DIVISION OF PALLIATIVE MEDICINE 2003 – DR. NEIL HAGEN, DIVISION CHIEF
BRIEF OVERVIEW
2003 was a very good year for the Division of Palliative Medicine. From a clinical perspective, the Pain and Palliative Care Tumor Group that was established at Tom Baker
Cancer Centre in 2002 continued to grow; it subsumed and integrated activities of the pain clinic and the fast track radiotherapy clinic, and provided oversight to the TBCC
Palliative Coordinator role. Dr. Jackson Wu has added radiotherapy research protocols to complement other clinical research activities of the group and we anticipate contributing significantly to NCIC symptom control clinical research activity in 2004.
Members of the Division of Palliative Medicine were extensively involved in undergraduate, postgraduate and continuing education. There were several innovations in education.
Dr. Jose Pereira is Principle Investigator for a $4.3 million grant , Pallium Phase II, supported by the Primary Health Care Transition Fund, Health Canada 2003-2005. This project aims to improve palliative care at primary care level. The project has a national scope and includes Alberta, British Columbia, Manitoba, Saskatchewan, North West
Territories and Yukon. It has collaborators and stakeholders from the academic, research, service delivery and advocacy sectors across these jurisdictions and across disciplines and sectors. Dr. Pereira continues his national leadership role in Education through the
Centre for Distance Learning for Palliative Care at the University of Calgary, as co-Chair of the Education Working Group for Health Canada’s Secretariat in Palliative and Endof-Life Care, and on the Steering Committee of a national project to incorporate palliative care in undergraduate and postgraduate curriculae of Canadian medical schools. Dr.
Pereira received a grant of $100,000 for undergraduate and postgraduate palliative oncology education of medical students and residents. Dr. Pereira is currently exploring ways of integrating palliative care into the clinical presentation undergraduate curriculum.
.
Dr. Pereira received the Clinical Specialized Teaching Award through the University of
Calgary Family Medicine Residency Program in recognition of outstanding contribution and commitment to clinical teaching of Family Medicine residents. In 2003 he was appointed as Vice President of the Canadian Hospice and Palliative Care
Association .
The Palliative Medicine residency program continued to be a high priority and the
Tertiary Palliative Care Unit, its educational hub. There is a broad array of educational activities, such as the several times per week journal club, weekly seminars, City Wide
Rounds, and others. The second resident of the Palliative Medicine Residency Program completed her training and is now on staff here in Calgary. The position of Palliative
Medicine Residency Program Director was ably taken on by Dr. Hubert Marr in late
2002. Participation in the University of Calgary Family Medicine Residency Training
Program is a major initiative by our group and reflects the high priority that the city-wide palliative care service places on supporting the primary care model of health care

delivery. We continue to support palliative medicine as a mandatory rotation within the
Family Medicine, Medical Oncology and Radiation Oncology Residency Training
Programs. We continued a weekly seminar series for the family medicine residents along with a three times per week journal club on the tertiary palliative care unit, which serves a s a hub of academic activity. Rotations were set up throughout the city-wide palliative care service at six separate sites. A total of 20 family medicine residents will go through this rotation this year, in addition to rotations by residents in Medical Oncology,
Radiation Oncology and other trainees. The feedback from residents as well as parent residency training program have been very positive.
Dr. Ted Braun has been very productive over the past few years in the area of quality assurance studies. He was first author on two publications this year, the first on an intervention to improve communication between oncologists and primary care physicians, and the second related to the development and implementation of practice guidelines on palliative sedation.
Dr. Neil Hagen is the principle investigator in a multi-centre Phase II study evaluating a novel analgesic agent, tetrototoxin. The interim results of this trial were presented as an expedited abstract in October and a large, multicentre Phase III trial of tetrodotoxin in severe cancer pain will be launched in early 2004.
The Alberta Palliative Research Initiative continues to develop and mature. To date, it has a four year budget of about $1,300,000 and has been successful in several competitive external grants totaling several times that dollar amount.
PUBLICATIONS
Braun TC, Hagen NA, Smith C, Summers N. Oncologists and family physicians. Using a standardized letter to improve communications. Canadian Family Physician 2003,
49:882-6.
Braun TC, Hagen NA., Clark T. Development of a clinical practice guideline for palliative sedation. Journal of Palliative Medicine 2003, 6(3):345-50.
Forsyth PA, Weaver S, Fulton D, Brasher PM, Sutherland G, Stewart D, Hagen NA,
Barnes P, Cairncross JG, DeAngelis LM. Prophylactic anticonvulsants in patients with brain tumour. Canadian Journal of Neurological Sciences 2003, 30(2):106-12.
Pietersma P, Follett-Bicks, Wilkinson B, Guebert N, Fisher K, Pereira J. A bedside food cart as an alternative food service for acute and palliative oncological patients.
Supportive Care in Cancer 2003, 11:611-14.
Mack L, Pereira J, Temple W. Decompressive Tube Esophagostomy: A Forgotten
Palliative Procedure? Journal of Palliative Medicine 2004, 7:265-267.
Watanabe S, Goldman R, Pereira J, Librach L. This House Believes that Opioid Rotation

is Useful in Palliative Settings. Current Oncology 2003, 10(1):50-3.
Mpanga L, Mwangi-Powell F, Pereira J, Spence C. The Cape Town Palliative Care
Declaration: Home-Grown Solutions for Sub-Saharan Africa. Journal Palliative
Medicine 2003, 6(3):341-3
The Cape Town Declaration: The Need for Palliative Care in Sub-Saharan Africa.
Journal Palliative Medicine 2003, 6(3):341-343
Pereira J. EAPC Euthanasia Report: Comments from Canada. Journal Palliative
Medicine . 2003, 17(2):167-8.
Pereira J. Best Evidence for Cancer Pain Management. Journal of Pain and Symptom
Management . 2003, 25(1):92-3 (Book Review).
SUBMITTED/IN PRESS
Spice R and Hagen NA. Capsaicin in burning mouth syndrome: titration strategies.
Canadian Journal of Otolaryngology
Lemieux L, Kaiser S, Pereira J, Meadows L. Sexuality in Palliative Care: a qualitative study.
ABSTRACTS
Neil A. Hagen, Calgary; Kim Fisher, Calgary; Patrick du Souich, Montreal; Srini Chari,
Saskatoon; Dwight Moulin, London; Ed Sellers, Toronto (on behalf of the Canadian
Tetrodotoxin Study Group) Tetrodotoxin for severe cancer pain:interim analysis from a multicentre, open label, dose escalation study. Expedited Abstract at the International
Society for Biological Therapy of Cancer, Bethesda, October 30 2003
Mah M, Pauling-Shepard K, Standish-Hawthorne J, Lye T, Hagen N, Stuart G, Mysak M,
Louie T, Calgary Health Region and Alberta Cancer Board, Calgary, Alberta, Influenza vaccination attitudes among staff of a regional cancer centre. Commnity and Hospital
Infection control Association annual meeting, Thunder Bay January 23, 2003.
Fisher K, Hagen NA. Effective Management of Breakthrough Pain: The Challenge of
Matching Pain Characteristics with the Appropriate Therapeutic Strategy, Proceedings of the Updates on the Clinical Pharmacology of Opioids with Special Attention to Long-
Acting Drugs, Memorial Sloan-Kettering Cancer Center, May 3-4, 2003.
Murray A, Hagen NA. Hydromorphone Proceedings of the Updates on the Clinical
Pharmacology of Opioids with Special Attention to Long-Acting Drugs, Memorial Sloan-
Kettering Cancer Center, May 3-4, 2003.
Willment J, Pereira J, Lyndon J. Training Health Care Educators to be Online
Facilitators; Results of an Online Course. Proceedings; Abstract for 3rd Conference on

Researching Work and Learning, Tampere, Finland, July 25-27, 2003.
Lemieux LM, Kaiser S, Pereira J. Sexuality in Palliative Care. Abstracts of the 8 th
Congress of the EAPC Research Network, The Hague, The Netherlands, April 2-5, 2003.
Pereira J. Morphine: Still a Useful Opioid. Abstracts of the 8 th Congress of the EAPC
Research Network, The Hague, The Netherlands, April 2-5, 2003.
Pereira J. The Internet Supporting Communities of Learning. Abstracts of the 8 th
Congress of the EAPC Research Network, The Hague, The Netherlands, April 2-5, 2003.
Sinclair SA, Raffin S, Pereira J, Guebert N. Collective Soul: The Spirituality of an
Interdisciplinary Team. Abstracts of the 8 th
Congress of the EAPC Research Network,
The Hague, The Netherlands, April 2-5, 2003.
BOOK CHAPTERS
Fainsinger R, Pereira J. Clinical Decision Making in Anorexia and Cachexia. In Oxford
Textbook of Palliative Medicine; 3 rd
Edition (Hanks G, Doyle D, Cherny N, Calman K)
(eds). Oxford Press; Oxford U.K. 2003.
RESEARCH AND SUPPORT
05/2000-
03/2003
$800,000
$200,000/first year
$250,000/second
$300,000/third
2003 $5,000
Alberta Cancer Board Palliative Care Research Initiative
(PI: R Fainsinger, T Fields, N Hagen)
01/2002current
2003
$60,000-$100,000
$9800.00
International
WEX Technology, Inc
Secretariat for Palliative and Endof-Life Care, Health
Canada
(EFPEC Project) protocol for sublingual methadone hydrochloride for the management of cancer related breakthrough pain.
(PI: K. Fisher, NA Hagen).
An open, multi-dose efficacy and safety study of intramuscular tetrodotoxin (Tetrodin) in patients with severe cancer-related pain
(PI: NA Hagen).
National survey of palliative and end-of-life curriculum content at
Canadian medical, nursing, social work, and pharmacy schools.
(Collaborator: J. Pereira)

2003
2003
2003
2003
$4500.00
$21000.00
$700,000
100,000
Rural Physician Action
Plan of Alberta (RPAP)
Novaritis
(Pharmaceutical
Sponsorship)
Health Canada
Private donation
Distance palliative care course for rural family medicine residents.
(Co-founder & Developer:
J. Pereira)
Zoledronic Acid for management of hypercalcemia in the community in patients with cancer.
(PI: J. Pereira)
Part of $4.3 from the Primary Care
Health Transition Fund, Health
Canada, for Pallium Phase II or undergraduate and postgraduate palliative oncology education of medical students and residents
BOOK CHAPTERS
Fainsinger R, Pereira J. Clinical Decision Making in Anorexia and Cachexia. In Oxford
Textbook of Palliative Medicine; 3 rd
Edition (Hanks G, Doyle D, Cherny N, Calman K)
(eds). Oxford Press; Oxford U.K. 2003.