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Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours

Release Date: August 5, 2015
Expiration Date: August 5, 2016

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon above.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:

1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD
Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Executive Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP
Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 10+, has been reviewed and is acceptable for up to 13.25 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins April 29, 2015. Term of approval is for one year from this date. Each weekly update is approved for .25 Prescribed credits. Credit may be claimed for one year from the date of each update. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 13.0 contact hour(s) of continuing education by the American Association of Nurse Practitioners. Program ID 1504207. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

DynaMed Careers

The DynaMed editorial team is seeking specialist editors in the following fields: Gastroenterology, Nephrology, Oncology (especially Breast cancer and Pancreatic cancer), Ophthalmology, and Pediatric Neurology.

If interested, please send a recent copy of your CV to Rachel Brady at rbrady@ebsco.com.

Last week 344 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 155 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to inform clinical practice," one article was selected by the DynaMed Editorial Team.

Palliative Chemotherapy May Reduce Quality of Life in Patients with End-Stage Cancer and Good Performance Status

Reference: JAMA Oncol 2015 Jul 23 early online (level 2 [mid-level] evidence)

Determining the best treatment for patients with end-stage cancer is difficult, with little clinical evidence to guide decision making. Chemotherapy has been used for palliative purposes in patients with metastatic disease who have had disease progression on previous chemotherapy regimens, but there is significant variation in its use at the end of life (Ann Oncol 2015 Jul;26(7):1440).  While early palliative care has been shown to improve quality of life and survival in patients with non-small cell lung cancer (N Engl J Med 2010 Aug 19;363(8):733), palliative chemotherapy in the last month of life has been associated with increased risk of intensive medical treatment and death in an intensive care unit (Ann Oncol 2011 Nov;22(11):2375, BMJ 2014 Mar 4;348:g1219).  However, there remain many uncertainties with regard to quality of life outcomes in patients receiving chemotherapy near the end of life.

A recent prospective cohort study followed 621 patients with end-stage, progressive metastatic cancer after at least 1 chemotherapy regimen. All patients had a life expectancy ≤ 6 months based on physician estimation. The most common cancers in this study were lung, breast, colon, pancreatic and other gastrointestinal cancers, which together comprised approximately 70% of all cancers. During the study 384 patients died. The analysis included 312 patients (81.3%) who were not participating in clinical trials and who had complete data.  Of these 312 patients, 50.6% received palliative chemotherapy at baseline and the distribution of Eastern Cooperative Oncology Group (ECOG) performance status (PS) scores included 39.1% with good performance (PS 1), 37.2% with moderate performance (PS 2), and 18.6% with poor performance (PS 3).  Patients receiving chemotherapy were significantly younger (p < 0.001) and had better baseline performance status (p < 0.001).  The patient’s quality of life during their last week of life was assessed through an interview at a median of 2.4 weeks after the patient’s death with the caregiver most knowledgeable about the patient’s care.  Comparing chemotherapy use vs. nonuse, chemotherapy use was associated with a reduction in the quality of life near death for patients with a good baseline performance status (odds ratio 0.35, 95% CI 0.17-0.75).  There was no association between chemotherapy use and quality of life near death for patients with moderate or poor performance status, however.  There was also no significant association between chemotherapy use and mortality.

For patients with poor ECOG performance,  this study found no association between palliative chemotherapy and quality of life, in agreement with previous studies. Surprisingly, for patients with good ECOG performance, palliative chemotherapy was associated with a reduced quality of life near death.  This is the population most likely to receive palliative chemotherapy and in whom it is thought chemotherapy may provide the greatest benefit. Palliative chemotherapy was also not associated with improvement in survival, but the study was underpowered to detect differences in this outcome.  Overall, the results of this trial suggest that for all patients with end-stage cancer and an estimated life expectancy of ≤ 6 months, palliative chemotherapy may negatively impact patient quality of life or at best, offer no benefit.

For more information see the Management of advanced non-small cell lung cancer topic in DynaMed.

American College of Physicians and EBSCO Health partner to give 141,000 ACP members access to DynaMed Plus

The American College of Physicians (ACP) recently announced a partnership with EBSCO Health to provide the 141,000 members of ACP complimentary access to DynaMed Plus, a new cross-platform evidence-based clinical decision support tool. ACP is contributing expertise, content, and multimedia to DynaMed Plus.

“ACP looks forward to collaborating with the already strong DynaMed editorial team and extending the reach of our content and expertise,” said Dr. Wayne J. Riley, president, ACP. “ACP’s clinical leadership will help to continually develop and maintain internal medicine topics that are important to ACP members.”

Dr. Robert Centor, immediate past chair of ACP’s Board of Regents, and ACP Regent Dr. Jack Ende will join the DynaMed Executive Leadership Board. They will join Dr. Amir Qaseem, ACP’s director of clinical policy, who is a current board member. ACP will also provide a deputy editor to be a part of the editorial team overseeing internal medicine topics for DynaMed Plus.

Select content from ACP’s current clinical reference tool, ACP Smart Medicine, such as tables, images, and graphics, will be included in DynaMed Plus. Individual paid ACP Smart Medicine subscribers who wish to convert to DynaMed Plus may do so beginning January 1, 2016, when ACP Smart Medicine will be discontinued.

Click here to read the whole press release

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