MASCC Palliative Care Study Group

Leadership

Chair: Gregory Crawford, MD - Australia
Vice-Chair: Sandip Mukhopadhyay, MD - India

Annual Meeting 2019 - San Francisco, USA
Palliative Care Study Group Annual Meeting Minutes (MASCC login required

Subgroup: Cancer Pain  (View details)

Leadership
Chair: Mellar Davis, MD - USA

Vice-Chair: Akhila Reddy, MD - USA

For more information or to contact the Study Group Leaders, please send an email to Leslie Johnson.


Goal

The goal of this study group is to foster international collaborations related to education and research in supportive and palliative oncology to improve the quality of cancer care.


News

MASCC Recommendations for the Management of Constipation in Patients with Advanced Cancer
A subgroup of the Palliative Care Study Group has published evidence-based recommendations for the management of constipation in patients with advanced cancer, in whom constipation, a side effect of opioid medications, is a common problem.
Following a search of Medline, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials, recommendations were categorized by level of evidence as either “recommendation,” "suggestion,” or "no guideline possible.” The results, published by Supportive Care in Cancer in August 2019,* include 15 recommendations relating to the assessment, treatment, and re-assessment of constipation. The resulting paper gives an overview of constipation in patients with advanced cancer, the methodology involved in developing the recommendations, and the evidence to support the recommendations and the grading of the evidence.
Two recommendations were made with the highest levels of evidence:

  1. Conventional laxatives should be considered first-line treatment for patients with functional constipation.

  2. Peripherally acting mu-opioid receptor antagonists (PAMORAs) should always be considered for patients with opioid-induced constipation.

Suggestions include regular assessment for all patients with advanced cancer and individualized management plans. Others pertain to re-assessment and/or management of patients with secondary, refractory, or resistant constipation, treatment of reversible causes, and lifestyle changes. These recommendations provide a framework for managing constipation in advanced cancer.
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*Davies A, Leach C, Caponero R, Dickman A, Fuchs D, Paice J, Emmanuel A. MASCC recommendations on the management of constipation in patients with advanced cancer. Support Care Cancer. 2019 Aug 9. The authors include Andrew Davies, MD, (Royal Surrey County Hospital, Guildford, UK), Charlotte Leach (Royal Surrey County Hospital, Guildford, UK), Ricardo Caponero (Hospital Alemão Oswaldo Cruz, São Paulo, Brazil), Andrew Dickman (Royal Liverpool Hospital, Liverpool, UK), D Fuchs (Kepler University Hospital, Linz, Austria), Judith Paice (Norhwestern University, Chicago, IL, USA), and Anton Emmanuel (University College London Hospitals, London, UK).


Recent Projects

Updated MASCC/ESMO Consensus Recommendations for Management of Nausea and Vomiting in Advanced Cancer
Updated MASCC/ESMO Consensus Recommendations for Management of Nausea and Vomiting in Advanced Cancer.
 Walsh D, Davis M, Ripamonti C, Bruera E, Davies A, Molassiotis A. 2016 updated MASCC/ESMO consensus recommendations: management of nausea and vomiting in advanced cancer. Support Care Cancer 2017; 25: 333-40.

Referral Criteria for Outpatient Speciality Palliative Cancer Care
Referral Criteria for Outpatient Speciality Palliative Cancer Care: An International Consensus. Hui D, Mori M, Watanabe SM, Caraceni A, Strasser F, Saarto T, Cherny N, Glare P, Kaasa S, Bruera E. Referral criteria for outpatient specialty palliative cancer care: an international consensus. Lancet Oncol 2016 Dec;17(12):e552-e559.

MASCC/ESMO/EAPC Survey of Palliative Care Programs
MASCC/ESMO/EAPC Survey of Palliative Care Programs. Davis MP, Strasser F, Cherny N, Levan N. MASCC/ESMO/EAPC survey of palliative programs. Supportive Care in Cancer 2015; 23:1951-68.

Integration of Oncology and Palliative Care Programs
Indicators of Integration of Oncology and Palliative Care Programs: An International Consensus. Hui D, Bansal S, Strasser F, Morita T, Caraceni A, Davis M, Cherny N, Kaasa S, Currow D, Abernethy A, Nekolaichuk C, Bruera E. Ann Oncol. 2015 Sep;26(9):1953-9.


Guidelines

Management of Cancer Pain: ESMO Clinical Practice Guidelines
Ripamonti CI, Santini D, Maranzano E, Berti M, Roila F; ESMO Guidelines Working Group..
Ann Oncol. 2012 Oct;23 Suppl 7:vii139-54.

Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update
Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T, Stovall EL, Zimmermann C, Smith TJ. J Clin Oncol. 2017 Jan;35(1):96-112.


Palliative Care Subgroup on Cancer Pain

More than 80% of patients with advanced cancer develop severe pain, a primary concern for both patients and their caretakers. For these patients, opioids are a highly effective treatment that can reduce pain intensity, restore function, and improve quality of life. However, the drug, dosage, and route of administration are complex and must be personalized for maximum symptom control. In addition, addiction risk, overdose, drug interactions, and the high cost of these drugs are critical issues in the use of opioids for cancer pain. The subgroup has been established to focus attention on these issues and to address some of the most challenging issues in cancer pain management. Topics of interest include the following:

  • Use of levorphanol in cancer pain
  • Patient and caregiver perspectives on NARCAN® (naloxone HCl) spray for accidental opioid overdose
  • Development of guidelines to address non-medical opioid use among cancer patients
  • Methadone as a co-analgesic in patients receiving morphine equivalent daily dose of more than 100 mg
  • Buprenorphine as a means of tapering opioids in patients with prolonged abstinence and complex persistent dependence
  • Use of the cannabinoid nutraceutical, palmitoylethanolamide as an analgesic and co-analgesic
  • Risk of death with co-administration of gabapentinoids and opioids

Subgroup Leaders

Chair Mellar Davis, MD, is FCCP FAAHPM is a member of the Palliative Care Department, and Section Head, Geisinger Medical System in Danville, Pennsylvania, USA. He is a former Chair of the Palliative Care Study Group and a member of MASCC’s Board of Directors.
Vice-Chair Akhila Reddy, MD, is an Associate Professor in the Department of Palliative, Rehabilitation, and Integrative Medicine at MD Anderson Cancer Center in Houston, Texas, USA. She is also the Medical Director for the MD Anderson’s Supportive Care Center.

How to Join
To join this Subgroup, a MASCC member must also be a member of the Palliative Care Study Group. Join the Cancer Pain Subgroup by editing your Profile in your Account settings. (Log in at the MASCC website, go to My Account, and then Edit Profile. Click to check the Cancer Pain Subgroup and click Save.)

For more information or to contact the Subgroup Leaders, please send an email to Leslie Johnson.


MASCC International Pain Management Center

Dr. Mellar Davis has created the MASCC International Pain Management Center, a web resource that provides (PDF) access to many consensus guidelines and position statements on pain management. The Center also contains teaching resources, books, and articles of interest.


Past Workshops


Recent Member Publications

Recent Study Group member publications related to palliative care.


Relevant Journals and Organizations

American Journal of Hospice & Palliative Medicine
BMJ Supportive & Palliative Care
The Journal of Community and Supportive Oncology
Palliative Medicine
Progress in Palliative Care

European Association for Palliative Care
American Academy of Hospice and Palliative Medicine 
National Hospice and Palliative Care Organization
International Association for Hospice and Palliative Care


Please contact the Study Group Chairs above with your questions.
MASCC Study Group Coordinator, Leslie Johnson