Characteristics of Untreated Cancer Patients Admitted to an Acute Supportive/Palliative Care Unit.

BACKGRUND: The characteristics of patients who had never received anticancer treatments at admission of an acute supportive palliative care unit (ASPCU) have never been explored. MEASURES: From a consecutive sample of 422 advanced cancer patients, 62 patients with no previous anticancer therapy were selected and compared with a random sample of patients who had received anticancer treatments. Age, gender, primary tumor, Karnofsky status, characteristics of admission, the level of education, economic status, awareness of disease, the presence of cachexia, and comorbidities and palliative prognostic score, symptom intensity, opioid drugs used at admission, reasons for admission to APSCU were recorded in both groups. At time of discharge, ESAS and analgesic drugs used were recorded again. Discharge modalities were also recorded. One month after the end of recruitment period (the last patient enrollment), a follow-up was performed by phone contacts with relatives to assess survival at three months after discharge. OUTCOMES: Patients without previous anticancer therapy (14.7%) were mainly admitted to ASPCU for a low Karnofsky level and high symptom burden, often waiting for or needing a histological diagnosis to make a decision for the next therapeutic steps. This group of patients were older (P<0.0005), more frequently males (P=0.007), and had more comorbidities (P<0.0005) in comparison with treated patients. Twenty-four per cent of these patients started chemotherapy subsequently. Treatment-naive patients had a higher level of symptom burden, which was less responsive to a comprehensive palliative and more frequently died within three months in comparison with treated patients. DISCUSSION: Treatment-naive patients showed a higher level of symptom burden, which was less responsive to a comprehensive palliative treatment. In addition they more frequently died within three months in comparison with treated patients.

Conversion ratios for opioid switching: a pragmatic study.

BACKGROUND: The final conversion ratios among opioids used for successful switching are unknown. The aim of this study was to determine the initial and final conversion ratios used for a successful opioid switching in cancer patients, and eventual associated factors. METHODS: Ninety-five patients who were successfully switched were evaluated. The following data were collected: age, gender, Karnofsky performance score, primary cancer, cognitive function, the presence of neuropathic, and incident pain. Opioids, route of administration, and their doses expressed in oral morphine equivalents used before OS were recorded as well as opioids use for starting opioid switching, and at time of stabilization. Physical and psychological symptoms were routinely evaluated by Edmonton Symptom Assessment Scale. RESULTS: No statistical changes were observed between the initial conversion ratios and those achieved at time of stabilization for all the sequences of opioid switching. When considering patients switched to methadone, there was no association between factors taken into considerations. CONCLUSION: Opioid switching is a highly effective and safe technique, improving analgesia and reducing the opioid-related symptom burden. The final conversion ratios were not different from those used for starting opioid switching. Patients receiving higher doses of opioids should be carefully monitored for individual and unexpected responses in an experienced palliative care unit, particularly those switched to methadone. Future studies should provide data regarding the profile of patients with difficult pain to be hospitalized.

Cancer survivors: long-term opioid therapy - the challenge.

The use of opioids in cancer survivors with chronic pain raises concerns as it occurs with chronic non-malignant pain .Thus, in some circumstances advanced therapeuthic strategies should be performed to allow pain control for prolonged periods of time We describe a case of a long-survivor patient receiving prolonged opioid therapy. She received multiple opioid rotations or some more complex treatments, including burst of ketamine and midazolam, which allowed to maintain an acceptable pain control for 12 years, despite her poor compliance. Different opioids in different phases were given. A high level of knowledge, experience, and assessment is mandatory to implement of pain management among survivors.

High-flow nasal OXYGEN therapy.

OBJECTIVE: To report data of the use of high-flow nasal therapy (HFNT) in the palliative care setting. METHODS: Five hypoxaemic patients were treated by HFNT in a 1-year period in a palliative care setting, either in the last days of life or as part of an intensive treatment for a reversible cause of hypoxic dyspnoea. RESULTS: Four patients had a similar clinical pattern. After starting HFNT, dyspnoea intensity decreased and oxygen saturation improved, providing a clinical improvement for a duration of 2-3 days, but after 48-72 hours, their conditions deteriorated and patients underwent palliative sedation. Indeed, one patient with pulmonary embolism and pneumonia was treated by HFNT successfully and was discharged home 2 weeks after admission. CONCLUSIONS: HFNT may be helpful for severely hypoxaemic patients who are unresponsive to common measures adopted in the last weeks/days of life of patients with advanced cancer or to treat reversible conditions. The findings of this case series showed the ethical and psychological aspects of end of life, particularly for caregivers. Future studies should assess an early use of this device in combination with lower doses of opioids or as an alternative to their use.