Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
-
Support Care Cancer · Mar 2005
Review Comparative StudyAdvances in opioid therapy and formulations.
Newly developed opioid analgesics and drug delivery systems may provide pain relief for patients intolerant of morphine. Long-acting oral opioids supply satisfactory analgesia at more convenient dosing intervals. Implantable pumps can provide full analgesic doses of opioids both subcutaneously and intrathecally over extended time periods. Optimal opioid use should rely on individualized dose-finding approaches to enhance pain relief while limiting drug-related side effects and avoiding the common problems associated with opioid prescription in clinical practice.
-
Support Care Cancer · Mar 2005
Review Comparative StudyOutcome research in palliative care: could it represent a new dimension of clinical research or clinical practice?
Outcome research is a new dimension of clinical research, and all fields of clinical medicine are involved in this kind of analysis. Overall survival and quality of life are the main outcomes identified in clinical oncology. The former must be the main outcome whenever possible; the latter has to be the main outcome when an improvement of overall survival cannot be expected. ⋯ We also review the main randomized clinical trials on the treatment of cancer cachexia, trying to define the role of the treatments in cachexia-related symptom control and quality of life improvement. Strictly related to outcome analysis is the dimension of pharmacoeconomic evaluation. The models of the different designs of pharmacoeconomic analysis are revisited in an attempt to conjugate the pharmacoeconomic evaluation with the particular dimension of palliative care.
-
Support Care Cancer · Mar 2005
Review Comparative StudyContribution to variability in response to opioids.
Opioids are the oldest and most effective agents for the short- and long-term control of severe pain, particularly chronic cancer pain palliation. However, morphine and other opioids display wide variations in pharmacological efficacy and tolerability, and a significant number of patients are unable to achieve adequately controlled pain at doses that do not produce intolerable adverse effects. This article reviews factors that affect the efficacy and tolerability of opioid analgesics and clinical strategies for successful pain mangement.