration
For those of you who are not formally a part of a PhD-programme at NTNU, please fill out this form and return it filled out and signed to Patrick Reurink (patrick.reurink@ntnu.no) by 15 August, 2011 to register. If you do not have a Norwegian ID number, please submit a copy of your Passport and do not enter an ID number in the form. Also enclose documentation that you have a Master's degree or equivalent education. The final application deadline is September 15, please register as soon as possible! For those of you who already are enrolled in a PhD-programme at NTNU, please register at StudentWeb.

Students must cover travel and accomodation in Trondheim and Edinburgh, respectively. Students that are not admitted to a PhD-programme at NTNU will also have to pay a term registration fee of NOK 450 (approx. € 60).

For more information, please contact: Patrick Reurink (patrick.reurink@ntnu.no) or Mariann Hansen (mariann.hansen@ntnu.no).

Among the invited lecturers we find leading researchers from around the world;  David Currow (AU), Augusto Caraceni (IT), Marie Fallon (UK), Per Sjøgren (DK), Mike Bennett (UK) and Stein Kaasa (NO) to mention a few.

The idea behind the seminar is to provide and share information about and discuss international and regional initiatives and research projects, and this first seminar will have a Scandinavian focus. The PRC is aiming to host the next seminar in 2013 in Eastern Europe. These seminars will be a complement to the biannually held Research Congress of the EAPC.

A blend of national, regional and international researchers and clinicians from different fields of study with interest in palliative care research, is the target audience. The seminar will also be an important meeting place for young researchers and PhD candidates. The number of participants is limited to 300. 

The seminar takes place at Copenhagen University Hospital, Rigshospitalet, and the participant fee will be DKr 1600. Information on how to register will be announced in due time at the PRC and EAPC Research Network websites. For more information, please visit: www.pallres.org

 The depression guidelines have been developed by a Work Package team at King's College in London. The process has involved expert and public consultations in addition to literature reviews. The latter include a Cochrane review on the use of antidepressants for depression in physically ill people.

Patient friendly leaflets has been prepared in five languages, and these will be published along with the guidelines.