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The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.
GENERAL PRINCIPLES OF PALLIATIVE CARE
New ASCO guideline aims to improve communication skills (September 2017)
The way in which serious news is conveyed can substantially influence the emotional response to the news, beliefs and attitudes toward the medical staff, and how patients view their future. While there are no consistent findings from randomized interventional studies that show better patient outcomes after modifying communication skills to deliver serious news, a number of studies have shown that clinician communication skills can be improved by training. A 2017 guideline from the American Society of Clinical Oncology (ASCO) recommends communication skills training for oncologists and presents best practices for core communication skills when clinicians are communicating with patients and their loved ones about goals of care, prognosis, treatment options, and end of life care (table 1) . (See "Discussing serious news", section on 'Can communication skills be taught and learned?'.)
Misuse of prescribed opioids (September 2017)
Misuse of prescribed opioid drugs is a major source of escalating rates of opioid use disorder and opioid overdose in the United States. The 2015 National Survey on Drug Use and Health estimated that among the 92 million US adults prescribed opioid drugs in the prior year, almost 13 percent reported prescription opioid misuse, and 2 percent reported having a prescription opioid use disorder . Misuse reported by study subjects included taking higher or more frequent doses than prescribed and buying or using opioids prescribed to someone else. (See "Prescription drug misuse: Epidemiology, prevention, identification, and management", section on 'Misuse'.)
Opana ER withdrawn from the US market (July 2017)
A long-acting abuse-deterrent formulation of oxymorphone, Opana ER, is being voluntarily withdrawn from the United States (US) market at the request of the US Food and Drug Administration due to concerns related to injection abuse, including reports of thrombotic microangiopathy (TMA) when the oral formulation is injected intravenously (IV) [3-5]. The TMA is thought to be due to an inert component that was added to the formulation to make it crush-resistant and thus deter IV injection. Generic extended-release oxymorphone products remain on the US market. (See "Cancer pain management with opioids: Optimizing analgesia", section on 'Oxycodone, hydrocodone, hydromorphone, and oxymorphone' and "Drug-induced thrombotic microangiopathy", section on 'Drugs of abuse'.)
Safe storage of prescription opioids (May 2017)
Although safe storage of prescription opioid medications (eg, locked cabinet) is recommended, it infrequently occurs. In a United States nationally representative survey of over 1000 adults with prescription opioid use in the past 12 months, only 9 percent reported safe storage of their medications . In further analysis of those adults with children younger than 18 years of age in the household, safe storage was reported in less than one-third of households with young children and 12 percent of households with children older than six years of age . These results support the need for anticipatory guidance by health care providers, emphasizing opioid safe storage and how it may limit opioid misuse and overdose, especially in households with children and adolescents. Further research should focus on developing and implementing effective means of secure storage in households. (See "Opioid intoxication in children and adolescents", section on 'Safe storage'.)
Concurrent benzodiazepines in opioid-using patients and overdose risk (April 2017)
Benzodiazepines can potentiate the respiratory depressant effects of opioid medication, and concurrent use may be a factor in the rising rate of opioid overdose. In an analysis of a large sample of patients prescribed an opioid, the proportion who concurrently received a benzodiazepine nearly doubled over 12 years . Concurrent use of both medications was associated with an increased risk of opioid overdose compared with patients receiving only the opioid. Avoiding this medication combination may prevent some overdoses. (See "Prevention of lethal opioid overdose in the community", section on 'Risk factors'.)
- Gilligan T, Coyle N, Frankel RM, et al. Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline. J Clin Oncol 2017; :JCO2017752311.
- Han B, Compton WM, Blanco C, et al. Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health. Ann Intern Med 2017; 167:293.
- http://endo.com/news-events/press-releases?c=123046&p=irol-newsArticle&ID=2284981 (Accessed on July 11, 2017).
- https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm562401.htm (Accessed on July 11, 2017).
- Hunt R, Yalamanoglu A, Tumlin J, et al. A mechanistic investigation of thrombotic microangiopathy associated with IV abuse of Opana ER. Blood 2017; 129:896.
- Kennedy-Hendricks A, Gielen A, McDonald E, et al. Medication Sharing, Storage, and Disposal Practices for Opioid Medications Among US Adults. JAMA Intern Med 2016; 176:1027.
- McDonald EM, Kennedy-Hendricks A, McGinty EE, et al. Safe Storage of Opioid Pain Relievers Among Adults Living in Households With Children. Pediatrics 2017; 139.
- Sun EC, Dixit A, Humphreys K, et al. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis. BMJ 2017; 356:j760.