The Center to Advance Palliative Care (CAPC) is a national organization dedicated to increasing the availability of quality palliative services for people facing serious illness. CAPC provides peer-reviewed, evidence-based summaries of key palliative care topics, termed “Fast Facts”. Two recently released Fast Facts that focus on Opioids and substance abuse disorder are excellent resources for hospice clinicians. Fast Facts #311 (Opioids/Chronic Pain Substance Abuse Disorder #1) and #312 (Opioids/Chronic Pain Substance Abuse Disorder #2) discuss the assessment and initiation of opioid therapy in patients with a history of a substance use disorder (SUD) and highlight expert suggested strategies for opioid monitoring in this population.
Link to Palliative Care Network of Wisconsin (PC NOW): Palliative Care Fast Facts and Concepts article abstract (May 3, 2016)
Cystic fibrosis is a life-limiting genetic disorder that affects several body systems including the lung (bronchiectasis), pancreas (malabsorption), liver (biliary cirrhosis), and sweat glands (heat shock). The cause is a mutation of the gene CFTR (cystic fibrosis transmembrane conductance regulator). Development and improved delivery of medications have resulted in a median life expectancy older than 40 years for this disorder once characterized as a pediatric illness. A recent Lancet article published online summarizes new therapies, that target CFTR, deemed effective in improving lung function and reducing exacerbations, as well as current research in small molecule and gene-based therapies.
Link to Lancet article abstract (04/29/2016)
Of patients with Parkinson’s disease (PD), 60% experience psychosis and 80% develop dementia. The use of antipsychotics to manage symptoms in this population is common. It has been established that the use of antipsychotics in patients with dementia is associated with increased mortality, but whether this risk extends to patients with PD is unknown. Weintraub and colleagues performed a retrospective, matched-cohort study of nearly 8,000 patients with idiopathic PD to examine this risk.
They found that patients with PD who started antipsychotic therapy were more than twice as likely to die within six months, compared with those who were not taking antipyschotics. The conventional antipsychotic haloperidol was linked with the highest mortality risk, followed by the atypical antipsychotic agents olanzapine, risperidone, and quetiapine.
In an accompanying editorial, a historical review of antipsychotics and reports of their increase on mortality is described. Limitations of the study are also discussed, such as lack of confidence in the diagnosis of both PD and dementia in the population and whether the diagnosis of psychosis was a contributing factor in the patient’s death, rather than the therapies used to treat it. We also gain appreciation for the challenge of clinicians in managing symptoms in patients with dementia, with or without Parkinson’s disease, and the need for a well-designed prospective study to guide treatment recommendations.
Proton pump inhibitors (PPIs) are widely used for the treatment of gastrointestinal diseases but have also been associated with cognitive decline. Gomm and colleagues performed a prospective, cohort study of almost 74,000 patients, aged 75 years or older and free of dementia to examine the association between the use of PPIs and the risk of dementia in the elderly. The 3,000 patients receiving regular PPI medication had a significantly increased risk of dementia compared with the patients not receiving PPI medication.
Link to JAMA Neurology article abstract (02/15/2016)