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https://www.readbyqxmd.com/read/28335763/identification-of-drug-combinations-administered-by-continuous-subcutaneous-infusion-that-require-analysis-for-compatibility-and-stability
#1
Andrew Dickman, Matthew Bickerstaff, Richard Jackson, Jennifer Schneider, Stephen Mason, John Ellershaw
BACKGROUND: A continuous subcutaneous infusion (CSCI) delivered via syringe pump is a method of drug administration used to maintain symptom control when a patient is no longer able to tolerate oral medication. Several classes of drugs, such as opioids, antiemetics, anticholinergics, antipsychotics and benzodiazepines are routinely administered by CSCI alone or in combinations. Previous studies attempting to identify the most-common CSCI combinations are now several years old and no longer reflect current clinical practice...
March 23, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28333571/screening-and-assessment-of-substance-use-in-hospice-care-examining-content-from-a-national-sample-of-psychosocial-assessments
#2
Paul Sacco, John G Cagle, Melissa L Moreland, Elizabeth A S Camlin
BACKGROUND: Quality of care provided by hospice and palliative care agencies depends on a thorough understanding of the patient, the family, their history, and current risk factors. It is therefore imperative for social workers and other providers in these settings to assess patients and caregivers for substance use disorders and potential for substance misuse. OBJECTIVE: We aimed to examine how hospice social workers in the United States screen and assess for alcohol and substance use and risk of medication diversion among patients and family caregivers...
March 23, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28249546/assessment-of-palliative-care-services-in-western-kenya
#3
Hijab Zubairi, Priyanka Tulshian, Sarah Villegas, Brett D Nelson, Kennedy Ouma, Thomas F Burke
BACKGROUND: The need for palliative care services is rapidly increasing due to the rising number of patients with non-communicable diseases. The objective of this study was to assess the current availability and barriers to palliative care and healthcare worker knowledge and perceptions on palliative pain control in western Kenya. METHODS: An evidence-based 40-question assessment tool was conducted between October 2015 and February 2016 in Siaya County, western Kenya...
January 19, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/28229834/-pain-intensity-and-time-to-death-of-cancer-patients-referred-to-palliative-care
#4
Pedro Barata, Filipa Santos, Graça Mesquita, Alice Cardoso, Maria Paula Custódio, Marta Alves, Ana Luísa Papoila, António Barbosa, Peter Lawlor
INTRODUCTION: Pain is a common symptom experienced by cancer patients, especially in those with advanced disease. Our aim was to describe pain intensity in advanced cancer patients, referred to the palliative care unit, the factors underlying moderate to severe pain and its prognostic values. MATERIAL AND METHODS: This was a prospective observational study. All patients with mestastatic solid tumors and with no specific oncologic treatment were included. Pain intensity was accessed using the pain scale from Edmonton Symptom Assessment Scale, rated from 0 to 10 on a numerical scale, where zero = no pain and 10 = worst possible pain...
November 2016: Acta Médica Portuguesa
https://www.readbyqxmd.com/read/28226414/methylene-blue-for-the-treatment-of-intractable-pain-associated-with-oral-mucositis
#5
Carlos J Roldan, Kent Nouri, Thomas Chai, Billy Huh
Oral mucositis is a common and often debilitating complication among cancer patients receiving radiation therapy to the head and neck or chemotherapy agents, or undergoing hematopoietic stem cell transplantation. Pain and decreased oral function associated with oral mucositis may persist long after the conclusion of therapy. Although most patients respond to conservative management, a subset of patients develop intractable pain with severe consequences. For some, the use of total parenteral nutrition with insertion of percutaneous endoscopic gastrostomy feeding tubes is the only alternative...
February 22, 2017: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/28216871/role-of-ketamine-and-methadone-as-adjunctive-therapy-in-complex-pain-management-a-case-report-and-literature-review
#6
Wasek Faisal, Judith Jacques
Assessment and management of complex cancer pain always remains a major challenge for any palliative care team, given its heterogeneity of underlying pathophysiology and limitations of any pharmacotherapy. Here, we present a case of complex pain management in a young patient with a life-limiting illness, highlighting the issues of organic and nonorganic contributors of pain and provide some insight into the role of ketamine and methadone as adjunctive therapy to opioid analgesics. A brief literature review is also done to provide the context of use of these adjunctive drugs in this setting...
January 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/28210861/the-effects-of-alcoholism-and-smoking-on-advanced-cancer-patients-admitted-to-an-acute-supportive-palliative-care-unit
#7
Sebastiano Mercadante, Claudio Adile, Patrizia Ferrera, Alessandra Casuccio
AIM: The aim of this prospective study was to determine the characteristics and symptom burden of advanced cancer patients with alcoholism problems and smoking, who were referred to an acute palliative/supportive care unit (ASPCU) of a comprehensive cancer center. METHODS: Patients' characteristics, indications for admission, kind of admission, awareness of prognosis, and anticancer treatments were recorded. The Edmonton Symptom Assessment Scale (ESAS) was used to assess physical and psychological symptoms, and the CAGE questionnaire for the diagnosis of alcoholism...
February 16, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28186850/the-use-of-dexmedetomidine-in-pediatric-palliative-care-a-preliminary-study
#8
Jamie Burns, Kevin Jackson, Kathy A Sheehy, Julia C Finkel, Zenaide M Quezado
OBJECTIVE: To evaluate the effect of dexmedetomidine infusions in patients with advanced malignancies, advanced heart disease, or after stem cell transplantation (SCT), who during end-of-life care had pain and/or agitation unresponsive to conventional therapies. BACKGROUND: Pediatric patients with intractable advanced malignancies, end-stage congenital heart diseases, or after SCT can suffer a great deal during end of life. Pain, drowsiness, fatigue, irritability, and worrying are experienced frequently, considered distressing, and are strongly associated with reductions in health-related quality-of-life scores...
February 10, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28186837/methadone-and-corrected-qt-prolongation-in-pain-and-palliative-care-patients-a-case-control-study
#9
Katherine M Juba, Tina M Khadem, David J Hutchinson, Jack E Brown
BACKGROUND: Methadone (ME) is commonly used in pain and palliative care (PPC) patients with refractory pain or intolerable opioid adverse effects (AEs). A unique ME AE is its corrected QT (QTc) interval prolongation risk, but most evidence exists in methadone maintenance therapy patients. OBJECTIVE: Our goal was to identify QTc interval prolongation risk factors in PPC patients receiving ME and other medications known to prolong the QTc interval and develop a risk stratification tool...
February 10, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28181371/comparative-economic-evaluation-of-home-based-and-hospital-based-palliative-care-for-terminal-cancer-patients
#10
Koki Kato, Haruhisa Fukuda
AIM: To quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients. METHODS: We carried out a case-control study of home-care patients (cases) who had died at home between January 2009 and December 2013, and hospital-care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records...
February 8, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28167655/improving-community-access-to-terminal-phase-medicines-through-the-implementation-of-a-core-medicines-list-in-south-australian-community-pharmacies
#11
Paul Tait, Chris Horwood, Paul Hakendorf, Timothy To
OBJECTIVES: Difficulties accessing medicines in the terminal phase hamper the ability of patients to die at home. The aim of this study was to identify changes in community access to medicines for managing symptoms in the terminal phase throughout South Australia (SA), following the development of a 'Core Medicines List' (the List) while exploring factors predictive of pharmacies carrying a broad range of useful medicines. METHODS: In 2015, SA community pharmacies were invited to participate in a repeat survey exploring the availability of specific medicines...
February 6, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28161787/characteristics-of-advanced-cancer-patients-who-were-readmitted-to-an-acute-palliative-supportive-care-unit
#12
Sebastiano Mercadante, Claudio Adile, Patrizia Ferrera, Alessandra Casuccio
OBJECTIVES: The aim of this study was to assess the characteristics of patients readmitted to an acute supportive/palliative care unit (ASPCU), the reasons for readmission, and the outcome after receiving specialistic assessment and treatment. METHODS: A consecutive sample of patients was assessed for a period of 10 months. Epidemiological characteristics, including age, gender, Karnofsky level, diagnosis, caregivers, education, disease awareness, kind of admission, and anticancer treatment in the previous 30 days, were recorded, as well as hospital stay, death, and discharge at home...
February 4, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28160235/characteristics-of-patients-with-an-unplanned-admission-to-an-acute-palliative-care-unit
#13
Sebastiano Mercadante, Claudio Adile, Patrizia Ferrera, Alessandra Casuccio
The aim of this cohort study is to compare the symptom burden of patients who have an unplanned admission to an acute palliative care unit (APCU) with patients who have a regular planned admission. A consecutive sample of advanced cancer patients who were admitted to an APCU was prospectively assessed. The reasons and the kind of admission were recorded (unplanned, UP, or planned, P). Anticancer treatments, whether patients were on/off treatment or uncertain, previous care setting, and who referred the patient to the unit were also recorded...
February 3, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28156677/insurer-pre-authorization-and-copayment-for-palliative-patients-with-cancer-receiving-opioids-other-than-morphine
#14
Akhila Sunkepally Reddy, Eden Mae Rodriguez, Eduardo Bruera
217 Background: Uncontrolled pain is one of the main fears for patients with cancer and their families. Opioid analgesics are highly effective agents, but the choice of type, route, and dose needs to be personalized. The highly cost of some of them can make it difficult for patients to received adequate pain control without appropriate insurance coverage. There is a lack of information regarding the frequency of denials or heavy copayments by insurers. METHODS: We evaluated 143 continuous opioid test claims for prescriptions by our palliative care providers for opioids other than morphine, including transdermal fentanyl, extended release oxycodone, hydromorphone and oxymorphone...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156665/efficacy-and-safety-of-methadone-in-the-treatment-of-pain-in-palliative-care-patients-with-cancer-the-equimeth2-national-randomized-open-phase-iii-study
#15
Marie Pierre Berleur, Shimsi Lefki, Daniele Lefebvre Kunt, Eric Serra, Gisele Chvetzoff, Alain Derniaux, Flora Tremellat, Marilène Filbet, Anna Simon, Bich Dang Vu, Cyril Guillaume
212 Background: Methadone is used more and more as a second-line treatment for refractory cancer pain in palliative care patients. METHODS: The study aimed to compare the effect of two methadone titration methods (Stop and Go vs progressive titration) in 146 palliative care cancer patients with pain inadequately relieved or intolerant to level 3 opioids. The primary endpoint was the rate of success/failure at Day 4 defined by pain relief (reduction of at least two points of the numerical scale (0 - 10) AND a pain score < 5 for 2 consecutive days) AND no overdose (Rudkin scale ≥ 3 AND respiratory rate < 8/min)...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156658/changes-in-opioid-type-and-dose-among-cancer-patients-referred-to-outpatient-palliative-care
#16
Joseph Baidoo, Yee Choon Meng, Donna S Zhukovsky, Kimberson Cochien Tanco, Holly A Stewart, Tonya Edwards, Manju P Joy, Leela Kuriakose, Zhanni Lu, Diane D Liu, Janet L Williams, Eduardo Bruera
106 Background: Opioid prescriptions are regulated at both federal and state levels. Examples of such regulations include use of risk evaluation and mitigation strategies (REMS), mandatory sharing of prescription data with state prescription drug monitoring programs and the reclassification of hydrocodone as schedule II opioid in October 2014. One possible consequence of such changes would be earlier referral to palliative care (PC) for opioid management. Alternatively, primary oncologist may treat patients with weak opioids or use strong opioids with lower daily dose...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156624/a-study-of-discrepancy-between-laboratory-calculated-and-weight-based-glomerular-filtration-rate-gfr-as-a-marker-of-renal-function-in-a-palliative-care-population
#17
Miriam Colleran
58 Background: Renal function is important in a palliative care population and can impact on frequently-used medications including chemotherapeutic agents, opioids, non-steroidal anti-inflammatory drugs and neuropathic agents. In local practice, estimated glomerular filtration rate (eGFR), calculated on a presumed weight of 70kg, is displayed in laboratory results. However, the weight of palliative patients varies considerably, for example, due to cancer cachexia or malabsorption and a considerable population weigh less than 70kg...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156584/survivor-pain-experience-at-an-oncology-palliative-care-clinic
#18
Lisa Emond, Ann Wojtaszczyk
260 Background: As of January 2014 there are an estimated 14.5 million cancer survivors in the United States. In observational studies of cancer survivors up to 40% report chronic pain. Opioids remain an important and effective treatment for active cancer pain. For survivors, however, we must take into account the paucity of data supporting long term benefits of opioids on pain and functional outcomes, and extensive evidence of potential harms. We present data from our palliative care clinic where we have established a nuanced approach to pain management in this population, which includes risk mitigation, consistent education, emphasis on non-pharmacological and non-opiate medications, and attempts to down-taper opioid analgesics when feasible...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156580/characteristics-of-patients-with-unscheduled-versus-scheduled-visits-to-outpatient-supportive-care-center-scc-at-a-comprehensive-cancer-center
#19
Ahsan Azhar, Maria Agustina Cerana, Vishidha Reddy Balankari, Madhuri Adabala, Diane D Liu, Janet L Williams, Eduardo Bruera
144 Background: There is limited literature regarding outpatient palliative care, and even more limited literature describing factors associated with unscheduled visits. Our aim was to identify clinical characteristics of patients who walk-in (present unscheduled) to the outpatient SCC with the hypothesize that the patients who present for unscheduled visits have more severe symptom distress as compared to those patients who present for scheduled appointments. METHODS: We compared 183 patients with unscheduled consults (CO) vs a random sample of 361 patients with scheduled CO and 159 patients with unscheduled follow-up (FU) visits vs a random sample of 318 patients with scheduled FU visits...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156579/snapshot-of-an-outpatient-supportive-care-center-at-a-comprehensive-cancer-center
#20
Maxine Grace De la Cruz, Angelique Wong, Debra Castro, Eduardo Bruera
145 Background: Integration of Palliative Care (PC) in oncology has been found to improve symptom distress, quality of life and survival in patients with advanced cancer. Early integration is most appropriate in the outpatient (OP) setting. However, most PC services in the U.S. do not have an OP component. Our study aims to provide a snapshot of the type of patients that are referred to this novel setting for the delivery of early PC. METHODS: We reviewed a day in the SCC to illustrate the structure and process involved in the delivery of outpatient PC...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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