ABSTRACT
Introduction: In patients receiving opioids, relief of cancer pain by palliative radiation therapy or other means can lead to opioid discontinuation and subsequent withdrawal symptoms, such as agitation, insomnia, and diarrhea, due to opioid-related physical dependence. Appropriate steps should be taken to prevent these symptoms. Case: A 72-year-old man underwent surgery for esophageal cancer. He developed low back pain and right lower limb pain, and was diagnosed with sacral and right iliac bone metastases. His pain was resistant to oxycodone (OXC), so he was simultaneously treated with methadone (MDN) and palliative radiotherapy. His pain gradually decreased, and MDN was tapered and switched to OXC, which was in turn discontinued at 20 mg/day at the patient's strong request. After OXC discontinuation, akathisia, anxiety, and diarrhea appeared as withdrawal symptoms. These were treated with immediate-release OXC, transdermal fentanyl, and suvorexant. Discussion: When discontinuing opioids, dose reduction below 10% per week is recommended, de-escalation to the lowest possible dose should be followed by cessation. In case of withdrawal symptoms, immediate-release opioids may be used, and opioid tapering should be attempted in parallel with symptom control.
ABSTRACT
<p>The aims of this study were to clarify difficulties experienced by families facing the cessation of home-based care for terminal cancer patients, and to review the associated necessary nursing practices. We conducted semi-structured interviews with ten families. A qualitative research design was selected for this study, and the data was interpreted using content analysis techniques. The results were integrated into seven major categories: “unable to assess present symptoms for lack of understanding terminal cancer symptoms,” “feeling emotional pain during the patient’s aggravated condition,” “difficulties in coping with various patients’ physical symptoms: problems regarding inexperienced care,” “exhausted by living 24 hours a day with patient: lack of support, because of constraints from important people in the caregiver’s life,” and “difficulties faced by primary family caregivers in preparing a treatment environment.” Family caregivers were not able to prepare a treatment environment, because of a lack of understanding the symptoms of terminal cancer and an unwillingness to admit experiencing mental and physical burdens. The findings of this study suggested that the role of a nurse is to understand the family’s condition and values, provide required information in advance, and to adjust and prepare the treatment environment.</p>