Literature Review

Navigating the complexities of palliative care for patients with comorbidities and complicated symptomsPharmacy Times; 6/6/24In an interview with the Pharmacy Times, Justin Kullgren, PharmD, FAAHPM, Palliative Medicine Clinical Pharmacist Specialist and PGY2 Pain Management & Palliative Care Residency Program Director at The Ohio State University Wexner Medical Center, James Cancer Hospital, shares insights into palliative care and common challenges faced by pharmacists treating patients with complicated symptoms. He discusses the complex nature of patient cases in palliative care, emphasizing the importance of effective treatment management, pain tolerance, and overcoming patient barriers to treatment.

Controversial conversations: Key takeaways from The Jeffrey Fudin Debates on pain and palliative care practices Pharmacy Times; Interview with Lee Kral, PharmD, FASHP, NBC-HWC, CPMC, CPE; 6/5/24In an interview with the Pharmacy Times®, Lee Kral, PharmD, FASHP, NBC-HWC, CPMC, CPE, clinical pharmacy specialist of pain management at the University of Iowa Hospitals and Clinics, shares her insights into pain management in palliative care for patients with cancer-related chronic pain. She highlights the crucial role of pharmacists in managing patient treatment regimens, including administration of opioids, the role of off-label prescribing, and the potential of deprescribing to improve patients’ quality of life. 

ASCO updates Guidelines on Palliative Care Hematology Adviosor; by Jen Smith; 5/30/24 The American Society of Clinical Oncology (ASCO) has released an update to its guidelines on palliative care for cancer patients. The guidelines and related information were published in the Journal of Clinical Oncology and JCO Oncology Practice. To develop updated recommendations for integrating palliative care into cancer care, an expert panel reviewed randomized controlled trials, systematic reviews, and meta-analyses published during 2015-2023. Based on their findings, the experts recommend that patients with advanced cancer be referred to specialized interdisciplinary palliative care teams soon after diagnosis, while the patients are still receiving active cancer treatment.

‘We don’t talk about death’: Winston-Salem journalist seeks to help people understand dying, deathbed visions Fox 8 WGHP - High Point, NC; by Bob Buckley; 5/29/24 There may not be anything that fascinates people more than death. It may be the thing many people avoid confronting the most. “In our culture, we’re pretty separated from death. And I don’t know the figures, but the vast majority … take place in hospitals. We don’t talk about death a lot in our culture,” said Phoebe Zerwick, a journalist based in Winston-Salem who recently wrote about deathbed visions for the New York Times Magazine. ... Zerwick became aware of the work of Dr. Christopher Kerr. ... “The biggest difference between hallucinations and these experiences is how the person is made to feel,” Dr. Kerr said. “Most hallucinations leave the person distressed and agitated and would be further confused. These experiences bring comfort. They bring meaning. They’re drawn from life. They really validate the life.” ... “I think the moral of the story is to be present and to be present with people when they are terminally ill. Be present when they’re dying,” Zerwick said.

Laws in motion to bring ‘Right to Try’ psychedelics at end-of-life Hospice News; by Holly Vossel; 5/21/24Hospice providers are navigating an evolving landscape of laws opening up pathways of access around psychedelic utilization at the end of life. Despite mounting evidence that psychedelics can improve experiences and reduce symptom burden in some terminally ill patients, these drugs remain difficult to access for those wishing to utilize them. Some states and the federal government have considered legislation that would establish a “right to try” psychedelics and other experimental interventions for certain seriously ill patients. 

A Philadelphia pharmacy’s closure after 26 years highlights the industry’s growing challenges Times Daily; by Lizzy McClellan Ravitch, The Philadelphia Inquirerer; 5/11/24Last Monday, Friendly Pharmacy filled 318 prescriptions. For about 100 of them, insurance companies paid the pharmacy less than $3. In 22 instances that day, the reimbursement was less than the cost of the medication. ... [Managing pharmacist Brad] Tabaac plans to close his doors on May 31 after 26 years in business. ... Independent pharmacies like Friendly, as well as some chains, have been pinched by pricing and fees set by pharmacy benefit managers — the companies that handle prescription drug plans for health insurance. The three biggest pharmacy benefit managers are CVS Health, Optum Rx and Express Scripts. They control nearly 90% of the market, according to the National Community Pharmacists Association (NCPA), and some of their parent companies also own pharmacies.

Ordered to pay $1.536B in criminal fines and forfeiture for distributing misbranded opioid medication Office of Public Affairs, U.S. Department of Justice; Press Release; 5/3/24Endo Health Solutions Inc. (EHSI) was ordered to pay $1.086 billion in criminal fines and an additional $450 million in criminal forfeiture — the second-largest set of criminal financial penalties ever levied against a pharmaceutical company —for violations of the Federal Food, Drug and Cosmetic Act related to the distribution of the opioid medication Opana ER with INTAC (Opana ER). ...

Substance use disorders in hospice palliative care: A narrative review of challenges and a case for physician interventionCambridge University Press; by Lauren Rudy and Emilie Lacroix; 2/29/24Objectives: Substance use disorders (SUDs) are frequently encountered in hospice palliative care (HPC) and pose substantial quality-of-life issues for patients. However, most HPC physicians do not directly treat their patients’ SUDs due to several institutional and personal barriers. ...Results: ... Recommendations for physicians and training environments to address these challenges include developing familiarity with standardized SUD assessment tools and pain management practice guidelines, creating and disseminating visual campaigns to combat stigma, including SUD assessment and intervention as fellowship competencies, and obtaining additional training in psychosocial interventions.

Walmart Health is closingWalmart; 4/30/24Back in 2019, we launched Walmart Health centers. During our five-year journey, we made meaningful impacts with patients while continuing to learn, pivot and evolve. While our mission to help people save money and live better remains, today we are sharing the difficult decision to close Walmart Health and Walmart Health Virtual Care. Through our experience managing Walmart Health centers and Walmart Health Virtual Care, we determined there is not a sustainable business model for us to continue.

Drug discount program is exploiting poor patients while corporate giants profit Minnesota Reformer; by David Balto; 4/26/24 ... The federal 340B drug discount program was created three decades ago to help economically vulnerable Americans access affordable prescription medications and providers in underserved areas expand and improve services. Under the program, drug companies participating in Medicaid — known in Minnesota as Medical Assistance — provide sizeable discounts as high as 50% to these ‘safety net’ health care facilities. ... Unfortunately, over time, the tens of billions of dollars flowing through this program have proven irresistible to for-profit corporate entities, including giant health systems and big box chain pharmacies — and there is no guarantee those discounts are reaching patients. 

AI could play role in preventing prescribing of unnecessary drugs in older adults McKnights Senior Living, by Kristen Fischer; 4/22/24 A new study finds that artificial intelligence could encourage doctors to stop prescribing drugs that aren’t necessary — especially in older adults, who tend to be on multiple medications. The report was published 4/18 in the Journal of Medical Systems. More than 40% of older adults are taking five or more prescription medications, a rate that raises their risk for potentially harmful drug interactions. ... AI isn’t a perfect tool compared with having an actual doctor. For instance, it tended not to pay much attention to a person’s pain level, suggesting that the patient stop taking pain medications but not others for clinical ailments such as high cholesterol or high blood pressure, the authors reported.

Comparative effectiveness of acupuncture vs massage for relieving pain in patients with advanced cancer The ASCO Post; by Jun J. Mao, MD, MSCE and Andrew S. Epstein, MD; 4/17/24... The IMPACT study was conducted at Memorial Sloan Kettering Cancer Center and regional sites in New York, New Jersey, and Florida to evaluate the long-term comparative effectiveness of acupuncture vs massage for pain in patients with advanced cancer. ... The primary outcome—change in worst pain intensity score from baseline to 26 weeks—was measured using the Brief Pain Inventory (BPI ranging from 0–10; higher numbers indicate worse pain intensity or interference). The secondary outcomes included fatigue, insomnia, and quality of life. ... To use these therapies, it is important to seek credentialed practitioners who have training or experience in working with patients who have cancer. 

‘We’re the telescope looking forward’: Medical ethicists ask tough questions as part of $66 million research project CU Department of Medicine, by Mark Harden; 4/5/24 In the original “Jurassic Park” movie, after the process of bringing dinosaurs back to life is explained to a team of consultants, one of them voices a warning: “Your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.” University of Colorado Department of Medicine faculty members will be asking the “should” question years before there’s an answer to “could.” They’ve joined in a nationwide study of whether tiny, battery-powered electric devices and genetic material, swallowed in capsule form, could one day replace surgery or injections as treatments for metabolic diseases such as diabetes and obesity.