International Association for Hospice & Palliative Care

International Association for Hospice & Palliative Care

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Promoting Hospice & Palliative Care Worldwide


2006; Volume 7, No 8, August



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Article of the Month:
Dr. Ripamonti

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Dr. Woodruff, MD

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Advanced course in pain and
symptom management 2006

July 6-7, 2006, Oxford, UK

An advanced course in pain and symptom management was conducted July 6-7 in Oxford , United Kingdom . The course was organized by the Sobell Study Centre, an Oxford international centre for palliative care and a WHO collaborating centre for palliative cancer care. I was able to attend this course thanks to the financial support provided to me by the International Association for Hospice and Palliative Care (IAHPC).

This was a two day course aimed to provide participants with an update on pain and symptom management. It was challenging and evidence-based. Participants were provided a synopsis of the top 10 publications in the past year, a distillation of information about evidence-based use of palliative care drugs, and the program provided an opportunity to network with colleagues.

The course had one central theme - breathlessness. The pathophysiology of breathlessness was reviewed as well as the different methods (pharmacological and non-pharmacological) to control it. The controversial role of nebulisers as well as the place of oxygen therapy in relieving breathlessness was discussed. Other difficult-to-control symptoms were also considered, such as neuropathic pain and nausea and vomiting. The role of palliative care physicians in the management of patients with heart failure was also presented.

The course also provided us with an example of a research study in palliative care - a qualitative study examining patient’s views on commencing morphine. The spotlight on drug effectiveness gave us a thorough overview of what’s proven, what’s not proven, and what may be emerging in the future.

As a result of this course, I was able t o acquire a comprehensive knowledge and an understanding of these difficult-to control symptoms. Every presentation was concluded with a take home message, a valuable list of recommended references and useful websites for future reading and learning. Moreover, all course slides are available at the Sobell Study Centre website. This course also helped me to be able to evaluate the evidence about the effectiveness of existing and new drugs as well as to compare my practice with that of other colleagues.

In a cancer centre, where patients are actively treated, this education will help me facilitate appropriate integration of (a patient / family-directed) palliative care with disease-directed, anticancer therapies. The goals of oncology can no longer be limited to the reduction of tumour burden and the deferral of death, but must also include preservation and improvement of the patient’s quality of life in every phase of the disease. Anticancer therapies and palliative care interventions should be placed alongside each other and tailored to the clinical circumstances of each and every patient. The multinational exchange of knowledge is the core of any progress. I would like to express my appreciation to IAHPC for offering the funding to Serbia because there have been extremely limited opportunities for palliative care training.

Snežana Bošnjak, MD, PhD
Institute for Oncology and Radiology of Serbia
Pasterova 14
11 000 Belgrade, Serbia


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