Cancer
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Some patients with cancer pain may develop uncontrolled adverse effects, including generalized myoclonus, delirium, nausea and emesis, or severe sedation before achieving adequate analgesia during opioid dose titration. Sequential therapeutic trials should be considered to determine the most favorable drug. ⋯ When pain is relieved inadequately by opioid analgesics given in a dose that causes intolerable side effects despite routine measures to control them, treatment with the same opioid by an alternative route or with an alternative opioid administered by the same route should be considered. Opioid rotation may be useful in opening the therapeutic window and for establishing a more advantageous analgesia/toxicity relationship. By substituting opioids and using lower doses than expected according to the equivalency conversion tables, it is possible in the majority of cases to reduce or relieve the symptoms of opioid toxicity in those patients who were highly tolerant to previous opioids while improving analgesia and, as a consequence, the opioid responsiveness.
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Review Comparative Study
Adjuvant therapy for gastric carcinoma patients in the past 15 years: a review of western and oriental trials.
The early detection of gastric carcinoma is neither feasible nor practiced around the world, except on a limited basis in Japan. Thus, because gastric carcinoma is detected later in most patients throughout the world, those who undergo curative resection still remain at high risk for relapse. Adjuvant therapy therefore has a potentially important place in the treatment of these patients. It has been extensively investigated in the Orient, North America, and Europe. The authors reviewed the results of these trials to determine the current status of adjuvant therapy. ⋯ Postoperative chemotherapy as an adjuvant to potentially curative resection of gastric carcinoma remains investigational despite more than 30 years of investigation in the West. Newer therapeutic combinations or strategies (preoperative chemotherapy or chemoradiotherapy) have the potential to benefit the high risk patients.