The journal of supportive oncology
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Comparative Study
Adjunctive nabilone in cancer pain and symptom management: a prospective observational study using propensity scoring.
A prospective observational study assessed the effectiveness of adjuvant nabilone (Cesamet) therapy in managing pain and symptoms experienced by advanced cancer patients. The primary outcomes were the differences between treated and untreated patients at 30 days' follow-up, in Edmonton Symptom Assessment System (ESAS) pain scores, and in total morphine-sulfate-equivalent (MSE) use after adjusting for baseline discrepancies using the propensity-score method. Secondary outcomes included other ESAS parameters and frequency of other drug use. ⋯ Other ESAS parameters that improved significantly in patients receiving nabilone were nausea (P < 0.0001), anxiety (P = 0.0284) and overall distress (total ESAS score; P = 0.0208). The nabilone group showed borderline improvement in appetite (P = 0.0516). When compared with those not taking nabilone, patients using this cannabinoid had a lower rate of starting nonsteroidal anti-inflammatory agents, tricyclic antidepressants, gabapentin, dexamethasone, metoclopramide, and ondansetron and a greater tendency to discontinue these drugs.
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Despite their use of prophylactic antiemetic therapies, cancer patients continue to consider chemotherapy-induced nausea and vomiting (CINV) to be a significant problem. Patients frequently use various "breakthrough" medications for these symptoms. Unfortunately, there is a paucity of trials regarding treatment of breakthrough CINV. ⋯ When the severity of CINV was quantified on a scale of 0-10, the mean CINV score decreased significantly from a 6.1 before gel application to a 1.7 as evaluated 30 minutes following gel application (P < 0.005). Topical use of ABH gel appears to be a promising and safe rescue therapy for breakthrough CINV that occurs despite prophylactic antiemetic therapy. These results warrant further confirmation in a large, randomized, placebo-controlled trial.
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An oral, patient-controlled analgesia (PCA) device uses radiofrequency identification technology to allow patients direct, controlled access to medication at the bedside. Twenty oncology inpatients participated in a pilot study to evaluate the device's design function and patient, nursing, and pharmacy satisfaction. The referring oncology physicians ordered oral pain tablets or capsules on an as-needed basis; the drugs were dispensed by the device with a specified lockout time interval and with a provision for administration of an immediate dose, if desired. ⋯ Pharmacy staff agreed that the device's disposable medication tray was easy to fill; however, it did not save them time. The results of a Cronbach's-alpha statistic calculated for patient and nursing questionnaires showed these surveys to be reliable tools that featured consistent responses. The overall conclusion from this pilot study was that the oral PCA device was a useful, functional device that should improve pain management in selected patients in the acute care setting.
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Randomized Controlled Trial
Symptom clusters in patients with newly-diagnosed brain tumors.
A symptom cluster comprises three or more concurrent symptoms. There is a paucity of symptom cluster research in cancer patients. Data from a previously conducted clinical trial were analyzed to search for symptom clusters. ⋯ Two symptom clusters were identified using exploratory factor analysis--a language cluster including difficulty reading, writing, and finding the right words and a mood cluster including feelings of sadness, anxiety, and depressed mood; these clusters were supported by MDS and cluster analysis. Our results suggest that interventions that target both cognitive function and mood should be considered in this patient population. Further research on symptom clusters in brain tumor patients is needed.