High-Dose Fentanyl Patch for Cancer Pain of a Patient with Cholangiocarcinoma

We describe here a patient who obtained a good analgesic effect with high-dose fentanyl patches for controlling cancer pain. A 52-year-old man was referred to our hospital because of severe cancer pain that was 7/10 on a numeric rating scale (NRS). He had been diagnosed with locally advanced cholangiocarcinoma 3 months previously. We prescribed weak opioids and an antidepressant, but his pain was not relieved. We introduced strong opioids (transdermal fentanyl patches for the background pain and a short-acting opioid for the breakthrough pain) and his pain was tolerable on 250 microg/hr of fentanyl patches for 3 months. With time, however, his pain intensity became worse and this reached up to 8/10 to 9/10 on the NRS. Percutaneous transhepatic biliary drainage was performed, which did not relieve his pain. We increased gradually the dose of transdermal fentanyl to 1,050 microg/hr (20 patches). At this dose, the patient was mentally alert, with good pain control (NRS 2/10 to 3/10) and no exacerbation of side effects. To the best of our knowledge, we report here on the highest dose of transdermal fentanyl that has been successfully used for treating a patient suffering from visceral cancer pain.

Utilization of Health Care Resources and Costs of Stroke Patients: Patients' Perspective

BACKGROUND: Policy-makers are required to know the current patterns of resource use and the costs of stroke. However, the scientific evidence, on which health policy-making can be based, is not sufficient. Our study aimed to investigate resource utilization and costs during the one year after stroke. METHODS: Among patients with acute ischemic stroke (7 days from onset) who were admitted from July of 2001 to July of 2002, 223 were interviewed one year after the onset of stroke through a home visit by an experienced research nurse. Resource utilization and related costs were investigated. RESULTS: The average length of stay was 25 days. The average first inpatients costs was won 2, 230, 000. After discharge, the average outpatient visit was 22 days. The average expenditure per patient during the one year from onset of stroke was won 5, 235, 000. The hospital charge was 59% of the total cost, the cost for hiring a care-giver was 14%, and the fee for the outpatient clinic was 13%. Thirty-nine percent (won 2, 051, 000) of the total expenditure was consumed in the first month, 12% was in the second, 8% was in the third, and around 5% monthly was after 3 months. CONCLUSIONS: Our study is the first one to investigate the resource utilization and the related costs in stroke patients in Korea. The results of this study should not be generalized to all Korean stroke patients, but this study may serve as a reference for inferring the real status in Korea and may be a starting point for further nationwide resource utilization and costs studies.