Patient-Controlled Intravenous Analgesia for Advanced Cancer Patients with Pain: A Retrospective Series Study

Objective. To compare the efficacy and side effects of patient-controlled intravenous analgesia (PCIA) with hydromorphone, sufentanil, and oxycodone on the management of advanced cancer patients with pain. Methods. Patients allocated to receive PCIA between January 2015 and December 2016 were chosen for this study. After reviewing medical records, we verified if hydromorphone, sufentanil, or oxycodone for PCIA could equally provide effective pain relief. A numeric rating scale (NRS) of cancer pain was applied before PCIA, at 4 hours after PCIA, and at the discontinuation of PCIA. Secondary, the incidence of clinical side effects attributed to PCIA was observed. Results. A total of 85 medical records were reviewed. PCIA with hydromorphone (n=30), sufentanil (n=34), and oxycodone (n=21) was used for cancer pain management. PCIA successfully improved pain control in 97.6% of the patients. The most common side effects were constipation (11.8%), nausea (8.2%), and sedation (5.9%). Drug addiction, delirium, or respiratory depression associated with PCIA was not reported in this case series study. No significant intergroup difference was observed in NRS at any of the abovementioned time points. There was no significant difference of analgesic effect among the hydromorphone, sufentanil, or oxycodone. Conclusion. PCIA provided timely, safe, and satisfactory analgesia for advanced cancer patients with pain and may be useful for titration of opioids, management of severe breakthrough pain, and conversion to oral analgesia. There was no significant difference of analgesic effect and side effect among the hydromorphone, sufentanil, and oxycodone.

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Undertreatment of cancer pain - a retrospective analysis of medical records of advanced cancer patients hospitalized in a palliative care department

Annals of Oncology ◽

10.1093/annonc/mdw384.09 ◽

2016 ◽

Vol 27 ◽

pp. vi457

Author(s):

N.R. Yordanov ◽

I. Marinova ◽

A. Marinova ◽

S. Aleksandrova

Keyword(s):

Palliative Care ◽

Cancer Pain ◽

Retrospective Analysis ◽

Cancer Patients ◽

Advanced Cancer ◽

Medical Records ◽

Advanced Cancer Patients ◽

Care Department

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The Importance of a Home Care Program for Patients with Advanced Cancer Pain

Tumori Journal ◽

10.1177/030089168507100506 ◽

1985 ◽

Vol 71 (5) ◽

pp. 449-454 ◽

Cited By ~ 30

Author(s):

Vittorio Ventafridda ◽

Marcello Tamburini ◽

Silvana Selmi ◽

Luigi Valera ◽

Franco De Conno

Keyword(s):

Home Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Performance Status ◽

Care Program ◽

Pain Clinic ◽

Advanced Cancer Patients ◽

Sample Group ◽

Significant Difference ◽

Quality Of Life Index

At the Pain Clinic of the National Cancer Institute of Milan, a special Home Care Program has been set up to assist advanced cancer patients with pain and their families during their remaining survival. The Home Care Unit comprises a team of physicians, nurse clinicians, psychologists and many volunteers who are active both in the hospital and at the patient's home. This entire operation provides a continuous relationship between the family, the patient and the Home Care Unit. This Home Care Program, which is one of a kind with other forms of treatment for advanced cancer patients (i.e. hospices), has produced interesting results. Out of a sample group of 50 patients, 33 were monitored at home by the Home Care Unit while 17 had their families to do the monitoring. Over a six-week period the following results were reported: a) Improvement of psycho-emotional factors such as anxiety, weakness and mood for both patients and their families who entered the Home Care Program. b) The Quality of Life Index remained unchanged for the sample group that entered the Home Care Program whereas it deteriorated for patients monitored by their families. c) A decrease in the Integrated Pain Score for both groups; however, results showed a statistically significant difference in favor of patients on the Home Care Program. d) The Performance Status decreased by very little over the study period, and there was little difference between the two groups. These results confirm the need for a Home Care Program which must go hand in hand with the Pain Clinic as an effective way to control Total Pain.

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Placebo and nocebo effects in randomized double-blind clinical trials for fatigue in advanced cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9640 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9640-9640

Author(s):

M. de la Cruz ◽

D. Hui ◽

H. A. Parsons ◽

P. Lynn ◽

C. Parker ◽

...

Keyword(s):

Clinical Trials ◽

Side Effects ◽

Cancer Patients ◽

Advanced Cancer ◽

Randomized Clinical Trials ◽

Placebo Response ◽

Well Being ◽

Advanced Cancer Patients ◽

Edmonton Symptom Assessment Scale ◽

Nocebo Effects

9640 Background: We have previously reported significant placebo response in randomized controlled treatment trials for cancer related fatigue (CRF). We conducted a retrospective study to determine the frequency and predictors of response to placebo and nocebo effect in patients with CRF. Methods: We reviewed patients that received placebo in two previous randomized clinical trials conducted by our group and determined the proportion of patients who demonstrated clinical response to fatigue using an increase (ΔFACIT-F score) > 7 from baseline to day 8, and those with nocebo response as those who reported side effects. Baseline patient characteristics and symptoms recorded from the Edmonton Symptom Assessment Scale (ESAS) were analyzed to determine their association with placebo and nocebo effects. Results: A total of 105 advanced cancer patients received placebo. 59 (56%) patients responded to placebo (median Δ FACIT-F score of 22). Worse baseline anxiety and well-being subscale score (univariate) and well-being (multivariate, MR) were significantly associated with placebo response. Common side effects reported were insomnia (79%), anorexia (53%), nausea (38%) and restlessness (34%). MR analysis showed that worse baseline (ESAS) sleep, appetite, nausea, and restless are associated with increased reporting of these side effects ( Table ). Conclusions: Nearly half of advanced cancer patients enrolled in the fatigue trials responded to placebo. Worse physical well-being score was associated with placebo response. Patients experiencing specific symptoms at baseline were more likely to report these as side effects of the medication. These findings should be considered in fatigue clinical trial design. [Table: see text] No significant financial relationships to disclose.

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Characteristics and outcomes of advanced cancer patients admitted to an acute palliative care unit (PCU) with severe dyspnea receiving high flow oxygen (HFO).

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.247 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 247-247 ◽

Cited By ~ 1

Author(s):

Marvin Omar Delgado-Guay ◽

Alfredo Rodriguez-Nunez ◽

Oluwatobi O Adegboyega ◽

Amy Newton ◽

Maria Gabriela Hernandez-Azmitia ◽

...

Keyword(s):

Cancer Patients ◽

Median Time ◽

Advanced Cancer ◽

Hospital Death ◽

Advanced Cancer Patients ◽

Symptomatic Management ◽

High Flow Oxygen ◽

Significant Difference ◽

Possible Cause

247 Background: Dyspnea is very complex and distressing symptom in patients with advanced cancer. The therapeutic goal of its symptomatic management is to relieve the patient’s breathlessness sensation. Limited literature has addressed the characteristics and clinical outcomes of advanced cancer patients with severe dyspnea receiving HFO admitted to PCU. Methods: We reviewed the records of 101 advanced cancer patients with dyspnea receiving HFO and 110 matched PCU inpatients with dyspnea receiving regular O2 flow (NoHFO) between January 1 to December 31, 2012. Demographics, frequency and intensity of symptoms at PCU admission and follow-up, and outcomes were recorded. Results: Median age: 60 years, range (51, 69). 56% were Male. White(71%), Hispanic(13%), African American(10%), Asian (4%). Primary cancer: Lung (27%), Gastrointestinal (19%), Hematological (18%), Breast (13%), Gynecological (6%). Dyspnea was present in all cases and it was related mainly to: lung involvement by cancer (53%), pneumonia (40%), Congestive Heart Failure (6%), COPD (8%). ECOG: 4. No significant difference in age, ethnicity and type of cancer, ECOG, and possible cause of dyspnea among both groups. HFO and NoHFO were started the same day of admission. Median ESAS symptoms (Interquartile range: IQR) for HFO was Pain 4.5 (2, 7) vs. 5 (3, 7) for NoHFO, p = 0.1423; fatigue [7(5, 8) vs. 7 (5, 8), p = 0.450]; depression [3 (1, 5) vs. 3.5 (2, 5), p = 0.81]; anxiety 7 (4, 9) vs. 6 (3, 8), p = 0.01; dyspnea [7.5( 6, 9) vs. 5 (3, 8), p < 0.0001]. Memorial Delirium Scale 5 (2, 15) vs. 7(2, 15), p = 0.77). Morphine Equivalent Daily Dose: 48 (36, 120) vs. 55 (30, 120), p = 0.72. The median difference among first and follow up ESAS was Pain 0 (-3, 1) vs. -1(-2, 1), p = 0.62; fatigue[(-2, 1) vs. 0 (-2, 0), p = 0.63]; depression [0 (-1, 1) vs. 0 (-1, 2), p = 0.93]; anxiety [0 (-2, 2) vs. 0 (-2, 2), p = 0.94; dyspnea [0( -1, 1) vs. -1 (-2, 1), p = 0.18]. Memorial Delirium Scale 0 (-1.5, 5.5) vs. 0 (-2, 3), p = 0.21).The median time (IQR) from HFO started to discharge was 10 days (6, 15) vs. 8.5 (5, 14) days for NoHFO, p = 0.07). The median time(IQR) from HFO started to Death was 10.5 (7, 19) vs. 13.5 (7, 26) days for NoHFO, p = 0.18. 77/101(76%) HFO patients vs. 56/110 (51%) NoHFO died at the hospital, p = 0.002. 24/101(23%) HFO patients were discharged alive weaned off HFO. The Odd ratio for hospital death in patients with HFO vs. NoHFO was 4.83 (95% CI: 1.72 – 13.59), p = 0.003. Conclusions: Severe dyspnea is significant at the end of life of advanced cancer patients. Patients with HFO require similar MEDD than NoHFO patients. Inpatient mortality is higher in patients with HFO. More research is needed.

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Perceptions of the working alliance among medical staff and cancer patients

Palliative & Supportive Care ◽

10.1017/s1478951515000759 ◽

2015 ◽

Vol 14 (3) ◽

pp. 199-203 ◽

Cited By ~ 1

Author(s):

Gil Bar-Sela ◽

Inbal Mitnik ◽

Doron Lulav-Grinwald

Keyword(s):

Cancer Patients ◽

Working Alliance ◽

Advanced Cancer ◽

Medical Staff ◽

Medical Setting ◽

Advanced Cancer Patients ◽

Staff Members ◽

Working Alliance Inventory ◽

Significant Difference ◽

Staff Interactions

ABSTRACTObjective:A working alliance (WA) is considered an essential factor in therapeutic relationships, relating to the mutual and interactive aspects of the relationship. In the medical setting, a WA has been found to be related to various positive outcomes; however, it has previously been investigated solely from the patient's perspective. The aim of the current study was to measure the concept from both sides of the patient–medical staff interaction.Method:Physicians, nurses, and advanced cancer patients completed the Working Alliance Inventory–Short Revised.Results:Some 32 physicians, 39 nurses, and 52 advanced cancer patients completed the study. Senior staff members rated the WA higher than trainees, both among physicians and nurses. Physicians and nurses rated the “bonds” subscale highest, while patients rated “goals” at the highest level. In addition, a significant difference was demonstrated between physicians and patients, with patients rating the WA higher.Conclusions:These preliminary findings demonstrate different perspectives among advanced cancer patients and medical staff interactions. Future studies should investigate the interactive aspects of the WA concept in the medical setting.Significance of results:Awareness of the working alliance in patient–staff interactions may improve the quality of treatment given to patients confronting cancer.

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An Exploratory Study on the Anti-inflammatory Effects of Fucoidan in Relation to Quality of Life in Advanced Cancer Patients

Integrative Cancer Therapies ◽

10.1177/1534735417692097 ◽

2017 ◽

Vol 17 (2) ◽

pp. 282-291 ◽

Cited By ~ 27

Author(s):

Hidenori Takahashi ◽

Mitsuhiko Kawaguchi ◽

Kunihiro Kitamura ◽

Seiji Narumiya ◽

Munenori Kawamura ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Study ◽

Side Effects ◽

Cancer Patients ◽

Advanced Cancer ◽

High Sensitivity ◽

Advanced Cancer Patients ◽

Open Label ◽

Anti Inflammatory

Background. Conventional anticancer therapies still cause difficulties with selective eradication and accompanying side effects that reduce patients’ quality of life (QOL). Fucoidan is extracted from seaweeds and has already exhibited broad bioactivities, including anticancer and anti-inflammatory properties, in basic studies. It is expected to enhance therapeutic efficacy and minimize side effects in cancer patients; however, despite its potential benefits, there are very few clinical trials using fucoidans. Therefore, we performed an exploratory clinical study for advanced cancer patients to examine the efficacy of fucoidans, especially focusing on inflammation in relation to QOL scores. Methods. We conducted a prospective, open-label clinical study for advanced cancer patients using fucoidans via oral administration; 20 advanced cancer patients with metastases were recruited and were given 400 mL/d fucoidan (10 mg/mL) for at least 4 weeks. Inflammatory biomarkers, including high-sensitivity C-reactive protein and various cytokines, and QOL scores were monitored before treatment, after 2 weeks, and after 4 weeks of fucoidan ingestion. Results. The main proinflammatory cytokines, including interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α) were significantly reduced after 2 weeks of fucoidan ingestion. QOL scores, including fatigue, stayed almost stable without significant changes during the study period. The univariate and multivariate analyses revealed that the responsiveness of IL-1β was a significant independent prognostic factor. Conclusion. This is the first study providing evidence of the anti-inflammatory effects of fucoidans for advanced cancer patients. In future studies, larger blinded, controlled trials are required to establish the efficacy of fucoidan as supportive care for cancer patients, especially those undergoing chemotherapy.

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Methylphenidate (MP) and nursing telephone intervention (NTI) for cancer-related fatigue (CRF) in advanced cancer patients: A double-blind randomized phase II trial.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9023 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9023-9023

Author(s):

Eduardo Bruera ◽

Sriram Yennurajalingam ◽

Pedro Emilio Perez-Cruz ◽

David Hui ◽

Susan Frisbee-Hume ◽

...

Keyword(s):

Regression Analysis ◽

Cancer Patients ◽

Advanced Cancer ◽

Mixed Model ◽

Rank Test ◽

Telephone Intervention ◽

Advanced Cancer Patients ◽

Significant Difference ◽

Edmonton Symptom Assessment Scale ◽

Longitudinal Regression

9023 Background: CRF is the most common and distressing symptom in advanced cancer patients. Preliminary studies support MP and NTI for CRF (Bruera et al. JCO 2006). The primary objective of our study was to determine the effect of MP as compared to placebo (P). A secondary objective was to investigate the role of NTI as compared to control telephone intervention (CTI). Methods: Advanced cancer patients with fatigue ≥4/10 on the Edmonton Symptom Assessment Scale (ESAS), normal cognition, no evidence of major depression and hemoglobin ≥8 were eligible. Patients were randomized to 4 groups in a 2x2 factorial design (MP+NTI, P+NTI, MP+CTI and P+CTI). Primary endpoint was Functional Assessment of Chronic Illness-Fatigue (FACIT-F) subscale scores between day 15 and baseline. The dose and duration of methylphenidate was 5 mg every two hours, as needed, up to 20 mg/day. We tested the median difference in FACIT-F subscale scores between the groups using the Kruskal Wallis test and Wilcoxon signed rank test. Longitudinal regression analysis was conducted with a mixed model. Results: Total accrual was 197. Mean (SD) age was 58 (12), female 67% (N=148), white 72% (N=136), gastrointestinal cancers were the most common 22% (N=41). Baseline FACIT-F subscores were similar among the 4 groups. The median FACIT-F subscores showed significant improvement between Day 15 and baseline for all four groups except for P+CTI (Table): MP+NTI (4.5, P=0.004), P+NTI (8, P<0.001), MP+CTI (7, P<0.001), and P+CTI (5, P=0.06), with no statistically significant difference between MP and P (6 vs. 6, P=0.89). Longitudinal regression analysis showed a time effect (P<0.001) and group differences for NTI vs. CTI with FACIT-F (P=0.13) and ESAS (P=0.03). Grade 3 toxicities were similar between the MP and P arms (34/93 vs. 24/97, P=0.09). Conclusions: MP was not effective as compared to P for CRF in advanced cancer patients. NTI may be effective and should be further studied. [Table: see text]

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