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Carbonara L, Casale G, Bosetti C, Uggeri S, Armento G, Blasi M, De Marinis MG, Corli O. Pain, symptoms and therapy satisfaction in adult oncologic patients at admission to palliative care: An Italian prospective, multicenter, observational study. Pain Pract 2024. [PMID: 38855952 DOI: 10.1111/papr.13395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/18/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Pain in cancer patients is a complex clinical problem. Pain is systematically assessed and treated during palliative care, but little is known about how it is addressed before starting palliative care. AIM This study primarily analyzed pain, symptoms, ongoing therapy at patients' admittance to the palliative care unit, and the relationships between pain and tumor, comorbidities, performance status and quality of life (QoL). Notably, patient satisfaction with the received antalgic therapy was assessed. METHODS A multicentric, prospective, observational study was conducted in seven Italian palliative centers. The population consisted of adult cancer patients admitted to specialist palliative care units in hospice and home care. RESULTS The sample consisted of 476 patients. Ninety-three patients reported moderate pain of 4.0 and worst pain of 5.9 at the initial medical examination. The pain was high, and QoL was lower in breakthrough pain. The pain was lower in older subjects when it was discontinuous and when it was also treated with corticosteroids. A total of 61% of the patients were unsatisfied with the prescribed pain therapy. CONCLUSIONS Before the beginning of palliative care, physicians do not manage pain adequately. We support the idea that palliative care is not only intended for the last days of life but must be started early and simultaneously with oncological treatments. All that, in our opinion, is often ignored, and we hope that our study could have a positive influence and that the study results stimulate further research in this area with in-depth studies.
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Affiliation(s)
- L Carbonara
- Palliative Centre Fondazione Antea, Tor Vergata University, Rome, Italy
| | - G Casale
- Palliative Centre Fondazione Antea, Rome, Italy
| | - C Bosetti
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - S Uggeri
- Traslational Research in Gynecology Oncology Unit, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Armento
- Palliative Centre Campus Bio-Medico, Rome, Italy
| | - M Blasi
- Palliative Centre Campus Bio-Medico, Rome, Italy
| | - M G De Marinis
- Fondazione Policlinico Campus Bio-Medico, Università Campus bio-Medico di Roma, Rome, Italy
| | - O Corli
- Department of Oncology, Pain and Palliative Care Research Unit, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Ingielewicz A, Szymczak RK. Intranasal Therapy in Palliative Care. Pharmaceutics 2024; 16:519. [PMID: 38675179 PMCID: PMC11054984 DOI: 10.3390/pharmaceutics16040519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
In recent years, the use of the intranasal route has been actively explored as a possible drug delivery method in the palliative patient population. There are reports demonstrating the effectiveness of nasally administered medications that are routinely used in patients at the end of life. The subject of this study is the intranasal drug administration among palliative patients. The aim is to summarize currently used intranasal therapies among palliative patients, determine the benefits and difficulties, and identify potential areas for future research. A review of available medical literature published between 2013 and 2023 was performed using online scientific databases. The following descriptors were used when searching for articles: "palliative", "intranasal", "nasal", "end-of-life care", "intranasal drug delivery" and "nasal drug delivery". Out of 774 articles, 55 directly related to the topic were finally selected and thoroughly analyzed. Based on the bibliographic analysis, it was shown that drugs administered intranasally may be a good, effective, and convenient form of treatment for patients receiving palliative care, in both children and adults. This topic requires further, high-quality clinical research.
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Affiliation(s)
- Anna Ingielewicz
- Department of Emergency Medicine, Faculty of Health Science, Medical University of Gdansk, Mariana Smoluchowskiego Street 17, 80-214 Gdansk, Poland;
- Hospice Foundation, Kopernika Street 6, 80-208 Gdansk, Poland
| | - Robert K. Szymczak
- Department of Emergency Medicine, Faculty of Health Science, Medical University of Gdansk, Mariana Smoluchowskiego Street 17, 80-214 Gdansk, Poland;
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Villegas Estévez FJ, López Alarcón MD, Beato C, Sanz-Yagüe A, Porta-Sales J, Morera López RM. Procedural pain in patients with cancer: a Delphi expert management consensus. BMJ Support Palliat Care 2023; 13:e428-e436. [PMID: 34210716 DOI: 10.1136/bmjspcare-2020-002668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/14/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Diagnosis, treatment and care of cancer often involve procedures that may be distressing and potentially painful for patients. The PROCEDIO Study aimed to generate expert-based recommendations on the management of moderate to severe procedural pain in inpatients and outpatients with cancer. METHODS Using a two-round Delphi method, experts from pain and palliative care units, medical and radiation oncology and haematology departments expressed their agreement on 24 statements using a 9-point Likert scale, which were classified as appropriate (median 7-9), uncertain (4-6) or inappropriate (1-3). Consensus was achieved if at least two-thirds of the panel scored within the range containing the median. RESULTS With an overall agreement on the current definition of procedural pain, participants suggested a wider description based on evidence and their clinical experience. A strong consensus was achieved regarding the need for a comprehensive pre-procedural pain assessment and experts emphasised that healthcare professionals involved in procedural pain management should be adequately trained. Most panellists (98.2%) agreed that pharmacological treatment should be chosen considering the duration of the procedure. Transmucosal fentanyl (96.5%) and morphine (71.7%) were recommended as the most appropriate drugs. Oral and nasal transmucosal fentanyl were agreed as the most suitable for both outpatients and inpatients, while consensus was reached for intravenous and subcutaneous morphine for inpatients. CONCLUSIONS These results provide updated expert-based recommendations on the definition, prevention and treatment of moderate to severe procedural pain, which could inform specialists involved in pain management of patients with cancer.
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Affiliation(s)
| | | | - Carmen Beato
- Departamento de Oncología Médica, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | - Josep Porta-Sales
- Unidad de Cuidados Paliativos, Institut Catalá d'Oncologia, Girona, Spain
| | - Rosa M Morera López
- Servicio de Oncología Radioterápica, Hospital Universitario La Paz, Madrid, Spain
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Júnior SADO, Oliveira ACDS, Dantas Araújo MP, Dantas BADS, Sánchez MDCG, Torres GDV. Influence of pain on the quality of life in patients with venous ulcers: Cross-sectional association and correlation study in a brazilian primary health care lesions treatment center. PLoS One 2023; 18:e0290180. [PMID: 37582120 PMCID: PMC10426926 DOI: 10.1371/journal.pone.0290180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023] Open
Abstract
We aimed to verify the association and correlation between pain and QoL in people with VU treated in a Brazilian Primary Health Care (PHC) lesions treatment center. This is an observational, cross-sectional study with a quantitative approach, carried out in a service specialized in the treatment of chronic injuries, linked to 29 PHC units. Sociodemographic and health characterization instruments were used. The Short Form Health Survey-36 (SF-36) and Visual Analogue Pain Scale (VAPS) also were used. The Kruskal-Wallis test verified the association between the scalar variables of QoL and pain intensity. With Spearman's correlation test, we verified the level of correlation between the scales applied. A total of 103 patients participated in the study. Higher QoL scores associated with moderate pain were found, especially in the Physical role functioning, Physical functioning, and Vitality domains. Correlation analysis showed its greatest (moderate) strength in the interaction between the highest scores in the Physical role functioning and Emotional role functioning domains with the lowest pain levels.
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Dieudonné Rahm N, Zaccaria I, Gil Wey B, Pautex S, Habre W, Elia N. Intranasal Dexmedetomidine for Pain Management in Older Patients: A Cross-Over, Randomized, Double-Blinded, Active-Controlled Trial. Drugs Aging 2023; 40:527-538. [PMID: 37170043 PMCID: PMC10174599 DOI: 10.1007/s40266-023-01027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Daily care procedures provoke breakthrough pain and anxiety in palliative situations. Dexmedetomidine may be an alternative to opioids during nursing procedures for older patients. OBJECTIVE We aimed to compare the efficacy of intranasal dexmedetomidine with subcutaneous opioids on the intensity of pain and anxiety during comfort management procedures. METHODS We conducted a randomized, active-controlled, double-blind, crossover trial (NCT03151863). Patients aged ≥ 65 years were randomized to receive, 45 min before nursing care, either intranasal dexmedetomidine together with subcutaneous placebo or intranasal placebo together with a subcutaneous opioid. Each of these two interventions were administered in a cross-over design and spaced out over a 24- or 48-h period. The primary outcome was the number of patients with an Elderly Caring Pain Assessment score > 5. Secondary outcomes included pain, sedation score, and vital signs. RESULTS Because of difficult recruitment, the trial was interrupted after the inclusion of 24 patients. Three patients withdrew after randomization, leaving 21 patients undergoing 42 complete sessions for descriptive analyses. Of the 21 patients, 12 (57.1%) were women, and their median age was 84 years, interquartile range (75-87 years). Nine (42.9%) patients presented an Elderly Caring Pain Assessment score > 5 when receiving subcutaneous opioids, and seven (33.3%) with intranasal dexmedetomidine. Hypoxemia occurred in a single patient receiving subcutaneous opioids. No episode of bradycardia was observed. CONCLUSIONS Intranasal dexmedetomidine is feasible in elderly patients and may be an alternative to opioids to ensure comfort during nursing care. Future studies are needed to confirm the efficacy and safety of this procedure.
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Affiliation(s)
- Nathalie Dieudonné Rahm
- Division of Palliative Medicine, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Hôpital de Bellerive, Chemin de la Savonnière 11, 1245 Collonge Bellerive, Geneva, Switzerland.
- Medical Faculty, University of Geneva, Geneva, Switzerland.
| | - Isabelle Zaccaria
- Unit for Anaesthesiological Investigations, Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland
| | - Béatrice Gil Wey
- Unit for Anaesthesiological Investigations, Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland
| | - Sophie Pautex
- Division of Palliative Medicine, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Hôpital de Bellerive, Chemin de la Savonnière 11, 1245 Collonge Bellerive, Geneva, Switzerland
- Medical Faculty, University of Geneva, Geneva, Switzerland
| | - Walid Habre
- Medical Faculty, University of Geneva, Geneva, Switzerland
- Unit for Anaesthesiological Investigations, Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland
| | - Nadia Elia
- Medical Faculty, University of Geneva, Geneva, Switzerland
- Unit for Anaesthesiological Investigations, Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland
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Taffurelli C, Barello S, Cervantes Camacho V, Bertuol M, Savarese M, Artioli G. Taking care of dying patients through an 'interprofessional ecosystem': a grounded theory study on the experience of an interprofessional team in palliative care. Scand J Caring Sci 2020; 35:1169-1178. [PMID: 33200845 DOI: 10.1111/scs.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/19/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The interprofessional approach is part of the philosophy in palliative care, and its benefits are already documented. However, there are no evidence regarding the process through which the interprofessional team faces the process of the patient's end-of-life and how this experience might be of value for the team's development itself. The aim of this study was to analyse and understand the psychosocial processes that occurs when an interprofessional team accompanies patients and their families to death in palliative care, with the ultimate aim to develop a substantive theory to describe this phenomenon. METHODS A Grounded Theory method, as theorized by Strauss and Corbin, was adopted for this study. Data were collected through semi-structured interviews and then independently analysed using constant comparison analysis. Fourteen healthcare professionals - belonging to different disciplines (doctor, nurse coordinator, nurse, nurse assistant, psychologist) - were interviewed in a Northern Italy palliative care facility. FINDINGS The core category of this study was identified to be the process of accompaniment of the dying patient as an interprofessional ecosystem. Moreover, the results showed four main factors determining the development of the core psychosocial process: from professionals' 'Hidden Amazement' to 'Onerous Happiness' where 'Weaving of Professional Resources' and 'Work Meaning' are the underlying conditions to catalyse the process itself. CONCLUSION Interprofessional care appears an essential value, which becomes the source of the team's strength when facing end-of-life experiences. Health policies and organisations should take the importance of the characteristics of the work environment more carefully. The meaning that professionals attribute to their work and to the team itself, indeed, it may have impact on the overall quality of care and contribute to sustain work engagement, even in stressful situations like end-of-life care.
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Affiliation(s)
| | - Serena Barello
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Maria Bertuol
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mariarosaria Savarese
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Giovanna Artioli
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Palliative Care Unit - Azienda USL-IRCS of Reggio Emilia, Reggio Emilia, Italy
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Pardo J, Mena A, Jiménez E, Aymar N, Ortiz I, Roncero R, Mestre F, Vidal M. Effectiveness of fentanyl pectin nasal citrate in controlling episodes of breakthrough cancer pain triggered by routine radiotherapy procedures. Clin Transl Oncol 2019; 21:1568-1572. [PMID: 31093890 DOI: 10.1007/s12094-019-02125-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/19/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the study was to evaluate the effectiveness of fentanyl pectin nasal spray (FPNS) in controlling procedural breakthrough cancer pain (BTCP) in advanced cancer patients undergoing radiotherapy. MATERIALS AND METHODS This study involved 62 advanced cancer patients, with well-controlled background pain, who presented BTCP associated to routine radiotherapy procedures, treated with FPNS according to our protocol of administration. The BPE intensity was measured using a visual analog scale (VAS). RESULTS The BTCP was triggered during the computed tomography simulation (79.3%) or treatment delivery (20.7%). Patients indicated a mean VAS of 8.8 (range 7-10) when attempting the procedure. After 4.5 min (range 2-10) of the first FPNS dose, the majority of patients (85.5%) indicated a VAS of 4.3 (range 2-6). 15.5% of the patients did not respond after 15 min; requiring a second dose. All these patients responded, reporting a mean VAS of 4.2 (range 4-6) after 3.0 min (range 2-5) of the second dose. None of the patients required a third dose, nor reported an AE after the administration of FPNS. CONCLUSIONS In our knowledge, our study is the one of highest recruitment, and with the fastest response of BTCP treated with FPNS reported in advanced cancer patients undergoing radiotherapy. FPNS has proven to be highly effective in reducing the intensity of procedural BTCP in a very short period of time.
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Affiliation(s)
- J Pardo
- Radiation Oncology Department, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07010, Palma de Mallorca, Spain. .,Institut d'Investigació Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain. .,Hospital Universitari General de Catalunya, Quirónsalud, Barcelona, Spain.
| | - A Mena
- Radiation Oncology Department, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07010, Palma de Mallorca, Spain.,Institut d'Investigació Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain
| | - E Jiménez
- Radiation Oncology Department, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07010, Palma de Mallorca, Spain.,Institut d'Investigació Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain
| | - N Aymar
- Radiation Oncology Department, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07010, Palma de Mallorca, Spain
| | - I Ortiz
- Radiation Oncology Department, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07010, Palma de Mallorca, Spain
| | - R Roncero
- Radiation Oncology Department, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07010, Palma de Mallorca, Spain
| | - F Mestre
- Radiation Oncology Department, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07010, Palma de Mallorca, Spain
| | - M Vidal
- Radiation Oncology Department, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07010, Palma de Mallorca, Spain
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Magnani C, Mastroianni C, Giannarelli D, Stefanelli MC, Di Cienzo V, Valerioti T, Casale G. Oral Hygiene Care in Patients With Advanced Disease: An Essential Measure to Improve Oral Cavity Conditions and Symptom Management. Am J Hosp Palliat Care 2019; 36:815-819. [PMID: 30754984 DOI: 10.1177/1049909119829411] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Oral problems are frequent in palliative care and can cause disabling symptoms such as orofacial pain, dysgeusia, and xerostomia. Even if oral care is an essential aspect of nursing, it is often not considered as a priority, especially when various complex patients' needs have to be managed. OBJECTIVE The aim of this study was to describe oral conditions and evaluate the impact of standard oral care on symptom control and patient's perceived comfort in a sample of terminally ill patients. METHOD A prospective cohort study was carried out among 415 patients who were admitted to hospice. Patients were recruited before undergoing standard assisted procedure for oral hygiene care. Oral cavity condition, symptoms, and comfort were assessed at the recruitment (T0) and after 3 days (T2). RESULTS Seventy-five eligible patients were recruited. The Oral Assessment Guide score was significantly decreased after oral standard care (P value <.0001). The average time spent by nursing staff for oral hygiene care was 5.3 minutes. Dysgeusia and xerostomia were significantly decreased after oral standard care (P = .02 and P = .03). Patients reported a high level of comfort (86.6%) after the procedures for oral hygiene care. CONCLUSION Patients admitted to hospice had frequent alterations in oral cavity with partial loss of its functions that can compromise their quality of life. Standard procedures for oral hygiene care are simple and fast to perform, and they may improve oral cavity conditions, symptoms control, and patients' comfort.
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Affiliation(s)
| | | | - Diana Giannarelli
- 2 Biostatistics Unit, Regina Elena National Cancer Institute, Rome, Italy
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Magnani C, Giannarelli D, Calvieri A, Dardeli A, Eusepi G, Restuccia MR, Mastroianni C, Casale G. Breakthrough cancer pain tailored treatment: which factors influence the medication choice? An observational, prospective and cross-sectional study in patients with terminal cancer. Postgrad Med J 2018; 94:566-570. [DOI: 10.1136/postgradmedj-2018-135659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 09/07/2018] [Accepted: 09/15/2018] [Indexed: 11/04/2022]
Abstract
BackgroundVarious options for the pharmacological treatment of breakthrough cancer pain (BTcP) are available. International guidelines on BTcP treatment are not univocal. A tailored treatment should be based on the assessment of different variables such as BTcP characteristics, oral mucositis, chronic rhinitis and a patient’s ability to take medication.ObjectiveThe goal of this study is to assess the relationship between these variables and the medication treatment for BTcP in a sample of patients with terminal cancer.MethodsA prospective, cross-sectional study was carried out among 1180 patients who were receiving palliative care programmes. Patients were recruited if they had a diagnosis of BTcP and had been prescribed rescue opioids. Variables that might influence the BTcP treatment were assessed.ResultsOne hundred and forty-nine eligible patients were enrolled; 59.1% of patients received short-acting oral morphine (OM), 27.5% transmucosal immediate-release fentanyl (TIRF) and 13.4% parenteral morphine for BTcP treatment. Short-acting OM prescription was related to background pain treatment with OM <60 mg daily (p<0.0001) and to home-care setting of assistance (p=0.004). Continuous intravenous morphine infusion and the presence of a vascular access were the main factors related to intravenous morphine prescription for BTcP. TIRF use was mainly related to background opioid dosage and the patient’s self-sufficiency in taking medication.ConclusionIn clinical practice, the factors that most influenced the pharmacological treatment for BTcP were baseline opioid dosage, setting of assistance and self-ability to take medication. Further research is needed to improve the knowledge on tailored BTcP treatment.
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Tanaka R, Ishikawa H, Sato T, Shino M, Omae K, Sato T, Osaka I. Safety profile of prophylactic rescue dosing of immediate-release oral opioids in cancer patients. J Pharm Health Care Sci 2018; 4:25. [PMID: 30214820 PMCID: PMC6130058 DOI: 10.1186/s40780-018-0121-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Appropriate prophylactic rescue dosing of opioids is considered effective for cancer pain relief, but no study has reported the safety of such prophylactic rescue. We compared the safety of prophylactic rescue dosing of immediate-release oral opioids with that of regular rescue dosing. METHODS The study included 103 cancer patients who used either immediate-release morphine syrup or immediate-release oxycodone powder at Shizuoka Cancer Center between January and December 2016. Patients were divided into those who mostly used (prophylactic group) and those who never used (regular group) prophylactic rescue doses of opioids and compared the incidence of adverse events (AEs). We also investigated whether the prophylactic rescue dose negatively interfered with its objective activity, such as meals. RESULTS Incidence of each AE in the prophylactic versus regular groups was as follows: somnolence, 20.6% versus 14.3%; nausea, 22.1% versus 17.1%; constipation, 19.1% versus 20.0%; urinary retention, 1.5% versus 2.9%; delirium, 4.4% versus 8.6%; and pruritus, 0% versus 2.9%. No serious AE associated with prophylactic rescue dosing was observed. No significant difference was observed in the incidence of any AE between the two groups (p > 0.05, Fisher's exact test). No AE interfered with the objective activity of the prophylactic rescue dose. CONCLUSION Incidence of AEs associated with prophylactic rescue dosing is not different from that associated with regular rescue dosing. In addition, the prophylactic rescue dose did not adversely affect its objective activity, suggesting the safety of appropriate prophylactic rescue dosing was similar to that of regular rescue dosing. TRIAL REGISTRATION The study approval number in the institution; H29-J30-29-1-3. Registered June 5, 2017.
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Affiliation(s)
- Rei Tanaka
- Department of Pharmacy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| | - Hiroshi Ishikawa
- Department of Pharmacy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| | - Tetsu Sato
- Department of Pharmacy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| | - Michihiro Shino
- Department of Pharmacy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| | - Katsuhiro Omae
- Clinical Research Promotion Unit of Clinical Research Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| | - Tetsumi Sato
- Department of Palliative Medicine, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
| | - Iwao Osaka
- Department of Palliative Medicine, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka-ken, 411-8777 Japan
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