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Biomedical subjects

V Ventafridda

Publications and source records attributed to V Ventafridda.

At least 55 records · Page 3Linked to original sources
PubMed1990

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↗
PubMed1990

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↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1989

Psychological aspects of testis cancer therapy: a prospective study.

We examined the impact of testis cancer and its curative therapies on the outlook of life, working activity, partner relationship and sexual function in 31 consecutive patients 18 to 51 years old (mean age 29.3 years, median 28 years) who already had undergone orchiectomy. Of the patients 13 subsequently were treated with chemotherapy alone, 6 with retroperitoneal lymph node dissection alone, and 7 with chemotherapy and an operation, while 5 seminoma patients were treated with radiotherapy. The patients were examined 3, 6 and 18 months after orchiectomy. Each patient was required to fill out a questionnaire to gather information relative to their work activities, emotional relationship with the partner and sexual life. The patients also completed an assessment form on the quality of life (Spitzer QL-Index) and a series of horizontal analogues to evaluate anxiety, mood, nausea, weakness and general health status. The statistical analysis of the linear and quadratic components for the variables under study was done with the general linear model for block design. Psychosocial adaptability of these patients, regardless of the treatment they underwent, in time became progressively less problematic and the development of psychosocial problems during the long-term adjustment was low. Only 2 patients reported worsening of the emotional relationship with the partner after treatment: 1 underwent chemotherapy and an operation, and 1 underwent radiotherapy. With regard to sexual life, no serious dysfunction was noted apart from the loss of ejaculation in 11 of 13 patients who underwent retroperitoneal lymph node dissection. Of our sample patients who had lost ejaculation only 2 suffered from a high state of anxiety. The anxiety scores on the last completed linear analogue were 2.6 and 4.1, whereas at the same time the mood scores were 1.9 and 4.4. Therefore, it is important for the clinician to assess the psychogenic aspect of this side effect when this type of operation is proposed.

Adaptation, Psychological↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1988

Psychologic aspects of patients participating in a phase I study with the synthetic retinoid 4-hydroxyphenyl retinamide.

One hundred and one patients participating in a phase I study with the synthetic retinoid 4-HPR (4-hydroxyphenyl retinamide) were evaluated. The study was set up by Veronesi et al. during 1986 at the National Cancer Institute of Milan. The patients were randomized into 4 groups of therapy: 25 in the placebo group, 25 in the group receiving a daily dose of 100 mg of HPR, 26 in the group receiving 200 mg/day of HPR, and 25 in the group receiving 300 mg/day of HPR. All patients were previously treated at our Institute for breast cancer. None had received adjuvant therapy, chemotherapy or hormone therapy. After 4-5 months from the beginning of treatment, all patients received a series of tests to evaluate anxiety, depression and sexual life. Moreover, during one the follow-up checkups after 4-5 months, the patients filled-out a self-scoring mood questionnaire. The results did not show any particular differences between the groups, although we found that the administered drug and experimental setting do not interfere with the psychologic state of the participating patients.

Adaptation, Psychological↗
PubMed1988

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↗
PubMed1987

[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↗
PubMed1987

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↗
PubMed1987

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↗
PubMed1987

Intraspinal morphine for cancer pain.

From a survey of the recent literature on chronic intraspinal morphine administration for cancer pain concerning 412 cases, the present authors observe that: 1. data regarding follow-up on pain relief and complications are lacking; 2. continuous administration by closed systems shows more efficacy in long-term pain relief; 3. tolerance, although not reported by all authors, is present and becomes remarkable in prolonged administration; 4. serious side-effects are less frequent with the epidural administration technique. These data are confirmed by the present authors' clinical experience of 22 patients treated with epidural morphine administration and 53 patients treated with intrathecal morphine. The widespread use of these methods is limited not only by technical complications but also by the existence of certain types of pain which do not respond to morphine and which may develop, as part of the evolution of the neoplastic disease, even during treatment with intraspinal morphine.

Humans↗