Speciality
Spotlight

 




 


Oncology


 

 





Supportive
Care


 

  • Bernabei R, for the SAGE Study Group [Universita Cattolica del Sacro Cuore, Rome; et al]

    Management of Pain in Elderly Patients With Cancer

    JAMA 279: 1877-1882, 1998

          

    This study of 13,645 patients with cancer aged 65 years or older was studied for adequacy of pain management in nursing homes. 26% of patients experiencing pain daily received no analgesic agent. Patients aged 85 or older with daily pain were more likely to receive no analgesia.

            

  • Lee
    CW, Bociek G, Faught W [ Univ of Ottawa, Ont, Canada]

    A Survey of Practice in Management of Malignant Ascites

    J Pain Symptom Manage 16: 96-101, 1998

       

    Malignant ascites can complicate the treatment of various neoplasm especially breast cancer, gastrointestinal or gynecologic cancer. This study is a survey of patients with malignant ascites by eighty Canadian physicians. Paracentesis is the most commonly used treatment for malignant ascites followed by diuretics and peritoneovenous shunting although it is clear that new treatment is needed.

         

  • Diel
    IJ, Solomayer E-F, costa SD, et al [Univ of Heidelberg, Germany; Univ of Frankfurt, German]

    Reduction in New Metastases in Breast Cancer With Adjuvant Clodronate Treatment

    N Engl J Med 339: 357-363, 1998

       

    The bisphosphonates decreases the frequency of skeletal complications in patients with breast cancer metastatic to bone.

       

    This study of 302 patients with primary breast cancer and tumor cell in the bone marrow after standard surgical treatment and hormonal or chemotherapy was assigned randomly to clodronate, 1600 mg/day orally for two years standard follow-up. 

      

    Clodronate decreases the incidence and number of new bone and visceral metastasis in patients with breast cancer. The authors hypothesis was that bisphosphonates interfere with adhesion and invasiveness and therapy change the microenvironment at metastatic sites. This enhances the activity of cytotoxic drugs.

        

  • Ronald Kanner (Albert Einstein College of Medicine and Department of Neurology, Long Island Jewish Medical Center, New Hyde Park, New York)

    Diagnosis and Management of Neuropathic Pain in Patients with Cancer

    Cancer Investigation 2001 Vol. 19 (3) Pg. 324-333

      

    Pain a frequent symptom i.e. in approximately 90% in terminal cancer patients is noted. The cancer pain syndromes are classified as per the pathophysiology. The nociceptive and non-nociceptive. The physiological apparatus for perceiving noxious stimuli is nociceptive nervous system which can arise from somatic structures such as muscles, bones or aponeueroses or from the viscera in the thorax and abdomen. The non-nociceptive pain syndromes are neuropathic and psychological pain. The basic mechanism of neuropathic pain is incompletely understood.

       

    The common sensory disturbances described in neuropathic pain are allodynia, dysethesia neuralgia. Neuropathic pain is generally associated with depression. 

       

    The common neuropathic pain syndromes include branchial plexus injury, tumor involvement of lumbar plexus, base of skull metastases, peripheral nerve injuries, carcinomatous meningitis, spinal cord compression.

       

    The neuropathic syndromes could be associated with radiation (spinal cord injury), surgical (phantom limb) and chemotherapy (peripheral neuropathy).

        

    The commonly used analgesics, Acetaminophen, nonsteroidal anti-inflammatory drugs, and minor opioids are indicated for mild to moderate pain but have less satisfying results for neuropathic pain. Opioids to be considered for moderate to severe pain. Methadone is particularly useful.

       

    The adjuvant medications used in neuropathic pain are tricyclic antidepressants, amitriptyline, anticonvulsants. Carbamazepine, baclofen have been used for trigeminal neuralgia and Gabapentin for post herpetic neuralgia. Carticosteroid in combination with opioids is useful in refractory neuropathic pain syndrome. Oral mexiletine is also widely used for neural pain.

       

    Local anesthetics when applied topically have been able to control
    allodynia.                  

                                                                                       

  • Kearon C, Gent M, et al (McMaster Univ, Hamilton, Ont, Canada; Hamilton Civic Hosps Research Centre, Ont, Canada; et al)

    A Comparison of Three Months of Anticoagulation With Extended Anticoagulation for a First Episode of Idiopathic Venous Thromboembolism

    N Engl J Med 340: 901-907, 1999

                                                         

    The optimal duration of anticoagulation for patients with acute venous thrombosis has been controversial a subgroup analysis had revealed 3 months of anticoagulation is necessary for patient with DVT and transient risk factors such as surgery. 

                                                       

    This double blind randomized study assigned patients with DVT for 3 months of anticoagulation therapy and then to combine warfarin or placebo for 24 months. 

                                                    

    The rate of recurrent venous thromboembolism was 27.4% per patient year in placebo subgroup compared to 1.3% per patient year in warfarin but with increased non fatal major bleeding episode.

       

  • Maranzano E, for the italian group for antiemetic research in radiotherapy (UO radioterapia oncologia, perugia, italy; et al)

    radiation-Induced Emesis: a prospective observational multicenter italian trial

    int j radiat oncol biol phys 44: 619-625, 1999

       

    This large multicenter trial of adult patients with cancer who were on radiation therapy (RT) and did not receive concomitant chemotherapy were evaluated of radiation-induced emesis (RIE). Nausea and vomiting occurred in 38.7% of patients enrolled in this study.

     

    The RT related significant variable were irradiation site and field size. The RT of the thorax, head and neck, and upper abdomen were most likely to produce
    RIE.

      

    RT fields above 400 cm2 were also associated with greater risk for
    RIE.

      

  • Theriault RL, for the Protocol 18 aredia breast cancer study group (Univ of texas mD anderson cancer ctr, houston; et al)

    pamidronate reduces skeletal morbidity in women with advanced breast cancer and lytic bone lesions: a randomized, placebo-controlled trial

    j clin oncol 17: 846-854, 1999

      

    This study of adult women patients with breast cancer and atleast 1 lytic metastatic bone lesion on stable hormonal therapy received pamidronate, were evaluated for skeletal morbidity rate
    (SMR).

      

    Secondary outcome measures included bone pain, analgesic use, quality of life, and performance status. The skeletal morbidity rate were significantly reduced at 12, 18, and 24 cycles in patients treated with pamidronate compared with placebo.

     

    The time to first skeletal complication was also longer in the pamidronate group. This improvement did not translate into improvement in survival.

       

  • jorenby DE, leischow SJ, et al (Univ of wisconsin, madison; univ of arizona, tucson; los angeles clinical trials; et al)

    a controlled trial of Sustained-release Bupropion, a Nicotine Patch, or Both for Smoking Cessation

    n engl j med 340: 685-691, 1999

      

    Only 6% of smokers who attempt to quit succeed in long term. The symptoms of nicotine are correlated with depression, the antidepressant bupropion is hence useful.

     

    This study of young healthy volunteers were motivated to quit smoking received placebo or nicotine patch, or bupropion, and nicotine +
    bupropion.

      

    The group with nicotine patch had no difference in outcome than those in placebo group. Whereas the group that received bupropion alone or with nicotine patch were more than twice as likely to be off cigarettes at 1 year.

      


 

 



 

 

Speciality Spotlight

 

 

Supportive Care
 

  • Bernabei R, for the SAGE Study Group [Universita Cattolica del Sacro Cuore, Rome; et al]
    Management of Pain in Elderly Patients With Cancer
    JAMA 279: 1877-1882, 1998
          
    This study of 13,645 patients with cancer aged 65 years or older was studied for adequacy of pain management in nursing homes. 26% of patients experiencing pain daily received no analgesic agent. Patients aged 85 or older with daily pain were more likely to receive no analgesia.
            

  • Lee CW, Bociek G, Faught W [ Univ of Ottawa, Ont, Canada]
    A Survey of Practice in Management of Malignant Ascites
    J Pain Symptom Manage 16: 96-101, 1998
       
    Malignant ascites can complicate the treatment of various neoplasm especially breast cancer, gastrointestinal or gynecologic cancer. This study is a survey of patients with malignant ascites by eighty Canadian physicians. Paracentesis is the most commonly used treatment for malignant ascites followed by diuretics and peritoneovenous shunting although it is clear that new treatment is needed.
         

  • Diel IJ, Solomayer E-F, costa SD, et al [Univ of Heidelberg, Germany; Univ of Frankfurt, German]
    Reduction in New Metastases in Breast Cancer With Adjuvant Clodronate Treatment
    N Engl J Med 339: 357-363, 1998
       
    The bisphosphonates decreases the frequency of skeletal complications in patients with breast cancer metastatic to bone.
       
    This study of 302 patients with primary breast cancer and tumor cell in the bone marrow after standard surgical treatment and hormonal or chemotherapy was assigned randomly to clodronate, 1600 mg/day orally for two years standard follow-up. 
      
    Clodronate decreases the incidence and number of new bone and visceral metastasis in patients with breast cancer. The authors hypothesis was that bisphosphonates interfere with adhesion and invasiveness and therapy change the microenvironment at metastatic sites. This enhances the activity of cytotoxic drugs.
        

  • Ronald Kanner (Albert Einstein College of Medicine and Department of Neurology, Long Island Jewish Medical Center, New Hyde Park, New York)
    Diagnosis and Management of Neuropathic Pain in Patients with Cancer
    Cancer Investigation 2001 Vol. 19 (3) Pg. 324-333
      
    Pain a frequent symptom i.e. in approximately 90% in terminal cancer patients is noted. The cancer pain syndromes are classified as per the pathophysiology. The nociceptive and non-nociceptive. The physiological apparatus for perceiving noxious stimuli is nociceptive nervous system which can arise from somatic structures such as muscles, bones or aponeueroses or from the viscera in the thorax and abdomen. The non-nociceptive pain syndromes are neuropathic and psychological pain. The basic mechanism of neuropathic pain is incompletely understood.
       
    The common sensory disturbances described in neuropathic pain are allodynia, dysethesia neuralgia. Neuropathic pain is generally associated with depression. 
       
    The common neuropathic pain syndromes include branchial plexus injury, tumor involvement of lumbar plexus, base of skull metastases, peripheral nerve injuries, carcinomatous meningitis, spinal cord compression.
       
    The neuropathic syndromes could be associated with radiation (spinal cord injury), surgical (phantom limb) and chemotherapy (peripheral neuropathy).
        
    The commonly used analgesics, Acetaminophen, nonsteroidal anti-inflammatory drugs, and minor opioids are indicated for mild to moderate pain but have less satisfying results for neuropathic pain. Opioids to be considered for moderate to severe pain. Methadone is particularly useful.
       
    The adjuvant medications used in neuropathic pain are tricyclic antidepressants, amitriptyline, anticonvulsants. Carbamazepine, baclofen have been used for trigeminal neuralgia and Gabapentin for post herpetic neuralgia. Carticosteroid in combination with opioids is useful in refractory neuropathic pain syndrome. Oral mexiletine is also widely used for neural pain.
       
    Local anesthetics when applied topically have been able to control allodynia.                  
                                                                                       

  • Kearon C, Gent M, et al (McMaster Univ, Hamilton, Ont, Canada; Hamilton Civic Hosps Research Centre, Ont, Canada; et al)
    A Comparison of Three Months of Anticoagulation With Extended Anticoagulation for a First Episode of Idiopathic Venous Thromboembolism
    N Engl J Med 340: 901-907, 1999
                                                         
    The optimal duration of anticoagulation for patients with acute venous thrombosis has been controversial a subgroup analysis had revealed 3 months of anticoagulation is necessary for patient with DVT and transient risk factors such as surgery. 
                                                       
    This double blind randomized study assigned patients with DVT for 3 months of anticoagulation therapy and then to combine warfarin or placebo for 24 months. 
                                                    
    The rate of recurrent venous thromboembolism was 27.4% per patient year in placebo subgroup compared to 1.3% per patient year in warfarin but with increased non fatal major bleeding episode.
       

  • Maranzano E, for the italian group for antiemetic research in radiotherapy (UO radioterapia oncologia, perugia, italy; et al)
    radiation-Induced Emesis: a prospective observational multicenter italian trial
    int j radiat oncol biol phys 44: 619-625, 1999
       
    This large multicenter trial of adult patients with cancer who were on radiation therapy (RT) and did not receive concomitant chemotherapy were evaluated of radiation-induced emesis (RIE). Nausea and vomiting occurred in 38.7% of patients enrolled in this study.
     
    The RT related significant variable were irradiation site and field size. The RT of the thorax, head and neck, and upper abdomen were most likely to produce RIE.
      
    RT fields above 400 cm2 were also associated with greater risk for RIE.
      

  • Theriault RL, for the Protocol 18 aredia breast cancer study group (Univ of texas mD anderson cancer ctr, houston; et al)
    pamidronate reduces skeletal morbidity in women with advanced breast cancer and lytic bone lesions: a randomized, placebo-controlled trial
    j clin oncol 17: 846-854, 1999
      
    This study of adult women patients with breast cancer and atleast 1 lytic metastatic bone lesion on stable hormonal therapy received pamidronate, were evaluated for skeletal morbidity rate (SMR).
      
    Secondary outcome measures included bone pain, analgesic use, quality of life, and performance status. The skeletal morbidity rate were significantly reduced at 12, 18, and 24 cycles in patients treated with pamidronate compared with placebo.
     
    The time to first skeletal complication was also longer in the pamidronate group. This improvement did not translate into improvement in survival.
       

  • jorenby DE, leischow SJ, et al (Univ of wisconsin, madison; univ of arizona, tucson; los angeles clinical trials; et al)
    a controlled trial of Sustained-release Bupropion, a Nicotine Patch, or Both for Smoking Cessation
    n engl j med 340: 685-691, 1999
      
    Only 6% of smokers who attempt to quit succeed in long term. The symptoms of nicotine are correlated with depression, the antidepressant bupropion is hence useful.
     
    This study of young healthy volunteers were motivated to quit smoking received placebo or nicotine patch, or bupropion, and nicotine + bupropion.
      
    The group with nicotine patch had no difference in outcome than those in placebo group. Whereas the group that received bupropion alone or with nicotine patch were more than twice as likely to be off cigarettes at 1 year.
      

 

 

 

By |2022-07-20T16:43:56+00:00July 20, 2022|Uncategorized|Comments Off on Supportive Care

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