At present, there is no universally accepted cancer pain assessment tool for use in palliative care (PC). The European Palliative Care Research Collaborative (EPCRC), therefore, aims to develop an international consensus-based computerised pain assessment tool. As part of this process, we have performed (1) a literature review on pain assessment tools for use in the PC and (2) an international expert survey to gain information on the relevant dimensions for pain assessment in PC. 230 publications were identified, only six met the inclusion criteria. Three further articles were identified through manual searching, totalling 11 different pain assessment tools. Nine tools were multidimensional. Pain intensity was assessed in seven, using various numerical/verbal rating scales (NRS/VRS); five tools focused on pain management. Three publications did not identify the rationale for the need to develop a new tool, and the selection procedure for items/dimensions was not described in six tools. Patient and/or professional expert groups were involved in the development of five tools and only two tools were extensively validated or cross-culturally tested. Thirty-two experts (71%) completed the expert survey and identified 'intensity', 'temporal pattern', 'relief/exacerbation', 'pain quality' and 'location' as the five most relevant dimensions. Most preferred assessment of 'pain intensity' was by NRS rather than VRS. Time windows extending 24 h were regarded as less relevant. Development of PC pain assessment tools seems to be a continuous process, which does not adhere to systematic guidelines, thus does not contribute to a universally accepted tool. No tool contained all relevant dimensions as defined by the experts. Many tools focused on particular dimensions, suggesting that specific research interests may drive the tool development process. Extensive literature reviews, expert and patient input and clinical studies are a needed approach in the development of a new consensus-based pain assessment tool.

The resulting module with 29 questions, thus currently named EORTC QLQ-LC29, retained 12 of the 13 original items, supplemented with 17 items that primarily assess treatment side-effects of traditional and newer therapies.

ObjectivesPalliative care (PC) services and patients differ across countries. Data on PC delivery paired with medical and self-reported data are seldom reported. Aims were to describe (1) PC organisation and services in participating centres and (2) characteristics of patients in PC programmes.MethodsThis was an international prospective multicentre study with a single web-based survey on PC organisation, services and academics and patients' self-reported symptoms collected at baseline and monthly thereafter, with concurrent registrations of medical data by healthcare providers. Participants were patients ≥18 enrolled in a PC programme.Results30 centres in 12 countries participated; 24 hospitals, 4 hospices, 1 nursing home, 1 home-care service. 22 centres (73%) had PC in-house teams and inpatient and outpatient services. 20 centres (67%) had integral chemotherapy/radiotherapy services, and most (28/30) had access to general medical or oncology inpatient units. Physicians or nurses were present 24 hours/7 days in 50% and 60% of centres, respectively. 50 centres (50%) had professorships, and 12 centres (40%) had full-time/part-time research staff. Data were available on 1698 patients: 50% females; median age 66 (range 21–97); median Karnofsky score 70 (10–100); 1409 patients (83%) had metastatic/disseminated disease; tiredness and pain in the past 24 hours were most prominent. During follow-up, 1060 patients (62%) died; 450 (44%) <3 months from inclusion and 701 (68%) within 6 months. ANOVA and χ2 tests showed that hospice/nursing home patients were significantly older, had poorer performance status and had shorter survival compared with hospital-patients (p<.0.001).ConclusionsThere is a wide variation in PC services and patients across Europe. Detailed characterisation is the first step in improving PC services and research.Trial registration numberClinicalTrials.gov Identifier: NCT01362816.

Aims: Bedside electromagnetic (EM) guided nasojejunal feeding tube placement by nurses is a simple and safe technique which has replaced endoscopy in several patient categories. An altered anatomy such as after pancreatoduodenectomy is currently seen as relative contra-indication for this technique. The aim of this study was to determine the feasibility and safety of bedside EM-guided placement of nasojejunal feeding tubes as compared to endoscopy in patients after pancreatoduodenectomy. Methods: We performed a prospective monocenter pilot study in patients requiring enteral feeding after pancreatoduodenectomy (July 2012eMarch 2014). Nasojejunal tubes were placed under EM-guidance by two nurses with extensive experience with the technique, or by endoscopy when neither of the two nurses was available. Primary endpoint was the success rate of primary tube placement confirmed on plain abdominal X-ray followed by successful enteral feeding. Results: Overall, 53 of 126 (42%) patients who underwent pancreatoduodenectomy required a nasojejunal feeding tube. In 36 patients the tube was placed under EM-guidance and in 17 by endoscopy at a median of 8 (6e11) days after pancreatoduodenectomy. Initial tube placement was successful in 21 of 36 (58%) patients with EM-guidance and 9 of 17 (53%) patients with endoscopy (P = 0.71). No complications occurred during the placement procedures. Dislodgement and/or blockage of the tube occurred in 14 of 36 (39%) patients in the EM-guided group and 8 of 17 (47%) patients in the endoscopic group (P = 0.57). Conclusions: Bedside EM-guided placement of nasojejunal feeding tubes by nurses was equally successful as endoscopic placement in patients after pancreatoduodenectomy. Future, randomized studies should confirm these preliminary findings.

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