Sam Hjelmeland Ahmedzai

• BSc MBChB FRCP
• Emeritus Professor at The University of Sheffield

Background: OXN PR, a fixed dose combination of opioid and peripherally-acting mu-opioid antagonist, offers analgesia while reducing opioid-induced constipation (OIC). Few have studied OXN vs other strong opioids for impact on bowel function, safety and QoL in patients with CP. Methods: Systematic review of literature from PubMed and EMBASE that ev...

Background: OXN PR, a fixed dose combination of opioid and peripherally-acting mu-opioid antagonist, offers analgesia while reducing opioid-induced constipation (OIC). Few have studied OXN vs other strong opioids for impact on bowel function, safety and QoL in patients with CP. Methods: Systematic review of literature from PubMed and EMBASE that ev...

To undertake a mixed-methodology implementation study to improve the well-being of men with gastrointestinal late effects following radical radiotherapy for prostate cancer. All men completed a validated screening tool for late bowel effects (ALERT-B) and the Gastrointestinal Symptom Rating Score (GSRS); men with a positive score on ALERT-B were of...

Background A recent Lancet commission called for more research on palliative care in low- and middle-income (LMIC) countries such as Colombia. A research priority setting approach has been recommended by The Global Forum for Health Research to address the huge gap in research output between LMIC and high-income countries, with influential health se...

Objectives We determined the validity and reliability of the Spanish translation Sheffield Profile for Assessment and Referral for Care (SPARC-Sp) questionnaire to identify the palliative care (PC) needs of patients with chronic noncommunicable diseases (NCDs) in Colombia. Methods We developed a cross-sectional observational study of scale assessm...

Objectives We aimed to translate and linguistically and cross-culturally validate Sheffield Profile for Assessment and Referral for Care (SPARC) in Spanish for Colombia (SPARC-Sp). Methods The linguistic validation of SPARC followed a standard methodology. We conducted focus groups to assess the comprehensibility and feasibility. The acceptability...

Background The need for palliative care has been conservatively estimated to be between 69 and 90% of all deaths in high-income countries. (Murtagh, 2014, Fantoni et al, 2023). Yet, palliative and end of life care (peolc) has been shown to be one of the lowest funded areas of healthcare research in the UK. The Health Research Classification System...

In Colombia, timely access to palliative care (PC) is hampered by difficulties in identifying and referring to necessary services. The SPARC (Sheffield Profile for Assessment and Referral for Care) instrument provides a holistic needs assessment to improve referrals for different forms of care. SPARC was recently validated in Colombian Spanish (SPA...

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Background Men with prostate cancer experience immediate and long-term consequences of the disease and its treatment. They require both long-term monitoring for recurrence or progression and follow-up to identify and help manage psychosocial and physical impacts. Holistic Needs Assessment aims to ensure patient-centered continuing cancer care. Howe...

The Myeloma X trial provided a platform to explore genetics in relation to systematic assessment of patient-reported outcomes at key points during salvage treatment in multiple myeloma (MM) patients. Blood DNA was obtained in 191 subjects for single nucleotide polymorphism (SNP) genotyping. By univariable analysis, the non-coding rs2562456 SNP, ups...

Background Many organisations supporting patients and families within the community, are not funded by the NHS, eg hospices. These are known as non-NHS providers and patients can either be referred or signposted to them. The number and range of non-NHS providers have grown rapidly and they receive patients from the NHS for clinical, psychological a...

Introduction: The demand for palliative and end of life care is increasing with an ageing population. NIHR and Marie Curie are the two largest funders of palliative and end of life care research in the UK. We wish to understand more about how funds are being deployed so that research support needs and evidence gaps can be identified, understood and...

Objectives To describe communication regarding cancer patient’s end-of-life (EoL) wishes by physicians and family caregivers. Methods An online questionnaire and telephone-based surveys were performed with physicians and family caregivers respectively in three teaching hospitals in Colombia which had been involved in the EoL care of cancer patient...

Palliative care is on the global health agenda, as only approximately 14% of people who require palliative care receive it [...]

Objectives: To describe communication regarding cancer patient’s end-of-life (EoL) wishes by physicians and caregivers. Methods: An online questionnaire and telephone-based surveys were performed with physicians and caregivers respectively in three teaching hospitals in Colombia who had been involved in the EoL care of cancer patients. Results: For...

Opioids such as oxycodone are recommended in the management of moderate‐to‐severe, chronic cancer pain. All opioids can potentially cause constipation, which may be a significant barrier to their use. Multiple randomised clinical trials have shown that the use of naloxone as a peripherally acting mu‐opioid receptor antagonist, in combination with o...

Healthcare aims to help older people to live well, but ultimately must also support them to die well. Most people die in old age, but predicting death in both short- and long-term is impossible for many, although not all, older people. Frail older people live with hope and pride in coping, and often anticipate recovery when ill. Key objectives of h...

Purpose: This study aimed to validate the Sheffield Profile for Assessment and Referral to Care (SPARC) as an effective tool for screening palliative care needs among Korean cancer patients. Materials and methods: The English version of the SPARC was translated by four Korean oncologists and reconciled by a Korean language specialist and a medic...

Rapid Response: Managing COVID-19 symptoms in the community (including at the end of life): NICE NG163 is a welcome step, but needs review Dear Editor We read with great interest the summary of NICE guideline NG163: COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community.[1] NICE is to be congratulated on produ...

Background The Neuberger Commission (2013) and NICE guidelines (2015, 2019) have emphasised the paucity of good quality evidence for palliative and end of life care. In the UK, hospices have a significant role in determining standard of care. We sought to quantify the extent to which hospices contribute to nationally impactful research. Methods We...

There is an increasing need to measure treatment-related side effects in normal tissues following cancer therapy. The ALERT-B (Assessment of Late Effects of RadioTherapy - Bowel) questionnaire is a screening tool that is composed of four items related specifically to bowel symptoms. Those patients that respond with a "yes" to any of these items are...

Introduction: Do-not-attempt-cardiopulmonary-resuscitation (DNACPR) practice has been shown to be variable and sub-optimal. This paper describes the development of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT). ReSPECT is a process which encourages shared understanding of a patient’s condition and what outcomes they value...

Breathlessness is the subjective experience of breathing discomfort, which arises as a distressing symptom in many diseases. It has several pathophysiological causes involving peripheral and central receptors and is modulated by cortical processing including emotions. Older people and patients with sarcopenia or cachexia are more susceptible to bre...

The National Institute for Health Research (NIHR) and Marie Curie are the two largest funders of end of life care research in the UK. NIHR and Marie Curie enable and support research at different times of the translational pathway, or by co-funding research. Undertaking a research impact assessment (RIA) on our combined investment is important to m...

Pain is a major symptom of bone metastases from advanced cancer and represents a clinical challenge to treat effectively. Basic neurobiology in preclinical animal models implicates enhanced sensory processing in the central nervous system, acting through N-methyl-D-aspartate (NMDA) glutamate receptors, as an important mechanism underpinning persist...

Purpose Adequate cancer pain management (CPM) is challenging in resource-limited settings, where current international guideline recommendations are difficult to implement owing to constraints such as inadequate availability and accessibility of opioids, limited awareness of appropriate opioid use among patients and clinicians, and lack of guidance...

Context: Pain is one of the most prevalent symptoms associated with cancer. Strong opioids are commonly used in the analgesic management of the disease, but carry the risk of severe side effects. Cebranopadol is a first-in-class drug candidate, combining nociceptin/orphanin FQ peptide and opioid peptide receptor agonism. For cancer patients, frequ...

Purpose: Salvage autologous stem-cell transplantation (sASCT) in patients with multiple myeloma (MM) relapsing after a prior autologous stem-cell transplantation leads to increased remission duration and overall survival. We report a comprehensive study on patient-reported outcomes, including quality of life (QoL) and pain in sASCT. Methods: Pat...

Background and Objective Pain is a common symptom in patients that survive cancer and in those that live with progressive advanced disease. Evidence from meta‐analyses suggests that pain remains poorly controlled for a large proportion of patients; barriers to good management include poor assessment of pain, inadequate support for patient self‐mana...

The National Institute for Health Research (NIHR) is responsible for funding, delivery and monitoring of clinical research studies in the NHS. The main subset of NHS studies relevant to hospices is categorised under ‘Supportive and Palliative Care’ and ‘Psychosocial Oncology and Survivorship’ (SPC/POS). In the NIHR, the Clinical Research Network (C...

Background Cancer‐related pain is a growing health problem given the increasing life expectancy of cancer patients. Opioids are commonly used to treat cancer‐related pain, but carry the risk of severe side effects, limiting their use. Cebranopadol is a first‐in‐class drug candidate, combining nociceptin/orphanin FQ peptide and opioid peptide recept...

Many malignancies give rise to pulmonary complications resulting in symptoms such as breathlessness and cough. The presence of comorbidities, especially in older cancer patients, can also contribute to pulmonary symptoms. In addition, all modalities of anticancer treatments can be associated with pulmonary toxicities which cause similar symptoms an...

Men don't talk about their health is a familiar trope. Evidence suggests that in the United States (US) and in the United Kingdom (UK) this is indeed the case. A survey of five hundred men in the US over the age of eighteen reported only 7% discussing their health with their peers [1]. Only 42% of men surveyed were prepared to consult a health care...

Background: The potential of technology to aid integration of care delivery systems is being explored in a range of contexts across a variety of conditions in the United Kingdom. Prostate cancer is the most common cancer in UK men. With a 10-year survival rate of 84%, there is a need to explore innovative methods of care that are integrated betwee...

Purpose of review: As people are living longer after a diagnosis and primary treatment for cancer, or indeed living with cancer as a chronic disease, new problems are emerging in this growing population of so-called 'survivors'. Persistent or chronic pain is one of the commonest complaints, arising from the tissue damage caused by the original neo...

Opioid receptor agonists are known to relieve restless legs syndrome (RLS) symptoms, including both sensory and motor events, as well as improving sleep. The mechanisms of action of opioids in RLS are still matter of speculation. The mechanisms by which endogenous opioids contribute to the pathophysiology of this polygenetic disorder, in which ther...

Introduction Radiotherapy treatment for prostate cancer can cause bowel problems, which may lead to severe difficulties for cancer survivors including limiting travel, work or socialising. These symptoms can appear at any time following radiotherapy. This study focuses on the early identification and protocol-based management of effects known to ca...

Background: There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England. Methods: 1) Modelling palliative care services and selecting a set of Quality...

Background: Little is known regarding the burden of opioid-induced constipation (OIC) among patients who suffer from cancer-related pain. Methods: A prospective longitudinal study was conducted among cancer patients in the United Kingdom (UK), Canada, and Germany, which included medical record data abstraction, Internet-based patient surveys, an...

Care of people in their last days of life should be based on compassion, respect and, wherever possible, on research evidence. Previously the Liverpool Care Pathway attempted to facilitate this but it was withdrawn after an independent government report found that its uncritical implementation could lead to poor care. This Concise Guideline overvie...

Objectives: Modern management of myeloma has significantly improved survival, with increasing numbers of patients living beyond a decade. However, little is known about the long-term cardiovascular and respiratory status of intensively treated and multiply relapsed survivors. Methods: We performed detailed cardiovascular and respiratory evaluati...

159 Background: Radiotherapy treatment for prostate cancer can cause severe long –term bowel problems, including limiting travel, work or socialising. Around half of patients suffer from late effects, appearing more than six months after radiotherapy. These symptoms often remain unmonitored in follow up care, despite the existence of effective trea...

#### What you need to know In 2013, the UK Department of Health called for the abolition of the Liverpool care pathway, which was designed to bring a standard of care for the dying from the hospice sector into other settings. This move was provoked by an independent review,1 which showed that the pathway had been misused and misinterpreted as a ti...

Introduction. The impact of therapy in the management of disease relapse in patients with myeloma (MM) needs to be balanced with the impact on quality of life (QoL). The benefit of a salvage autologous stem cell transplant (ASCT2) has been demonstrated in terms of durability of response over non-transplant consolidation (NTC) (G Cook, et al., Lance...

Breathlessness is a distressing symptom that arises in many diseases. It has several pathophysiological causes involving peripheral and central receptors and modulated by cortical processing. Older people and patients with cachexia are more susceptible to breathlessness on exertion. Most patients can be assessed by physical examination, and simple...

Introduction: Constipation is a common adverse effect of opioids. As an example, constipation is reported in 52% of people with advanced malignancy, and this figure rises to 87% in people who are terminally ill and taking opioids. There is no reason to believe that people with chronic non-malignant disease who are prescribed opioids will be any le...

Myeloma is one of the most common malignancies that results in osteolytic lesions of the spine. Complications, including pathological fractures of the vertebrae and spinal cord compression, may cause severe pain, deformity and neurological sequelae. They may also have significant consequences for quality of life and prognosis for patients. For pati...

Objective Patient and public involvement (PPI) has become an established theme within the UK health research policy and is recognised as an essential force in the drive to improve the quality of services and research. These developments have been particularly rapid in the cancer field. Methods This paper outlines a model of PPI in research (known a...

Aim To evaluate the long-term safety and efficacy of prolonged-release oxycodone/naloxone (OXN PR) and its impact on quality of life (QoL), in patients with moderate-to-severe cancer pain. Methods This was an open-label extension (OLE) of a 4 week, randomized, double-blind (DB) study in which patients with moderate-to-severe cancer pain had been r...

Background Pain is a common symptom in patients with multiple myeloma (MM). Many patients are dependent on analgesics and in particular opioids, but there is limited information on the impact of these drugs and their side effects on health-related quality of life (HRQoL). Method In a cross-sectional study, semi-structured interviews were performed...

Background: The immune system has a central role in controlling cancer, and factors that influence protective antitumour immunity could therefore have a significant impact on the course of malignant disease. Opioids are essential for the management of cancer pain, and preclinical studies indicate that opioids have the potential to influence these...

Life expectancy in multiple myeloma has significantly increased. However, a high incidence of chemotherapy induced peripheral neuropathy (CIPN) can negatively influence quality of life during this period. This study applied functional magnetic resonance imaging (fMRI) to compare areas associated with central pain processing in patients with multipl...

It is recommended that patients with multiple myeloma should be assessed for unmet holistic needs at key times in their disease trajectory. The aim of this exploratory study was to characterise the holistic needs of advanced, intensively treated multiple myeloma using a structured assessment tool. Patients with multiple myeloma who had undergone a...

Modern treatment strategies have increased life expectancy in multiple myeloma, but little is known about the endocrine, metabolic and nutritional status of long-term survivors. We performed endocrine, metabolic, bone, body composition and nutritional evaluations in 32 patients with intensively-treated, advanced but stable, myeloma a median duratio...

PecFent(®) is a powerful fast-acting fentanyl nasal spray which is used for breakthrough cancer pain. When it is not administered correctly or titrated quickly enough, we suspect aspects of patient care may suffer, with sub-optimal pain control, loss of confidence in the medication, and unnecessary cost to the health service. To assess hospital nur...

Methadone is a synthetic opioid used in refractory pain. There is increased awareness of methadone related adverse events including respiratory depression and QTc prolongation. In our region several methods exist for methadone initiation, falling into two categories: switching one opioid to methadone (stop and go - SAG) and adding methadone to anot...

Patients nearing the end of life can have difficulty in eating and drinking due to variety of reasons. Currently there are differences of opinion in perceived benefits of medically assisted nutrition and hydration (MNH) for dying patients who have inadequate oral intake. We conducted a study of patients with advancing disease but not yet at end of...

Ketamine is a potent analgesic with potentially serious adverse effects (eg dysphoria, bladder dysfunction), being used in palliative medicine. Its evidence base is limited and a recent RCT using the SC route in cancer pain failed to show efficacy. Neither route nor dosing are standardised, which raises questions for clinical governance in palliati...

Opioid-induced constipation is common in palliative care. The evidence base for most laxatives and rectal interventions is poor, but for sc methylnaltrexone is good. Patient choice is important for individualising treatment. To identify if patients want to choose their laxative treatment from current options. To identify acceptability of different...

ABSTRACT The European Society for Medical Oncology guidance on cancer pain management is described. Causes of pain form cancer management modalities, treatment of cancer-related pain, the role of pain management specialists in these patients' care, and the place of opioid pharmacotherapy and risks of opioid adverse events are discussed. This report...

Background Validated quality indicators can help health-care professionals to evaluate their medical practices in a comparative manner to deliver optimal clinical care. No international set of quality indicators to measure the organizational aspects of palliative care settings exists. Aim To develop and validate a set of structure and process indi...

There is evidence to suggest that patients with cancer and other non-malignant chronic progressive illnesses can experience distressing symptoms, or concerns, which can often remain unrecognised. There is little disagreement that routine systematic questioning is useful in identifying supportive or palliative care needs that would otherwise not be...

Studies have demonstrated that whereas some opioids have little effect on immunity (eg, buprenorphine), others can be immunosuppressive (eg, morphine) or immunostimulatory (eg, tramadol). However, a variety of approaches have been used, especially in vitro and animal models, and the findings are variable. We hypothesised that opioids have different...

Background: The diagnosis of motor neurone disease (MND) has a profound effect on the functioning and well-being of both the patient and their family, with studies describing an increase in carer burden and depression as the disease progresses. Aim: This study aimed to assess whether patient use of noninvasive ventilation (NIV) impacted on their...

Objectives There is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia across five countries. Method One focus group (n = 7...

According to EU policy, anyone in need of palliative care should be able to have access to it. It is therefore important to investigate which palliative care topics are subject to legislation and regulations in Europe and how these are implemented in (national) health care plans. This paper aims to deliver a structured overview of the legislation,...

Background Non-invasive ventilation improves quality and quantity of life in patients with motor neurone disease who have respiratory failure. Use of non-invasive ventilation may, however, result in complex clinical issues for end-of-life care, with concerns as to whether and how it should be withdrawn. Aim This study aimed to describe carer and h...

Context: The cumulative impact of disease and treatment-related factors on health-related quality of life (HRQoL) in long-term survivors of multiple myeloma is poorly characterized. Objectives: To characterize HRQoL and symptom burden in advanced, intensively treated myeloma. Methods: We performed detailed assessments in patients who had under...

ABSTRACT Personalized medicine can be defined as the tailoring of therapies to defined subsets of patients based on their likelihood to respond to therapy or their risk of adverse events. This medical model is more established in oncology but personalized pain therapy is showing potential promise. Pharmacogenomics is of growing relevance to the pai...

This study aimed to examine the experiences of patients with motor neuron disease and their carers following the recommendation to use non-invasive ventilation (NIV). Qualitative interviews were carried out with 20 patients and 17 carers within one month of NIV being initiated. The study identified a range of potential barriers to usage including:...

Context: Assessment of the needs of advanced cancer patients is a very important issue in palliative care. Objectives: The aim of the study was to adapt the Sheffield Profile for Assessment and Referral for Care (SPARC) to the Polish environment and evaluate its usefulness in needs assessment of patients with advanced cancer. Methods: A forwar...

Context: Dyspnea is a poorly understood subjective sensation. Existing dyspnea measures fail to adequately address its multidimensionality. A Japanese group developed and validated the Cancer Dyspnea Scale (CDS) for assessing dyspnea in patients with advanced lung cancer. Objectives: We evaluated the validity and reliability of the English versi...

Despite increasing attention in the past decade there is still little published work on palliative care (PC) and dementia. There is consensus that there is a need to improve the organisation and structure of PC services for dementia, however little is published on the problems and issues. To develop a model of PC for dementia suitable for European...

Background Opioids are commonly used in the management of pain, diarrhoea, cough and dyspnoea. However, their ability to modulate the ubiquitous endogenous opioid system can lead to many side effects. A potentially covert side effect which has been attracting increasing interest relates to opioid-induced immune suppression. This may be of particula...

Background The use of oral and subcutaneous medications is well established in palliative care. There are however certain situations where these routes may not be appropriate or effective in symptom control of patients. Below we illustrate three recent cases where intravenous administration of drugs helped relieve intractable symptoms and thus impr...

Background Ketamine is used in palliative care to help relieve refractory pain that does not respond to conventional opioids or adjuvant analgesics. It is commonly administered via subcutaneous or the oral route. This however has its limitations since ketamine infusion can cause skin irritation and result in its reduced absorption and intolerable a...

Background Bacterial infection is a common complication in patients with advanced disease, including cancer. Ingestion (phagocytosis) and subsequent killing of bacteria by neutrophils and monocytes are critical in the control of infection. Using a range of different methodologies, previous invitro and in vivo studies have generally reported that so...

Background While intensive and novel treatments have significantly extended life expectancy in multiple myeloma, the cumulative impact of disease and treatment related factors on quality of life in relapsed patients is poorly characterised. Aims To define the spectrum of quality of life, fatigue, pain, peripheral neuropathy and work disability affe...

Supportive care is a major component in the management of malignant diseases that affect the respiratory system. It should be included in the overall management plan for the patient from the very outset. Many patients who present with new respiratory or systemic symptoms of lung cancer will need urgent palliation of these problems, even before a de...