Journal of pain and symptom management
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J Pain Symptom Manage · Apr 1999
Randomized Controlled Trial Clinical TrialHow effective are supplementary doses of opioids for dyspnea in terminally ill cancer patients? A randomized continuous sequential clinical trial.
Supplementary doses of opioids are recommended to relieve dyspnea in terminally ill cancer patients. We conducted a randomized continuous sequential clinical trial to evaluate their efficacy. We recruited 33 terminally ill cancer patients from three palliative care centers, all of whom had persistent dyspnea after rest and treatment with oxygen. ⋯ Overall, both mean dyspnea intensity and respiratory frequency decreased significantly relative to baseline. Dyspnea reduction was relatively greater in patients with initially low and moderate dyspnea intensity. In terminally ill cancer patients with persistent dyspnea, 25% of the equivalent 4-hourly dose of opioid may be sufficient to reduce both dyspnea intensity and tachypnea for 4 hours.
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J Pain Symptom Manage · Apr 1999
Multicenter StudyA new palliative prognostic score: a first step for the staging of terminally ill cancer patients. Italian Multicenter and Study Group on Palliative Care.
In recent years, extensive research has been performed to identify prognostic factors that predict survival in terminally ill cancer patients. This study describes the construction of a simple prognostic score based on factors identified in a prospective multicenter study of 519 patients with a median survival of 32 days. An exponential multiple regression model was adopted to evaluate the joint effect of some clinico-biological variables on survival. ⋯ The PaP Score based on simple clinical and biohumoral variables proved to be statistically significant in a multivariate analysis. The score is valid in this population (training set). An independent validation on another patient series (testing set) is required and is the object of a companion paper.
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J Pain Symptom Manage · Apr 1999
Multicenter StudySuccessful validation of the palliative prognostic score in terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care.
The aim of this work was to validate a previously constructed prognostic score for terminally ill cancer patients in order to determine its value in clinical practice. The Palliative Prognostic Score (PaP Score) was tested on a population of 451 evaluable patients consecutively entered in the hospice programs of 14 Italian Palliative Care Centers. The score subdivided patients into three specific risk classes based on the following six predictive factors of death: dyspnea, anorexia, Karnofsky Performance Status (KPS), Clinical Prediction of Survival (CPS), total white blood count (WBC), and lymphocyte percentage. ⋯ Survival medians were remarkably similar to those of the training set (64 days in group A, 32 days in group B, and 11 days in group C). In the complex process of staging terminally ill patients, the PaP Score is a simple instrument which permits a more accurate quantification of expected survival. It has been validated on an independent case series and is thus suitable for use in clinical practice.
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J Pain Symptom Manage · Apr 1999
Case ReportsNebulized scopolamine in the management of oral dribbling: three case reports.
Difficulty swallowing saliva or its excessive production may be problematic for some patients. The resulting oral dribbling is often embarrassing. Three patients were admitted for hospice care complaining of oral dribbling. Each patient was given nebulized scopolamine hydrobromide which helped lessen the dribbling.
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J Pain Symptom Manage · Apr 1999
Case ReportsLow-dose ketamine in the management of opioid nonresponsive terminal cancer pain.
Two patients with far-advanced cancer, near death, who were experiencing excruciating and intractable pain that was poorly responsive to rapidly escalating doses of morphine and hydromorphone were treated with low-dose intravenous ketamine (0.1-0.2 mg/kg). This intervention eliminated the need for any further opioid use, providing profound analgesia and a sense of calm during the last hours and days of these patients' lives. ⋯ This is an important matter to disseminate in order to reassure the public that we do have the tools necessary to keep the promise that no one need die with uncontrolled pain. This therapeutic approach may also serve to reassure concerned physicians that their efforts to assure pain relief may not be misconstrued as hastening death.