Investigative Analysis of Inappropriate Opioid Use for Cancer Outpatient

Objectives: The purpose of this study was to investigate current fact of cancer outpatients’ opioid pain management and its possible abusive applications and to establish corrective treatments by the palliative care team. Methods: Our palliative care team investigated cancer outpatients’ prescribed opioid clinical records for 4 months in 2014, and the result revealed inappropriate opioid use which could lead to further abuse or dependency. Through this the team recommended attending physicians viable options including decrease of opioid eventually leading to final withdrawal. Results: Among 67 cancer outpatients, the finding of inappropriate opioid use which could lead to further abuse or dependency was in 5 patients (7.4%). The details are as follows: (1) Three patients were treated with opioid analgesia for initial pain relief but the application continued in spite of recovering from a cancer which had been responsible to the pain. (2) Two patients were medicated with opioid for pain but further diagnosis revealed the disease which caused pain was benign. Four out of 5 patients were successfully withdrawn from opioids. Conclusion: In cancer outpatient settings, it can be overlooked or undetected inappropriate use of opioids which may lead to abuse or dependency without a team approach. To prevent opioid abuses, it is imperative to find the cause of pain as accurately as possible.

Effectiveness of the etiology-based antiemetic recommendations by a palliative care team for nausea in cancer patients

<b>Purpose</b>: To clarify the effect of a palliative care team intervention for nausea of cancer patients. <b>Methods</b>: The study participants were all cancer patients who were referred to a palliative care team in Yodogawa Christian Hospital in 2010, and had nausea with score 2 or over of the Support Team Assessment Schedule Japanese version (STAS－J). The causes of nausea were classified into 4 categories. Etiology－based antiemetic medications were recommended, and the intensities of nausea were assessed using the STAS－J on the day of referral, and 7 days after. <b>Result</b>: Among 27 patients were recruited for this study, 24 were assessed 7 days after. Nine patients had chemically induced nausea, eight had impaired gastric emptying, four had vestibular and central nervous system disturbance, and three had bowel obstruction. The mean STAS－J score significantly decreased from 3.0 (SD, 0.55) on the day of referral to 1.1 (0.80) after 7 days (<i>p</i>＜0.001). Two patients had mild drowsiness. <b>Conclusion</b>: The recommendations of etiology－based antiemetics by the palliative care team may be effective for managing nausea in cancer patients.

Family-perceived usefulness of a pamphlet for families of imminently dying patients: a multicenter study

<b>Purpose:</b> To clarify the family-perceived usefulness of a pamphlet for families of imminently dying patients. <b>Methods:</b> Physicians and/or nurses provided medical and practical information about the dying process using a pamphlet for families of imminently dying patients. We surveyed family members 6 months after the death of the patient about the perceived usefulness. <b>Results:</b> We sent out a questionnaire to 325 bereaved, and obtained an answer from 260 (response rate: 85%). Overall, 81% reported the pamphlet to be “very useful” or “useful”. The experience reported by the bereaved included: “Helped me to understand the dying process” (84%); “Helped me to understand how symptoms and changes occur” (76%), “Useful in preparation for patient's death“ (75%), “Helped me to understand the physical conditions of the patient” (75%), “Helped me to know what I can do for the patient” (74%). <b>Conclusion:</b> “A pamphlet for families of imminently dying patients” may be useful for members of an imminently dying patient's family.

Effectiveness and long term safety of gabapentin in the management of neuropathic pain of terminally-ill cancer patients

<b>Purpose</b>: This study is aimed at the evaluation of the effectiveness and safety of gabapentin for the management of cancer-related neuropathic pain in terminally-ill cancer patients. <b>Methods</b>: We investigated terminally-ill cancer patients prescribed gabapentin for the management of cancer-related neuropathic pain, from November 200X to October 200X+2. We assessed average daily pain on the numerical rating scale (NRS) before administration, after one week, and while on a stable dose. <b>Result</b>: 44 patients were enrolled during this period and 19 patients completed the study. The medication and the survival period on average were 52.0 and 67.2 days, respectively. The average gabapentin daily dose after one week was 358 mg. The average period needed to reach a stable dose was 11.6 days and the average stable daily dose was 463 mg (male 620 mg, female 289 mg). The mean NRS decreased from 5.7 (before) to 2.1 (after one week, <I>p</I><0.001) and 1.9 (stable dose, <I>p</I><0.001), respectively. 57.9% of patients showed side effects, somnolence in 52.6%, delirium in 5.3%, tremor in 5.3%. <b>Conclusion</b>: Gabapentin can be expected to be effective and safe for managing cancer-related neuropathic pain for a long period even when in critical condition through careful titration. Palliat Care Res 2011; 6(1): 101-108