Oxycodone: a pharmacological and clinical review.

Oxycodone is a semi-synthetic opioid with an agonist activity on mu, kappa and delta receptors. Equivalence with regard to morphine is 1:2. Its effect commences one hour after administration and lasts for 12 h in the controlled-release formulation. Plasma halflife is 3-5 h (half that of morphine) and stable plasma levels are reached within 24 h (2-7 days for morphine). Oral bioavailability ranges from 60 to 87%, and plasma protein binding is 45%. Most of the drug is metabolised in the liver, while the rest is excreted by the kidney along with its metabolites. The two main metabolites are oxymorphone--which is also a very potent analgesic--and noroxycodone, a weak analgesic. Oxycodone metabolism is more predictable than that of morphine, and therefore titration is easier. Oxycodone has the same mechanism of action as other opioids: binding to a receptor, inhibition of adenylyl-cyclase and hyperpolarisation of neurons, and decreased excitability. These mechanisms also play a part in the onset of dependence and tolerance. The clinical efficacy of oxycodone is similar to that of morphine, with a ratio of 1/1.5-2 for the treatment of cancer pain. Long-term administration may be associated with less toxicity in comparison with morphine. In the future, both opioids could be used simultaneously at low doses to reduce toxicity. It does not appear that there are any differences between immediate and slow-release oxycodone, except their half-life is 3-4 h, and 12 h, respectively. In Spain, controlled-release oxycodone (OxyContin) is marketed as 10-, 20-, 40- or 80-mg tablets for b.i.d. administration. Tablets must be taken whole and must not be broken, chewed or crushed. There is no food interference. The initial dose is 10 mg b.i.d. for new treatments and no dose reduction is needed in the elderly or in cases of moderate hepatic or renal failure. Immediate-release oxycodone (OxyNorm) is also available in capsules and oral solution. Side effects are those common to opioids: mainly nausea, constipation and drowsiness. Vomiting, pruritus and dizziness are less common. The intensity of these side effects tends to decrease over the course of time. Oxycodone causes somewhat less nausea, hallucinations and pruritus than morphine.

Oxycodone: a pharmacological and clinical review

Oxycodone is a semi-synthetic opioid with an agonist activity on mu, kappa and delta receptors. Equivalence with regard to morphine is 1:2. Its effect commences one hour after administration and lasts for 12 h in the controlled-release formulation. Plasma halflife is 3-5 h (half that of morphine) and stable plasma levels are reached within 24 h (2-7 days for morphine). Oral bioavailability ranges from 60 to 87%, and plasma protein binding is 45%. Most of the drug is metabolised in the liver, while the rest is excreted by the kidney along with its metabolites. The two main metabolites are oxymorphone--which is also a very potent analgesic--and noroxycodone, a weak analgesic. Oxycodone metabolism is more predictable than that of morphine, and therefore titration is easier. Oxycodone has the same mechanism of action as other opioids: binding to a receptor, inhibition of adenylyl-cyclase and hyperpolarisation of neurons, and decreased excitability. These mechanisms also play a part in the onset of dependence and tolerance. The clinical efficacy of oxycodone is similar to that of morphine, with a ratio of 1/1.5-2 for the treatment of cancer pain. Long-term administration may be associated with less toxicity in comparison with morphine. In the future, both opioids could be used simultaneously at low doses to reduce toxicity. It does not appear that there are any differences between immediate and slow-release oxycodone, except their half-life is 3-4 h, and 12 h, respectively. In Spain, controlled-release oxycodone (OxyContin) is marketed as 10-, 20-, 40- or 80-mg tablets for b.i.d. administration. Tablets must be taken whole and must not be broken, chewed or crushed. There is no food interference. The initial dose is 10 mg b.i.d. for new treatments and no dose reduction is needed in the elderly or in cases of moderate hepatic or renal failure. Immediate-release oxycodone (OxyNorm) is also available in capsules and oral solution. Side effects are those common to opioids: mainly nausea, constipation and drowsiness. Vomiting, pruritus and dizziness are less common. The intensity of these side effects tends to decrease over the course of time. Oxycodone causes somewhat less nausea, hallucinations and pruritus than morphine (AU)

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Control of oncologic pain in relief of suffering. Our experience.

BACKGROUND: Pain and suffering are not synonymous terms. The concept of suffering is wider than just physical pain. People can suffer for multiple causes, pain among them, but it is not the only reason since <>. If our main objective is the achievement of the well-being and the relief of pain, it will be necessary, according to Lazarus, Folkman, Chapman, Gravin, Bayés and Labrador, to reduce or eliminate the physical (cancer, pain and so on) and psychosocial harm (loneliness, culpability, etc.) perceived like a threat and to increase the perception of control about this situation. AIMS: The main objectives of our work were: First: to evaluate the efficacy of a tool that allows the identification of the symptoms perceived by the patient as a threat in order to reduce or suppress them and empower their resources at the same time; and secondly to evaluate the incidence of pain in the suffering. MATERIALS AND METHODS: Our tool includes the following groups of variables: subjective perception of the time course, emotional aspects, concerns and confrontation strategies, perception of adaptation and sense of life, perceived support and pain. This tool has been tested in 73 oncologic patients, 31 men and 42 women, mean aged 55, 41 (SD = 14, 54) visited at the Medical Oncology Service of La Paz Hospital. RESULTS: Mainly, people who refers great suffering are those with more pain (p < 0.05); while patients with less suffering and higher well-being are those that use strategies to face their situation (p < 0.05). Our tool reduces perceived threats and that reflects the need for a good control of pain and at the same time to empower the resources to relieve the suffering as much as possible. CONCLUSION: The referred tool seems to be effective in order to easy the intervention to relieve the suffering.

Un grupo de duelo para hijos de pacientes fallecidospor cáncer / A mourning group for daughters and sons of patients died of cancer

Introducción: La muerte del padre o de la madre, figuras importantes y significativas, es siempre dolorosa y triste. Se considera uno de los eventos más estresantes de la vida. La mayoría de jóvenes atraviesa el periodo de duelo sin mayores problemas; sin embargo, algunos requieren de una intervención que facilite el proceso. Debido a que los jóvenes muchas veces son reacios a aceptar una intervención individual se considera oportuno ofrecerles una intervención grupal. Objetivo: Facilitar el proceso de adaptación. Método: El grupo está formado por 7 jóvenes cuya media de edad es de 20 años. Hijos de pacientes oncológicos con factores de riesgo de duelo complicado. Se utiliza un diseño preexperimental y se realiza una evaluación pre y postratamiento. Resultados: Las escalas de desesperanza y depresión muestran una disminución estadísticamente significativa (p< 0,05) desde el inicio al final. Lo mismo ocurre con los resultados de ansiedad al compararse la media del principio de las sesiones con el final de estas (p< 0,05). También aumentan los modos de afrontamiento que se potencian en las sesiones. Conclusiones: La intervención terapéutica realizada disminuye la depresión, la desesperanza y la ansiedad y también potencia las estrategias de afrontamiento (AU)

Radioquimioterapia preoperatoria frente a postoperatoria en el carcinoma de recto estadios II-III: estudio comparativo no aleatorizado / Preoperative versus postoperative radiochemotherapy in stages II and III rectal carcinoma: a non-randomized comparative study

Propósito: comparar la eficacia, toxicidad y tasa de complicaciones quirúrgicas del tratamiento adyuvante frente al tratamiento neoadyuvante en el carcinoma de recto.• Material y métodos: 111 pacientes con carcinoma de recto estadios II-III recibieron tratamiento complementario con radioterapia (RT) y quimioterapia (QT). La QT consistió en leucovorin (500 mg/m2) intravenoso el primer día, seguido de lencovorin oral 15 mg/12 horas entre los días 2 y 14 del ciclo, y UFT 390 mg/m2/día entre los días 1 y 14 (350 mg/m2 durante la RT) . En 32 enfermos el tratamiento se realizó de forma neoadyuvante (grupo N), mientras que en los 79 restantes se administró tras la cirugía (grupo A).• Resultados: no hubo diferencias significativas en la supervivencia libre de enfermedad (72 por ciento en el grupo A y 69 por ciento en el grupo N) ni en la supervivencia global a los 3 años (91 por ciento en el grupo A y 95 por ciento en el grupo N). La tasa de complicaciones mayores tras la cirugía fue similar en ambos grupos. La tasa de diarrea grado 3-4 fue del 43 por ciento en los primeros 14 pacientes del grupo N (que recibieron UFT 350 mg/m2), mientras que en el grupo A fue del 18 por ciento (Fisher, p=0.07). En los restantes 18 pacientes del grupo N la dosis de UFT fue reducida a 300 mg/m2. La tasa de cirugía conservadora de esfínter en los tumores situados en los 10 cm últimos del recto fue superior en el grupo N (53 por ciento vs 38 por ciento, p=n.s.).• Conclusiones: el tratamiento neoadyuvante en el cáncer de recto no presenta diferencias significativas con el tratamiento adyuvante en cuanto a tasa de complicaciones quirúrgicas, tasa de recaídas y supervivencia, pero sí aumenta la toxicidad gastrointestinal. (AU)

Lenguaje oncológico 2002 / Oncologic Language in 2002

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Varón de 63 años con síndrome general y masa esplénica / 63-year old male patient with general syndrome and splenic mass

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Farmacoeconomía en Oncología / Pharmaeconomy and oncology

La evaluación económica ha ido adquiriendo una gran importancia dentro de la Medicina y se han desarrollado diferentes estudios famacoeconómicos con distinto impacto en la práctica clínica. Los costes directos de los enfermos con cáncer se sitúan en torno a un 10 porciento del total de los costes médicos por lo que este énfasis ha influido también en los estudios oncológicos. Desafortunadamente, a pesar del aumento de los análisis económicos publicados en la literatura, es difícil saber todavía cuál es el impacto real en Oncología. En este articulo se revisan los conceptos básicos de farmacoeconomía y una visión general de su aplicación en la práctica oncológica (AU)

La difícil serenidad / The difficult serenity

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La transmisión del conocimiento empieza en la palabra (Normas elementales para una correcta publicación) / The trasnmission of knowledge stars with speech (basic rules for a correct publication)

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Cuidados paliativos en Oncología: pasado y presente / Palliative care in oncology: past and present

Los Cuidados Paliativos han adquirido actualmente un importante protagonismo debido a, su reconocimiento como especialidad médica en Gran Bretaña. Muchas son las innovaciones que han aparecido durante los últimos años, tanto en lo referente a aspectos académicos (publicaciones, congresos, cursos...), como en la mejora en el tratamiento y la atención del enfermo por personal experto. Esta revisión pretende dar una visión del pasado y presente en España de los Cuidados Paliativos (AU)

El Cáncer de Jardiel

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Cutaneous malignant melanoma and sun exposure in Spain.

Cutaneous malignant melanoma has an increasing importance all over the world. However very few epidemiological studies have been published from Spain, and Spanish people have not become aware of the problem. This study was designed to examine sun exposure patterns and other related items among 116 consecutive patients with melanoma and 235 controls. Each subject answered a questionnaire covering the place of residence, sun exposure details and other risk factors, and underwent a skin examination. Continuous sun exposure due to residence or occupation was associated with an odds ratio (OR) of 2.0 (95% confidence interval [CI] = 1.2-3.3). People who lived in the city but spent 50% of their time in rural areas for holidays had an OR of 2.2 (95% CI = 1.3-3.8) when compared with those living in urban and rural areas. The OR for people who sunbathed more than 30 times a year was 1.8 (95% CI = 1.2-2.8), and outdoor leisure time was also associated with melanoma appearance when exposure was greater than 60 units in the last 2 years, with an OR of 3.0 (95% CI = 1.6-5.5); 1 unit is equivalent to total body sun exposure for at least 2 h. These OR estimates were adjusted for age, skin type and the number of naevi. Construction workers (OR = 1.6; 95% CI = 0.5-5.6) had increased risk after adjustment for skin type, age and freckle count (OR = 4.3; 95% CI = 1.8 9.9) or mole count (OR = 2.8; 95% CI = 1.4-5.8). Working as a farmer was a protective factor after adjustment (OR = 0.5; 95% CI = 0.3-0.8). The use of sunscreens was a protective factor against melanoma (OR = 2.6; 95% CI = 1.6-3.6 for non-users). Campaigns should focus on advising people to avoid sun exposure in sunny places and to use sunscreens every time they are exposed to the sun.

[Cancer of unknown origin: diagnostic and therapeutic yield]. / Cáncer de origen desconocido: rentabilidad diagnóstica y terapéutica.

Patients with carcinoma of unknown origin represents at least 5% on the total neoplastic patients. A review of the main metastatic locations and the different histological types has been done; giving special attention to the most frequent primitive neoplasms. Diagnostic yield in this type of cancer is emphasized, since many times, it is advisable to limit the number of explorations directed to find the primary tumor, as they decrease patient quality of life while no profit is obtained from the knowledge of the primary tumor, for most of the patients. However, this must not drive us to the opposite end: diagnostic and therapeutic nihilism. We have to rule out, in a reasonable way, certain types of tumors which have an useful treatment even in advanced phases (oat all carcinoma, germinal neoplasms, lymphomas).