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updated: 13 May 2010
EAPC publications
Intensity and treatment of symptoms in 3,030 palliative care patients: a cross-sectional survey of the EAPC Research Network.
Laugsand EA, Kaasa S, de Conno F, Hanks G, Klepstad P. J Opioid Manag 2009: 5: 11-21
This article is based on a study aimed to describe intensity and treatment of symptoms other than pain in European palliative care units.
The conducted survey shows that clinically relevant symptoms are frequent and that one-third to half of the patients with a symptom observed as moderate or severe do not receive any treatment aimed to reduce the symptom intensity. Several symptoms and treatments differed between WHO-groups, cancer diagnoses, metastasis locations, countries, and genders. Prescription practice varied between countries both in terms of medication administered and percent of patients receiving specific treatment.
EAPC will request to the publisher permission to publish the paper as download file
European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care
Nathan I Cherny, Lukas Radbruch and The Board of the European Association for Palliative Care. Palliative Medicine 23(7) 581–593; 2009
The European Association for Palliative Care (EAPC) considers sedation to be an important and necessary therapy in the care of selected palliative care patients with otherwise refractory distress. Prudent application of this approach requires due caution and good clinical practice. Inattention to potential risks and problematic practices can lead to harmful and unethical practice which may undermine the credibility and reputation of responsible clinicians and institutions as well as the discipline of palliative medicine more generally. Procedural guidelines are helpful to educate medical providers, set standards for best practice, promote optimal care and convey the important message to staff, patients and families that palliative sedation is an accepted, ethical practice when used in appropriate situations. EAPC aims to facilitate the development of such guidelines by presenting a 10-point framework that is based on the pre-existing guidelines and literature and extensive peer review.
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The EAPC Research Network meets in Trondheim 
The European Association for Palliative Care (EAPC) has hold its 5th Research
Forum, in Trondheim, Norway. Two of the leading figures in the Association,
Augusto Caraceni and Stein Kaasa, outline the importance of research in palliative care
Augusto Caraceni, Chair of the Scientific Committee; Stein Kaasa, Chair of the EAPC RN, Chair of the Local Organising Committee.
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DISCLAIMER: This document is held under copyright by Hayward Group Plc publishers of the European Journal of Palliative Care. It may be downloaded for single academic use only. Reproduction for any other purpose is not allowed.
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Fatigue in palliative care patients – an EAPC approach
Lukas Radbruch Department of Palliative Medicine, RWTH Aachen University, Aachen,
Florian Strasser Department of Internal Medicine, Cantonal Hospital, St. Gallen, Frank Elsner Department of Palliative Medicine, RWTH Aachen University, Aachen, Jose Ferraz Gonçalves Department of Palliative Care, Portuguese Institute of Oncology, Porto, Jon Løge Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Stein Kaasa Palliative Medicine Unit, Department of Oncology, St Olavs Hospital, Trondheim, Friedemann Nauck Department of Palliative Medicine, University of Göttingen, Göttingen, Patrick Stone Department of Mental Health, St George’s Hospital Medical School, London and the Research Steering Committee of the European Association for Palliative Care (EAPC)
Fatigue is one of the most frequent symptoms in palliative care patients, reported in .80% of cancer patients and in up to 99% of patients following radio- or chemotherapy. Fatigue also plays a major role in palliative care for noncancer patients, with large percentages of patients with HIV, multiple sclerosis, chronic obstructive pulmonary disease or heart failure reporting fatigue.This paper presents the position of an expert working group of the European Association for Palliative Care (EAPC), evaluating the available evidence on diagnosis and treatment of fatigue in palliative care patients and providing the basis for future discussions. As the expert group feels that culture and language influence the approach to fatigue in different European countries, a focus was on cultural issues in the assessment and treatment of fatigue in palliative care.
As a working definition, fatigue was defined as a subjective feeling of tiredness, weakness
or lack of energy. Qualitative differences between fatigue in cancer patients and in healthy
controls have been proposed, but these differences seem to be only an expression of the
overwhelming intensity of cancer-related fatigue.
The pathophysiology of fatigue in palliative care patients is not fully understood. For a systematic
approach, primary fatigue, most probably related to high load of proinflammatory cytokines and secondary fatigue from concurrent syndromes and comorbidities may be differentiated. Fatigue is generally recognized as a multidimensional construct, with a physical and cognitive dimension acknowledged by all authors. As fatigue is an inherent word only in the English and French language, but not in other European languages, creening for fatigue should include questions on weakness as a paraphrase for the physical dimension and on tiredness as a paraphrase for the cognitive dimension.
Treatment of fatigue should include causal interventions for secondary fatigue and symptomatic treatment with pharmacological and nonpharmacological interventions. Strong evidence has been accumulated that aerobic exercise will reduce fatigue levels in cancer survivors and patients receiving cancer treatment. In the final stage of life, fatigue may provide protection and shielding from suffering for the patient and thus treatment may be detrimental. Identification of the time point, where treatment of fatigue is no longer indicated is important to alleviate distress at the end of life. Palliative Medicine 2008; 22: 13–22.
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Patient demographics and centre description in European palliative care units
A cross sectional survey of the European Association for Palliative Care (EAPC) Research Network
Stein Kaasa Faculty of Medicine, Norwegian University of Science and Technology, Trondheim and Department
of Oncology, St. Olavs University Hospital, Trondheim, Karin Torvik Department of Nursing, College of Higher
Eduction, Oslo, Nathan Cherny Department of Oncology, Shaare Zedek Medical Center, Jerusalem,
Geoffrey Hanks Department of Palliative Medicine, Bristol Haematology and Oncology Centre, Bristol and
Franco de Conno Rehabilitation and Palliative Care, Istituto Nazionale Dei Tumori, Milano. Palliative Medicine 2007; 21: 15-22
This paper is the result of a Cross-sectional survey, the first empirical multicentre study organised by the EAPC Research Network.
The study includes 21 countries, all the 15 member states of the European Union as well as Norway, Switzerland, Iceland, Israel, Romania and Cyprus. For each country, one national co–ordinator recruited five (if possible) to a maximum of 10 participating centres to the study. A network of 142 centres was set up.
The study was co–ordinated by a core group of four Steering Committee members: Stein Kaasa, Geoffrey Hanks, Nathan Cherny and Franco De Conno.
All the organisation, distribution of information, dispatching of documents, collecting data and drawing up of data bases was carried out by Karin Torvik, the data manager of the Unit for Applied Clinical Research, Faculty of Medicine, Trondheim, Norway. The entire study was carried out without any external financial support. The questionnaires were completed in all countries in the English language, and a French translation of the questionnaire was available.
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This document can be downloaded as pdf files for personal academic use.
Anyone wishing to use it for commercial purposes or needing to make multiple copies must contact the publisher - SAGE Publications Ltd, Oliver’s Yard, 55 City Road, London EC1Y 1SP, United Kingdom
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Prognostic Factors in Advanced Cancer Patients: Evidence-Based Clinical Recommendations—A Study by the Steering Committee of the European Association for Palliative Care
Marco Maltoni, Augusto Caraceni, Cinzia Brunelli, Bert Broeckaert, Nicholas Christakis,
Steffen Eychmueller, Paul Glare, Maria Nabal, Antonio Viganò, Philip Larkin, Franco De Conno,
Geoffrey Hanks, and Stein Kaasa
Prognostication of life expectancy is a significant clinical commitment for clinicians involved
in oncology and palliative care. More accurate prognostication is feasible and can be achieved
by combining clinical experience and evidence from the literature. Using and communicating
prognostic information should be part of a multidisciplinary palliative care approach.
J Clin Oncol 23:6240-6248. © 2005 by American Society of Clinical Oncology
Pain and pain treatments in European palliative care units.
A cross sectional survey from the European Association for Palliative Care Research Network
Pa° l Klepstad, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Stein Kaasa, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway, Nathan Cherny, Pain and Palliative Medicine, Shaare Zedek Medical Center, Jerusalem, Israel, Geoffrey Hanks, Department of Palliative Medicine, Bristol Oncology Centre, Bristol, UK, Franco de Conno, Istituto Nazionale dei Tumori, Milan, Italy and the Research Steering Committee of the EAPC. Palliative Medicine 19(6): 477-484
The Research Network of the European Association for Palliative Care (EAPC) performed a survey of 3030 cancer patients from 143 palliative care centres in 21 European countries. The survey addressed pain intensity and the use of non-opioid analgesics, adjuvant analgesics and opioids. Click here to download
This document can be downloaded as pdf files for personal academic use.
Anyone wishing to use it for commercial purposes or needing to make multiple copies must contact the publisher - SAGE Publications Ltd, Oliver’s Yard, 55 City Road, London EC1Y 1SP, United Kingdom
Email: |
Pain measurement tools and methods in clinical research
The paper has been published as a special Article:
Pain Measurement Tools and Methods in Clinic Research in Palliative Care: Recommendations of an Expert Working Group of the EAPC. Augusto Caraceni, Nathan Cherny, Robin Fainsinger, Stein Kaasa, Philippe Poulain, Lukas Radbruch, Franco De Conno and the Steering Comittee members of the EAPC Research Network. JPSM, Vol:23 No.3 March 2002; 239-255.
We have obtained permission from Elsevier to publish the article online.
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| This document can be downloaded as pdf files for personal academic use. Anyone wishing to use it for commercial purposes or needing to make multiple copies must contact the publisher Elsevier Science Inc. Permissions may be obtained via Elsevier's web site www.elsevier.com |
Breakthrough pain state of the art and the need for structured research
Episodic (breakthrough) pain, Consensus conference of an expert working group of the European Association for Palliative Care
Sebastiano Mercadante, M.D. 1 *, Lukas Radbruch, M.D. 2, Augusto Caraceni, M.D. 3, Nathan Cherny, M.D. 4, Stein Kaasa, M.D., Ph.D. 5, Friedemann Nauck, M.D. 6, Carla Ripamonti, M.D. 3, Franco De Conno, M.D. 1 3, Steering Committee of the European Association for Palliative Care (EAPC) Research Network in Cancer 2002;94:832-9
Pdf file unfortunately not available.
Depression in palliative care: a pragmatic report of an expert working group of the European Association for Palliative Care
F Stiefel, M Die Trill, A Berney, JN Olarte, D Razavi and the members
of the steering committee of the research network of the European Association for Palliative Care. Supportive Care of Cancer 2001; 9: 477488.
We have obtained permission from Springer Verlag to publish this online.
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We have purchased reprints and have distributed them to those EAPC members who do not have access to the Internet.
Clinical practice recommendations for the management of bowel obstruction in patients with end-stage cancer
Carla Ripamonti, Robert Trycross, Mary Baines, Stefano Capri, Franco De Conno, Brett Gemlo, Trevor M. Hunt, Hans B. Krebs. Sebastiano Mercadante, René Schaerer, Pauline Wilkinson: Expert working Group of the of the EAPC. Supportive Care of Cancer 2001; 9: 223233.
We have obtained permission from Springer Verlag to publish this online.
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We also have purchased reprints and distributed them to those EAPC members who do not have access to the Internet.
Strategies to manage the adverse effects of oral morphine.
An evidence-based report
N Cherny, C Ripamonti et al and the Expert working Group of the of the Research Network of the EAPC. Journal of Clinical Oncology 2001; 19(9): 25422554.
Its importance is being highlighted and it is being published in a separate section of the journal as an 'ASCO Special article'.
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| The document can be downloaded as pdf files for personal academic use. Anyone wishing to use it for commercial purposes or needing to make multiple copies must contact the publisher - www.jco.org . |
Morphine and alternative opioids in cancer pain: the EAPC recommendations
GW Hanks, F De Conno et al and the members of the steering committee of the research network of the European Association for Palliative Care: Expert working Group of the Research Network of the European Association for Palliative Care. British Journal of Cancer 2001; 84: 587593. Published 6 March 2001.
This paper is a result of the Expert Working Group on Opioids which first met in Sicily in 1992 and produced an earlier publication: Morphine in cancer pain: modes of administration. BMJ 1996; 312: 823-826. Because of the success of that publication and its widespread distribution the Expert Working Group met again and up-dated it and extended its recommendations to cover the use of alternatives to morphine.
EAPC distributed reprints in English to the EAPC members and has obtained the right to publish the English, French, German, Italian and Swedish version on its website.
| The documents can be downloaded as pdf files for personal academic use. Anyone wishing to use it for commercial purposes or needing to make multiple copies must contact the publisher - . |
WHO guidelines on cancer pain management: report on international application and current appraisal
The purpose of this working group was to review the current application of the WHO guidelines on cancer pain management in various countries around the world. In association with Excerpta Medica, a report of the meeting has been produced.
The EAPC has received complementary copies for its individual members. It was distributed to EAPC members at the last two EAPC Congresses. Members can request a copy, while stocks last.
Morphine in cancer pain: modes of administration
The findings of an EAPC expert working group of palliative care specialists and cancer experts on routes of administration of opioids were published as a review in the British Medical Journal 1996; 312: 823826. A reprint in French is available.
Barriers to controlling pain in patients with cancer
A leading article commenting on the EAPC paper was published in the Lancet 1996; 347: 1278.
Guidelines on artificial nutrition versus hydration in terminal cancer patients
This paper by an EAPC Expert Working Group of palliative care specialists and cancer experts was published in the journal Nutrition 1996; 12(3): 163167.
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has finalised the translation into Swedish of the statements.