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Palliative Care

SAN FRANCISCO—A novel smallcaliber metal stent can provide a low-risk means of palliation for severe malignant dysphagia, according to investigators who have created these stents and are now testing them in trials. The results were presented at the 2011 Gastrointestinal Cancers Symposium by Stephen Kucera, MD, of H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, where he is an interventional endoscopy fellow.

A palliative medicine consultation can be most effective with symptom management and improving quality of life when compared with anesthesia-pain medicine, according to a pilot study. In an assessment of symptom management, investigators found the both methods are effective in improving cancer pain. Patients in the palliative-medicine group showed clinically significant improvement in 8 of 19 symptoms compared with 3 of 19 in the anesthesia-pain medicine group.

Even though palliative care has been an important aspect of medical care in the United States for more than 25 years, it has yet to gain full public acceptance. Attempts to offer advanced care planning that allows patients to focus on care consistent with their values and preferences have been met with resistance. On January 1, 2011, Medicare proposed clinician reimbursement for advanced care planning. Within several weeks, however, this recommendation was reversed because some politicians worried the public would equate advanced care planning with healthcare rationing.

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