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Cancer related pain is prevalent among patients with a cancer diagnosis, occurring from the tumor itself or as a result of treatment. Many patients require opioid therapy to manage pain and providers must balance efficacy with side effects. Transdermal buprenorphine (TDB) has shown promise for pain management, however, the maximum dose available in the US is considered low, resulting in doubts of efficacy. This study set out to assess if the patch strengths available in the US (5-20 mcg/hour) are able to provide analgesia for patients with cancer in a palliative medicine clinic. This retrospective chart review analyzed patient charts for outpatient TDB use within a palliative medicine clinic in the United States. Patients had to have a follow up visit with the clinic in order to be included. Sixty-eight patients were included for analysis with 54 (79%) continuing at least 28 days and 37 (54%) continuing for at least 84 days. The median change in pain score was 0, though 25 (46%) of patients reported a decrease of 1 or more points at the first follow up. TDB is a viable option for cancer related pain for select patients, demonstrated by duration of use and stable reporting of pain.

Context: The effect of methadone on corrected QT interval (QTc) in patients with cancer pain is not well-known. Objectives: To describe and characterize the effect of low-, moderate-, and high-dose enteral methadone on QTc interval in patients with cancer. Methods: Retrospective cohort study including patients prescribed enteral methadone during the 27-month study period. Participants were divided into 3 methadone daily dose groups: 450 ms for females and >430 ms for males). Secondary outcomes included the magnitude of change in QTc after starting methadone, the incidence of clinically significant QTc prolongation (>500 ms) and the prevalence of torsades de pointes and syncope. Results: Two hundred three patients met study inclusion criteria: 91 (45%) low dose, 52 (26%) moderate dose, and 60 (29%) high dose. Incidence of QTc prolongation for low-, moderate-, and high-dose groups was 50 (55%), 37 (71%), and 43 (72%), respectively ( P = .039, low vs high dose). Incidence of clinically significant QTc prolongation was 10 (11%), 4 (8%), and 7 (12%) for low-, moderate-, and high-dose groups. For patients without QTc prolongation prior to initiating methadone, 62% of moderate-dose patients and 67% of high-dose patients had QTc prolongation, while taking methadone. Conclusion: This study found a notably high incidence of QTc prolongation in patients with cancer using enteral methadone. Future studies should aim to determine the risk of adverse cardiac effects in the cancer population and determine appropriate monitoring of methadone for pain management.

Older adults are at high risk for developing an infection. Once an infection occurs, older adults experience high short- and long-term morbidity and mortality. A number of risk factors (e.g., living in a long-term care facility, chronic disease, malnutrition, age-related immune dysfunction, polypharmacy, difficulty in accessing health care, increased use of prosthetic devices and medical instrumentation) place older adults at high risk for increased susceptibility to infection, and older adults tend to have poor outcomes from infection. Common clinical infections in older adults include pneumonia, urinary tract infections, sepsis, gastroenteritis and viral infections. Serious infection in older adults can result in an increased risk of adverse events well beyond the patient’s hospital stay. Acute infections may worsen chronic diseases in older adults, which may in turn put the older adult at a greater risk of serious infection. Altering modifiable risk factors (e.g., inactivity, malnutrition) may reduce the risk of infection in older adults. Vaccination remains an important strategy to prevent infections despite their variable efficacy in older adults.

Objective: To examine how spiritual care is perceived in an African context by recording the lived experiences of palliative care workers at Hospice Africa Uganda (HAU). Methods: Fifteen palliative care workers with experience in providing spiritual care were interviewed and their responses were thematically analyzed. Results: The participants rarely saw a distinction between religion and spirituality. Although many were comfortable dealing with religious issues emanating from the major religious traditions, including those different from their own, they were less comfortable in handling issues arising from native Ugandan traditions and culture. Beliefs such as witchcraft and cursing in particular were considered harmful and not spiritual, and several participants reported feeling uncomfortable when providing spiritual care to patients with these beliefs. The interviewees also cited difficulties such as the lack of time, resources, and available religious leaders in the community, as well as language barriers. Conclusion: Although the palliative care workers at HAU have views on spirituality and spiritual care that have much in common with the palliative care literature from North America and Europe, they also face more specific challenges. These include providing spiritual care in a resource-poor setting to patients undergoing severe economic hardship, and providing spiritual care to those with traditional African religious beliefs.

We hypothesized that the higher risk of severe sepsis and mortality observed after infection in prior epidemiologic studies are due to age-related differences in immune response.