Palliative medicine
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Palliative medicine · Jul 2001
Multicenter StudyTransdermal fentanyl for the management of cancer pain: a survey of 1005 patients.
Transdermal fentanyl was released in Germany in 1995. From October 1996 to February 1998 transdermal treatment was documented for 1005 patients (506 men and 499 women with a mean age of 60 years, range 20-92 years) with chronic pain in an open survey including 290 physicians from hospitals and general practitioners throughout Germany. Most patients suffered from cancer pain and only 11 patients had chronic pain from non-malignant disease. ⋯ One of these patients, as well as another patient with an episode of apnoea, had to be treated with artificial respiration for several hours, but both patients recovered without sequelae. Transdermal therapy with fentanyl was safe and efficient in this national survey. Transdermal fentanyl can be recommended for treatment of moderate to severe cancer pain and probably may even be used as a first-line drug on step 3 of the World Health Organization recommendations in selected patient groups.
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Palliative medicine · Jul 2001
Comparative StudyA comparison of the palliative care needs of patients dying from chronic respiratory diseases and lung cancer.
This paper reports on data from the Regional Study of Care for the Dying, conducted in 1990, and compares symptoms, care and service utilization for patients with chronic lung diseases (CLD) and lung cancer (LC) in the final 12 months of life. Post-bereavement structured interviews were conducted with informal carers of 449 LC patients and 87 CLD patients. The LC patients were significantly younger than those with CLD (P = 0.001) and these respondents were more likely to have been a spouse (P = 0.034). ⋯ LC patients were reported to be more likely to have known they might die (76% LC vs 62% CLD, P = 0.003) and to have been told this by a hospital doctor (30% LC vs 8% CLD, P = 0.001). Among those that knew, LC patients were told earlier prior to death than CLD patients. This study suggests that patients with CLD at the end of life have physical and psychosocial needs at least as severe as patients with lung cancer.
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Palliative medicine · Jul 2001
Letter Case ReportsGabapentin: resistant neuropathic pain and malignancy.
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Palliative medicine · Jul 2001
Clinical TrialSublingual fentanyl citrate for cancer-related breakthrough pain: a pilot study.
The effects of sublingual fentanyl citrate (SLFC) were assessed in 11 hospice inpatients with cancer-related breakthrough pain. Patients were asked to rate their pain, using a visual analogue scale, before SLFC, then after 3, 5, 10, 15, 30, 45 and 60 min. Six patients (55%) had reductions in pain scores at 10 min and nine patients (82%) at 15 min. ⋯ Seven patients (64%) said they would continue to use SLFC. Sublingual fentanyl citrate appears safe and well tolerated by these patients. Randomized placebo-controlled and dose ranging studies are required to confirm these findings.
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Palliative medicine · Jul 2001
Comparative Study Clinical TrialA study comparing hyoscine hydrobromide and glycopyrrolate in the treatment of death rattle.
This study looked at the efficacy of drug treatment in managing death rattle in a 30-bedded specialist palliative care unit. The study was conducted in two phases. In the first, patients received hyoscine hydrobromide as the antimuscarinic; glycopyrrolate was used in the second phase. ⋯ There was no statistically significant difference in improvement at 1 h, or at the last recorded score before death. A comparison of the cost of drug treatment using hyoscine or glycopyrrolate was made, and the potential reduction in cost per patient in the glycopyrrolate group was largely offset by increased expenditure on other drugs, especially diamorphine, midazolam and levomepromazine. The results of this study suggest that: (1) glycopyrrolate 0.2 mg is less effective at reducing death rattle than hyoscine hydrobromide 0.4 mg when assessed at 30 min, (2) the use of glycopyrrolate may lead to an increased need for other sedative or anti-emetic medication such as diamorphine, midazolam or levomepromazine, and (3) the cost benefit of using glycopyrrolate over hyoscine hydrobromide is a small part of the total drug budget, and may be less than anticipated due to the increased need of these other drugs.