Impact of setting of care on pain management in patients with cancer: a multicentre cross-sectional study
Biomarkers of Pain
BACKGROUND: No study has so far addressed whether differences do exist in the management of cancer-related pain in patients admitted to oncology and non-oncology settings. PATIENTS AND METHODS: A multicentre cross-sectional study in 48 Italian hospitals has enrolled 819 patients receiving analgesic therapy for cancer-related pain. Demographics and clinical and analgesic therapy information have been prospectively collected by standardized forms. Adequacy of pain management has been evaluated by the Pain Management Index (PMI). RESULTS: Differences in the analgesic drug administration according to settings of care have been evident, non-opioids more frequently being administered in non-oncology units (19.6% versus 7.0%; P < 0.0001), while strong opioids are more frequently used in the oncology units (69.5% versus 51.9%; P < 0.0001). The number of patients receiving inadequate therapy (PMI < 0) has lowered in oncology compared with non-oncology units (11.3% versus 18.8%; P = 0.0024). Results of multiple logistic regression analysis have shown that the admission to non-oncology setting [odds ratio (OR) = 1.75, 95% confidence interval (CI) = 1.15-2.67; P = 0.0096] and the absence of metastatic disease (OR = 1.60, 95% CI = 1.04-2.44; P = 0.0317) were independent factors associated with an increased risk of receiving an inadequate analgesic therapy. CONCLUSION: Oncology wards provide the most adequate standard of analgesic therapy for cancer-related pain.
2010
Sichetti D; Bandieri E; Romero M; Di Biagio K; Luppi M; Belfiglio M; Tognoni G; Ripamonti CI; Working Group for ECAD
Annals Of Oncology : Official Journal Of The European Society For Medical Oncology / Esmo
2010
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/annonc/mdq155" target="_blank" rel="noreferrer">10.1093/annonc/mdq155</a>
Subcutaneous clodronate: a study evaluating efficacy in hypercalcemia of malignancy and local toxicity
Female; Humans; Male; Aged; Middle Aged; 80 and over; Injections; Neoplasms/complications; Subcutaneous; Clodronate; Hypercalcemia/drug therapy; Clodronic Acid/administration & dosage/adverse effects
The logistics of administering intravenous bisphosphonates may be problematic in the care of advanced cancer patients, especially in the home setting. Hypodermoclysis is a convenient method of administering fluid via subcutaneous infusion, presently used in the domiciliary setting. Results of the administration of clodronate via this route are reported.
1997
Walker P; Watanabe S; Lawlor P; Hanson J; Pereira J; Bruera E
Annals Of Oncology : Official Journal Of The European Society For Medical Oncology / Esmo
1997
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1023/a:1008274608267" target="_blank" rel="noreferrer">10.1023/a:1008274608267</a>
Patient-controlled analgesia with oral methadone in cancer pain: preliminary report
Female; Humans; Male; Analgesics; Aged; Middle Aged; Analgesia; Administration; Oral; Dose-Response Relationship; Drug; Neoplasms/complications; Patient-Controlled; Methadone/administration & dosage/adverse effects/blood; Opioid/administration & dosage/adverse effects/blood; Pain/etiology/prevention & control
BACKGROUND: Methadone is a very useful drug in cancer pain because of its low cost, lack of active metabolites, high oral availability, and the rapid onset of its analgesic effect. It seems to be well tolerated in patients with difficult pain syndromes who are receiving high doses of opioids, and it may deter the development of tolerance, but a high individual variation in terminal elimination half-life can result in different rates and extents of drug accumulation. For this reason, oral patient-controlled analgesia with methadone was used in 24 advanced-disease patients with pain. PATIENTS AND METHODS: A regimen of self-administered oral methadone at fixed doses and flexible patient-controlled dosage intervals to achieve adequate analgesia, while avoiding toxic effects of methadone accumulation, was used in 24 patients requiring opioid therapy. After a priming period of three days with fixed doses of 3-5 mg three times a day for naive patients and 50% of the morphine equivalent of methadone in patients switched from morphine, patients and relatives were instructed to maintain the night-time dose and to administer a second dose when the pain recurred. When more than four doses of methadone a day were used, an increase of the dosage was prescribed. Continuous pain assessment and monitoring of symptoms were offered. RESULTS: The majority of patients achieved good pain relief until death, and three were switched to very low doses of subcutaneous morphine in their final days. The methadone escalation index was about 2% a day, with a mean dosage increase of 0.3 mg a day for an average of 60 days of treatment at doses ranging from 9 to 80 mg. The plasma concentration in 14 patients ranged from 0.013 to 0.273 mcg/ml with dosages of 20-80 mg during chronic treatment. A mean of 2.4 doses a day was reported, including the fixed night-time dose. The extent of side effects was considered acceptable. CONCLUSION: Patient-administered analgesia with oral methadone appears to be a simple, cheap and relatively safe technique for controlling cancer pain, permitting individualization by the patient him- or herself and avoiding the risk of accumulation. Continuous assessment is necessary.
1996
Mercadante S; Sapio M; Serretta R; Caligara M
Annals Of Oncology : Official Journal Of The European Society For Medical Oncology / Esmo
1996
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/oxfordjournals.annonc.a010679" target="_blank" rel="noreferrer">10.1093/oxfordjournals.annonc.a010679</a>