Cancer pain management: recommendations from a Latin-American experts panel.

Generating a consensus in the Latin-American region on cancer pain management is a current need. Thus a panel of Latin-American experts met in Madrid in March 2017 in order to review the published literature, discuss the best approach for cancer pain classification and evaluation and also make recommendations of pharmacological and nonpharmacological therapies for cancer pain management improvement in Latin-American countries. The result of that meeting is presented in this document. The experts participating were from Costa Rica, Mexico, Chile, Colombia, Peru, Brazil and Ecuador, and the project coordinator was from Spain.

SIADH-related hyponatremia in hospital day care units: clinical experience and management with tolvaptan.

Hyponatremia (Na ˂ 135 mmol/l) is the most frequent electrolyte disorder in clinical practice, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the commonest cause of hyponatremia in cancer patients. Correcting hyponatremia in these patients can reduce morbidity and mortality, increase the response to anti-cancer agents, and help reduce hospital length of stay and costs. Tolvaptan is an oral medication used to treat SIADH-related hyponatremia patients that needs to be initiated at hospital so patients can have their serum sodium monitored. If tolvaptan could be initiated in hospital day care units (DCUs), performing the same tests, hospitalization could be avoided, quality of life improved, and costs reduced. This is the first publication where a panel of oncologists are sharing their experience and making some recommendations with the use of tolvaptan to treat SIADH-related hyponatremia in DCU after collecting and examining 35 clinical cases with these type of patients. The conclusion from this retrospective observational analysis is that the use of tolvaptan in DCU is safe and effective in the therapeutic management of SIADH-related hyponatremia.

Diagnóstico y tratamiento del dolor irruptivo oncológico: recomendaciones de consenso / Diagnosis and treatment of break-through cancer pain: Consensus recommendations

INTRODUCCIÓN Y OBJETIVOS: El dolor irruptivo oncológico (DIO) es una exacerbación aguda del dolor que presenta diferentes criterios diagnósticos y de tratamiento por parte de los diferentes especialistas implicados en su manejo. Para facilitar la toma de decisiones en la práctica clínica habitual, ocho especialistas de referencia de 4 sociedades científicas implicadas en el manejo del paciente oncológico, han diseñado este documento de consenso. MÉTODOS: Tras una búsqueda bibliográfica en las publicaciones más relevantes sobre DIO, se establecieron las recomendaciones preliminares. El grupo de expertos realizó una reunión de trabajo siguiendo la metodología Metaplan(R), donde se debatieron las recomendaciones a incorporar al documento. Cada una de las afirmaciones y recomendaciones fueron clasificadas según su grado de recomendación, atendiendo a las categorías del sistema SIGN (Scottish Intercollegiate Guidelines Network). RESULTADOS: El manejo del DIO requiere de una anamnesis completa, tanto del DIO como del dolor basal, y una exploración física del paciente asociada a pruebas complementarias cuando sean precisas. Los fármacos de elección para el tratamiento del DIO deben ser aquellos que muestren una analgesia potente, con rápido inicio de acción, efectos secundarios mínimos y de fácil administración. El fentanilo administrado por vía transmucosa es actualmente el principio activo más adecuado a las necesidades analgésicas del dolor irruptivo, con independencia del opioide mayor utilizado para el control del dolor basal. CONCLUSIÓN: Este consenso puede ser una herramienta útil para la mejora de la calidad de vida del paciente con cáncer, ya que permite un mejor diagnóstico y tratamiento del DIO

INTRODUCTION OBJECTIVES: Breakthrough cancer pain (BTcP) is an acute exacerbation of baseline pain. The clinicians involved in its management have different diagnostic and therapeutic criteria. In order to facilitate decision making in usual clinical practice, 8 reference experts from 4 scientific associations involved in the management of patients with cancer pain have developed this Consensus Document. METHODS: After an initial search on the most relevant publications in BTcP literature, a set of preliminary recommendations were established. A working meeting was subsequently held with the experts, following the Metaplan(R) methodology -a structured brainstorming technique- that produced a first version of the Consensus Document which, after several review rounds, was validated by all the participants. Every statement and recommendation was sorted according to its degree of recommendation, following the categories in the SIGN (Scottish Intercollegiate Guidelines Network) system. OUTCOMES: The management of BTcP requires a full anamnesis, both of BTcP itself and of baseline pain, a physical examination and the supplementary tests that are deemed necessary. The drugs of choice for the treatment of BTcP must be those with a potent and rapid analgesic effect a short duration, minimal side effects and easy administration. Transmucosal fentanyl is currently the active ingredient most fitting to the analgesic needs of BTcP, regardless of the major opioid used for control of the baseline pain. CONCLUSION: This Consensus can be a very useful tool to improve the quality of life in cancer patients, because it guides the clinician towards a better diagnose and treatment of BTcP

El dolor irruptivo oncológico o la cenicienta revelada / Oncologic breakthrough pain or the uncovered cinderella

Al igual que la Cenicienta es un personaje de cuento de hadas que representa el arquetipo de persona joven que consigue la plenitud después de amargas pruebas debido a la incomprensión y falta de atención de su entorno familiar y social, el dolor irruptivo oncológico (DIO) es un problema clínico relevante por su frecuencia y su intensidad pero también víctima del desconocimiento y la falta de interés. A pesar de su alta prevalencia e intensidad, sigue siendo un síntoma mal conocido y, por ello, poco investigado e incorrectamente tratado. Sin embargo, son factibles su diagnóstico y evaluación correctos y el tratamiento ha evolucionado al aparecer fármacos basados en el fentanilo administrado a través de las mucosas que se ajustan, como el pie de Cenicienta al zapato de cristal, a las características del dolor irruptivo. Otros pies se habrán probado el zapatito y se habrán mutilado para intentar encajar en él pero sólo la misteriosa habitante de los fogones puede legitimar la propiedad y, por tanto, ser la elegida del príncipe (AU)

Cinderella is a fairy tale character who represents the archetypal young person getting happiness after bitter experiences due to misunderstanding and lack of attention from her family and social environment. Similarly, breakthrough pain is a relevant clinical problem due to its frequency and intensity but it is also a victim of lack of knowledge and lack of interest. Breakthrough pain, despite is a relevant clinical problem because of its high prevalence and its intensity, remains poorly understood and therefore improperly treated and poorly investigated. However, proper diagnosis and assessment are feasible, and treatment includes drugs as fentanyl administered through mucous membranes that fits to the characteristics of the breakthrough pain as the shoe of glass slipper fits in the foot of Cinderella. Other feet have been tested with no luck but only the mysterious kitchen’s girl can legitimize the ownership and therefore be the chosen by the prince (AU)

Management of dermatitis in patients with locally advanced squamous cell carcinoma of the head and neck receiving cetuximab and radiotherapy.

Locally advanced squamous cell carcinoma of the head and neck is generally managed with a combination of surgery, RT, and/or chemotherapy or cetuximab. Appropriate management of radiation dermatitis associated with cetuximab and radiotherapy is necessary to allow adequate drug administration and to improve the quality of life and outcome. We generate a recommendation for radiation dermatitis on the basis of a systematic revision of the literature. Radiation dermatitis is experienced by the majority of patients undergoing radiotherapy for HNSCC, generally being mild to moderate (grades 1-2), showing about 25% severe toxicity (grade ≥ 3). Recommendations for prophylaxis and therapeutic interventions for each type of toxicity were proposed. This paper reviews comprehensive consensus guidelines to help manage the radiation dermatitis in order to make an optimal use of available therapeutic arsenal.

Professional survey on knowledge and clinical patterns of pain management in Spanish medical oncology.

Cancer pain is still not treated adequately. The barriers impeding its appropriate treatment include lack of knowledge, erroneous beliefs and inappropriate attitudes with regard to pain, which are sustained by some or all of those involved in the problem. The present study shows the results of an exploratory survey using a large sample of specialists in clinical oncology. Its main objective is to evaluate daily analgesic practices and compliance with clinical guidelines in order to identify areas that should be improved in this particular therapeutic field. Information collection from the responders was in the form of a self-administered written questionnaire, structured in three thematic areas: clinical patterns and resources used in pain treatment in clinical practice, pain and pain-relief therapy, and theoretical knowledge and decision-making in clinical practice. The study identified those skills that most need improvement in the treatment of pain (scientific and technical knowledge and clinical decision-making capacity of professionals) in order to reduce the unjustified variability in current clinical practice.