High-flow oxygen (HFO) and bilevel positive airway pressure (BiPAP) for refractory dyspnea in patients with advanced cancer: A randomized controlled trial.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9611-9611
Author(s):  
David Hui ◽  
Margarita Morgado ◽  
Gary B. Chisholm ◽  
Laura Withers ◽  
Quan Nguyen ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Rating Scale ◽  
Rank Test ◽  
Randomized Controlled ◽  
Bilevel Positive Airway Pressure ◽  
High Flow Oxygen ◽  
Before And After ◽  
Physiologic Parameters

9611 Background: Dyspnea is one of the most common and distressing symptoms in cancer patients. Few treatments are evidence based because research in this area is difficult. The role of HFO and BiPAP in the palliation of severe refractory dyspnea has not been well characterized.We examined the changes in dyspnea, physiologic parameters and adverse effects in patients receiving HFO and BiPAP. Methods: In this phase II “pick the winner” randomized trial, we assigned hospitalized advanced cancer patients with refractory dyspnea to either HFO or BiPAP for 2 hours. We assessed dyspnea with the numeric rating scale (NRS) and modified Borg scale (MBS) before and after intervention. We also documented the vital signs, transcutaneous carbon dioxide and adverse effects. We used the sign rank test to compare before and after each intervention, and the Wilcoxon rank sum test to compare between arms with intention-to-treat analysis. Results: Thirty patients were enrolled (1:1 ratio) and 23 (77%) completed the assigned intervention. The median baseline dyspnea NRS was 7/10 (Q1-Q3 5-8), despite being on supplemental oxygen and opioids. Both HFO and BiPAP were associated with significant improvement in dyspnea after 2 h, with no differences detected between arms (Table). We observed prolonged dyspnea relief in 6 patients 1 h after completion of the study intervention. HFO improved oxygen saturation. No adverse effects were observed. Conclusions: HFO and BiPAP alleviated dyspnea, improved physiologic parameters and were safe. Our results justify larger randomized controlled trials to confirm these findings. Clinical trial information: NCT01518140. [Table: see text]

Parenteral hydration (PH) in advanced cancer patients: A multi-center, double-blind, placebo-controlled randomized trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9025-9025 ◽  
Author(s):  
Shalini Dalal ◽  
David Hui ◽  
Isabel Torres-Vigil ◽  
J. Lynn Palmer ◽  
Julio Allo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Overall Survival ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Normal Saline ◽  
Rating Scale ◽  
Assessment Scale ◽  
Rank Test ◽  
Edmonton Symptom Assessment Scale

9025 Background: The vast majority of cancer patients at the end of life receive PH in hospitals and no PH in hospice. There is limited evidence supporting either practice. Our preliminary study suggested that PH (1L/day) improved dehydration symptoms (Bruera et al. JCO 2005). In this randomized controlled trial, we determined the effect of PH on symptoms associated with dehydration, quality of life and survival for patients with advanced cancer. Methods: We randomly assigned 129 cancer patients from 6 hospices to receive subcutaneous PH (normal saline 1 L/day) or placebo (normal saline 100 mL/day) daily over 4 hours. The primary outcome was change in the sum of 4 dehydration symptoms (fatigue, myoclonus, sedation and hallucinations, 0=best and 40=worst possible) between day 4 and baseline. Secondary outcomes included Edmonton Symptom Assessment Scale (ESAS), Memorial delirium assessment scale [MDAS], Nursing delirium screening scale [NuDESC], unified myoclonus rating scale [UMRS], FACIT-F, creatinine, urea, and overall survival. Intention-to-treat analysis was conducted to examine the change in each variable between baseline and day 4 or day 7. Log rank test was used for survival analysis. Results: Mean age was 67 (range 43-92), female 61%, Caucasians 60%, gastrointestinal, genitourinary and lung cancers 70%, performance status 3-4 113 (88%), with no baseline differences between the hydration (N=63) and placebo (N=66) groups. No significant differences were found between the hydration and placebo groups for the sum of 4 dehydration symptoms (-3.3 v. -2.8, p=0.77), ESAS (all non-significant), MDAS (1 vs. 3.5, p=0.084), NuDESC (0 v. 0, p=0.13) and UMRS (0 vs. 0, p=0.54). We also did not identify any group differences for day 7, except for a decrease in urea level in the hydration group (-2 vs. 2, P=0.02). Median overall survival was 21 days for PH and 15 days for placebo (p=0.83). Conclusions: PH at 1 L/day did not improve symptoms, quality of life or survival compared to placebo. Further studies are required to determine if any subgroups would benefit from PH.

scholarly journals Effectiveness of rapid titration with intravenous administration of oxycodone injection in advanced cancer patients with severe pain

2019 ◽  
Vol 49 (11) ◽  
pp. 1061-1064
Author(s):  
Nobuhisa Nakajima
Keyword(s):  
Pain Relief ◽  
Adverse Effects ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Severe Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Advanced Cancer Patients ◽  
Morphine Group ◽  
Time Required

Abstract Some cancer patients suddenly develop severe, excruciating pain that requires rapid management using opioid medication. This study aimed to evaluate the effectiveness of rapid titration using oxycodone injection. Study subjects were advanced cancer patients who experienced severe pain (numeric rating scale ≥7) and needed prompt pain relief. Primary endpoint was (i) time required for the initial sign of significant analgesia to become evident. Secondary endpoints were (ii) pain relief stabilization success rate and (iii) adverse effects. Groups treated with oxycodone (oxycodone group) and morphine (morphine group) were retrospectively compared. The oxycodone group had 33 cases and the morphine group had 32 cases: (i) 15.6 ± 4.3 min in the oxycodone group and 19.3 ± 4.7 min in the morphine group (P = 0.001); (ii) 70 and 63% within 24 hours, and 88 and 84% within 48 hours in the oxycodone group and the morphine group, respectively (P = 0.36, 0.48). Although (iii) adverse effects appeared in both groups in the form of respiratory suppression, etc., the effects were mild. Rapid titration using oxycodone injections may be considered a beneficial choice.

The potential role of an activity-based guitar program on the anxiety and fulfillment levels of younger relatives of cancer patients: A pilot study

2021 ◽  
pp. 025576142110273
Author(s):  
Erkan Sülün ◽  
Hüseyin Olgaçer ◽  
Hakkı Cengiz Eren
Keyword(s):  
Cancer Patients ◽  
Trait Anxiety ◽  
Potential Role ◽  
Rank Test ◽  
Satisfaction Scale ◽  
Before And After ◽  
Signed Rank Test ◽  
Total State ◽  
Rank Differences

In this study, the authors evaluated the potential role of an activity-based guitar training program on reducing anxiety and providing fulfillment for younger relatives of cancer patients. Ten active members of KHYD (The Society for Relatives of Cancer Patients), between ages 11 and 17 participated in an 8-week guitar education program. The participants filled out two questionnaires before and after their engagement in the 8-week program, one to measure changes in their anxiety levels (State-Trait Anxiety Inventory) and the other to measure changes in their general fulfillment levels (Multidimensional Students’ Life Satisfaction Scale). Wilcoxon signed rank test, as well as descriptive statistics were used in the analysis of data. Mean rank differences were observed to be statistically significant with respect to total state and trait anxiety scores; in both cases, the participants’ scores decreased after their engagement in the program. Statistically significant mean rank differences were also observed in the overall MSLSS scores and its “friends” and “environment” sub-dimensions; with respect to these, participants’ scores increased after their engagement in the program. Recommendations for more comprehensive, larger-scale studies are given at the end.

scholarly journals Intensive Motion Style Acupuncture Treatment (MSAT) Is Effective for Patients with Acute Whiplash Injury: A Randomized Controlled Trial

2020 ◽  
Vol 9 (7) ◽  
pp. 2079
Author(s):  
Doori Kim ◽  
Kyoung-Sun Park ◽  
Jin-Ho Lee ◽  
Won-Hyung Ryu ◽  
Heeyoung Moon ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Whiplash Injury ◽  
Rating Scale ◽  
Acupuncture Treatment ◽  
Controlled Trial ◽  
Rank Test ◽  
Control Group ◽  
Korean Medicine ◽  
Randomized Controlled ◽  
Motion Style

In this single-center, parallel, randomized controlled trial, we aim to examine the effects and safety of motion style acupuncture treatment (MSAT; a combination of acupuncture and Doin therapy) on pain reduction and functional improvement in patients with whiplash-associated disorders (WADs). Ninety-seven patients with cervical pain admitted to the Bucheon Jaseng Hospital of Korean Medicine, South Korea, due to acute whiplash injury were treated with integrative Korean medicine (IKM) with (MSAT group, 48 patients) or without (control group, 49 patients) an additional 3-day MSAT during hospitalization (5–14 days) and followed-up for 90 days. The mean numeric rating scale (NRS) scores of the MSAT and control groups at baseline were 5.67 (95% confidence interval (CI), 5.33, 6.01) and 5.44 (95% CI, 5.06, 5.82), respectively, and on day 5, 3.55 (95% CI, 3.04, 4.06) and 4.59 (95% CI, 4.10–5.07), respectively. The NRS change difference between the groups was −1.07 (95% CI, −1.76, −0.37). The rate of recovery of neck pain (NRS score change ≥ 2 points) was significantly faster in the MSAT than in the control group (log-rank test p = 0.0055). IKM treatment combined with MSAT may be effective in reducing the pain and improving the range of motion in patients with WADs.

Switching From Morphine to Methadone to Improve Analgesia and Tolerability in Cancer Patients: A Prospective Study

2001 ◽  
Vol 19 (11) ◽  
pp. 2898-2904 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Alessandra Casuccio ◽  
Fabio Fulfaro ◽  
Liliana Groff ◽  
Roberto Boffi ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Pain Intensity ◽  
Cancer Patients ◽  
Pain Control ◽  
Therapeutic Option ◽  
Oral Morphine ◽  
Oral Methadone ◽  
Before And After ◽  
Clinical Benefits ◽  
A Prospective Study

PURPOSE: To evaluate the clinical benefits of switching from morphine to oral methadone in patients who experience poor analgesia or adverse effects from morphine. PATIENTS AND METHODS: Fifty-two consecutive cancer patients receiving oral morphine but with uncontrolled pain and/or moderate to severe opioid adverse effects were switched to oral methadone administered every 8 hours using different dose ratios. Intensity of pain and adverse effects were assessed daily, and the symptom distress score (DS) was calculated before and after switching. RESULTS: Data were analyzed for 50 patients. Switching was considered effective in 80% of the patients; results were achieved in an average of 3.65 days. In the 10 patients who switched to methadone because of uncontrolled pain, a significant reduction in pain intensity (P < .005) and an average of a 33% increase in methadone doses necessary (P < .01) were found after an average of 3.5 days. DS significantly decreased from an average of 8.4 to 4.5 (P < .0005). In the 32 patients switching because of uncontrolled pain and morphine-related adverse effects, significant improvement was found in pain intensity (P < .0005), nausea and vomiting (P < .03), constipation (P < .001), and drowsiness (P < .01), but a significant increase in the methadone dose of an average of 20% (P < .004) was required. CONCLUSION: In most patients with cancer pain referred for poor pain control and/or adverse effects, switching to oral methadone is a valid therapeutic option. In the clinical setting of poor pain control, higher doses of methadone are necessary with respect to the equianalgesic calculated dose ratios previously published.

Comorbidity and survival in cancer patients receiving palliative care

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9066-9066
Author(s):  
V. T. Chang ◽  
N. Sambamoorthi ◽  
B. Zhou ◽  
H. Yan ◽  
M. L. Gonzalez ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Rating Scale ◽  
Cox Regression ◽  
Early Stage ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Survival Analyses ◽  
Comorbidity Index

9066 Background: Comorbidity has received increasing attention in the assessment of patients with early stage cancer, or at diagnosis. We studied whether three indices of comorbidity, the Charlson Comorbidity Index (CMI), the Cumulative Illness Rating Scale (CIRS), and the Kaplan Feinstein Index (KFI) add prognostic information for cancer patients receiving palliative care. Methods: In an IRB approved protocol, 103 patients with advanced cancer were seen at the time they were starting palliative care. They had a Karnofsky Performance Status (KPS) determination, and were followed longitudinally. Comorbidity scores were coded from the medical record. At this time, all patients had died and survival analyses were performed. Results: The median age was 69 years (range 41–87), median Karnofsky Performance Status (KPS) was 70% (range 20–90); primary sites were lung 41 pts (40%), prostate 23pts (22%), colorectal 10 pts (10%), other cancers 29 pts (28%). Median survival was 111 days (range 4–1,145 days). Median CMI was 10 (range 4–14), CIRS15 4 (2–5), CIRS16 9 (4–12), CIRS17 2.3 (1.5–3.33), CIRS18 1 (0–3), KFI 2 (0–3). In univariate survival analyses, when bisected by median values, the KPS, age, CMI, and subscales of the CIRS (CIRS 16, CIRS 17, CIRS18) were significantly related to survival, but not the KFI. In multivariate Cox regression analyses that included KPS (p<0.0001) and age (p<0.003) and a comorbidity index, the CMI (p<0.0001), and certain subscales of the CIRS were independently predictive of survival, specifically the CIRS 15 (p<0.0001), CIRS16 (p<0.0001), CIRS 17 (p<0.0001), and CIRS18 (p<0.0001). The primary site was not an independent survival predictor. Conclusion: In patients with advanced cancer receiving palliative care, measures of comorbidity may contribute to refining estimates of prognosis and ultimately to health care resource utilization. The optimal comorbidity measure remains to be determined. These results will be confirmed in larger populations. Supported in part by the Soros Open Society Institute Project Death in America and VA HSRD IIR 02–103 No significant financial relationships to disclose.

The Effect of Using an Electric Fan on Dyspnea in Chinese Patients With Terminal Cancer

2016 ◽  
Vol 34 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Sio Leng Wong ◽  
Sok Man Leong ◽  
Cheng Man Chan ◽  
Sut Peng Kan ◽  
Hon Wai Benjamin Cheng
Keyword(s):  
Advanced Cancer ◽  
Large Scale ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Relevant Literature ◽  
Chinese Patients ◽  
Control Group ◽  
Significant Difference ◽  
Before And After ◽  
Experimental Group

Background: Fan therapy is often suggested for relieving the symptom of dyspnea in patients with advanced cancer, but relevant literature among Asians is limited. Objective: Phase 2 clinical trial to assess the clinical feasibility and outcome of using an electric fan to alleviate the symptom of dyspnea in Chinese patients with advanced cancer. Methods: Thirty patients with advanced cancer having unresolved breathlessness were recruited from Hospice and Palliative Care Centre of Kiang Wu Hospital in Macau. Participants were randomly and equally allocated to the experimental group and the control group, respectively. Outcome Measures: Verbal numerical rating scale (NRS) of breathlessness, respiratory rate (RR), and saturation of peripheral oxygen (SpO2) was collected before and after the intervention. Results: T test was used to analyze the data collected. There was a significant difference in the NRS scores of the experimental group ( P < .01), indicating a significant reduction in the patients’ sensation of breathlessness after fan therapy, whereas no significant difference was found in the objective statistic results of RR and SpO2. No significant difference ( P > .05) was found in the control group for all the 3 variables before and after routine treatment. Conclusion: The results of the study suggested that fan therapy could be effective in alleviating dyspnea in Chinese patients with advanced cancer. It should be considered as one of the nonpharmacological treatment option. Future large-scale phase 3 clinical trials are warranted.

scholarly journals PROGRESSIVE MUSCLE RELAXATION EFFECT ON THE LEVEL ANXIETY of CANCER PATIENTS UNDERGOING CHEMOTHERAPY

2018 ◽  
Vol 2 (01) ◽  
pp. 62-69
Author(s):  
Enny Virda Yuniarti ◽  
Ima Rahmawati
Keyword(s):  
Cancer Patients ◽  
Rating Scale ◽  
Emotional Experience ◽  
Muscle Relaxation ◽  
Sampling Technique ◽  
Relaxation Effect ◽  
Progressive Muscle Relaxation ◽  
Rank Test ◽  
Test Statistic ◽  
Long Term Treatment

The physical effects of cancer and its therapy can lead to an unpleasant emotional experience. Long-term treatment of chemotherapy and the presence of perceived side effects can cause anxiety. One of the nonpharmacological measures to overcome this anxiety is the relaxation of Progressive Muscle Relaxation therapy. to know the effect of relaxation Progressive Muscle Relaxation on the level of anxiety in cancer patients who underwent chemotherapy. Independent Variables are Progressive Muscle Relaxation and Dependent Variables of Anxiety Level. This research design uses Pre- Experiment with Pretest-Posttest approach design. Sample amounted to 30 people. Sampling technique Purposive Sampling. The tool used in the HRS-A (Hamilton Rating Scale-Anxiety) questionnaire. The research was conducted from March to April 2017 at Leprosy Hospital SumberGlagahPacet, Mojokerto. Progressive Muscle Relaxation performed one up to two times for 3 weeks with a duration of 15 minutes per session. The test statistic used is to use the Wilcoxon Rank Test test. ρ = 0.046 and α = 0.05 so that means H0 rejected and H1 accepted which means there is influence progressive muscle relaxation to the level anxiety cancer patients who underwent chemotherapy at Leprosy Hospital Pacet, Mojokerto. Progressive Muscle Relaxation is recommended as one of the non-pharmacological complementary therapies because this relaxation technique is easy to do and does not cost.

Sign in / Sign up

Export Citation Format

Share Document