NEWS
RCP publishes end of life care resource
The Royal College of Physicians (RCP) has produced a resource in collaboration with the Society of Acute Medicine to support hospital doctors in improving the care and choices provided to people at the end of their life. The End of life care in the acute care
setting resource aims to help hospital doctors identify those patients who are in their last days or weeks of life and ensure that their patients’ choices are heard and supported, in a holistic and sensitive way. It provides guidance on starting the often-difficult conversation about end of life (EOL) care with patients and their families or carers, recognising that every patient will have different needs and priorities. This resource provides: l Guidance on how to identify people in the last year of their life.
l Suggestions for starting a conversation about EOL care.
l The role of advance care planning and specialist palliative care.
l Advice on clinical management and anticipatory prescribing for the dying patient.
l Recommendations for professional development in EOL care.
l An addendum on care of the dying patient with COVID-19.
Identifying that someone is approaching the end of their life is challenging, as is offering them and those close to them a conversation about treatment choices for the future and different options for care. As a result, people with long-term conditions can be admitted repeatedly to hospital, although this may not be what they would want if asked. The majority of patients who express a preference would prefer to die at home, but currently only 45% of people at the end of their life die in their usual place of residence. Dr. Sarah Cox, lead clinician for the end of life care resource, said: “We know that around 30% of hospital inpatients are in their last years of life and yet, in a busy hospital setting, it can be hard to identify when a patient is at the point of needing end of life care. “This resource was produced with that in mind, aiming to equip doctors with the tools needed to identify patients in those last days or weeks of life, and to have open and honest conversations with them about the care they want to receive. This is an area of healthcare which is also in need of change in attitude and culture. Death should not always be equated with failure, but
rather as a natural process.” Dr. Nick Scriven, immediate past president of the Society for Acute Medicine (SAM), added: “This tool will not only give advice to healthcare professionals on identifying this stage and managing those difficult decisions and conversations but also offers practical advice for helping manage symptoms that cause distress and can be tricky to solve especially in an acute setting.”
Anti-cancer drug may improve outcome for severe COVID-19 patients
Treating severe COVID-19 patients with the anticancer drug bevacizumab may reduce mortality and speed up recovery, according to a small clinical study in Italy and China that was led by researchers at Karolinska Institutet in Sweden between February and April 2020. On average, blood oxygen levels, body temperature and inflammatory markers significantly improved in patients treated with a single dose of bevacizumab in addition to standard care. The research is published in Nature Communications. “To reduce COVID-19 mortality, we aim to develop an effective therapeutic paradigm for treating patients with severe COVID-19,” commented corresponding author, Yihai Cao, professor of vascular biology at the department of microbiology, tumour and cell biology at Karolinska Institutet. “Our findings suggest that bevacizumab plus standard care is highly beneficial for patients with severe COVID-19 and should be considered as a potential first-line therapeutic regimen for this group.” Bevacizumab is a medication that has been used to treat various types of cancer since 2004. It works by slowing the formation of new blood vessels by
inhibiting a growth factor known as VEGF. Many patients with severe COVID-19 have elevated levels of VEGF as well as symptoms associated with this marker, including excess fluid and disorganised blood vessels in the lungs. Against this background, the researchers designed a clinical trial to investigate the effect of combining bevacizumab with standard care for treating patients with severe COVID-19. Twenty-six patients were recruited from two hospitals in China and Italy between mid-February and early April in 2020. The patients had confirmed COVID-19 and symptoms such as difficulty breathing, low blood oxygen levels and pneumonia. They were retrospectively matched with 26 patients of similar characteristics who received standard care at the same hospitals in roughly the same time period and thus served as the control group. The recruits received standard care plus a single low dose of about 7.5 mg/ kg bevacizumab, which markedly improved blood oxygen levels within 24 hours compared to the control group. By the end of the 28-day follow-up period, 92% of the bevacizumab-treated patients no longer
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needed the same level of oxygen support as before the trial began, compared with an improvement rate of 62% for the controls. None of the bevacizumab-treated patients died and 17 (65%) improved so much that they were able to leave the hospital within the follow-up period. In the control group, three died and only 46% were discharged within 28 days. Bevacizumab also shortened the duration of oxygen-support to a median of nine days compared with 20 for the standard care group.
Other interesting findings include reduction in fever, an increase in white blood cells and a sharp decrease of c-reactive protein (CRP) levels, an inflammatory marker. No severe safety concerns were detected. “Many patients with severe COVID-19 require significant oxygen support during long hospital stays, which pose global challenges to medical supplies,” Yihai Cao commented. “Our study shows that bevacizumab could help reduce the need for oxygen support and reduce days in hospital, thus improving the outcome for the individual patient while easing pressure on medical resources.”
MARCH 2021
©Katarzyna Bialasiewicz
Photographee.eu
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