Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
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Support Care Cancer · Mar 1999
The anti-emetic efficacy of tropisetron plus dexamethasone in patients treated with high-dose chemotherapy and stem cell transplantation.
Among the most distressing symptoms experienced by patients who have undergone high-dose chemotherapy and stem cell transplantation are nausea and vomiting. The chemotherapy regimens used in high-dose conditioning protocols are highly emetogenic. The 5HT3 receptor antagonists are very effective in the prevention and abolition of nausea and vomiting resulting from chemotherapeutic drugs. ⋯ Among them the most common were headache (in three patients) and constipation. No patient withdrew from the study because of toxicity. It has become evident from our data that the administration of 5 mg tropisetron daily in combination with 20 mg dexamethasone for 8 days can prevent the acute emesis otherwise experienced by patients receiving high-dose chemotherapy as conditioning in stem cell transplantation programmes.
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Support Care Cancer · Mar 1999
Mechanical ventilation in critically ill cancer patients: outcome and utilisation of resources.
Intensive care is increasingly being used in the management of cancer patients. It is important that a disproportionate share of special care resources is not expended on futile care of terminally ill patients. A requirement for mechanical ventilation has been stated to affect survival in cancer patients. ⋯ The role of ICU facilities, including mechanical ventilation, is important for optimal supportive care in cancer patients. Our results indicate that this treatment modality should not generally be restricted in critically ill cancer patients. The quality of life of the patients who survived should be of interest to those involved in further medical and ethical decisions concerning the level of care in the ICU.
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Support Care Cancer · Jan 1999
Case ReportsWhen all else fails: stepwise multiple solutions for a complex cancer pain syndrome.
In the presence of insufficient pain relief and substantial adverse effects, application of alternative routes of administration and a change of opioid are the main methods used to improve the analgesic response. When all else fails, the result may further be optimized using adjuvant drugs by an alternative route, namely the intrathecal route. ⋯ We found it possible to manage a very difficult pain situation by intrathecal home infusion through the efforts of a well-trained family and GP and a continuous exchange of information and advice with the pain relief team about changes in therapy to adapt to the clinical situation. A stepwise and a meaningful approach to clinical problems with use of advanced techniques and alternative drugs in the patient's home may be helpful in the treatment of conditions otherwise considered intractable.
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Support Care Cancer · Nov 1998
ReviewControversies over spinal treatment in advanced cancer patients.
About 10% of patients with cancer pain do not obtain pain relief or experience unacceptable side effects with systemic opioids. In some cases a change of the route of administration can improve the balance of analgesia and adverse effects. In this paper the use of spinal opioids in such patients is discussed from various aspects: patient selection, epidural vs intrathecal administration, dosage, association with local anaesthetic agents, dosage conversion systems (for the change from systemic administration) and home use. The main problems involved are dealt with an attempt to find how to use the drugs and techniques involved to the best possible advantage.
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Support Care Cancer · Nov 1998
Randomized Controlled Trial Comparative Study Clinical TrialAn open-label dose comparison study of ondansetron for the prevention of emesis associated with chemotherapy prior to bone marrow transplantation.
Nausea and vomiting are significant side effects in bone marrow transplant (BMT) patients who receive high-dose preparative regimens. Higher than conventional ondansetron doses and continuous infusion might improve emetic control, because of the high doses and combinations of chemotherapy (CT) used in this setting. Our objective was to conduct a prospective, randomized study comparing two different administration methods of high-dose ondansetron during a BMT preparative regimen in breast cancer patients. ⋯ There were no differences in efficacy when high-dose ondansetron was given as CIV or INT for the control of nausea and vomiting in breast cancer patients undergoing high-dose CT for autologous BMT. Ondansetron alone was not adequate to provide sustained control of CT-induced nausea and vomiting over the entire 5-day study period. A combination of antiemetics targeting various mechanisms of CT-induced nausea and vomiting may be necessary to improve response rates.