The journal of supportive oncology
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Many patients in the terminal phase of their illness experience reduced oral intake before death, due to causes related to their cancer or its treatment. When oral intake is not adequate, dehydration and malnutrition are the obvious results. But these terminally ill patients present a challenge to healthcare providers: to rehydrate these patients or not and, if so, how? Adequate hydration levels are much lower in terminal patients with cancer than in normal adults. ⋯ In doubtful cases, a short trial of hydration may be appropriate. If hydration is considered, there are a number of methods to consider based on the needs of the patient, including intravenous administration, hypodermoclysis, and proctoclysis. The subcutaneous route is an excellent alternative due to its simplicity, low cost, and feasibility in the home setting.
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Patients with cancer frequently experience chronic pain, especially in the terminal phases of illness. Fortunately, most patients (90%) can achieve good pain relief using standard and adjuvant analgesics. For those patients who experience severe pain resistant to traditional analgesic therapies, interventional pain management techniques often provide welcome pain relief. ⋯ The percutaneous placement of catheters for the chronic infusion of spinal analgesics can provide pain relief for virtually any part of the body. Internal or external infusion pumps can be well managed at home, improving quality of life. The physician treating the pain should be aware of these and other interventional pain management techniques to provide alternative therapies to patients with refractory cancer pain.
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Review Comparative Study
Meeting the challenges in cancer pain management.
Improved life expectancy among patients with cancer has unfortunately resulted in significant increases in the number of patients experiencing chronic, intractable pain-neuropathic pain syndromes, in particular. Yet treatment for this pain is frequently suboptimal. This is due, at least partially, to the generalized nature of available therapeutics, which are often aimed toward symptom management and temporal pain properties rather than targeted directly toward the multiple mechanisms underlying the generation and propagation of pain. ⋯ However, in oncology perhaps more than in any other field, pain is dynamic and ever-changing in response to a variety of factors, including chemotherapeutic, radiation, or surgical interventions. For this reason, patient-specific assessment and continual monitoring are warranted when selecting a therapeutic regimen. General considerations, particularly when an opioid agent is utilized, should include pharmacoclinical, pharmacoeconomic, and pharmacogenetic variables.