Pain, Palliative Care

Survival, Palliative Care and the Industrial Medical Complex: a #hpm tweetchat

Tonight, I am delighted to host the first Hospice and Palliative Medicine (#hpm) Tweetchat of 2012. Yes, welcome to 2012, but a tweetchat, you ask? What is a Tweetchat? Essentially, at a designated time, twitter users from around the globe tweet about a topic.  I have often used the analogy of a party. There are often lots of conversations going on in the room.  You are engaged in one, but are distracted as you overhear others around the room as the words buzz by.  

The role of the host is to try and keep some focus on the discussion and to engage the “lurkers,” those who would rather sit on the side and watch.  At the end of the hour, one can feel that one has engaged in a full hour of discussion with colleagues. Other nights, I lurk. Using the #hpm allows people to following this discussion, and spread it through cyperspace (A great guide to #hpm tweetchat is available at

So the discussion topic tonight? (9pm EST, 8 pm CST, 6 pm PST; late morning in Oz).

Why is the survival advantage of the Tennel study so important to palliative care? To remind you, this was a randomized study of palliative care + usual care vs usual care alone in patients with advanced lung cancer.  While not the primary end point, the study showed a survival advantage for those randomized to the palliative care intervention. Exciting news and similar to our own findings on an internet intervention for patients with advanced lung cancer.  I believe this has been one of the more exciting pieces of research for oncology and palliative care in 2011.

But why are we focused on the survival advantage of this study?

Palliative Care, by the WHO definition, is neither about prolonging life, nor hastening death. So some questions……

Are we falling into the hands of the “industrial medical complex” with this focus on living longer? Is death the enemy and now we too in palliative care can keep you from death’s door for a little longer?

Does this study meet a high standard of evidence based medicine, that I am asking my oncology colleagues to apply when they consider new chemotherapy interventions (survival was not the primary endpoint of this study)?

What are the implications to this “survival” push in the USA to the implementation of palliative care in Low and Middle countries? When 90% of the world’s people lack access to opioids, does a survival advantage really matter.

As I often say to patients, “No right answers, just lots of difficult questions?”

Join the tweetchat tonight.  For those in Europe and Africa who will be sleeping at that time, post your comments here, and I will get your views into the discussion. I will also post a link to the transcript of tonight’s discussion at this site.


About Pain policy & palliative care

Improving global pain relief by achieving balanced access to opioids worldwide


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