S. Hernansanz

The reality of palliative care in Spain

With the sponsorship of the Spanish Society of Palliative Care (SECPAL), two nation-wide studies from the University of Valladolid were carried out in 1996 and 1998 into the state of palliative care teams in Spain. This report is based on those studies and is the first overall analysis of the current situation of palliative care in Spain. A total of 143 programmes were identified and data were collected from 128 teams (89%): 53 were programmes with hospitalised patients, 75 for home-based patients and 15 were mixed programmes. From the activity data, provided by 75% of the teams, it may be estimated that each year 22 638 terminally ill patients receive palliative care attention. Of these, 18 021 (79.6%) are cancer sufferers. Of the patients who die from cancer each year in our country, 21.2% receive palliative care during the final weeks of life. More than 10 years have passed since the first teams in Spain started their work. The time has now come to recognize the reality of palliative care in our society and to adopt a national policy for terminally ill patients, in line with World Health Organization recommendations formulated in 1989.

Spain: Palliative Care Programs in Spain, 2000: A National Survey

Carlos Centeno, MD, Silvia Hernansanz, MD, Luis A. Flores, RN, Alvaro S. Rubiales, MD, and Francisco Lopez-Lara, MD Facultad de Medicina (C.C., S.H., L.A.F., A.S.R., F.L.L.), Universidad de Valladolid; Centro Regional de Cuidados Paliativos y Tratamiento del Dolor (C.C.), Salamanca; Equipo Domiciliario de Cuidados Paliativos (S.H.), Hospital Universitario de Valladolid; Centro de Salud de Medina del Campo (L.A.F.), Valladolid; and Servicio de Oncologia (A.S.R., F.L.L.), Hospital Universitario de Valladolid, Spain.

Multicentre, double-blind, randomised placebo-controlled clinical trial on the efficacy of methylphenidate on depressive symptoms in advanced cancer patients

Introduction Methylphenidate is a psychostimulant that has been used to relieve depressive symptoms in advanced cancer patients. No studies compare its efficacy against placebo in this group of patients. Objective To explore the efficacy of methylphenidate compared with placebo in the relief of depressive symptoms in advanced cancer patients. Material and methods A multicentre, double-blind, randomised placebo-controlled clinical trial was undertaken comparing the efficacy of methylphenidate and placebo in depressive symptoms. Advanced stage cancer patients were eligible if they scored at least two points on the Two Question Screening Survey for depression. A reduction of at least two points on the Edmonton Symptom Assessment Scale for depression (0–10) was considered as a response. Results Sixty-nine patients were included (methylphenidate: n=31, placebo: n=38); median daily dose of methylphenidate was 25 mg. Fifty-eight patients (84%) who completed the first week of treatment were considered suitable for evaluation. In the intention to treat analysis, there were 14/31 (45%) responses with methylphenidate and 10/38 (26%) responses with placebo (difference: 19%; 95% CI: 4% to 39%; p=0.10). With the Hospital Anxiety and Depression Scale, 11/19 (58%) patients with methylphenidate and 10/24 (42%) with placebo improved from a score compatible with depression in the first 7 days (difference 16%; 95% CI 13% to 42%; p=0.29). The proportion of patients indicating adverse effects was similar for both cohorts (p=0.99). Conclusion Compared with the placebo, methylphenidate demonstrated a positive trend in the incidence of response for depressive symptoms in advanced cancer patients.

Reacción de llamarada en el cáncer de mama avanzado

• Propósito: La reacción de llamarada se manifiesta de inicio como un aumento aparente de la actividad tumoral inducido por el propio tratamiento. No es raro que se presente como un incremento del metabolismo de las lesiones tumorales, principalmente óseas, sin embargo es infrecuente que aparezca junto con otros problemas como dolor o alteración metabólica. • Material y métodos: Presentamos dos pacientes con cáncer de mama avanzado que desarrollaron esta reacción de llamarada inducida en un caso por el tratamiento hormonal (tamoxifeno) y en el otro por quimioterapia. • Resultados: Ambas pacientes presentaron de inicio un aumento del dolor que sugería progresión de la enfermedad asociado a una elevación de los marcadores. Más tarde se evidenció una clara respuesta del tumor. Destaca el manuscrito en que la propia paciente describe cómo vive los síntomas que se le presentan. • Conclusiones: La reacción de llamarada puede manifestarse como un aparente empeoramiento transitorio de la enfermedad al que sigue la respuesta tumoral.