Journal of palliative medicine
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Perineal pain is a frequent complaint of patients with advanced cancer (colorectal, genitourinary, prostate), and often quite difficult to manage with significant impact on quality of life. Calcium channel blockers (CCBs) are potent inhibitors of intestinal smooth muscle contraction and have been shown to impact tone and motility of the gastrointestinal tract. As such, they have been used in various pain syndromes of the lower gastrointestinal tract, such as chronic anal fissure, to promote healing and improve pain. Here we describe two cases using oral diltiazem for malignancy-associated perineal pain and tenesmus. ⋯ Based on our experience with these two cases, we propose oral diltiazem for use as an adjunct therapy for management of chronic malignancy-associated perineal pain, specifically with characteristics of pressure-type pain and tenesmus.
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Recently, there has been a growing interest in the use of artificial hydration therapy (AHT) for terminally ill cancer patients. Some studies have demonstrated that appropriate hydration can contribute to patient comfort; however, few studies have examined the effects of volume reduction on patient symptoms and quality of life (QOL). ⋯ The provision of appropriate guideline-based AHT can contribute to alleviating hydration-related symptoms and improving QOL in terminally ill cancer patients.
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Inpatient palliative care (IPC) has been associated with numerous clinical benefits. Observational and randomized studies of cost savings associated with IPC provide conflicting results, and the association with readmission is not well understood. ⋯ Receipt of IPC appears to reduce hospitalization costs among adult western New Yorkers. Furthermore, care coordinated with postdischarge hospice services appears to substantially reduce the likelihood of readmission.
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Patients with swallowing dysfunction are usually very ill and have a constellation of challenging issues requiring palliation. Accumulation of oropharyngeal secretions leads to a substantial effort of medical teams including doctors, nurses, respiratory therapists, and ancillary staff. ⋯ We suggest that transdermal clonidine can be used as antisialogogue in patients with swallowing dysfunction. Clonidine pharmacology is physiologic grounds for this clinical application.