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News - June 2012

Contents

NICE recommends opioids for pain relief in palliative care

NICE has published new guidance that recommends the prescription of opioids to help relieve pain in patients receiving palliative care for chronic or terminal illnesses, such as cancer or heart failure.

Opioids can be the best source of pain relief for people with chronic or neurodegenerative conditions, but evidence suggests that pain caused by advanced disease remains under-treated. This may be attributed to concerns among healthcare professionals and patients about using strong opioids due to their potential side-effects and the possibility of addiction.

Clinical Guideline 140 aims to ensure that opioids are prescribed safely and consistently as a first-line treatment option to relieve pain in palliative care.

The guidance has been arranged into nine key recommendation areas:

  • Communication
  • Starting strong opioids—titrating the dose
  • First-line maintenance treatment
  • First-line treatment if oral opioids are not suitable:
    • transdermal patches
    • subcutaneous delivery
  • First-line treatment for breakthrough pain in patients who can take oral opioids
  • Management of:
    • constipation
    • nausea
    • drowsiness.

It is recommended that healthcare professionals discuss the following patient concerns:

  • Addiction
  • Tolerance
  • Side-effects
  • Fears that treatment implies end of life.

The guidance stipulates that patients should be offered access to a regular review of pain control and side-effects, and should be provided with information on who to contact out of hours.

When starting treatment, patients should be offered regular oral sustained-release or immediate-release preparations.

www.nice.org.uk

Quality standard released on recognition of ovarian cancer

Ovarian cancer is the leading cause of gynaecological cancer in the UK with around 6500 women diagnosed with the condition each year.

Ovarian cancer can be hard to diagnose as some symptoms can be confused with those seen in common conditions, such as irritable bowel syndrome. NICE has launched a new quality standard on recognising early symptoms of ovarian cancer to increase awareness and improve survival rates.

The quality standard consists of eight quality statements that describe high-quality, cost-effective care for ovarian cancer. The statements include ensuring that women who are aged over 50 years and report one or more symptoms occurring persistently or frequently and which are suggestive of ovarian cancer, are offered a CA125 test.

www.nice.org.uk

Guidance on responding to domestic abuse published

Guidance produced by the RCGP in collaboration with other stakeholders and funded by the Department of Health aims to support general practice recognise and respond to signs of domestic abuse.

The key principles covered in the guideline include:

  • establishing a domestic abuse care pathway
  • the role of management
  • training requirements for the practice team
  • implementation at a clinical commissioning level.

Other resources that can be found in the guideline include a process map for responding to domestic abuse and a services directory.

www.rcgp.org.uk/circ

Five new Evidence Updates published by NHS Evidence

NHS Evidence produces Evidence Updates, regular summaries of new evidence that might reinforce or generate future changes to the practice described in the associated accredited guidance; they also provide commentary on the potential impact. Evidence Updates aim to keep guideline developers informed of new guidance in their field. The five new updates cover the following topics:

Food allergy in children and young people
This Evidence Update (see evidence.nhs.uk/evidence-update-18) could have an effect on the following topics covered in Clinical Guideline (CG) 116:

  • IgE-mediated food allergy
  • Non-IgE-mediated food allergy.

Hypertension in pregnancy
After reviewing the Evidence Update, the Evidence Update Advisory Group (EUAG) concluded that no changes needed to be made to CG107 (see evidence.nhs.uk/evidence-update-16).

Improving outcomes in head and neck cancers
This Evidence Update (see evidence.nhs.uk/evidence-update-17) could have an effect on the following topics covered in the associated NICE cancer services guidance and SIGN 90:

  • Diagnosis:
    • Factors indicating prognosis
    • Imaging
  • Treatment:
    • Radiotherapy
    • Surgery
    • Surgery versus radiotherapy
    • Mixed treatment comparisons
  • Follow up:
    • Dental care
    • Early discharge.

Familial breast cancer
This Evidence Update (see evidence.nhs.uk/evidence-update-18) could have an effect on the following topic covered in CG41:

  • Care of women in specialist (secondary and tertiary) care.

Sedation in children and young people
After reviewing the Evidence Update, the EUAG concluded that no changes needed to be made to CG112 (see evidence.nhs.uk/evidence-update-19).

www.evidence.nhs.uk

News in brief: NICE has published Technology Appraisal 255 on the use of cabazitaxel for prostate cancer

Cabazitaxel in combination with prednisone or prednisolone is not recommended for the treatment of hormone-refractory metastatic prostate cancer previously treated with a docetaxel-containing regimen.

www.nice.org.uk

News in brief: NICE Technology Appraisal (TA) 256 approves new treatment for stroke prevention

The TA recommends rivaroxaban as an option for the prevention of stroke and systemic embolism within its licensed indication, that is, in people with non-valvular atrial fibrillation with one or more of the risk factors outlined in the appraisal.

www.nice.org.uk

News in brief: An NHS companion document has been published for An outcomes strategy for COPD and asthma

NICE Technology Appraisal 250 recommends that people receiving eribulin should have the option to continue until they and their clinician consider it appropriate to stop.

www.dh.gov.uk

News in brief: New Department of Health guidance aims to improve procurement across healthcare systems

NHS procurement: raising our game sets out proposed actions for NHS trusts and focuses on taking immediate action to tackle key areas of improvement.

www.dh.gov.uk

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