J Palliat Care
-
We describe a simple method for the assessment of symptoms twice a day in patients admitted to a palliative care unit. Eight visual analog scales (VAS) 0-100 mm are completed either by the patient alone, by the patient with nurse's assistance, or by the nurses or relatives at 10:00 and 18:00 hours, in order to indicate the levels of pain, activity, nausea, depression, anxiety, drowsiness, appetite, and sensation of well-being. The information is then transferred to a graph that contains the assessments of up to 21 days on each page. ⋯ S.), nurse alone (p = N. S.), or relative (p less than 0.01) respectively. We conclude that this is a simple and useful method for the regular assessment of symptom distress in the palliative care setting.
-
A recent report suggested that more than 50% of terminal cancer patients have physical suffering that requires sedation in the last days of life. To evaluate this finding on our 14-bed palliative care unit, a retrospective analysis of 100 consecutive patients admitted for 6 days or more was carried out. Information was collected on major symptoms requiring treatment, symptom control at admission and during each of the last 7 days of life, medications used, and changes that may have contributed to sedation. ⋯ Visual Analogue Scores (VAS) were done twice a day in all patients; mean pain showed a change from 31 +/- 24 on Day 6 to 24 +/- 19 on day of death (DOD) (p less than 0.05); nausea from 19 +/- 18 on Day 6 to 13 +/- 9 on DOD (p less than 0.01); drowsiness from 51 +/- 28 on Day 6 to 85 +/- 45 on DOD (p less than 0.001); symptom distress score from 49 +/- 11 on Day 6 to 52 +/- 9 on DOD (p less than 0.01). On the day of admission (DOA), 69% of VAS were done by the patient and 28% by the nurse as compared to 8% by the patient and 90% by the nurse on DOD. Level of consciousness on DOA was alert (72%), drowsy (28%), unresponsive (0%) and by DOD was alert (2%), drowsy (41%), unresponsive (57%).(ABSTRACT TRUNCATED AT 250 WORDS)
-
We review current knowledge on the rectal, buccal, and sublingual routes of narcotic administration as potential alternatives to oral, intramuscular, intravenous, and subcutaneous administrations of narcotics for the management of cancer pain. Most of the experience reported in the literature is based on the use of rectal, sublingual, and buccal narcotics for the management of acute pain syndromes. Preliminary evidence suggests that both morphine sulfate and chlorhydrate can be administered rectally because there is acceptable absorption with this route even if considerable interpersonal variation exists. ⋯ There are very few reports on the clinical effects of sublingual and buccal morphine, and pharmacokinetic data are often debatable. There is evidence to justify further research into all three routes of narcotic administration. At the moment rectal use is justified in clinical trials in cancer patients, but there are not enough data on the pharmacokinetics of different narcotics when administered by the buccal or sublingual routes.