The use of fentanyl in pain management in head and neck cancer patients: a narrative review

Background: Head and neck (H&N) cancers account for about 5% of all malignant tumours. Pain is one of the most feared consequences of H&N neoplasms and is experienced by up to 80% of patients and worsens their quality of life inhibiting speaking, eating, drinking or swallowing. Nevertheless, pain is still often underestimated and undertreated. Objectives: The role of opioids in cancer pain has been well established but evidences about the role and the relative effectiveness of opioids such as fentanyl in the context of H&N cancer pain remains unclear. Methods: A literature review based on the guidance of the Centre for Reviews and Dissemination was conducted. An iterative approach was used starting with an electronic search in the MEDLINE database. The search terms ((‘Neoplasms’[Mesh]) AND ‘Head and Neck Neoplasms’[Mesh]) AND ‘Fentanyl’[Mesh] were used. Results: A total of 18 publications were found by the first performed search on PubMed. Other publications concordant with our aim were found by cross-reference. Considering inclusion and exclusion criteria for our review, eight papers resulted eligible for analysis. Conclusion: Fentanyl transdermal therapeutic system (TTS) seems to be an important option, thanks to the way of administration, the good safety and tolerability profiles to control baseline pain. For breakthrough cancer pain (BTcP), several formulations of transmucosal fentanyl are available. All the formulations seem to be active and safety but we lack head-to-head studies of fentanyl versus other strong opioids, as well as with different formulation of fentanyl, particularly for BTcP where H&N cancer population is very poorly represented.

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Role of Oxycodone Hydrochloride in Treating Radiotherapy-Related Pain

Pain Research and Management ◽

10.1155/2020/7565962 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Yinxia Wang ◽

Ligang Xing

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Cancer Pain ◽

Cancer Patients ◽

Pain Control ◽

Analgesic Drugs ◽

Oxycodone Hydrochloride ◽

Radiation Esophagitis

Radiotherapy is commonly used to treat cancer patients. Besides the curable effect, radiotherapy also could relieve the pain of cancer patients. However, cancer pain is gradually alleviated about two weeks after radiotherapy. In addition, cancer patients who receive radiotherapy may also suffer from pain flare or radiotherapy-induced side effects such as radiation esophagitis, enteritis, and mucositis. Pain control is reported to be inadequate during the whole course of radiotherapy (before, during, and after radiotherapy), and quality of life is seriously affected. Hence, radiotherapy is suggested to be combined with analgesic drugs in clinical guidelines. Previous studies have shown that radiotherapy combined with oxycodone hydrochloride can effectively alleviate cancer pain. In this review, we firstly presented the necessity of analgesia during the whole course of radiotherapy. We also sketched the role of oxycodone hydrochloride in radiotherapy of bone metastases and radiotherapy-induced oral mucositis. Finally, we concluded that oxycodone hydrochloride shows good efficacy and tolerance and could be used for pain management before, during, and after radiotherapy.

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The Political-Military Organizations and the Emergence of Mass-Based Grassroots Organizations

Promoting Democracy ◽

10.18574/nyu/9781479811380.003.0002 ◽

2019 ◽

pp. 28-56

Author(s):

Manal A. Jamal

Keyword(s):

Civil Society ◽

Relative Effectiveness ◽

Grassroots Organizations ◽

Donor Funding ◽

Military Organizations ◽

Democratic Development ◽

Mediating Role ◽

The Impact

This chapter outlines how patterns of socio-political organizing diverged in the Palestinian and Salvadoran cases during the beginning of their respective conflicttopeace transitions. Departing from explanations that focus on the professionalization of mass-based organizations, the author explains how the domestic political contexts shaped the mediating role of Western donor funding. More specifically, the book argues the that “inclusivity” of political settlements (assessed by the extent of participation of major political groups and the degree of societal support) shaped the relative effectiveness of democracy promotion efforts and the impact of Western donor assistance on civil society and democratic development more generally. This chapter also explains how civil society is being addressed in the book and the methodology employed, which is a structured, focused comparison that is historically sensitive but conducive to generalizing across cases. It also explains how the quality of civil society and democratic development are assessed, and why the women’s sectors were chosen to examine these developments. It concludes with an outline of the remaining chapters of the book.

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A Gluten Free Diet in the Management of Epilepsy in People with Coeliac Disease or Gluten Sensitivity

Gastrointestinal Disorders ◽

10.3390/gidisord2030026 ◽

2020 ◽

Vol 2 (3) ◽

pp. 281-299

Author(s):

Zoë Gilbey ◽

Justine Bold

Keyword(s):

Coeliac Disease ◽

Small Sample ◽

Gluten Free Diet ◽

Gluten Sensitivity ◽

Gluten Free ◽

Exclusion Criteria ◽

Search Terms ◽

Small Sample Sizes ◽

Eeg Pattern

The aim of this review was to assess the effects of a gluten free diet (GFD) in the management of epilepsy in people with coeliac disease (CD) or gluten sensitivity (GS). A systematic approach was used to undertake a literature review. Five electronic databases (PubMed; Scopus; Google Scholar; Cochrane Epilepsy Group specialised register; Cochrane Register of Controlled Trails (CENTRAL) via the Cochrane Register of Online Trials) were searched using predetermined relevant search terms. In total, 668 articles were identified. Duplicates were removed and predefined inclusion and exclusion criteria were applied, and a PRISMA flow chart was produced. Data was extracted using Covidence software. Twelve studies on Epilepsy and CD involving a total of 70 participants were selected for analysis; narrative synthesis was used owing to the small sample sizes in the selected studies. None of the 12 studies meeting inclusion criteria investigated gluten sensitivity and epilepsy. All the included studies support a link between epilepsy and CD. GFD was effective in 44 out of 70 participants across the studies in terms of a reduction of seizures, reduction of antiepileptic drugs (AEDs) or normalisation of EEG pattern. A total of 44 participants showed a reduction in seizures (across eight studies) and complete cessation of seizures was reported in 22 participants. In general, the earlier the GFD is implemented after the onset of seizures, the better the likelihood of the GFD being successful in supporting control of seizures. Mechanisms linking gluten with epilepsy are not fully understood; possible hypotheses include gluten mediated toxicity, immune-induced cortical damage and malabsorption. Evidence suggests the effectiveness of a GFD in supporting the management of epilepsy in patients with CD, although the quality of evidence is low. There appears to be a growing number of neurologists who are prepared to advocate the use of a GFD. A multidisciplinary approaches and further research are recommended. It could be argued that when balancing potential treatments such as AEDs or surgery, a GFD has a low likelihood of harm.

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Salvage Surgery in Head and Neck Cancer

Critical Issues in Head and Neck Oncology ◽

10.1007/978-3-030-63234-2_16 ◽

2021 ◽

pp. 233-246

Author(s):

Stijn van Weert ◽

Sat Parmar ◽

C. René Leemans

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Organ Preservation ◽

Salvage Surgery ◽

Transoral Robotic Surgery ◽

Shared Decision ◽

Surgery Complications

AbstractSalvage surgery (SS) in head and neck cancer is considered a last resort treatment after failure of organ preservation treatments. It offers challenges to the patients and the surgeon. The outcome of SS is often uncertain in terms of survival and quality of life. This paper offers an overview of evolution in SS, tumor and patient factors to be considered, challenges in reconstructive surgery, complications of SS and the changing landscape with regard to increasing incidence of human papillomavirus positive tumours, the role of transoral robotic surgery, the importance of multidisciplinary management and shared decision making.

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Psychological Distress and Quality of Life Evaluation in Head and Neck Cancer: the Role of Family Caregiver

Annals of Oncology ◽

10.1016/s0923-7534(20)33604-8 ◽

2012 ◽

Vol 23 ◽

pp. ix343

Author(s):

O. Ostellino ◽

M. Airoldi ◽

M. Garzaro ◽

L. Raimondo ◽

G. Riva ◽

...

Keyword(s):

Quality Of Life ◽

Head And Neck Cancer ◽

Psychological Distress ◽

Head And Neck ◽

Neck Cancer ◽

Family Caregiver ◽

Life Evaluation

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SUN-P089: Weight Change and Quality of Life in Head and Neck Cancer Patients. the Role of a Dietitian in the Interdisciplinary Treatment Team

Clinical Nutrition ◽

10.1016/s0261-5614(16)30432-0 ◽

2016 ◽

Vol 35 ◽

pp. S77

Author(s):

L. Thoresen ◽

S. Berge ◽

E. Kampman

Keyword(s):

Quality Of Life ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Weight Change ◽

Interdisciplinary Treatment ◽

Treatment Team

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Stereotactic Radiosurgery Hypophysectomy for Palliative Treatment of Refractory Cancer Pain: A Historical Review and Update

Frontiers in Oncology ◽

10.3389/fonc.2020.572557 ◽

2020 ◽

Vol 10 ◽

Author(s):

M. Benjamin Larkin ◽

Patrick J. Karas ◽

John P. McGinnis ◽

Ian E. McCutcheon ◽

Ashwin Viswanathan

Keyword(s):

Pain Relief ◽

Cancer Pain ◽

Stereotactic Radiosurgery ◽

Advanced Cancer ◽

Pain Perception ◽

Historical Review ◽

Refractory Pain ◽

Small Series

Medically refractory pain in those with advanced cancer significantly reduces one’s quality of life. Therefore, palliative interventions to mitigate cancer pain and reduce opioid requirements are necessary to reduce patient suffering and opioid-induced side effects. Hypophysectomy, a largely forgotten pain procedure with several technical variations, has been repeatedly studied in small series with encouraging results, though historically has been fraught with complications. As a result, the minimally invasive and more tolerable stereotactic radiosurgery (SRS) hypophysectomy has resurfaced as a possible treatment for cancer-related pain. While the mechanism of pain relief is not entirely understood, the hypothalamohypophyseal axis appears to play an essential role in pain perception and transmission and involves C fiber signal processing and downstream modulation of the brainstem and spinal cord via the hypothalamus. This review highlights the role of hypophysectomy in alleviating advanced cancer pain, both in hormonal and nonhormonal malignancy and the current mechanistic understanding of pain relief for the three primary hypophysectomy modalities used historically: surgical and chemical adenolysis, as well as the more recent, SRS hypophysectomy. Given the lack of high-quality evidence for stereotactic radiosurgery hypophysectomy, there is a need for further rigorous and prospective clinical studies despite its ideal and noninvasive approach.

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The Role of Chloroquine and Hydroxychloroquine in Prophylaxis of Covid-19: A Literature Review

Childhood Stunting, Wasting, and Obesity, as the Critical Global Health Issues: Forging Cross-Sectoral Solutions ◽

10.26911/the7thicph.05.33 ◽

2020 ◽

Author(s):

Dewi Indra Sari ◽

◽

Mardiati Nadjib ◽

Keyword(s):

Public Health ◽

Observational Studies ◽

Cochrane Library ◽

Post Exposure Prophylaxis ◽

High Dose ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Exposure Prophylaxis

ABSTRACT Background: A pandemic potential Covid-19 spread rapidly worldwide. Ministry of Health, Republic Indonesia recommended one of the Covid-19 treatments with combination of hydroxychloroquine/ chloroquine and azithromycin. However, the effectiveness and safety of antimalaria regime remain debating topic. This study aimed to investigate the role of chloroquine and hydroxychloroquine in prophylaxis of Covid-19. Subjects and Method: A systematic review was conducted by searching from PubMed, SpringerLink, and Cochrane Library databases. The keywords were “prophylaxis”, “chloroquine” OR “hydroxychloroquine” “SARS-CoV-2” OR “Covid-19”. The inclusion criteria were phase IIb clinical trials, double masking, comparative observational studies, open access articles published until August 2020. The exclusion criteria were inaccessible and duplicate articles. The quality of selected articles was critically appraised. The data were reported by PRISMA flow chart. Results: Three articles out of 117 articles met the criteria inclusion. The findings showed that hydroxychloroquine could not prevent Covid-19 compatible disease or confirmed infections when used as post-exposure prophylaxis. High dose chloroquine was not recommended for critically ill COVID-19 patients because of its potential side effects, especially when administered with azithromycin and oseltamivir. Covid-19 patients with the need for oxygenation were not suggested to use hydroxychloroquine. Conclusion: There is scarce evidence to support prophylaxis and treatment effects of chloroquine or hydroxychloroquine in COVID-19 patients. Further research on the safety and use of chloroquine or hydroxychloroquine is required in the management of Covid-19. Keywords: prophylaxis, Chloroquine, Hydroxychloroquine, SARS-CoV-2, Covid-19 Correspondence: Dewi Indra Sari. Masters Program in Public Health, Faculty of Public Health, Universitas Indonesia, Depok, West Java. Email: [email protected]. Mobile: +628121983-6600. DOI: https://doi.org/10.26911/the7thicph.05.33

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Desafios e dificuldades enfrentadas por pacientes HIV em relação à adesão às terapias antirretrovirais

Revista Remecs - Revista Multidisciplinar de Estudos Científicos em Saúde ◽

10.24281/rremecs2526-2874.2019.4.7.10-16 ◽

2019 ◽

Vol 4 (7) ◽

pp. 10-16

Author(s):

Reilane Santos Loiola ◽

Vinicius Guilherme Pinna ◽

Alceni Do Carmo Morais Monteiro de Barros

Keyword(s):

Daily Life ◽

Electronic Journals ◽

Exclusion Criteria ◽

Infected People ◽

Health Team ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome ◽

Therapy Studies

Buscar na literatura os motivos pelos quais as pessoas infectadas abandonam o tratamento ou não o seguem de forma adequada, bem como conhecer o papel da equipe de saúde frente às dificuldades enfrentadas pelos pacientes não aderentes à TARV. A busca foi realizada nas seguintes bases de dados: LILACS, e nos seguintes Periódicos eletrônicos: SCIELO e na Biblioteca Virtual em Saúde (BVS), seguindo critérios de inclusão e exclusão pré-determinados. Ao identificar os motivos que interferem negativamente na qualidade de adesão ao regime terapêutico, apresentam-se vários obstáculos presentes no cotidiano do portador de HIV que prejudicam a terapêutica. Os estudos reconhecem a importância das atividades educativas como ferramenta para promoção da saúde no contexto da adesão com o intuito de motivar os usuários e trazê-los para o tratamento eficaz, considerando que o papel da equipe de saúde é essencial para o êxito da terapia.Descritores: Antirretrovirais, Infecção por HIV, Síndrome da Imunodeficiência Adquirida. Challenges and difficulties faced by HIV patients in relation to adherence to antiretroviral therapiesAbstract: To search the literature for the reasons why infected people abandon treatment or do not follow it adequately, as well as to know the role of the health team in face of the difficulties faced by patients not adherent to ART. The search was performed in the following databases: LILACS, and in the following electronic journals: SCIELO and the Virtual Health Library (VHL), following pre-determined inclusion and exclusion and exclusion criteria. By identifying the reasons that negatively affect the quality of adherence to the therapeutic regimen, there are several obstacles present in the daily life of people with HIV that impair the therapy. Studies recognize the importance of educational activities as a tool for health promotion in the context of adherence in order to motivate users and bring them to effective treatment, considering that the role of the health team is essential for the success of therapy.Descriptors: Antirretroviral Agents, HIV Infection, Acquired Immunodeficiency Syndrome. Desafíos y dificultades enfrentadas por los pacientes con VIH en relación con la adhesión a las terapias antirretroviralesResumen: Buscar em la literatura los motivos por los que las personas infectadas abandonan el tratamento no lo siguen de forma adecuada, así como conocer el papel del equipo de salud frente a las dificultades enfrentadas por los pacientes no aderentes a la TARV. La búsqueda fue realizada em las siguientes bases de datos: LILACS, y los siguientes Periódicos electrônicos: SCIELO y en la Biblioteca Virtual em Salud (BVS), siguiendo criterios de inclusión y exclusión predeterminados. Al identificar los motivos que interfieren negativamente em la calidad de adhesión al régimen terapêutico, se presentan vários obstáculos presentes em el cotidiano del portador de VIH que perjudican la terapéutica. Los estudios reconocen la importancia de las atividades educativas como herramienta para promover la salud em el contexto de la adhesión com el fin de motivar a los usuarios y traerlos para el tratamento eficaz, considerando que el papel del equipo de salud es essencial para el éxito de la salud da terapia.Descriptores: Antirretrovirales, Infección por VIH, Síndrome de Inmunodeficiencia Adquirida.

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