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Newsletter 2/2010

The 6th Research Congress of the EAPC
By Mike Bennett, Chair of the Glasgow Organising Comittee

The 6th Research Congress of the EAPC was held in Glasgow and broke several records for the highest number of submitted abstracts (663) and the highest number of participants (1406) from 39 countries. In all it was a great success and this congress secured the EAPC Research Congress as the premier international research meeting for palliative care.
 
We were delighted to welcome so many international speakers for the plenary sessions and the many themed sessions which spanned all research areas including symptom control, family carers and end of life care trajectories. As is normal for the research congress, the majority of the programme consisted of oral presentations of submitted abstract which is a great strength of the meeting and a big incentive for researchers to submit their Work. We awarded 5 prizes for the best oral abstracts and Drs Klepstad, Teno, Kurita, Simon and Abernethy were indeed worthy winners. We also presented the prestigious Junior Investigator Award to Dr Joachim Cohen for his exceptional work on using epidemiological data to research place of death.
 
The programme reflected the broad range of research in palliative care and also focused attention on a number of large European research initiatives including several multicentre studies and the recently formed Palliative Care Research Centre (PRC) in Trondheim, Norway. The PRC is now the centre-piece of the EAPC Research Network and it will further stimulate ambitious clinical research projects across Europe over the next years. The 7th EAPC Research Congress is scheduled for June 2012 in Trondheim, Norway.
 
Greeting from the EAPC Research Network
On behalf of the EAPC RN: Chair Stein Kaasa

Dear colleagues and friends,
 
the EAPC Research Network would like to express our gratitude to the organizing and scientific committee, chaired by Mike Bennett and Per Sjøgren respectively, for all the efforts required in organizing the 6th Research Congress of the EAPC. We would also like to thank all the skilled and enthusiastic participants for contributing to making the congress a success. The congress was a fantastic event and the EAPC RN is very proud.
 
Muscle wasting in advanced cancer – interpretation of clinical CT images
By Vickie Baracos

The research group of VE Baracos, Alberta Cancer Foundation Chair in Palliative Medicine, Edmonton Canada, established methods for assessing muscle loss and other facets of body composition using computed tomography (CT) imaging in cancer patients¹. These authors argue that diagnostic images are a valuable resource for assessing wasting of muscle, especially as it may occur independently of overall changes in body weight and be present in patients who are of normal weight, overweight or obese. Several recent works speak to the potential causes of muscle wasting in patients with metastatic colorectal cancer²and renal cell carcinoma³. Muscle wasting is prevalent in patients with both of these diseases and is often an occult condition in patients with normal or high body weight. Not surprisingly, muscle wasting advances exponentially when cancer becomes completely refractory to treatment². While successful cancer treatment would normally be expected to limit progression of cachexia and muscle wasting, specific classes of cancer therapy may exert unwanted effects on muscle. Muscle loss is specifically exacerbated by sorafenib, consistent with the evidence for a role of kinases in regulating muscle anabolism. Muscle loss is a sorafenib side effect which may relate to asthenia, fatigue and physical disability.

¹ Prado CM et al. The emerging role of computerized tomography in assessing cancer cachexia. Curr Opin Support Palliat Care. 2009. [Epub ahead of print].
² Lieffers JR et al. A viscerally driven cachexia syndrome in patients with advanced colorectal cancer: contributions of organ and tumor mass to whole-body energy demands. Am J Clin Nutr. 2009;89(4):1173-9.
³ Antoun S et al. The association of skeletal muscle wasting with treatment with sorafenib in patients with advanced renal cell carcinoma: results from a placebo controlled study. J Clin Oncol, 2010.
 
Projects related to neuropathic pain
By Nina Aass and Mike Bennett

One of the main objectives of the European Palliative Care Research Collaborative (EPCRC) is to develop an international, consensus based classification system for cancer pain. This work will be continued within the PRC / EAPC RN. The research strategy is described as a stepwise process¹, and so far the following steps have been undertaken: A systematic literature review, a survey among experts², and a qualitative study on advanced cancer patients’ experiences with pain and their opinion of assessment and classification of cancer pain. Recently the EPCRC-CSA data collection was finished. This is an international, multi-centre cross-sectional computerised data collection assessing pain, depression and physical function (cachexia) in advanced cancer patients.
 
The steps undertaken so far have identified pain mechanism (pathophysiology) as one domain to be included in a first version of a classification system for cancer pain. One of the sub-domains of pain mechanism is neuropathic pain. Correct diagnosis of neuropathic pain may be difficult. Neurophysiologic examination is the gold standard, but not applicable in daily clinical practice³. Within PRC / EAPC RN therefore two projects will now focus on neuropathic pain:

1. A systematic literature review identifying screening tools and measurement tools for neuropathic pain will be undertaken. Assessment methods as well as the content of the tools (domains, sub-domains and items) will be described. Furthermore, the patients included in the studies identified will be registered (patients with non-malignant diseases and/or cancer patients).
2. Analyses of data from the EPCRC-CSA data collection will be performed. In this study the patients filled in PainDetect, a screening tool for neuropathic pain. This instrument has so far not been validated in an advanced cancer population.

Both these projects will be of importance for the development of a classification system for cancer pain. The work on neuropathic pain is led by Mike Bennett, Lancaster University and Nina Aass, University of Oslo.
  
¹ Kaasa, S., et al., Symptom assessment in palliative care: a need for international collaboration. J Clin Oncol, 2008. 26(23): p. 3867-73.
² Knudsen, A.K., et al., Classification of pain in cancer patients - a systematic literature review. Palliat Med, 2009. 23(4): p. 295-308.
³ Bennett, M.I., et al., Using screening tools to identify neuropathic pain. Pain, 2007. 127(3): p. 199-203.


For more information regarding different upcoming studies and projects, please visit the EAPC RN and PRC websites.