Gan to kagaku ryoho. Cancer & chemotherapy
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Gan To Kagaku Ryoho · Dec 2009
[Usefulness of epidural catheter with distal subcutaneous reservoir for cancer pain control].
When an effective pain relief cannot be achieved by systemic administration of analgesics, neuraxial opioid therapy such as epidural (EPI) and subarachnoid (SA) catheters should be offered. During the period of 2004 to 2008, EPI (117 patients) and SA (1 patients) with an epidural catheter with subcutaneous reservoir also showed a significant improvement in their pain level calculated by numerical rating scale (NRS). ⋯ Long-term catheter trouble occurred in 15 patients (12.8%) which was considered to be the catheter obstruction caused by epidural fibrosis. It is necessary to establish the common guidelines between hospital doctors and general practitioners to prevent the incidence of the catheter troubles and infections.
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Gan To Kagaku Ryoho · Dec 2009
[The outpatient palliative care conference for the home palliative care shift (the second report)--the conference was used to look back on the case where the patient's QOL was kept and improved].
The patient was a 30-year-old woman with right tongue cancer and SCC (T4N2bM0). After it had relapsed, the outpatient palliative care conference intervened. The purpose of intervention was as follows: pain control, nutrition management, home recuperation support, and relief of a spiritual pain. ⋯ By offering necessary home care supports, the patient and family fully demonstrated their potentials what they could do to recuperate and resulted in a long home stay. It was thought that our relationship with the patient and family appeared to have enhanced their self-resistance feelings against the disease. Consequently, we contributed the improvement of QOL.
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From July 1 in 2003 through December 31 in 2008, 150 terminal lung cancer patients were provided home hospice care by us and died at home, whereas the following clinical characteristics along with the practical care we provided were examined by comparing with 432 non-lung cancer patients who died at home during that period. The frequency of home death (lung cancer/control group, 96.8/96.2%) and the duration of caring at home (48.7/54.6 days) did not show a significant difference. Significant differences were observed in suffering of breathing (62.7/31.5%), use of the opioids (96.0/ 87.5%), slow releasing oral morphine (32.7/18.1%), morphine suppository (73.3/56.5%), morphine injected subcutaneously (37.3/25.7%), slow releasing oral oxycodone (61.3/37.3%), and fentanyl (20.0/46.1%). These findings led us to conclude: (1) the main symptom, in case of the terminal lung cancer patients, was to control a difficulty in breathing, (2) the appropriate opioids were morphine and oxycodone in palliation of respiratory difficulties, (3) fentanyl was inappropriate for palliation of respiratory difficulties.
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Pain relief is a quite important subject for maintaining the home medical care of patients with terminal cancer. Therefore, the opioid rotation should be made in conjunction with an individual medical condition, which is of growing importance in a proper pain management. ⋯ The most important thing in the opioid rotation at home is to perform a rotation before exacerbation of pain becomes apparent. For this purpose, morphine hydrochloride injection is thought to be the best dosage form because it has advantages of: (1) quickness in varying the amount, (2) immediate rescue efficacy, and (3) usefulness in case of ingestion.