[Usage of gastric antisecretory drugs in palliative care of lung cancer patients].

Non-steroidal anti-inflammatory drugs(NSAID)and steroids are important drugs that are the most frequently prescribed medications for the relief of cancer pain. However, there is overwhelming evidence that these drugs cause various forms of gastric mucosal injury. Based on clinical experience, gastric antisecretory drugs such as the proton pump inhibitor(PPI)and the histamine-H2 receptor antagonist(H2RA)are widely used to avoid the gastrointestinal problems caused by NSAID and steroids. There are individual differences in how physicians use PPI and H2RA. In the present study, we retrospectively examined PPI and H2RA usage in the palliative care of 83 lung cancer patients, who were routinely prescribed an NSAID alone (single group)or a combination of an NSAID with a steroid(combination group). We also administered a questionnaire survey to 25 prescribing physicians specializing in respiratory medicine. The proportion of physicians prescribing a PPI prophylactically in the combination group was significantly higher than that of the single group. According to answers in the questionnaire survey, PPI prescribed by physicians in the single group was determined by the performance status and history of gastrointestinal problems in patients. Regardless of such factors, in the combination group, PPI was deliberately prescribed with steroids. Further investigation is needed to examine the clinical effects of PPI in palliative care, so as to establish more appropriate use of both PPI and H2RA.

[Preparation of standard protocol for cancer pain control and evaluation of its clinical effectiveness].

In order to promote the appropriate control of cancer pain by opioids, we distributed a pocket-sized protocol pamphlet on cancer pain control and opioid prescription to the medical staff of Nagoya University Hospital. In this study, we examined whether the prescription rate of opioids for rescue use, antiemetics for preventing adverse effects, and the rate of increase of regular opioid dosage were increased after distribution to evaluate its utility. Rescue opioid prescriptions, increase of regular opioid dosage and antiemetic prescription rate after distribution were all significantly increased, compared with before distribution. Furthermore, the frequency of nausea and vomiting was reduced by the use of prophylactic antiemetics. These results suggest that distribution of this protocol for cancer pain control may contribute to appropriate pain management.