Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
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Dyspnea is a frequent and devastating symptom among advanced cancer patients and is often difficult to control. However, there has been considerably less emphasis in the literature on the appropriate characterization and management of this symptom than of other cancer-related symptoms. The purpose of this paper is to review issues relating to the prevalence, causes, prognosis and treatment of dyspnea in patients with advanced cancer. ⋯ While the mechanism of breathing and the consequences of different pathologic conditions for both respiratory function and gas exchange are well known, the genesis and pathophysiology of dyspnea as a symptom are much less well understood. Palliative care assessment should be focused on dyspnea as a symptom rather than on the functional and gas exchange abnormalities. Increased research on the appropriate management of dyspnea is needed.
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Dyspnea, which has been defined as an "uncomfortable awareness of breathing," is a frequent and devastating symptom in advanced cancer patients. It has been reported to occur in 21-79% of patients evaluated a few days or weeks before death. In advanced cancer, the aim of effective management is to minimize the patient's perception of breathlessness, which depends in turn on a reliable assessment. ⋯ Mediators of dyspnea may be measured by the ATS-DLD-78, the Chronic Respiratory Questionnaire (CRQ), the Dyspnea Interview Schedule, the Pulmonary Functional Status Scale (PFSS) and the Therapy Impact Questionnaire (TIQ). Reactions to dyspnea may be assessed by the Dyspnea Visual Analogue Scale (DVAS), the TIQ and the Borg Scale, and the consequences of it by the TIQ, the Baseline Dyspnea Index (BDI), the Transition Dyspnea Index (TDI), and CRQ, and by the Oxygen Cost Diagram (OCD), the Dyspnea Interview Schedule and the Modified Medical Research Council Dyspnea Scale (MRC). No single assessment tool considers all the different components of dyspnea, and the final choice will depend on the purpose of the assessment, taking into account that the provision of quality of life is of paramount importance to patients who have limited time left to them and that the assessment should not therefore detract from the quality of life by being overlong, complicated or invasive.
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Support Care Cancer · Jul 1999
Comparative Study Clinical TrialThe use of intermittent subcutaneous injections of oxycodone for opioid rotation in patients with cancer pain.
Oxycodone is a strong opioid that has been available for at least 70 years. At present, commercially prepared parenteral oxycodone is only available in Finland. We report in this paper our experience of administering oxycodone s.c. ⋯ When hydromorphone s.c. was converted to a morphine s.c. equivalent dose and the results for these patients were added to those for the morphine s.c. group, the mean and median overall ratios of morphine s.c. equivalent dose to oxycodone were 1.9+/-1.5 and 1.4, respectively. The cost of the oxycodone s.c. was also evaluated and was found to be comparable to that of morphine s.c. and lower than that of hydromorphone s.c. We conclude that s.c. oxycodone can be an effective, safe and inexpensive alternative opioid agonist.
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Support Care Cancer · Jul 1999
Comparative StudyGranulocyte-colony stimulating factor for the prevention of chemotherapy-induced febrile neutropenia in the adult cancer patient population of Southern Israel.
To evaluate the efficacy of granulocyte-colony stimulating factor (G-CSF) prophylaxis in preventing chemotherapy-induced febrile neutropenia in the heterogeneous population of adult cancer patients treated in our institution, all adult cancer patients with either a solid tumor or lymphoma who were admitted for chemotherapy in our institution between 1 January 1994 and 31 July 1995 were retrospectively studied. We compared the characteristics of chemotherapy cycles in which G-CSF was given as prophylaxis and of those with no prophylaxis. In all, 1,079 chemotherapy cycles given to 209 patients were analyzed. ⋯ Febrile neutropenia developed in 40 cycles (4%). There was no difference in the rates of febrile neutropenia, infection, hospitalization or mortality between the study groups in general, and cycles administered to patients being treated for lymphomas in particular. The routine use of prophylactic G-CSF in a mixed cancer patient population with a low incidence of febrile neutropenia is not justified and should be reserved for individual patients with a high likelihood of developing febrile neutropenia.