Cancer treatment reviews
-
Cancer treatment reviews · Jan 1996
Patient-controlled analgesia (PCA) in the domiciliary care of tumour patients.
Patient-controlled analgesia (PCA) was administered in the domiciliary environment in 143 pre-terminally and terminally ill tumour patients suffering either from excruciating chronic pain or severe chronic/acute complex pain that could not be relieved adequately by oral analgesia. Morphine solutions were infused subcutaneously in concentrations between 1% and 3%. The intravenous route was preferred in patients with indwelling catheters or those susceptible to inflammatory skin reactions at the infusion site. ⋯ Thus, with support from an experienced mobile nursing team, PCA can be safely administered in the terminal domiciliary care of tumour patients. PCA is superior to oral analgesia, especially in the treatment of severe oscillating pain. PCA provides adequate pain control in about 96% of patients who are poorly responsive to oral opioids.
-
Cancer treatment reviews · Jan 1996
Capsules and suppositories of methadone for patients on high-dose opioids for cancer pain: clinical and economic considerations.
The dose ratio, analgesic efficacy, toxicity and cost of methadone for cancer pain were evaluated in a retrospective review of 50 consecutive patients treated on a Palliative Care Unit. Patients were switched from hydromorphone 267.7 +/- 178.8 mg sc per day to custom-made capsules (24) or suppositories (26) of methadone for reasons of uncontrolled pain (24), toxicity (8), both (15) or other (2). The change in opioid occurred over 2.5 +/- 3.6 days, with another 4.4 +/- 3.7 days required to reach stable methadone dose. ⋯ Total cost of treatment was Canadian $116.77 +/- 157.17 for methadone capsules and Canadian $105.34 +/- 146.35 for methadone suppositories, vs Canadian $3450.51 +/- 5098.58 (p = 0.0001) for hydromorphone parenteral solution and Canadian $1801.21 +/- 2661.52 (p = 0.0001) for hydromorphone powder. It is concluded that methadone is an effective and inexpensive alternative in patients receiving high-dose opioids for cancer pain, at dose ratios much lower than recommended in the literature. The incidence of serious toxicities suggests that methadone should only be initiated in an adequately monitored setting by pain management experts.