Genetic strategies to individualize supportive care

Ongoing controversies in the pharmacological management of cancer pain

Pain management remains a problem in advanced cancer. Despite the ready availability of effective analgesia and good evidence to support the prescription of medications, concerns continue over the safety of this practice. The aim of the present paper was to review often-raised questions when considering the use of opioids, especially in cancer pain, to ascertain the levels of evidence that already exist to support opioid-prescribing practice and to identify areas where further research is needed.

Narrative Accounts of Volunteers in Palliative Care Settings

The long and evolving tradition of palliative care has always had a strong volunteer dimension. The difficult nature of palliative care invites questions around why volunteers choose this particular line of contribution. To expand our knowledge of the elements that create meaning and capture the essence of volunteer experience, we asked volunteers to share the rewards and the challenges of their work and its personal meaning. Significant themes emerged around what volunteers considered the most valuable aspects of their experience. Volunteers identified freedom of choice and the ability to use their natural gifts as an important condition for satisfaction. In addition, they perceived emotional resilience and personal hardiness as important dimensions of their suitability for working in palliative care. Finally, volunteers felt that their approach must be one of a balanced perspective, with an understanding of life and death as part of the human condition.

Translating pharmacogenomics: challenges on the road to the clinic

Pharmacogenomics is one of the first clinical applications of the postgenomic era. It promises personalized medicine rather than the established "one size fits all" approach to drugs and dosages. The expected reduction in trial and error should ultimately lead to more efficient and safer drug therapy. In recent years, commercially available pharmacogenomic tests have been approved by the Food and Drug Administration (FDA), but their application in patient care remains very limited. More generally, the implementation of pharmacogenomics in routine clinical practice presents significant challenges. This article presents specific clinical examples of such challenges and discusses how obstacles to implementation of pharmacogenomic testing can be addressed.