Oncology
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Ovarian suppression has been used to treat hormone-responsive metastatic breast cancer in premenopausal women for over 100 years and is currently under continued evaluation for treatment in the adjuvant setting. In this article, ovarian suppression by surgery, radiation, and pharmacological therapy is discussed, including the risks, benefits, and efficacy of each strategy. The role of ovarian suppression in premenopausal women with early and advanced stages of breast cancer will be reviewed. It is hoped that this review will assist clinicians and their patients in selecting the appropriate therapy if ovarian suppression is indicated.
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The femur bone cancer pain model was developed by implanting mouse osteolytic tumor cells (NCTC 2472) into the intramedulla of the femur in C3H/HeN mice. In vivo imaging analysis revealed that the implanted tumor cells grew progressively over 14 days. Associated with the tumor growth, guarding behavior, which was an indication of ongoing pain, time-dependently increased. ⋯ Moreover, oxycodone (5-20 mg/kg, s.c.) dose-dependently reversed allodynia without affecting the sham-treated mice. Morphine (50 mg/kg, s.c.) and fentanyl (0.075-0.2 mg/kg, s.c.) also reversed allodynia, but morphine (50 mg/kg, s.c.) tended to affect and fentanyl (0.1 and 0.2 mg/kg, s.c.) affected the withdrawal threshold in sham-treated mice. These results suggested that oxycodone relieved not only ongoing pain, but also ambulatory and neuropathic pain, and that the analgesic profile of oxycodone could be different from that of either morphine or fentanyl.
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Within Malaysia's otherwise highly accessible public healthcare system, palliative medicine is still an underdeveloped discipline. Government surveys have shown that opioid consumption in Malaysia is dramatically lower than the global average, indicating a failure to meet the need for adequate pain control in terminally ill patients. Indeed, based on daily defined doses, only 24% of patients suffering from cancer pain receive regular opioid analgesia. ⋯ Additional barriers include the fact that no training in palliative care is given to medical students, and that smaller clinics often lack facilities to prepare and stock cheap oral morphine. A number of initiatives aim to improve the situation, including the establishment of palliative care departments in hospitals and implementation of post-graduate training programmes. Campaigns to raise public awareness are expected to increase patient demand for adequate cancer pain relief as part of good care.
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Multicenter Study Controlled Clinical Trial
Postmarketing surveillance study of OxyContin tablets for relieving moderate to severe postherpetic neuralgia pain.
To evaluate the efficacy and safety of OxyContin tablets(controlled-release oxycodone hydrochloride: 5, 10, 20, and 40 mg) in relieving moderate to severe postherpetic neuralgia (PHN) pain. ⋯ Controlled-release OxyContin tablets demonstrated fast onset of PHN pain control, superior efficacy in relieving both moderate and severe PHN pain, and a good safety profile.
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In order to evaluate the potential role of oxycodone in cancer pain management, neuropathic cancer pain was selected as a model for difficult pain syndromes. A nonsystematic, yet exhaustive, review of the literature provided the relevant evidence for the discussion. Ten randomized controlled trials (RCTs) and 5 open-label studies on oxycodone and cancer pain, 3 RCTs and 1 open-label study on oxycodone and neuropathic pain, and 2 RCTs on oxycodone and visceral pain were identified and reviewed. ⋯ The intrinsic difficulties in performing RCTs in cancer pain have traditionally justified the acceptance of drugs already known to be effective in benign neuropathic pain, in spite of insufficient evidence in malignant neuropathic pain. Therefore, a case is made for the development of specific guidelines for the management of both simple and complex cases of neuropathic cancer pain. An example of one of such clinical guidelines is provided, in which the role of oxycodone is particularly relevant given the existing evidence.