scholarly journals Programmable Pump for Intrathecal Morphine Delivery to Cisterna Magna: Clinical Implications in Novel Management of Refractory Pain Above Middle Thoracic Vertebrae Level Utilizing a Prospective Trial Protocol and Review

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Chang Sun ◽  
Yu-Tong Wang ◽  
Yu-Jie Dai ◽  
Zhi-Hui Liu ◽  
Jing Yang ◽  
...  
Keyword(s):  
Pain Relief ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Short Form ◽  
Intrathecal Morphine ◽  
Prospective Trial ◽  
Depression Scale ◽  
Thoracic Vertebrae ◽  
Advanced Cancer Patients ◽  
Refractory Pain

Background: The cisterna Intrathecal Drug Delivery system (IDDS) with morphine has proven to be effective in treating refractory cancer pain above the middle thoracic vertebrae level in some countries. However, it has not been fully investigated in others. We designed the current project to investigate the efficacy and safety of cisterna IDDS for pain relief in refractory pain above the middle thoracic vertebrae level in advanced cancer patients. Methods: This study protocol allows for eligible cancer patients to receive the cisterna IDDS operation. Pain intensity (Visual Analogue scale, VAS), quality of life (36-Item Short-Form Health Survey, SF-36), and depression (Self-Rating Depression scale, SDS) are assessed along with side effects in the postoperative follow-up visits. Recent literature suggests a potential role for cisterna IDDS morphine delivery for refractory pain states above the middle thoracic level. Conclusion: The results of this study may provide further evidence that cisterna IDDS of morphine can serve as an effective and safe pain relief strategy for refractory pain above the middle thoracic vertebrae level in advanced cancer patients.

Validation of the Brief Edinburgh Depression Scale (BEDS) in a Mexican population with advanced cancer in a palliative care service

2018 ◽  
Vol 17 (04) ◽  
pp. 436-440 ◽  
Author(s):  
Oscar Rodríguez-Mayoral ◽  
Bárbara Rodríguez-Ortíz ◽  
Leticia Ascencio-Huertas ◽  
Adriana Peña-Nieves ◽  
Emma Verástegui ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Depression Scale ◽  
Case Finding ◽  
Spanish Language ◽  
Advanced Cancer Patients ◽  
Major Depressive ◽  
Palliative Patients

AbstractObjectiveDepression in palliative advanced cancer patients is common, but often goes unrecognized. One of the first steps toward improving detection is the development of tools that are valid in the specific language and setting in which they are to be used. The Brief Edinburgh Depression Scale (BEDS) is a sensitive case-finding tool for depression in advanced cancer patients that was developed in the United Kingdom. There are no validated instruments to identify depression in Mexican palliative patients. Our aim was to validate the Spanish-language version of the BEDS in Mexican population with advanced cancer.MethodWe conducted a cross-sectional study with outpatients from the palliative care unit at the Instituto Nacional de Cancerología in Mexico City. The Mexican BEDS was validated against a semistructured psychiatric clinical interview according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, classification criteria for major depressive disorder. The interviewer was blind to the BEDS score at the time of the assessment.ResultSeventy subjects completed the scale and interview. Women represented 71.4% of the sample and median age of subjects was 56.5 years (range, 20–85 years). The prevalence of major depressive disorder according to the psychiatric interview was 20%. The most valid cutoff for defining a case of depression was a score ≥5 of 18 on the Mexican BEDS, which gave a sensitivity of 85.7% and specificity of 62.5%. The scale's Cronbach's alpha was 0.71.Significance of resultsMajor depressive disorder is frequent in Mexican palliative patients. The Spanish-language Mexican version of the BEDS is the first valid case-finding tool in advanced cancer patients in this setting.

scholarly journals Opioid-induced or pain relief-reduced symptoms in advanced cancer patients?

2006 ◽  
Vol 10 (2) ◽  
pp. 153-153 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Patrizia Villari ◽  
Patrizia Ferrera ◽  
Alessandra Casuccio
Keyword(s):  
Pain Relief ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients

The Role of Religiosity in Symptom Expression of Advanced Cancer Patients

2021 ◽  
pp. 104990912110413
Author(s):  
Sebastiano Mercadante ◽  
Claudio Adile ◽  
Marianna Ricci ◽  
Marco Maltoni ◽  
Giuseppe Bonanno ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Social Relationship ◽  
Karnofsky Performance Status ◽  
Depression Scale ◽  
Symptom Expression ◽  
Advanced Cancer Patients ◽  
Edmonton Symptom Assessment Scale ◽  
Relevant Role

Aim: The aim of this study was to assess the religious pattern and its impact on symptom expression in patients with advanced cancer. Methods: A consecutive sample of advanced cancer patients screened at admission to palliative care. Standard epidemiological data were recorded. Patients were asked about their religious beliefs, the degree of social relationship to existing religions, the role of religion in their life, and the frequency of their prayer. The Edmonton Symptom Assessment Scale (ESAS) and Hospital Anxiety Depression scale (HADS) were assessed. Results: Two-hundred-eighty-three patients were screened. Age and gender were found to be independently correlated with religious belief (p = 0.042 and p = 0.016, respectively). Gender (females, p = 0.026), age (p = 0.003), lower Karnofsky performance status (KPS) (p = 0.022), and higher values of HADS-A (p = 0.003) were independently correlated with the degree of social relationship to existing religions. Gender (females, p = 0.002), lower KPS (p = 0.005), and higher values of HADS-A (p = 0.04) were independently correlated with a more relevant role of religiosity. Gender (females, p < 0.0005), lower KPS (p = 0.001), and drowsiness (p = 0.05) were independently correlated with frequency of prayer. Conclusion: The more the patients have demanding religious issues, the greater the state of anxiety, particularly in older and female patients with a lower KPS. The religious pattern did not have relevant role in the expression of other symptoms included in the ESAS.

scholarly journals Episodic Breathlessness with and without Background Dyspnea in Advanced Cancer Patients Admitted to an Acute Supportive Care Unit

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2102
Author(s):  
Sebastiano Mercadante ◽  
Claudio Adile ◽  
Patrizia Ferrera ◽  
Giuseppe Bonanno ◽  
Vincenzo Restivo ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
Advanced Cancer Patients ◽  
Clinical Appearance ◽  
Factors Influencing ◽  
Numerical Scale ◽  
The Mean

Aim: To characterize episodic breathlessness (EB) in patients with advanced cancer, and to determine factors influencing its clinical appearance. Methods: A consecutive sample of advanced cancer patients admitted to an acute palliative care unit was surveyed. Continuous dyspnea and EB were measured by a numerical scale. The use of drugs used for continuous dyspnea and EB was recorded. Patients were asked about the characteristics of EB (frequency, intensity, duration and triggers). The Multidimensional dyspnea profile (MDP), the Brief dyspnea inventory (BDI), the Athens sleep scale (AIS) and the Hospital Anxiety and Depression Scale (HADS) were also administered. Results: From 439 advanced cancer patients surveyed, 34 and 27 patients had EB, without and with background dyspnea, respectively. The mean intensity and the number of episodes were higher in patients with background dyspnea (p < 0.0005 and p = 0.05, respectively). No differences in duration were observed. Most episodes lasted <10 min. A recognizable cause triggering EB was often found. The presence of both background dyspnea and EB was associated with higher values of MDP and BDI. EB was independently associated with frequency and intensity of background dyspnea (OR = 20.9, 95% CI (Confidence interval) 9.1–48.0; p < 0.0005 and OR = 1.97, 95% CI 1.09–3.58; p = 0.025, respectively) and a lower Karnofsky level (OR = 0.96, 95%CI 0.92–0.98, p = 0.05). Discussion: EB may occur in patients with and without continuous dyspnea, and is often induced by physical and psychological factors. EB intensity is higher in patients with continuous dyspnea. The duration was often so short that the use of drugs, as needed, may be too late, unless administered pre-emptively when the trigger was predictable.

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.

Facilitation of accurate and effective radiation therapy using fentanyl pectin nasal spray (FPNS) to reduce incidental breakthrough pain due to procedure positioning

2016 ◽  
Vol 11 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Isabel Prieto ◽  
José Pardo ◽  
Javier Luna ◽  
Juan P. Marin ◽  
Jesús Olivera ◽  
...  
Keyword(s):  
Pain Relief ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Pharmacoeconomic Analysis ◽  
Opioid Analgesic ◽  
Oral Morphine ◽  
Average Dose ◽  
Advanced Cancer Patients

AbstractPurposeTo provide effective and accurate radiotherapy (RT) for advanced cancer patients who experience breakthrough pain (BP) due to positioning manoeuvres, through the use of FPNS. Secondary endpoints were the dose and time required to achieve a 50% numeric rating scale (NRS) reduction and conduction of a pharmacoeconomic analysis.Patients and methodsTwenty-seven advanced cancer patients with moderate-severe BP associated with routine radiotherapy procedures and manoeuvres were selected to receive FPNS. Most patients (20/27) had bone metastases. The patients showed a low Karnovsky performance status (mean 54%; range: 30–80). BP intensity was scored with the NRS before and after the procedures that triggered it. All patients were already receiving opioid baseline treatment at a total dose equivalent to 40–160 mg oral morphine. Before the procedure, BP was treated with 100-400 μg of FPNS. Data related to tolerance, pain relief, onset of the relief and efficient dose to allow RT to proceed were collected.Results In 26 patients the BP score was reduced by at least 50% as determined in 15.5 min (range 8-35 min) after fentanyl pectin intranasal administration, and pain relief started after 7 min (range 3–15 min); p <0.05 in both cases. The duration of pain reduction facilitated the proceeding of RT. The Mean NRS score before the procedure was 9 (95%CI: 8.6–9.4) and decreased during procedure to 3 (95%CI: 2.5–3.8). The average dose of FPNS for most patients was 100-200 to achieve pain control, except in three patients who required progressive doses of up to 300–400 μg. After receiving 300 μg, one patient dropped out of the study due to severe adverse effects (nausea). Seven patients reported minor undesirable effects related to FPNS administration.Conclusions and implicationsCertain necessary RT procedures in advanced cancer patients can cause severe BP episodes. A simple, safe, fast acting and strong analgesic is needed. FPNS is a rapidly absorbed opioid analgesic with a pain relief profile that would be particularly well suited for this patient population. By reducing BP, the drug enables the completion of necessary RT procedures without needless patient discomfort. When BP is attenuated, Department productivity is maintained and unnecessary delays are avoided. Further studies and clinical trials are needed to assess therapeutic FPNS dosages with a view to defining efficacy in the correct clinical context.

Advanced Cancer Patients’ Perceptions of Dignity

2018 ◽  
Vol 33 (2) ◽  
pp. 88-94 ◽  
Author(s):  
Sotiria Kostopoulou ◽  
Efi Parpa ◽  
Eleni Tsilika ◽  
Stylianos Katsaragakis ◽  
Irene Papazoglou ◽  
...  
Keyword(s):  
Body Image ◽  
Psychological Distress ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Depression Scale ◽  
Physical Symptoms ◽  
Role Identity ◽  
Advanced Cancer Patients ◽  
And Performance

Purpose: The present study assesses the relationship between patient dignity in advanced cancer and the following variables: psychological distress, preparatory grief, and sociodemographic and clinical characteristics. Methods: The sample consisted of 120 patients with advanced cancer. The self-administered questionnaires were as follows: the Preparatory Grief in Advanced Cancer Patients (PGAC), the Patient Dignity Inventory–Greek (PDI-Gr), the Greek Schedule for Attitudes toward Hastened Death (G-SAHD), and the Greek version of the Hospital Anxiety and Depression Scale (G-HADS). Results: Moderate to strong statistically significant correlations were found between the 4 subscales of PDI-Gr (psychological distress, body image and role identity, self-esteem, and social support) with G-HADS, G-SAHD, and PGAC ( P < .005), while physical distress and dependency was moderately correlated with depression. Multifactorial analyses showed that preparatory grief, depression, and age influenced psychological distress, while preparatory grief, depression, and performance status influenced body image and role identity. Conclusions: Preparatory grief, psychological distress, and physical symptoms had significant associations with perceptions of dignity among patients with advanced cancer. Clinicians should assess and attend to dignity-distressing factors in the care of patients with advanced cancer.

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