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BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b3437 (Published 25 August 2009) Cite this as: BMJ 2009;339:b3437

Palliative care makes a difference for people with advanced cancer

Few studies have tested the effectiveness of palliative care for improving the lives of patients with advanced cancer. A trial reports on a multicomponent, psychoeducational intervention run by advanced practice nurses, which—when added to usual care—improved quality of life and mood compared with usual care alone. However, the intervention had no effect on symptom intensity scores, number of days spent in hospital or intensive care, number of visits to emergency departments, or survival. Among 322 participants, 133 (41%) had cancer of the gastrointestinal tract, 117 (36%) had lung cancer, 39 (12%) had genitourinary tract cancer, and 33 (10%) had breast cancer.

The intervention was telephone based—to improve access in rural populations—and consisted of four weekly educational sessions that covered symptom management, advance care planning, treatment decision making, communication, and unfinished business. Participating nurses followed a manual called “Charting your course” (www.cancer.dartmouth.edu/palliative/index.shtml).

Patients were encouraged to be active in communicating their values, priorities, and treatment preferences, especially when the prognosis was poor. Monthly support sessions continued the intervention until death or study completion.

Plant extract tops sulfasalazine for treating rheumatoid arthritis

The root of Tripterygium wilfordii Hook F, also known in China as “thunder god vine,” has long been used in traditional Chinese medicine as an anti-inflammatory agent. The plant extract has shown promise in treating autoimmune and inflammatory diseases, as well as cancer.

A randomised trial compared extracts of T wilfordii Hook F (60 mg three times daily) with sulfasalazine (1 g twice daily) for treating active rheumatoid arthritis. All 121 patients had six or more painful and swollen joints. They were allowed to continue stable doses of corticosteroids or non-steroidal anti-inflammatory drugs, but they had to stop taking disease modifying antirheumatic drugs at least one month before randomisation.

Around half of the participants were lost to follow-up at 24 weeks, but 62% …

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