An Internet-based survey evaluating attitudes of cancer patients towards pain intervention

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18540-18540
Author(s):  
C. B. Simone ◽  
N. Vapiwala ◽  
M. K. Hampshire ◽  
J. M. Metz
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Pain Control ◽  
Statistical Significance ◽  
Healthcare Providers ◽  
Common Symptom ◽  
Pain Medications ◽  
Education Levels ◽  
Pain Intervention ◽  
Pain Symptoms

18540 Background: Pain is a common symptom among cancer patients (pts), but many pts experience inadequate medical management for pain. There are little data quantifying reasons that cancer pts fail to receive optimal analgesic treatment. This study evaluated those reasons and investigated the causes of pain in cancer pts. Methods: An Internet-based questionnaire assessing pt demographics and pain symptoms was piloted with pts and healthcare providers and posted on the OncoLink (http://www.oncolink.org) website. The questionnaire included 22 queries evaluating medication utilization, pain control and attitudes regarding pain medications. The questionnaire was IRB approved and held on a secure server. Between 11/05–1/06, 99 pts responded to the questionnaire. They were predominantly Caucasian (76%), female (78%) and pursued education beyond high school (66%). The most common diseases included cancer of the breast (51%), lung (8%) and brain (6%). Cancer treatment included surgery (75%), chemotherapy (63%) and radiation (45%). Results: Half (49%) of the respondents reported pain directly from their cancer and 42% complained of pain due to cancer treatment. This pain was primarily intermittent (42%) or chronic (35%). Most (77%) pts did not use medication specifically to help manage their pain. Analgesic usage trended less in women (19% vs. 36%, p = 0.10), Caucasians (19% vs. 38%, p = 0.06), and pts with higher education levels (17% vs. 26%, p = 0.29) but did not reach statistical significance. Reasons most commonly cited for not taking analgesics included the healthcare provider not recommending medications (86%), fear of becoming addicted or dependent (80%) and an inability to pay for medication (75%). Participants experiencing pain, but not taking analgesics, sought alternative measures for pain control such as physical therapy (84%), massage (7%) and acupuncture (4%). Conclusions: Although many cancer pts experience pain regularly, both from their cancer and cancer treatment, most pts in this study did not seek out analgesics. Pts do seek complementary therapies for pain control. Healthcare providers should regularly have open discussions with pts regarding pain symptoms. Further study will be needed to evaluate attitudes of pts towards pain based on disease condition. No significant financial relationships to disclose.

Sexual Dysfunction in Oncology

2017 ◽  
Vol 41 (S1) ◽  
pp. S282-S282
Author(s):  
M.C. Cochat Costa Rodrigues ◽  
R.G. Faria ◽  
S. Almeida
Keyword(s):  
Sexual Dysfunction ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Clinical Presentation ◽  
Healthcare Providers ◽  
Sexual Dysfunctions ◽  
Cancer Treatments ◽  
Pelvic Tumors ◽  
Pelvic Nerves ◽  
Competing Interest

IntroductionSexual dysfunction is a common consequence of cancer treatment that affects at least half of men and women treated for pelvic tumors and more than one quarter of individuals with other malignancies.Objectives/aimsIdentification of the main sexual dysfunctions related to cancer treatments. Awareness to the importance of addressing sexuality to cancer patients, identifying the main reasons why healthcare providers usually do not.MethodsLiterature review concerning researched articles published in Pubmed/Medline as well as related bibliography.ResultsMost sexual problems are not caused by the cancer itself, but by toxicities of cancer treatment. Damage during cancer treatment to pelvic nerves, blood vessels and organ structures leads to the highest rates of sexual dysfunction. The most common sexual dysfunction in men under cancer treatment is the loss of desire for sex and erectile dysfunction. In women, the most common sexual dysfunctions are vaginal dryness, dyspareunia and loss of sexual desire, usually accompanied by difficulties in both the arousal and orgasm phases. According to literature, there are many cancer patients who would like to be informed and advised by their healthcare providers about the consequences of cancer treatment on their sexual health. Unfortunately, this rarely happens.ConclusionsThis work intends to publicize current existing information on sexual dysfunction in oncology, focusing on the prevalence, etiology and clinical presentation. The authors also intend to promote communication about sexual function and possible sexual dysfunctions resulting from cancer treatments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

P–460 Impact of various cancers on semen parameters in a tertiary onco-fertility unit in India

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
P Aggarwal ◽  
T B Rohatgi ◽  
R Singh ◽  
S Patel ◽  
S Ghumman ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Statistical Significance ◽  
Sperm Concentration ◽  
Semen Parameters ◽  
Limiting Factor ◽  
Patient Counseling ◽  
Ethnic Population ◽  
Number Of Patients

Abstract Study question This study evaluated differences in semen parameters in male cancer patients in our ethnic population who banked their sperms prior to cancer treatment Summary answer We found significant differences in semen concentration, motility and morphology between different types of cancers, especially testicular cancers What is known already Impaired spermatogenesis and abnormal semen parameters in cancer patients has been noted, however certain cancer types are more damaging than others. In testicular cancer, spermatogenesis impairment is more quantitative than qualitative with sperm morphology being the most affected parameter. Among non testicular cancers, lymphoma cases usually show the most significantly impaired semen parameters Study design, size, duration We conducted a retrospective study analyzing semen parameters in 49 cancer patients between October 2014 to January 2020 who presented to the onco-fertility unit, Max Multispeciality Hospitals, New Delhi. Furthermore, we did our analysis based on total of 101 samples and were broadly divided into testicular (37 samples) and non testicular cancers (64 samples). Patients who had previously received any form of cancer treatment including chemotherapy or radiotherapy were not included in this study Participants/materials, setting, methods Testicular Cancer(TC) group was further subcategorized into Seminoma and Non Seminoma groups whereas Non Testicular Cancer (NTC) group was subcategorized into Lymphoma and Non Lymphoma groups. Semen was collected by masturbation and analysis was performed in keeping with the WHO criteria. Statistical analyses was performed using SPSS software. p values <0.05 were considered to indicate statistical significance. Main results and the role of chance In Testicular cancer (TC), 92% samples (34/37) had abnormal semen parameters whereas only 24.4% samples (22/64) were abnormal in Non Testicular cancer (NTC). Additionally, there were significant differences in sperm concentration, motility and morphology between TC and NTC groups. Individually, TC: Oligozoospermia was seen in 73% (27/37) with subdivision between Seminoma and Non Seminoma groups being 81.3% (13/16) and 61.9% (13/21). Asthenozoospermia was seen in 86.5% (32/37) samples with subdivision between Seminoma and Non Seminoma groups being 87.5% (14/16) and 81% (17/21). Teratozoospermia was seen in 59.5% (22/37) samples with subdivision between Seminoma and Non Seminoma groups being 75% (12/16) and 42.86% (9/21). Combined OATS observed in 59.5% (22/37) samples with subdivision between Seminoma and Non Seminoma groups being 75% (12/16) and 42.86% (9/21) NTC: Oligozoospermia was seen in 18.8% (12/64) samples with subdivision between Lymphoma and Non Lymphoma groups being 26.92% (7/26) and 26.32% (10/38). Asthenozoospermia was seen in 32.8% (21/64) samples with subdivision between Lymphoma and Non Lymphoma groups being 34.62% (9/26) and 34.21% (13/38). Teratozoospermia was seen in 17.2% (11/64) samples with subdivision between Lymphoma and Non Lymphoma groups being 26.9% (7/26) and 23.68% (9/38). Combined OATS observed in 17.2% (11/64) samples with subdivision between Lymphoma and Non Lymphoma groups being 26.9% (7/26) and 23.68% (9/38). Limitations, reasons for caution Study was conducted in a single institution with lesser overall number of patients. Duration, staging and grading of cancers were also not individually assessed, which could be a further limiting factor. Wider implications of the findings: Testicular cancers, especially seminomas, have the most severe effect upon semen parameters. Among NTC patients, lymphomas have the worst impact. Knowing the varying effect of different cancers on semen parameters in our ethnic population helps ART specialists and oncologists to appropriately modify patient counseling and improve fertility outcomes. Trial registration number RMO13019

scholarly journals The perceptions and beliefs of cannabis use among Canadian genitourinary cancer patients

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Shipra Taneja ◽  
Yanbo Guo ◽  
Marissa Slaven ◽  
Aly-Khan Lalani ◽  
Erynn Shaw ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Cancer Progression ◽  
Healthcare Providers ◽  
Cannabis Use ◽  
Current Evidence ◽  
Care Plans ◽  
Genitourinary Cancer ◽  
Social Media Platforms ◽  
One Year

Introduction: The legalization of recreational cannabis in Canada in 2018 has led to many patients being curious about the benefits of taking cannabis in conjunction with their cancer treatment. We investigated the perceptions among genitourinary cancer (GUC) patients regarding cannabis use as part of their care plans. Methods: A survey was created to explore current cannabis use behaviors, reasons for cannabis use, and the beliefs of cannabis usefulness towards cancer-related care, including cancer treatment, among GUC patients. The survey was distributed across Canada online via RedCAP through social media platforms, email, and patient advocacy groups. The survey was active from August to December 2020. Results: Of eighty-five responses, fifty-two met inclusion for analysis. Participants included 11 bladder, 26 kidney, and 15 prostate cancer patients. Many (48.1%) participants used cannabis daily and 75% had been using it for more than one year. Cannabis was consumed through oil-based products, edibles, and smoking. The most common reasons for using cannabis were cancer-related anxiety, to prevent cancer progression, cancer-related pain, recreational use, and other non-cancer-related illness or symptoms. Participants believed cannabis improved their sleep (70.2%), anxiety (65.9%), and overall mood (72.3%). Most participants were either unsure (38.3%) or neutral (31.9%) in the belief that cannabis might decrease their cancer progression. Conclusions: GUC patients use cannabis for a variety of cancer- and non-cancer-related symptoms. Many patients believe cannabis has benefited their cancer-related symptoms. These findings highlight the importance of healthcare providers remaining familiar with current evidence on cannabis to support patient conversations about cannabis use.

scholarly journals Treatment decision for cancer patients with fever during the coronavirus disease 2019 (COVID-19) pandemic

2021 ◽  
Vol 38 (4) ◽  
pp. 344-349
Author(s):  
In Hee Lee ◽  
Sung Ae Koh ◽  
Soo Jung Lee ◽  
Sun Ah Lee ◽  
Yoon Young Cho ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Cancer Progression ◽  
Clinical Manifestations ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Common Symptom ◽  
Cancer History ◽  
Computed Tomography Images ◽  
Laboratory Test Results

Background: Cancer patients have been disproportionally affected by the coronavirus disease 2019 (COVID-19) pandemic, with high rates of severe outcomes and mortality. Fever is the most common symptom in COVID-19 patients. During the COVID-19 pandemic, physicians may have difficulty in determining the cause of fever (COVID-19, another infection, or cancer fever) in cancer patients. Furthermore, there are no specific guidelines for managing cancer patients with fever during the COVID-19 pandemic. Thus, this study evaluated the clinical characteristics and outcomes of cancer patients with fever during the COVID-19 pandemic. Methods: This study retrospectively reviewed the medical records of 328 cancer patients with COVID-19 symptoms (fever) admitted to five hospitals in Daegu, Korea from January to October 2020. We obtained data on demographics, clinical manifestations, laboratory test results, chest computed tomography images, cancer history, cancer treatment, and outcomes of all enrolled patients from electronic medical records.Results: The most common COVID-19-like symptoms were fever (n=256, 78%). Among 256 patients with fever, only three (1.2%) were diagnosed with COVID-19. Most patients (253, 98.8%) with fever were not diagnosed with COVID-19. The most common solid malignancies were lung cancer (65, 19.8%) and hepatobiliary cancer (61, 18.6%). Twenty patients with fever experienced a delay in receiving cancer treatment. Eighteen patients discontinued active cancer treatment because of fever. Major events during the treatment delay period included death (2.7%), cancer progression (1.5%), and major organ dysfunction (2.7%).Conclusion: Considering that only 0.9% of patients tested for COVID-19 were positive, screening for COVID-19 in cancer patients with fever should be based on the physician’s clinical decision, and patients might not be routinely tested.

A comparison of percutaneous and endoscopic-guided celiac plexus block/neurolysis in pancreatic cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15767-e15767 ◽  
Author(s):  
Swetha Kambhampati ◽  
Elizabeth A. Sugar ◽  
Joseph M. Herman ◽  
Michael A. Erdek ◽  
Eun Ji Shin ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Pain Control ◽  
Rating Scale ◽  
Statistical Significance ◽  
Numeric Rating Scale ◽  
Celiac Plexus ◽  
Celiac Plexus Block ◽  
Post Procedure ◽  
Plexus Block

e15767 Background: Celiac plexus block (CPB) and celiac plexus neurolysis (CPN) are options for pain control in pancreatic cancer. Conventionally they are performed percutaneously (PC) with fluoroscopic or CT guidance. However endoscopic ultrasound (EUS) guidance is being increasingly used. The aim of this retrospective study is to compare PC-guided and EUS-guided CPB/CPN for pain control. Methods: Our retrospective cohort study included pancreatic cancer patients who underwent CPN/CPB for pain control from 2008 to 2015 at Johns Hopkins. Patients were assessed immediately post-procedure and at 1 month. Patients were selected using CPT and ICD diagnosis code guided searches of the EHR. Pain intensity was assessed using a Numeric Rating Scale (NRS). A response was defined as a decrease in NRS scores by = > 3 points. The validated FACT-Hep score was used to assess quality of life (QOL). Opiate usage was converted into morphine dosage equivalents. Wilcox rank-sum and Fisher’s exact test were used to compare the EUS and PC cohorts. Results: Of 107 patients, 46 (43%) had EUS-CPN, 57 (53%) PC-CPN, and 4 (4%) PC-CPB. 10 patients had procedural complications (7% EUS and 11% PC, p = 0.51) with the most common being chronic diarrhea. The baseline median NRS score was 7 with significantly higher scores for those receiving EUS compared to PC (9 vs 7, p < 0.001). Immediately post-procedure, more PC patients (87%) had a response when compared to EUS patients (72%), although it did not reach statistical significance (p = 0.08). By one month, there was no difference in response rates. (43% CPN vs 34% EUS, p = 0.42) FACT-Hep score declined significantly in all patients with a median drop of 8 points at 1 month and no difference between PC and EUS (9 vs 8, p = 0.46). There was no difference in opiate usage at 1 month (88% PC vs 93% EUS, p = 0.51). Conclusions: Both EUS and PC-guided CPN were effective at reducing post-procedural pain in pancreatic cancer patients but their effectiveness waned by 1 month. EUS did have slightly fewer complications although PC did have slightly higher rates of response post-procedurally. QoL declined and opiate usage was unchanged in both groups. Both procedures had temporary efficacy and need further evaluation.

scholarly journals Knowledge and Attitudes of Home Care Nurses in Cyprus in the Management of Cancer Pain

2020 ◽  
Vol 33 (1) ◽  
pp. 21-27
Author(s):  
Ifigeneia Christou Hadjisavva ◽  
Evridiki Papastavrou ◽  
Christiana Kouta
Keyword(s):  
Pain Management ◽  
Home Care ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Statistical Significance ◽  
Common Symptom ◽  
Duration Of Action ◽  
Knowledge And Attitudes ◽  
Positive Attitudes ◽  
Home Care Nurses

Pain is a common symptom for cancer patients. It is a problem for themselves and their relatives. Nurses are confronted with the treatment of cancer pain in their everyday clinical practice. Efficient management requires accurate and appropriate knowledge, positive attitudes, and competent evaluation skills. The aim is to explore the knowledge and attitudes of Cypriot home care nurses in pain management of cancer patients. Regarding methodology, a quantitative descriptive design was used and the data were collected with the Greek version of the McCaffery and Ferrell Nurses’ Knowledge and Attitudes Survey Regarding Pain questionnaire along with a demographic questionnaire. The sample of the study consisted of home care nurses working in non-profit organizations in Cyprus ( n = 31). For the analysis of data, the SPSSv.21. was used and the statistical significance was set to the p = .05. Results revealed of the total of 35 questions only 13 were answered correctly by the 80% of the participants. Limited knowledge was reported mainly on the duration of action, the effect and dosage of Pethidine, the risk of addiction and the use of non-medication interventions. Significant differences were found to the level of knowledge as regards the age and the experience of nurses. In the case study exercise, it was found that false assessment of pain was related to wrong decisions. Nurses’ attitudes seemed to be positive. In conclusion, the study revealed the knowledge deficits and need for continuous education of home care nurses on the assessment and management of pain for patients with cancer. Empowering nurses with better skills to deal with pain, a most distressing symptom of cancer, will result in a better quality of life for patients. However, the integration of pain management within the national cancer strategies is also very important.

scholarly journals Adult cancer patients’ barriers toward pain management: A literature review

2020 ◽  
Vol 10 (12) ◽  
pp. 38
Author(s):  
Hodan Ibrahim ◽  
Fadi Khraim ◽  
Atef Al-Tawafsheh
Keyword(s):  
Pain Management ◽  
Literature Review ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Healthcare Providers ◽  
Common Symptom ◽  
Pain Communication ◽  
Evidenced Based ◽  
Patient Barriers

Background and objective: Cancer pain is the most common symptom among cancer patients. Despite strategies to control cancer pain, cancer patients’ beliefs and attitudes influence the effectiveness of cancer pain management. The aim of this literature review was to identify and explore adult cancer patients’ barriers toward pain management.Methods: A literature review was conducted. CINAHL, Medline, and PsychINFO databases were searched for relevant articles from 2008 to 2019. Twenty one articles were included in this literature review. Thematic analysis was conducted to identify and explore adult cancer patients’ barriers toward pain management. Results: This literature review revealed several patient barriers toward pain management. These barriers were categorized into cognitive barriers that include poor pain communication, fatalism, and fear of addiction and tolerance; sensory barrier, such as fear of drug side effects; affective barriers, such as anxiety and depression, and socio-demographic barriers that influence cancer pain management.Conclusions: Adult cancer patients’ barriers toward pain management significantly compromise the effectiveness of pain management and affect cancer patients’ quality of life. A better understanding of cancer patients’ barriers toward pain management by the healthcare providers will result in better assessment and management of these barriers and will enhance evidenced-based patient education.

A comparison of percutaneous and endoscopic-guided celiac plexus block/neurolysis in pancreatic cancer patients.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 413-413 ◽  
Author(s):  
Swetha Kambhampati ◽  
Elizabeth A. Sugar ◽  
Joseph Herman ◽  
Michael A. Erdek ◽  
Eun Ji Shin ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Side Effects ◽  
Cancer Patients ◽  
Pain Control ◽  
Statistical Significance ◽  
Celiac Plexus ◽  
Pain Response ◽  
Celiac Plexus Block ◽  
Pain Scores ◽  
Lower Pain

413 Background: Pancreatic Cancer is associated with severe pain and often intractable due to its multifactorial nature. Celiac plexus neurolysis (CPN) has been shown to be effective in controlling pain and conventionally was performed percutaneously (PC) with fluoroscopic or CT guidance. However EUS guidance is being increasingly used and has shown to provide effective analgesia. The aim of this retrospective study is to compare PC-guided and EUS-guided CPN for pain control. Methods: Our retrospective cohort study included pancreatic cancer patients who underwent CPN for pain control from 2008 to 2015 at Johns Hopkins. The primary outcome was a good pain response defined as a drop in NRS pain scores to less than 1 or drop of at least 3 post-procedurally or at 1 month. Secondary outcomes were changes in opiate usage (morphine equivalents), QOL (FACT-Hep) scores and opiate-related side effects. Results: 151 patients underwent PC-CPN and 49 patients underwent EUS-CPN. Patients had their procedure on average 5 months after diagnosis. At baseline, EUS patients had significant higher median baseline pain scores, 9 (4-10) compared to 6 (5-7). A good pain response was seen in 86% of PC patients compared to 73% of EUS patients post-procedurally (p = 0.01). However, at 1 month 43% of EUS patients had a good pain response compared to 28% of PC patients, which trended towards statistical significance (p = 0.08). Following the procedure at 1 month, opiate dosage increased in both groups and no reduction in the proportion of patients with opiate related side effects was seen. EUS patients had significantly higher QOL scores at 1 month, 86 (79-92) vs 72 (67-82) (p < 0.001). Median time from procedure to death was significantly higher in EUS patients than PC patients (HR: 0.63, 95% CI: 0.44, 0.89, p = 0.008). No differences in adverse events between the two groups were seen. Conclusions: Both EUS and PC guided CPN were effective at reducing post-procedural pain in pancreatic cancer patients but their effectiveness waned by 1 month. Percutaneous patients had significantly lower pain scores immediately following the procedure. However, EUS patients seemed to have more durable pain relief with lower pain scores at 1 month and improved QOL.

QIM19-115: Barriers and Trends in Cancer Patients` Pain Management in Qatar: A Randomized Cohort Prospective Study

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-115
Author(s):  
Rehab Abdelwahab ◽  
Anas Hamad ◽  
Randa Al Okka ◽  
Mohd A. Wahid ◽  
Khalil Ullah Shibli ◽  
...  
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Pain Control ◽  
Short Form ◽  
Pain Severity ◽  
Mcgill Pain Questionnaire ◽  
Management Service ◽  
Pain Questionnaire ◽  
Pain Medications

Background: Up to 70% of cancer patients experience pain during the course of illness (Fallon, Support Care Cancer 2008). Studies showed that 40%–50% of patients with cancer pain receive insufficient analgesia due to different factors. Physicians are facing different challenges to accurately assess pain which might affect drug selection and pain control (Beyeler et al, Support Care Cancer 2008; Salminen et al, Support Cancer Care 2008; Stewart, Ulster Med J 2014). In NCCCR, treating physicians may prescribe analgesics to their patients or refer them to the Pain Management Service (PMS) based on their evaluation or as requested by patients. This study explored the factors which might lead to undertreatment of cancer pain in Qatar. In addition, focused on cancer patients’ pain management satisfaction and PMS awareness. Objectives: To assess the existing PMS at NCCCR from patients' perspective. Methods: In this study, we evaluated patients’ pain management perception via a validated written (Arabic and English) questionnaire (SF-MPQ-2; available at https://eprovide.mapi-trust.org/instruments/short-form-mcgill-pain-questionnaire#DESCRIPTIVE_INFORMATION; Gauthier et al, J Pain 2014) and a structured interview by outpatient pharmacists at a single point of time, to assess patients` awareness towards the PMS, if they are receiving pain medications or not, if they are experiencing any pain regardless on pain medications or not, pain severity, and patients’ level of satisfaction towards their medications. A sample of 400 patients was randomly selected amongst the total cancer population visiting NCCCR Pharmacy over a specific period of time. Participants were consented and interviewed. Results: 400 patients agreed to participate; the median age was 50. Male to female ratio was 3 to 7. Data showed that 61% (245/400) of participants were not aware of the existence of the PMS. Only 20% (78/400) were aware and followed by PMS, with a satisfaction rate of 76% (59/78). Although 69% (276/400) of the patients were on pain medications, only 70% (191/276) were satisfied with their current medications. However from the satisfied patients, 57% (109/191) rated their pain as 4–10 at the time of interview (ATI). In the 31% (124/400) that were not taking any pain medications; 77% (96/124) didn’t know about the PMS, and 44% (55/124) had 4–10 pain severity (ATI). Conclusion: These findings provide clear evidence that factors leading to undertreating of cancer pain in Qatar might be unawareness of the PMS existence, pain treatment by unspecialized physicians, and patients’ reluctance to express their pain. Thus, raising patients’ awareness and standardizing the referral criteria can improve pain control and quality of life amongst cancer patients.

Upper Extremity Deep Venous Thrombosis in Cancer Patients with Venous Access Devices - Prophylaxis with a Low Molecular Weight Heparin (Fragmin)

1996 ◽  
Vol 75 (02) ◽  
pp. 251-253 ◽  
Author(s):  
Manuel Monreal ◽  
Antoni Alastrue ◽  
Miquel Rull ◽  
Xavier Mira ◽  
Jordi Muxart ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Upper Extremity ◽  
Statistical Significance ◽  
Central Venous Access ◽  
Venous Access ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
Central Venous ◽  
True Incidence ◽  
Venous Access Devices

SummaryCentral venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism.We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily for 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested.On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% Cl: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 ±145 vs 207 ±81 X 109/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.

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