Cancer
-
This study examines the nature, pattern, and consequences of pain experienced by cancer patients, both during hospitalization and during the immediate posthospitalization period. Of the 240 hospitalized cancer patients screened, 45% were found to be in pain. Although 59% of these patients had found ways to reduce their pain, nearly one third reported being seriously limited in their daily activities. ⋯ Applied pain management strategies were rated by two physicians as inadequate in 54% of cases. The most frequent recommendation for improved pain management was an increase in the dosage or a change in the class of analgesics. The importance of periodic assessment of pain and its consequences, both physical and psychological, is discussed in light of increasing the level of information available to physicians and patients regarding appropriate approaches to pain management.
-
Case Reports
Neutrophilic eccrine hidradenitis. Evidence implicating bleomycin as a causative agent.
A 13-year-old girl receiving multiple agent chemotherapy for osteosarcoma was found to have neutrophilic eccrine hidradenitis (NEH). This dermatosis is marked histopathologically by necrosis of the eccrine structures with a neutrophilic infiltrate. Clinically, the presentation is variable and the differential diagnosis is extensive. ⋯ Currently, NEH is felt to be a complication of chemotherapy. The most likely causative agent in our patient was bleomycin. Physicians should be aware of this entity and its variable clinical presentation.
-
The patterns of disease extent, response to treatment, and survival rates were examined in 129 children registered as metastatic (Group IV) soft-tissue sarcoma patients on the Intergroup Rhabdomyosarcoma Study (IRS)-I protocol from November 1972 through October 1978. The patients' ages at diagnosis ranged from 3 months to 21 years (median, 10.5 years); 72 were male patients and 57 were female patients (male-to-female ratio, 1.3:1). The tumor arose in an extremity in 34 patients, the head and neck (exclusive of the orbit) in 27, the genitourinary tract in 25, the retroperitoneum or pelvis in 14, the trunk in 12, the intrathoracic region in nine, the hepatobiliary system in four, the perineum in two, and the orbit in two patients. ⋯ Only 10 of the other 84 (8%) are surviving disease-free at 2 years (P = 0.02). The presence of restricted rather than diffuse metastases at diagnosis (P = 0.02) was the only other characteristic significantly related to long-term complete remissions. One hundred and two patients (79%) died at a median of 47 weeks after diagnosis, 92 from sarcoma and ten from other causes.(ABSTRACT TRUNCATED AT 400 WORDS)
-
Randomized Controlled Trial Clinical Trial
A prospective randomized trial of HLA-matched versus mismatched single-donor platelet transfusions in cancer patients.
The use of histocompatability antigen (HLA)-matched platelets has been advocated for the support of thrombocytopenic cancer patients. We randomized 78 newly diagnosed cancer patients prospectively (before thrombocytopenia) to receive either HLA-matched or mismatched single-donor platelet transfusions. Three hundred forty-one platelet transfusions were given for 80 separate episodes of therapy-induced thrombocytopenia in 33 patients. ⋯ In patients where thrombocytopenia was significant, the transfusion of HLA-matched platelets did not appear to offer a significant advantage. However, HLA-matched platelet transfusions tended to be associated with higher posttransfusion increments in febrile patients and a trend toward fewer severe bleeding episodes. A multi-institution trial containing a large number of patients is needed to evaluate trends observed in this study.
-
From February 1985 until January 1987, 108 consecutive patients with pain due to advanced cancer requiring parenteral narcotics were treated with a subcutaneous infusion of morphine (62 patients) or hydromorphone (46 patients). Mean maximal daily dose of morphine and hydromorphone was 305 mg (range, 80-3000 mg) and 310 mg (range, 40-4024 mg), respectively. The infusion was maintained for a mean of 31 +/- 16 days (range, 2-156). ⋯ Local toxicity consisted in infection in two patients, bleeding in one, and chemical irritation in six. Cost analysis shows that subcutaneous infusion reduced costs by either allowing home discharges, or replacing intravenous infusion. The authors conclude that this method is safe and effective in patients admitted and at home, and should be considered the first choice when parenteral analgesia is required.