Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
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Cachexia and anorexia are often not observed at the time of diagnosis of cancer. While the initial medical intervention for cancer patients includes antitumor therapy and pain management, the consequences of cachexia and anorexia may be ignored, to the detriment of the patient's quality of life and his or her potential response to chemotherapy. The importance of a well-defined therapeutic strategy to treat cachexia is in order if the patient's overall wellbeing is to improve. Presented is a review of the pharmacological management of anorexia and cachexia, including a four-step ladder approach to medical management.
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Support Care Cancer · May 2000
Clinical TrialAntiemetic efficacy of combination therapy with granisetron plus prednisolone plus the dopamine D2 antagonist metopimazine during multiple cycles of moderately emetogenic chemotherapy in patients refractory to previous antiemetic therapy.
Effective antiemetic treatment of patients who have previously experienced chemotherapy-induced nausea and vomiting is difficult. The aim of this study was to evaluate the antiemetic efficacy of a single intravenous dose of granisetron plus a 3-day oral treatment with prednisolone 25 mg once a day plus metopimazine 30 mg four times a day in patients refractory to previous antiemetic treatment with granisetron or with prednisolone plus metopimazine. The study population was made up of 25 consecutive women with stage I or II breast cancer, who were treated with multiple cycles of adjuvant cyclophosphamide, fluorouracil plus methotrexate or cyclophosphamide, epirubicin plus fluorouracil given i.v. every 3 weeks. ⋯ Nineteen patients (76.0%) completed the scheduled nine cycles of chemotherapy, 1 being withdrawn because of > or =5 emetic episodes and 5, because they were not satisfied with the antiemetic treatment. The treatment was well tolerated. In conclusion, granisetron plus prednisolone plus metopimazine is a highly effective antiemetic treatment in patients receiving moderately emetogenic chemotherapy refractory to antiemetic therapy with granisetron or prednisolone plus metopimazine.
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Support Care Cancer · May 2000
Prevention of cisplatin-induced delayed emesis: still unsatisfactory. Italian Group for Antiemetic Research.
The incidence of and prognostic factors in cisplatin-induced delayed emesis were evaluated in 522 naive cancer patients. They each received an intravenous combination of ondansetron and one of four different doses of dexamethasone for the prevention of acute emesis and a combination of orally administered metoclopramide plus intramuscular dexamethasone for the prevention of delayed emesis. Despite the best prophylaxis for acute and delayed emesis, 37.4%/57.1% of patients experienced delayed vomiting/nausea. The presence of acute vomiting/nausea was the main prognostic factor in delayed vomiting/nausea; therefore, a multifactorial analysis of the results achieved during the delayed phase adjusted for those obtained during the acute phase should be carried out in every study evaluating the efficacy of different antiemetic drugs for delayed emesis.
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Support Care Cancer · Mar 2000
ReviewPsychopharmacology in supportive care of cancer: a review for the clinician: II. Neuroleptics.
Neuroleptics are frequently used in patients with advanced cancer. Most relevant and practical aspects of their use in supportive cancer care are reviewed, to assist the clinical oncologist and palliative care specialist when prescribing these drugs. This article reviews pharmacological properties, indications, such as delirium, nausea and vomiting, pain, anxiety and other symptoms, adverse effects, and drug interactions of neuroleptics and compares the profiles of different compounds. Special emphasis is put on the role of neuroleptics in the management of delirium.
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Support Care Cancer · Mar 2000
Case ReportsSuccessful palliation of hypoactive delirium due to multi-organ failure by oral methylphenidate.
Delirium is frequently observed in terminally ill cancer patients, but complete remission is often difficult to achieve. Therefore, symptom palliation is of great importance to improve patients' quality of life. ⋯ We report on a terminally ill cancer patient with hypoactive delirium caused by multi-organ failure, in whom methylphenidate was effective in improving the ability to maintain communication. This case highlights the efficacy of methylphenidate for hypoactive delirium in terminally ill cancer patients.