Response Rates to Methylnaltrexone in Hospitalized Cancer Patients.

Context: Methylnaltrexone is a peripherally-acting mu-opioid receptor antagonist studied in both cancer and non-cancer patients with opioid-induced constipation (OIC), but mostly in the outpatient setting. For adult hospitalized cancer patients with OIC, its effectiveness is unknown. Objectives: Describe the efficacy of methylnaltrexone for OIC in the inpatient setting, defined as bowel movement (BM) within 24 hours of methylnaltrexone administration. Methods: We performed a single-center, retrospective chart review of all hospitalized, adult patients with a cancer diagnosis who received methylnaltrexone from the palliative care team between January 1st, 2012 and July 1st, 2019. Results: We identified 194 patients. The mean age was 59, 50.5% were male and 88% were white. 192 patients (98%) received the 8 mg dose subcutaneously. The median oral morphine equivalent (OME) was 135 mg (IQR 70-354 mg). 45% (95% confidence interval, 38-53%) had a BM within 24 hours. Higher OME was correlated with successful BM, with a response in 93% (86/92) of patients receiving ≥150 OME and 2% (2/102) of patients receiving <150 OME (P < .0001). Prior laxative use did not predict response at 24 hours whether these were osmotic laxatives (40.7% vs 47.1%, P = .52), stimulant laxatives (45.7% vs 45.2%, P > .99), or stool softeners (44.7% vs 46.1%, P = .89). Conclusion: Methylnaltrexone has a high response rate when used as treatment for OIC in hospitalized adult cancer patients, especially for patients taking ≥150 OME.

Frequently asked questions about managing cancer pain: An update.

Most patients with cancer experience pain at some point in the disease course due to the disease itself or its treatment, or both. Pain management can involve pharmacologic (nonopioid medications, adjuvants, and opioids) and nonpharmacologic (radiation therapy, interventional procedures) therapies. This article provides a treatment approach to reduce pain for patients with cancer and improve their quality of life.

Hope, Symptoms, and Palliative Care.

BACKGROUND: Hope is important to patients with cancer. Identifying factors that influence hope is important. Anxiety, depression, fatigue, and pain are reported to impair hope. The objective of this study was to determine whether age, gender, marital status, duration of cancer, symptoms, or symptom burden measured by the sum of severity scores on the Edmonton Symptom Assessment Scale (ESAS) correlated with hope measured by the Herth Hope Index (HHI). METHODS: Patients with advanced cancer in a palliative care unit participated. Demographics including age, gender, marital status, cancer site, and duration of cancer were collected. Individuals completed the ESAS and HHI. Spearman correlation and linear regression were used to assess associations adjusting for gender (male vs female), age (< 65 vs ≥ 65 years), marital status (married or living with a partner vs other), and duration of cancer (≤ 12 vs > 12 months). RESULTS: One hundred and ninety-seven were participated in the study, of which 55% were female with a mean age of 61 years (standard deviation 11). Hope was not associated with gender, age, marital status, or duration of cancer. In univariable analysis, hope inversely correlated with ESAS score (-0.28), lack of appetite (-0.22), shortness of breath (-0.17), depression (-0.39), anxiety (-0.32), and lack of well-being (-0.33); only depression was clinically relevant. In multivariable analysis, total symptom burden weakly correlated with hope; only depression remained clinically significant. DISCUSSION: This study found correlation between symptom burden and hope was not clinically relevant but was so for depression. CONCLUSION: Among 9 ESAS symptoms, only depression had a clinically relevant correlation with hope.

Achieving effective control in cancer pain: a review of current guidelines.

Pain is one of the most common and distressing elements of suffering related to cancer and cancer treatment. Progress in cancer treatment means people will live longer with the sequelae of cancer and disease-directed treatments, and both the short- and long-term effects of opioid use must be considered. Skilled practitioners caring for individuals with cancer help to alleviate cancer-related pain by using the World Health Organization (WHO) step-wise approach to pain management as well as recently updated national and international guidelines. Current guidelines go beyond the unidimensional WHO model by addressing comprehensive assessment, pharmacological management of opioids and adverse effects associated with opioid use, the role of adjuvants, and the application of non-pharmacological treatments. By following current guidelines promoting a multifaceted approach to the management of cancer-related pain and advocating for patient-centered care, nurses are uniquely positioned to champion effective cancer pain management.