An increasing number of cancer patients live longer, and palliative care has become an important part of their treatment. Symptoms are often inadequately assessed and managed. A significant challenge in clinical trials is to control for the variability of the samples being studied. To overcome this problem, classification systems have been developed in order to characterise and stratify patients by grouping them according to major common characteristics. The lack of agreed methods for the assessment and classification of cancer pain has been clearly indicated in clinical trials and in clinical practice and may be one possible explanation for the inadequate treatment of cancer pain. This was the background to an international expert meeting arranged in September 2009 in Milan, Italy. The primary aims were to produce recommendations on how to assess and classify cancer pain and to recommend a strategy for the further development, validation and implementation of an international cancer pain classification and assessment system. The recommendations consisted of two basic working proposals, nine specific working proposals and seven recommendations for the further development of a cancer pain classification system. Examples of specific working proposals were to include pain intensity, pain mechanism, breakthrough pain and psychological distress as the core domains in this classification of cancer pain and to measure pain intensity with a 0-10 numerical rating scale with 'no pain' and 'pain as bad as you can imagine' as anchors. The proposed name for this international standard is Cancer Pain Assessment and Classification System (CPACS).
Over the last few years, there has been a rapid and steadily expanding demographic explosion in the elderly population in France. When the most dynamic segment of this growth is considered, i.e. patients aged 80 years or more (who, moreover, usually have several diseases), under-or over-prescribing and/or inappropriate prescribing are identified. Three short-and medium-term recommendations are proposed: to quickly get expert consensus on the theme of prescribing for the aged patient; to integrate systematic drug re-evaluation into annual consultations for people aged 80 years or more; and to better coordinate actions and communication between institutions, health professionals and the pharmaceutical industry.
RésuméL'explosion démographique des sujets âgés en France est en pleine et durable expansion depuis quelques années. Si on s'intéresse au segment le plus dynamique de cette croissance, à savoir plus particulièrement les patients âgés de 80 ans et plus, par ailleurs le plus souvent polypathologiques, on identifie fréquemment soit une sous-prescription, soit une surprescription et/ou une prescription inappropriée. Trois recommandations à court et moyen terme ont été proposées : obtenir rapidement des consensus d'experts sur le thème de la prescription chez le sujet âgé, intégrer la réévaluation systématique des médicaments dans des consultations annuelles pour les 80 ans et plus, mieux coordonner les actions et la communication entre les institutions, les professionnels de santé et l'Industrie. Mots clés : bon usage, médicament, iatrogénèse, sujet âgé PHARMACOLOGIE CLINIQUE
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