Frequency of suicide by cancer patients at the National Cancer Institute of Milan over 1986-90.
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Carcinoma↗
Biomedical subjects
F De Conno
Publications and source records attributed to F De Conno.
The management of inoperable gastrointestinal obstruction in terminal cancer patients.
The aim of the study was to assess vomit and pain control in terminal cancer patients with inoperable gastrointestinal obstruction, using a pharmacologic symptomatic treatment which prevents recourse to nasogastric tube placement and intravenous hydration, in hospital and home care settings. Twenty-two symptomatic patients, who were judged as inoperable, were treated with a pharmacologic association of morphine hydrochloride and scopolamine butylbromide as analgesics and haloperidol as an antiemetic. The drugs were administered by continuous subcutaneous infusion via a syringe driver or intravenously only when a central venous catheter had been inserted previously. Daily recordings included assessment of pain, number of vomiting episodes, dry mouth, drowsiness, and thirst sensation. Data were examined before starting the treatment (T0), 2 days after (T2) and 2 days before death (T-2). They showed that there was a significant decrease in the pain score (p less than 0.001) on T2 and a further decrease on T-2 (p less than 0.05). Vomiting was controlled in all patients, with the exception of three patients with upper abdomen obstruction who required nasogastric tube placement. Dry mouth showed an upward trend throughout the observation period (p less than 0.05) but was successfully treated by administering liquids by mouth or ice-cubes to suck. Drowsiness too presented an upward trend from T0 to T-2 (p less than 0.001). Only one patient out of 16 who reported to be thirsty required intravenous hydration. We believe that in terminal cancer patients, vomit and pain resulting from inoperable intestinal obstruction, with the exception of obstruction of the upper abdomen, can be controlled through administration of analgesic and antiemetic drugs, in the hospital and at home, without recourse to nasogastric tube placement or intravenous hydration.
Abdominal Neoplasms↗
Unendurable symptoms as prognostic indicators of impending death in terminal cancer patients.
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Dyspnea↗
Quality-of-life assessment during a palliative care programme.
By means of a cross-sectional study, 115 terminal cancer patients (53 males, 62 females) who were no longer responsive to anticancer treatment, were investigated. The sample included all patients who had been undergoing palliative care (PC) during a single week (at the out-patient clinic, in hospital or at home). From the start of PC, the quality of the patients' lives was assessed by a weekly self-descriptive record comprising 32 items at four levels of intensity. The responses given on the questionnaire during the sample week were compared to those given by the same patients at the beginning of PC (T0). From T0 to time during treatment, figures show a significant increase in the percentage of patients who reported drowsiness, and a significant decrease in pain, weakness, functional impairment and psychological distress. The global judgment of not feeling well was reduced from 49% of the patients at TO to 31% during the period of treatment (p less than 0.01). This result shows that, although the disease progressively develops, PC can enhance the quality of the lives of patients during the terminal stages of illness. The subjective judgment of not feeling well was much more closely correlated with physical, functional and psychological symptoms. Of the physical symptoms, pain has the closest correlation with feeling bad. However, pain has a low number of statistically significant correlations with respect to the other items, in marked contrast to the high number of correlations regarding psychological and functional items.(ABSTRACT TRUNCATED AT 250 WORDS)
Cross-Sectional Studies↗
Pain treatment in cancer of the pancreas.
Pancreatic cancer remains an important cause of suffering among oncologic patients. Due to the current poor response to specific therapies, a palliative approach represents the main treatment for this kind of tumour. The authors present the results of a prospective study performed on 41 patients treated according to the World Health Organization guidelines for cancer pain relief; 21 of them were treated by neurolytic coeliac blockade as well. Results, even if not comparable between the two groups, show that this neurolytic technique can play an important role in palliative treatment, on condition that it is part of a multimodal continuing care system.
Adult↗
Symptom prevalence and control during cancer patients' last days of life.
The lack of control of physical suffering among cancer patients in the last days or hours of life is a common medical problem but it is rarely discussed in an open fashion. We carried out a prospective study of the dying of 120 terminal cancer patients assisted by a home care team. We documented how long it was before death that physical symptoms, unendurable to the patient and controlled only by sedation-inducing sleep, appeared. In 63 patients (52.5%), unendurable symptoms due to tumor progression or irreversible acute organic phenomena appeared, on average two days before death. Of the 63 patients, 47 had only one uncontrollable symptom, 15 had two symptoms and one patient had three symptoms. The most common symptoms included dyspnea (33 patients), pain (31), delirium (11), and vomiting (5). The most frequent symptoms were dyspnea in lung and head and neck disease; pain in breast, gastrointestinal tract, colon-rectum, and male genitourinary tract cancer; and vomiting in female genitourinary tract malignancies. Data reported emphasize the clinical relevance of physical symptoms in the last days of life in terminal cancer patients and how these serve to indicate imminent death. More than 50% of these patients die with physical suffering that is controllable only by means of sedation.
Adult↗
Control of dyspnea in advanced cancer patients.
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Chlorpromazine↗
Sodium naproxen versus sodium diclofenac in cancer pain control.
In a single-blind random study, simultaneously carried out by five Pain Therapy and Palliative Care Centres, the analgesic power and side-effects of sodium naproxen (CAS 26159-34-2) and sodium diclofenac (CAS 15307-86-5) by mouth were compared in a group of 100 advanced cancer patients. The patients complained of somatic and/or visceral pain and were treated with non-steroid anti-inflammatories as required. The dose administered amounted to 550 mg every 12 h for sodium naproxen and to 100 mg every 12 h for sodium diclofenac. The study stressed the similar analgesic effect of the two drugs--pain intensity and duration decreased by half in the first week of treatment--and a comparatively low morbidity rate.
Aged↗
Comparison of home and hospital care of advanced cancer patients.
Treatment and care of terminal cancer patients are conducted in different ways, according to the cultural, social, political and economical situations of the countries which have progressively adopted and developed them. In Italy there are no specialized structures such as "hospices" or the "palliative care units" like in the Anglo-Saxon world: the care of terminal cancer patients is carried out either in a general hospital or at their own home. In Milan and elsewhere there are home care teams in which doctors, nurses, social workers and volunteers, all work in connection with hospital structures. In this way, patients can receive specialized care for physical, psychological and social problems at home too. To evaluate costs and effectiveness of this program, a comparison was made between the home care and the conventional treatment carried out in general hospitals. Two groups of thirty terminal cancer patients have been studied: the first group was composed of hospital patients in Desio and the second one included patients cared for by the home care service organized by the Floriani Foundation and the Italian League against Cancer (Milan Section). We evaluated intensity and duration of pain, hours of sleep and hours of standing, sitting and lying, presence of side-effects, performance status and therapies. Data were also collected on the quality of life (Spitzer QLI), social and economical needs of the patients, type and quality of care, degree of awareness of the diagnosis by the patient and the family. This data were collected by the nurse who looked after the patient. Care costs were also quantified. The comparison between the two groups significantly favours the home care group as shown by the performance status after 2 weeks of care, the "health scale" and the Total index of the Spitzer QLI and in general the greater satisfaction of the care received. Home care produces results equivalent to those achieved in hospitals as far as clinical parameters are concerned. An approximate quantification of the costs shows that an average cost for a day's home care was about Lit. 52,500 as compared with Lit. 360,000 for a day's hospitalization.
Activities of Daily Living↗
Clinical observations on controlled-release morphine in cancer pain.
The authors report the data from two studies on the use of controlled-release morphine sulphate tablets for cancer pain relief. This preparation allows just two administrations per day, in comparison with immediate release oral aqueous morphine solution. The first study, a randomized trial carried out on 70 patients suffering from advanced cancer pain, evaluated the analgesic efficacy and side effects of this drug. The second, an open study of 113 patients, assessed analgesic efficacy, incidence of side effects, and the effects of age on dose. The analgesia provided by controlled-release morphine administration proved to be superimposable to those of the oral aqueous morphine solution. Moreover, the use of controlled-release morphine was associated with a statistically significant reduction of some side effects. Ninety-one percent of patients needed controlled-release morphine every 12 hr, while 9% required it every 8 hr.
Adolescent↗
Issues in symptom control. Part 4. Oral complications in patients with advanced cancer.
Disturbances caused by lesions of the oral cavity play an important part in the alteration of the quality of life of cancer patients. The main complications affecting the oral cavity are infections (fungal, viral, bacterial), neutropenic ulcers, drug-induced stomatitis, dry mouth, and taste alteration. Most of the information available about these entities has been acquired in the cancer patient without advanced disease. The little knowledge about the epidemiology and physiopathology of such lesions in the advanced phase of cancer is presented, and approaches to management are suggested.
Humans↗
Oral complications in patients with advanced cancer.
Disturbances caused by lesions of the oral cavity play an important part in the alteration of the quality of life of cancer patients. The main complications affecting the oral cavity are infections (fungal, viral, bacterial), neutropenic ulcers, drug-induced stomatitis, dry mouth, and taste alteration. Most of the information available about these entities has been acquired in the cancer patient without advanced disease. The little known about the epidemiology and physiopathology of such lesions in the advanced phase of cancer is presented and approaches to management are suggested.
Humans↗
Treatment of postoperative pain: comparison between administration at fixed hours and 'on demand' with intramuscular analgesics.
From the data in the literature it can be seen that 40% of the surgical population has insufficient postoperative analgesia. Many reasons have been given for this: pain control delegated to the doctor on duty and/or the nursing staff; administration of drugs 'on demand', if the patient asks for them, or the nurses feel it to be necessary; fear of causing side effects such as respiratory insufficiency; or provoking addiction by giving narcotics. The aim of this paper is to evaluate the intensity of pain, the side effects, the degree of activity, anxiety, feeling of weakness and the mood of patients surgically treated for oncological diseases of the thorax and upper abdomen, comparing two different antalgic approaches. Thirty-five patients were studied. Pain was treated on demand with a narcotic, or an anti-inflammatory drug, or not treated at all; 20 patients were treated with analgesics given at predetermined hours, following the regime: methadone 10 mg intramuscularly (i.m.) every 12 h from the first to the third day following surgery and sodium diclofenac 75 mg (i.m.) every 12 h from the fourth to the seventh day. Results showed that patients treated with analgesics given intramuscularly at fixed hours have a significantly better pain control during the whole week of treatment (P less than 0.001), on average sleep more (P less than 0.001), spend more time standing or sitting and fewer hours lying down (P less than 0.001), have a higher performance status and feel less weak (P less than 0.05) than the group of patients treated with drugs 'on demand', or not treated at all.
Abdominal Neoplasms↗
Trazodone for deafferentation pain. Comparison with amitriptyline.
We report a clinical multicentre experience with antidepressant agents (trazodone and amitriptyline) in the treatment of chronic pain due to deafferentation. Forty five patients were admitted to the study; most of them with oncological peripheral nerve lesions. Almost all of them were already being treated with NSAID in association with weak or strong opioids. A random double blind study was performed: 23 patients were treated with trazodone, 22 with amitriptyline. In the assessment of results, pain intensity, hours of sleep, hours standing and lying, side effects, mood, anxiety and weakness were all taken into consideration. The therapeutic analgesic efficacy of the two drugs proved to be similar.
Adult↗
[Buprenorphine in cancer pain: cross comparison with pentazocine].
In a randomized cross-study analgesic activity and side effects of two narcotics, buprenorphine and pentazocine, administered orally in 91 advanced cancer patients whose pain intensity varied from moderate to severe, have been compared. The number of hours of sleep and hours standing after administration of both the drugs were also assessed and in 16 patients life activity was taken into consideration. The analysis of data showed: a better pain control with buprenorphine, than with pentazocine, with a statistically significant difference of P less than 0.001; an increase in the number of hours of sleep with buprenorphine, in comparison with pentazocine, with P less than 0.001; an increase in the number of hours standing with buprenorphine, in comparison with pentazocine; as for side effects, many more patients had to stop treatment with pentazocine than with buprenorphine.
Administration, Oral↗
Antidepressants increase bioavailability of morphine in cancer patients.
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Aged↗
A validation study of the WHO method for cancer pain relief.
The method for cancer pain relief proposed by the World Health Organization (WHO) consists of guidelines for a three-step treatment, from non-opioids to weak and then strong opioids, according to need. Adjuvant drugs can be added to each step. This report presents the 2-year experience of the WHO Collaborating Centre at the National Cancer Institute of Milan in the use of this method. This retrospective study shows that a correct use of the analgesic ladder can reduce pain to a third of its initial intensity. The use of non-opioids had an average duration of 19.2 days; in 52% of the cases treatment was discontinued due to inefficacy and in 42%, to side effects. Weak opioids were administered on an average for 28.0 days. A shift to Strong opioids was made in 92% of the cases due to inefficacy and in 8% because of side effects. Treatment with strong opioids lasted for an average of 46.6 days and can be considered the mainstay of cancer pain therapy. Performance status was not altered considerably during the study and hours of sleep were doubled. The analgesic ladder proved efficacious in 71% of the cases. Neurolytic procedures had to be used in 29%. The authors conclude that analgesics, as proposed by WHO, are the most suitable treatment arm in controlling pain in palliative treatment for advanced cancer patients. Lack of availability or underuse of opioids constitute the real obstacle to the application of this method.
Aged↗
Antidepressants for cancer pain and other painful syndromes with deafferentation component: comparison of amitriptyline and trazodone.
The Authors report a clinical multicentre experience with antidepressant agents (trazodone and amitriptyline) in the treatment of chronic cancer pain with deafferentation component. Forty-five patients were admitted to the study: 27 with oncological peripheral nerve lesions, 6 with post herpetic neuralgias, 10 with not oncological nerve lesions, 2 with central nervous lesions. Almost all of them were already being treated with NSAID associated with weak or strong opioids. A random double blind study was performed: 23 patients were treated with trazodone, 22 with amitriptyline. In the assessment of results, pain intensity, hours of sleep, hours standing and lying, side effects, mood, anxiety, weakness were all taken into consideration. The therapeutic analgesic efficacy of the two drugs proved to be similar.
Adult↗