Articles: palliative-care.
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The aim of this retrospective study was to evaluate the efficacy of 85Sr in the palliation of metastatic bone pain. 85Sr decays by electron capture with a gamma emission of 514 keV and associated x-ray emissions of 10-15 keV; physical half-life is 64 d. ⋯ Systemic radionuclide therapy using 85Sr is a feasible, effective and well-tolerated palliative treatment in patients with refractory bone pain. We attained at least the same response rate as that reported with bone-seeking beta-emitting radionuclides such as 89Sr. The patients who benefited the most from 85Sr treatment were in an early stage of metastatic disease or had prostate cancer. Our clinical findings could not be linked to either the total injected activity of 85Sr or the estimated absorbed dose delivered to metastases.
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Comparative Study
The cost effectiveness of metal oesophageal stenting in malignant disease compared with conventional therapy.
Expanding metal oesophageal stents are being used more commonly to palliate patients with inoperable oesophageal carcinoma. Many reports have so far documented their clinical effectiveness, however, their high acquisition cost has caused on-going concern when compared with the cost of conventional therapies. We reviewed 64 consecutive patients with inoperable oesophageal carcinoma, half of whom had received our conventional method of palliation using a variety of techniques including, BICAP diathermy, alcohol injection and Atkinson tube insertion. ⋯ However, once this was corrected for survival the difference in the cost of palliation on a per diem basis was reduced (metal stents = pound sterling 60 per day, conventional group = pound sterling 72 per day). The results of our study indicate that the initial high cost of metal stents is more than outweighed by resource savings elsewhere in the hospital by virtue of reduced need for re-intervention and shorter length of hospital in patient stay. Such cost savings taken in combination with the improved clinical effectiveness and low mortality related to metal stents provide significant support for introducing their use into clinical practice.
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Opioids used topically may exercise several useful clinical effects. Opioids may cause immediate local analgesia and also may work indirectly through decreasing the inflammation process. ⋯ The side effects of topical opioids were none or minimal. Possible mechanisms of topical analgesia are discussed.
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Enternal feeding is indicated in patients unable to ingest sufficient nutrients but whose gastrointestinal function is adequate for digestion and absorption. Indications in palliative care include patients with radical esophageal surgery, upper gastrointestinal tract obstruction, anorexia, and dysphagia. ⋯ A number of questions must be asked before a drug is considered for enteral administration. Firstly, is the drug in a suitable dosage form for administration? If not, can a different dosage form (or drug) be substituted or can the physical form of the original product be altered? Secondly, is the drug compatible with the enteral feed? Finally, are there any complicating factors that may affect drug absorption or clearance? This review attempts to answer these questions, provide easily understood guidelines for the successful enteral administration of medications, and discuss clinical implications for palliative care.