Nihon rinsho. Japanese journal of clinical medicine
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'Dyspnea' is a subjective symptom defined as "an uncomfortable sensation of breathing". It should be distinguished from 'respiratory failure' defined as hypoxia. ⋯ The important points of management of dyspnea are described here; (1)Treat the underlying causes (e.g. antibiotics for pneumonia, blood transfusion for anemia), (2) pharmacological interventions such as morphine and anxiolytics, (3) non-pharmacological interventions such as oxygen, respiratory rehabilitation and relaxation. Since dyspnea in cancer patients has multidimensional aspects, interdisciplinary team approach for the symptom management is important.
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It is reported that the common psychiatric disorders among cancer patients are adjustment disorder, major depression, and delirium. Pharmacotherapy is often provided for management of these distressing symptoms. Antianxiety drugs, especially benzodiazepines, are often used for ameliorating adjustment disorder. ⋯ Because there are no significant differences of effectiveness among available antidepressants, it is recommended that selection of antidepressant should depend on its adverse event profiles. Although the principal management strategies of delirium are detection and treatment of underlying causes of delirium, concurrent pharmacotherapy as symptomatic treatment is often needed. Neuroleptics, especially haloperidol, are most widely used for management of delirium.
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Adjuvant analgesics are drugs that have primary indications other than pain but are analgesic in selected circumstances. Antidepressants, anticonvulsants, local anesthetics, and NMDA receptor antagonists are drugs used in the treatment of neuropathic cancer pain. Assessment of pain is very important in selecting appropriate adjuvant analgesics. ⋯ Another problem is that morphine is the only rescue drug available for the assessment of opioid responsiveness since morphine is the only opioid with an immediately release form among the strong opioids available in Japan which are morphine, oxycodone, and fentanyl. Adjuvant analgesics also have side effects such as constipation and sleepiness, which may augment the side effects of morphine and may impair the QOL of cancer patients with neuropathic pain. There is a need to improve the systems of development and importation of adjuvant analgesics.
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Review
[Current perspectives and future direction of palliative medicine for cancer patients in Japan].
Role of palliative medicine for cancer patients has been expanding to even in earlier stage of disease. We have various new drugs in palliation of symptoms and signs, such as severe pain due to tumor invasion, depression, nausea and vomiting, chemotherapy-induced anemia and neutropenia, etc. Recently pharmacogenomics and drug metabolism became to be focused in cancer treatment. ⋯ The Japanese Society of Palliative Medicine (JSPM) is one of the candidate of these tasks. The JSPM consists with more than 4,900 members of doctors, nurses and other health professionals who are working in palliative cancer medicine. They have conducting to make guidelines for each symptom control and to increase lobby action to establish efficient networks of palliative cancer medicine in each district of Japan within several years.