Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Clinical Frailty Scale is a tool used to classify an individual's level of frailty based on a selection that describes their fitness or frailty. This classification helps in assessing the individual's physical and cognitive abilities as well as their degree of independence in daily life activities. Here’s how it works:

- The scale provides a list of descriptions, each capturing a different level of fitness or frailty. The individual selects the description that best matches their current condition.
- Each description corresponds to a specific level of frailty, ranging from "very fit" to "terminally ill."

Here's a breakdown of the descriptions and their corresponding frailty levels:

1. Individuals who are robust, active, energetic, and motivated, regularly engaging in exercise, are categorized as "Very fit."
2. Those without active disease symptoms, but who exercise or are active occasionally, are considered "Well."
3. People with well-controlled symptoms, who are active only through routine walking, fall under "Managing well."
4. If symptoms limit activity, leading to complaints of feeling "slowed up" or tired during the day, they are labeled as "Vulnerable."
5. When there is more evident slowing and help is needed in high-order instrumental activities such as managing finances and transportation, the label is "Mildly frail."
6. Needing help with outside activities and house maintenance, requiring assistance with stairs and bathing, indicates "Moderately frail."
7. Complete dependence on personal care, yet stable and not at high risk of imminent death, describes the "Severely frail."
8. Complete dependence and inability to recover even from minor illnesses suggest "Very severely frail."
9. Approaching the end of life with a life expectancy of fewer than six months, with no apparent frailty, indicates "Terminally ill."

Using this scale, the user’s selection directly translates to a specific level of frailty, which can aid healthcare professionals in evaluating and planning the appropriate care strategy.

The Clinical Frailty Scale (CFS) is a tool used to assess the level of frailty in older adults, typically those aged 65 and above. The scale is designed to provide a measure of the patient's vulnerability to adverse outcomes, including disability, hospitalization, and mortality. The CFS is particularly useful in geriatric medicine, where it can help guide treatment decisions and care planning. It is based on patient's physical activity, energy, physical ability, and health changes. The scale ranges from 1 (very fit) to 9 (terminally ill). The CFS may not be appropriate for use in younger populations or in individuals with primarily cognitive impairment, as it does not specifically assess cognitive function.

Clinical Frailty Scale

The Opioid Dose Conversion tool is designed to help users convert dosages between different types of opioids. Users provide two inputs by selecting the opioid type they are converting from and the type they want to convert to, each chosen from a preset list of options.

This tool operates using a predefined conversion factor table that relates each opioid type with one another. Depending on the "from" and "to" opioid selections, the tool computes a conversion factor indicating the equivalent dosage of the target opioid type necessary to achieve a therapeutic effect similar to the original opioid and dosage.

Here's a glance at how you can interpret these results and perform conversions:

- **Codeine to Other Opioids:**
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 1.15
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.0625
  - To Hydrocodone: Conversion factor is 0.15
  - Continue similarly for other drugs.

- **Fentanyl (buccal or sublingual) to Other Opioids:**
  - To Codeine: Conversion factor is 0.87
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.054
  - To Hydrocodone: Conversion factor is 0.13
  - Continue similarly for other drugs.

- **Fentanyl Transdermal to Other Opioids:**
  - To Codeine: Conversion factor is 16
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 18.5
  - To Hydrocodone: Conversion factor is 2.4
  - Continue similarly for other drugs.

- **Hydrocodone to Other Opioids:**
  - To Codeine: Conversion factor is 6.67
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 7.7
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.42
  - Continue similarly for other drugs.

- **Hydromorphone to Other Opioids:**
  - To Codeine: Conversion factor is 33.3
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 38.5
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 2.08
  - Continue similarly for other drugs.

- **Methadone to Other Opioids:**
  - To Codeine: Conversion factor is 31.33
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 36.15
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 1.96
  - Continue similarly for other drugs.

- **Morphine to Other Opioids:**
  - To Codeine: Conversion factor is 6.67
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 7.7
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.42
  - Continue similarly for other drugs.

- **Oxycodone to Other Opioids:**
  - To Codeine: Conversion factor is 10
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 11.54
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.625
  - Continue similarly for other drugs.

- **Oxymorphone to Other Opioids:**
  - To Codeine: Conversion factor is 20
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 23.1
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 1.25
  - Continue similarly for other drugs.

- **Tapentadol to Other Opioids:**
  - To Codeine: Conversion factor is 2.67
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 3.08
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.167
  - Continue similarly for other drugs.

- **Tramadol to Other Opioids:**
  - To Codeine: Conversion factor is 1.33
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 1.54
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.083
  - Continue similarly for other drugs.

These conversion factors allow practitioners to translate dosages across different opioid medications accurately. The purpose of these conversions is to ensure patient safety and maintain equivalent analgesic effects when switching opioid drugs. Each conversion must be carefully considered alongside clinical judgment, as individual patient response may vary.

The Opioid Dose Conversion calculator, also known as the Opioid Equianalgesic calculator, is a tool used in the management of patients who are on opioid therapy for pain control. This calculator is used to convert the dose of one opioid to the equivalent dose of another opioid, allowing for safe and effective switching between different opioids. It is particularly useful in patients with chronic pain, cancer pain, or those undergoing palliative care. 

The calculator takes into account the potency of different opioids and the patient's current opioid dose to provide an equivalent dose of a different opioid. It is important to note that this calculator should not be used in opioid-naive patients, as it assumes a degree of opioid tolerance. Additionally, the calculator does not account for individual variations in opioid metabolism and response, so clinical judgment is still required in dose adjustments.

Opioid Dose Conversion

Palliative care in patients with cancer

Management of pain

Management of pain, neuropathic pain

Management of pain, intrathecal analgesia

Management of nausea and vomiting

Management of fatigue

Management of fatigue, clinical assessment

Management of dyspnea

Management of dyspnea (bronchodilators)

Management of pain, general principles

Management of fatigue, alternative treatments

Management of pain (nerve block)

Management of pain (radiofrequency lesioning)

Management of bowel obstruction

Management of bowel obstruction, corticosteroids

Management of dyspnea, supplemental oxygen

Management of fatigue, indications for referral

Management of bowel obstruction, self-expanding metallic stents

Management of bowel obstruction (water-soluble contrast agents)

Management of fatigue, general counseling

Psychological support

Management of delirium

Management of dyspnea (other measures)

Management of dyspnea (general principles)

Thromboprophylaxis

Management of pain, osteoclast inhibitors

Nutritional support

Management of noisy breathing

Management of fatigue, physical activity

Management of fatigue (psychostimulants)

Management of bowel obstruction (bowel decompression)

Management of fatigue, choice of screening tool

Management of dyspnea, noninvasive ventilation

Management of bowel obstruction (opioids)

Management of pain (cannabinoids)

Management of pain (spinal cord stimulation)

Management of pain, corticosteroids

Initiation of palliative care

Initiation of palliative care (timing)

Spiritual support

Management of pain, neurolysis

Management of bowel obstruction, anticholinergics

Management of pain, opioids

Management of dyspnea, opioids

Management of pain, external beam radiation therapy

Management of pain (DREZ-otomy)

Management of fatigue (dietary supplements)

Management of malignant biliary obstruction

Management of esophageal dysphagia

Management of dyspnea, benzodiazepines

Management of pain, non-opioid analgesics

Management of bowel obstruction, palliative surgery

Management of bowel obstruction, antiemetics

Management of dyspnea (corticosteroids)

Bereavement care

Management of pain, assessment

Management of fatigue, psychosocial interventions

Management of bowel obstruction (laxatives)

Blood transfusion

Management of pain, cordotomy

Management of pain (vertebral augmentation)

Shared decision-making

Management of fatigue (laboratory evaluation)

Management of fatigue (minocycline)

Management of gastric outlet obstruction

Management of dyspnea (antidepressants)

Management of fatigue, general principles of management

Prognostic assessment

Initiation of palliative care, providers

Management of pain (percutaneous radiofrequency ablation)

Management of fatigue (indications for screening)

Management of fatigue (antidepressants)

Management of pain (alternative and complementary therapies)

Initiation of palliative care (components)

Updated 2024 ASCO guidelines on palliative care in patients with cancer


Palliative care in patients with cancer

Guidelines

Key sources