Journal of pain and symptom management
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J Pain Symptom Manage · Dec 2016
Randomized Controlled Trial Multicenter Study Comparative StudyComparison of the tolerability profile of controlled release oral morphine and oxycodone for cancer pain treatment. An open label randomized controlled trial.
Oxycodone and morphine are recommended as first-choice opioids for moderate/severe cancer pain, but evidence about their relative tolerability has significant methodological limitations. ⋯ This trial failed to show any difference in tolerability and analgesic efficacy of morphine and oxycodone as first-line treatment for moderate/severe cancer pain but results interpretation is difficult due to lack of power, potential bias from open-label design, and concerns about assay sensitivity. These data, however, can significantly contribute to future meta-analyses comparing WHO Step-III opioids and are relevant in designing future randomized studies.
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J Pain Symptom Manage · Dec 2016
Patient-reported symptom interference as a measure of postsurgery functional recovery in lung cancer.
Few empirical studies have combined the patient's perspective (patient-reported outcomes [PROs]) with clinical outcomes (risk for complications, length of hospital stay, return to planned treatment) to assess the effectiveness of treatment after thoracic surgery for early-stage non-small cell lung cancer (NSCLC). ⋯ Repeated measurement of MDASI interference characterized functional recovery after thoracic surgery for NSCLC and was sensitive to VATS' ability to enhance postoperative recovery. Further study of the clinical applicability of measuring recovery outcomes using PRO-based functional assessment is warranted.
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J Pain Symptom Manage · Dec 2016
ReviewSomatostatin analogues compared to placebo and other pharmacological agents in the management of symptoms of inoperable malignant bowel obstruction: a systematic review.
Somatostatin analogues are commonly used to relieve symptoms in malignant bowel obstruction (MBO) but are more expensive than other antisecretory agents. ⋯ There is low-level evidence of benefit with somatostatin analogues in the symptomatic treatment of MBO. However, high-level evidence from trials with low risk of bias found no benefit of somatostatin analogues for their primary outcome. There is debate regarding the clinically relevant study end point for symptom control in MBO and when it should be measured. The role of somatostatin analogues in this clinical situation requires further adequately powered, well-designed trials with agreed clinically important end points and measures.
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J Pain Symptom Manage · Dec 2016
Continuous home care reduces hospice disenrollment and hospitalization after hospice enrollment.
Among the four levels of hospice care, continuous home care (CHC) is the most expensive care, and infrequently provided in practice. ⋯ Although a minority of patients uses CHC, such services may be protective against hospice disenrollment and hospitalization after hospice enrollment.
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J Pain Symptom Manage · Dec 2016
Palliative Care Consultations in Nursing Homes and End-of-Life Hospitalizations.
Although specialty palliative care in hospital and outpatient settings is associated with lower acute care use, its impact in U.S. nursing homes (NHs) is unknown. ⋯ The introduction of specialty palliative care consults in NHs is associated with overall reductions in end-of-life hospitalizations.