Biomedical subjects

Michaela Bercovitch

Publications and source records attributed to Michaela Bercovitch.

3 recordsLinked to original sources

PubMed2006

High dose controlled-release oxycodone in hospice care.

Controlled-release oxycodone (OxyContin) is commonly used for pain relief in terminal cancer. This opioid may be considered as a treatment option for patients who prefer oral pain control, but who are unwilling to take oral morphine sulphate or cannot tolerate its side effects. However, little is documented about the use of high doses of this drug in terminal cancer patients. The purpose of this study was to investigate the clinical characteristics of terminally ill hospice inpatients treated with OxyContin for pain, and to compare those patients receiving high-dose OxyContin (150 mg/day) with patients taking low and more typical doses. This retrospective chart analysis with parallel groups included records of 97 consecutive terminal cancer patients. We recorded clinical and demographic data, as well as data regarding daily doses, rescue doses and parameters associated with quality of life. The mean daily OxyContin dose was 78.6 mg per day for all patients. Only 18 (18.55%) patients were treated with high doses (mean daily dose 231.1 mg). No statistically significant correlations were found between any of the deomographic parameters and dose ranges, with the exception of patients with painful bony metastases who consumed significantly higher doses (p = 0.008). No differences were observed in sleep quality or mood as a factor of OxyContin doses. However, compared with patients receiving low-dose (OR 1.0), patients treated with moderate and high doses maintained Karnofsky scores higher than 40 points most of the time (OR = 3.77, CI 1.1-13.0 and OR 4.95, CI 0.8-29.9, respectively). Survival was not related to OxyContin doses (Log Rank test, p = 0.12; Breslow test, p = 0.37). We conclude that the use of high dose OxyContin for terminal cancer pain management is safe, efficient, and unrelated to shorter survival times. The results suggest that health care professionals may use higher OxyContin doses, when indicated, to enable better pain relief and quality end-of-life care.

Analgesics, Opioid↗

PubMed2004

Patterns of high-dose morphine use in a home-care hospice service: should we be afraid of it?

BACKGROUND: Management of cancer pain is one of the most important goals of palliative care. Relieving pain is often problematic. High doses of morphine at home may be required to relieve patients' pain, and is therefore feared. The goals of the current study were to assess the feasibility of high-dose morphine use at home, to characterize the patients, and to examine whether the use of high-dose morphine might affect their survival. METHODS: The authors retrospectively studied the medical charts of 661 outpatients, which were completed by a home-care hospice team. The authors collected data regarding demographic parameters, medical diagnosis, pain type, morphine dosage, use of rescue doses in addition to regular doses, use of coanalgesics and adjuvant treatments, and survival time as associated with morphine dosage. The authors also compared the data of patients receiving high-dose morphine with those of a group of patients receiving regular doses. RESULTS: The authors identified 435 patients (65.8%) who received morphine for pain relief. Of these, 396 patients (91%) received a dose of 5-299 mg of morphine per day), 32 patients (7.4%) received 300-599 mg of morphine per day), and 7 patients (1.6%) received very high doses (> or = 600 mg of morphine per day). Overall, 39 patients (9%) received > 299 mg per day. Morphine dosage was found to be inversely correlated (r) with age (r = -0.254; P < 0.001). Male patients required slightly higher dosages than female patients (62.5% of high-dose and 71% of very high-morphine groups, respectively). Primary gastrointestinal (P = 0.015) and lung (P = 0.027) carcinomas, as well as metastatic bone disease (P = 0.001), ovarian carcinoma (P = 0.037), and brain tumors (P = 0.0053) were associated with higher and very higher morphine dosages. Adverse effects were similar in the groups receiving regular, high, and very high doses of morphine. The median survival of patients treated with high doses of morphine was 27 days and was 37 days for those treated with very high doses. Patients treated with low doses of morphine survived for 18 days. Patients not treated with morphine survived for 22 days (P = 0.001 by Mantel-Cox analysis; P = 0.029 by Breslow analysis). CONCLUSIONS: The use of high and very high morphine doses at home proved safe and did not appear to affect the patients' life expectancy adversely. The use of high or very high-dose morphine should not be a barrier to providing palliative terminal care for home-care hospice patients.

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PubMedDate not supplied

Multidimensional continuous pain assessment chart (MCPAC) for terminal cancer patients: a preliminary report.

Current use of pain measures is limited in clinical practice. The common pain measures neither target nor monitor the changes that occur with time with regard to the effect of other parameters associated with pain control. Changes in parameters, such as pain type, various pharmacological and nonpharmacological interventions, dosage of medications, and use of rescue doses, usually complicate pain control in terminal cancer patients. The authors propose use of a multidimensional, continuous pain chart that permits better assessment and control of pain. The chart integrates visual analogue pain assessment, special treatment techniques, regular medications and rescue doses, co-analgesics, pain categories, parameters relating to quality of life, sleep, and mobility. A total of 1,178 assessments were performed in 100 consecutive patients with full compliance. The chart permitted a continuous monitoring of patients 'most important needs concerned with pain control and was easily integrated into the hospice daily routines. We conclude that the chart represents an effective and friendly graphic tool to monitor pain and associated parameters that relate to the quality of the broad spectrum of pain control. The hope is that this tool may improve pain control by hospice professionals and facilitate communication between patients and the interdisciplinary team members.

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