0000000000461955
AUTHOR
Amanda Caruselli
Characteristics and care pathways of advanced cancer patients in a palliative-supportive care unit and an oncological ward.
Abstract BACKGROUND: A supportive palliative care unit (SPCU) may have a positive impact on patients' care. The aim of this study was to compare the pattern of patients admitted to a specialized SPCU and to a traditional oncologic ward (OW) in a consecutive sample of advanced cancer patients. METHODS: Data on patients demographics, reasons for and kind of admission, care-giver, anticancer treatments, being on/off treatment or uncertain, origin setting, who proposed hospital admission, the use of opioids, and hospitalization were gathered. The same parameters were recorded at discharge. A follow-up was performed by phone 1 month after discharge. RESULTS: Two-hundred patients were surveyed. A…
Patients' Acceptability of Different Fentanyl Products for Breakthrough Cancer Pain
OTFC (6) 1.7 (0.5) 1.5 (0.5) 2.0 (0.6) 1.5 (0.8) 1.5 (0.5) 33.1 (43.5) FBT (19) 2.0 (0.6) 2.0 (0.7) 1.8 (0.7) 1.8 (0.8) 1.9 (0.7) 15.9 (7.3) SLF (37) 2.1 (0.5) 2.2 (0.4) 1.8 (0.4) 2.0 (0.6) 2.1 (0.5) 16.7 (12.5) INFS (7) 2.1 (0.4) 2.1 (0.4) 2.0 (0.6) 2.0 (0.8) 2.0 (0.8) 15.7 (13.7) PFEN (11) 2.4 (0.5) 2.2 (0.4) 1.8 (0.4) 1.9 (0.7) 2.1 (0.5) 15.0 (13.7) P 0.120 0.043* 0.870 0.595 0.178 0.015x *,x Oral transmucosal fentanyl was significantly considered to be more problematic.
Pain intensity as prognostic factor in cancer pain management
Aim The aim of this study was to prospectively assess the prognostic value of initial pain intensity and its duration in advanced cancer patients. Methods A prospective study was conducted in a sample of patients with cancer requiring pain control. Patients underwent standard analgesic strategies used in our palliative care units. Pain intensity was measured at admission (T0) and after successful dose titration or opioid/route switching within a week (Ts). Patients were also asked about their pain intensity reported 15 days before admission (T-15). Doses of opioids and duration of opioid use were recorded. Patients were also assessed for the presence of incident pain, neuropathic pain, alco…
The use of ketamine in a palliative-supportive care unit: a retrospective analysis.
Background: To assess the response to ketamine in patients with difficult pain syndromes. Methods: The charts of patients with uncontrolled pain despite opioid dose escalation of at least two opioids or a combination of them, selected for a burst of ketamine and midazolam were reviewed. One hundred mg/day of ketamine and midazolam 15 mg/day by a continuous intravenous infusion for about 48 hours was offered to patients. Results: Forty-four patients received a burst of ketamine. Ten patients did not achieve any improvement. Pain intensity decreased from a mean of 7.8 (SD, 1.6) to 2.8 (SD, 1.3) (P<0.0005). The outcome was considered optimal, good, and mild in 24, 9, and 1 patients, respective…
Frequency and Indications of Parenteral Nutrition in an Acute Palliative Care Unit
The aim of this study was to estimate the use of parenteral nutrition (PN) in advanced cancer patients enrolled in an acute pain relief and palliative care unit of a comprehensive cancer center and the appropriateness of the criteria to select patients for PN. Fourteen out of 750 patients (1.8%) admitted to an acute palliative care unit were administered PN. Patients were referred from various settings. The mean age was 58 yr (range 37-79), and 9 were males. The mean hospital stay was 7.7 days (range 3-14), and the mean Karnofsky level was 35 (range 10-50). The principal indication was bowel obstruction. Ten patients (71%) were already receiving PN before admission, and 2 of them discontinu…
Sleep Disturbances in Patients with Advanced Cancer in Different Palliative Care Settings.
Abstract Context Information regarding sleep disturbances in the population with advanced cancer is meager. Objectives To assess the prevalence of sleep disturbances and possible correlations with associated factors in a large number of patients with advanced cancer admitted to different palliative care settings. Methods This was an observational study performed in different settings of palliative care. A consecutive sample of patients with advanced cancer was prospectively assessed for a period of six months. Epidemiological and clinical data, treatments received in the last month, Karnofsky status, Edmonton Symptom Assessment System scores, and concomitant medical treatment were recorded.…
The frequency of alcoholism in patients with advanced cancer admitted to an acute palliative care unit and a home care program
Abstract Context Cancer patients with a history of alcoholism may be problematic. The frequency of alcoholism among patients with advanced cancer has never been reported in Italy or other European countries. Objectives The aim of this prospective study was to determine the frequency of alcoholism, assessed with a simple and validated instrument, among patients with advanced cancer who were referred to two different palliative care settings: an acute inpatient palliative care unit (PCU) of a comprehensive cancer center in a metropolitan area and a home care program (HCP) in a territorial district, localized in the mountains of Italy. Methods A consecutive sample of patients admitted to an in…
The palliative-supportive care unit in a comprehensive cancer center as crossroad for patients' oncological pathway
Aim The aim of this study was to assess how an admission to an acute palliative-supportive care unit (APSCU), may influence the therapeutic trajectory of advanced cancer patients. Methods A consecutive sample of advanced cancer patients admitted to APCU was assessed. The following parameters were collected: patients demographics, including age, gender, primary diagnosis, marital status, and educational level, performance status and reasons for and kind of admission, data about care-givers, recent anticancer treatments, being on/off treatment or uncertain, the previous care setting, who proposed the admission to APSCU. Physical and psychological symptoms were evaluated at admission and at ti…
Epidemiology and Characteristics of Episodic Breathlessness in Advanced Cancer Patients. An Observational Study
Abstract Context Episodic breathlessness is a relevant aspect in patients with advanced cancer. Objectives The aim of this study was to assess the different aspects of this clinical phenomenon. Methods A consecutive sample of patients with advanced cancer admitted to different settings for a period of six months was surveyed. The presence of background breathlessness and episodic breathlessness, their intensity (numerical scale 0–10), and drugs used for treatment were collected. Factors inducing episodic breathlessness and its influence on daily activities were investigated. Results Of 921 patients, 29.3% ( n = 269) had breathlessness and 134 patients (49.8%) were receiving drugs for backg…