Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
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Up to 70% of patients with cancer should be expected to experience pain during the cancer illness. This is clearly more likely as disease progresses. The World Health Organisation (WHO) cancer pain guidelines remain the key to following a simple and systematic approach to cancer pain control in approximately 80% of patients. ⋯ However, lateral thought when managing challenging cancer-related pain becomes even more critical. This paper reviews the approach to the approximately 20% of patients who do not respond to the standard WHO three-step analgesic ladder approach and of course, by definition this means in practice those patients with severe pain which is not controlled by morphine or alternative strong opioids. Such cancer pain can be broadly categorised as opioid irrelevant pain, opioid partially responsive pain, opioid unresponsive pain or pain resulting from excess opioid.
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Support Care Cancer · Jun 2008
Specialized palliative care services are associated with improved short- and long-term caregiver outcomes.
The goal of this study was to evaluate, at a population level, the association between specialized palliative care services (SPCS) and short- and long-term caregiver outcomes. ⋯ At a population level, SPCS were associated with meaningful improvements in short-term ("unmet needs") and long-term ("moving on") caregiver-defined outcomes.
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Support Care Cancer · Jun 2008
ReviewA "TNM" classification system for cancer pain: the Edmonton Classification System for Cancer Pain (ECS-CP).
The purpose of this paper is to provide an overview of the development of a "TNM" cancer pain classification system for advanced cancer patients, the Edmonton Classification System for Cancer Pain (ECS-CP). Until we have a common international language to discuss cancer pain, understanding differences in clinical and research experience in opioid rotation and use remains problematic. The complexity of the cancer pain experience presents unique challenges for the classification of pain. To date, no universally accepted pain classification measure can accurately predict the complexity of pain management, particularly for patients with cancer pain that is difficult to treat. ⋯ The development of a standardized classification system that is comprehensive, prognostic and simple to use could provide a common language for clinical management and research of cancer pain. An international study to assess the inter-rater reliability and predictive value of the ECS-CP is currently in progress.
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Constipation is a significant problem in patients taking morphine for cancer pain. The aims of this study were (1) to assess the magnitude of constipation in this study cohort, (2) to analyse the constipation treatment strategies and (3) to look for evidence of inter-individual variation in both susceptibility to constipation and response to treatment with laxatives in this patient group. ⋯ Constipation affects a large proportion of cancer patients taking oral morphine. Constipation in these patients is generally inadequately treated.
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Support Care Cancer · May 2008
Management of febrile neutropenia in solid tumours and lymphomas using the Multinational Association for Supportive Care in Cancer (MASCC) risk index: feasibility and safety in routine clinical practice.
Febrile neutropenia (FN) represents a spectrum of severity in which low-risk patients can be defined using the Multinational Association for Supportive Care in Cancer (MASCC) risk index. However, despite publication in 2000, there remains limited published literature to date to support the use of MASCC risk assessment in routine clinical practice and eligibility for early hospital discharge. In this study, we present our experience with the routine use of the MASCC risk index to determine the management of FN in our institution. ⋯ The MASCC risk index is both feasible and safe when used in standard clinical practice to guide the management of FN in patients with solid tumours and lymphomas. Patients predicted to have low risk can be managed safely with oral antibiotics and early hospital discharge.