ABSTRACT
UNLABELLED: This study evaluated the use of methylphenidate for depression in advanced cancer DESIGN: Phase II open-label prospective study. ELIGIBILITY CRITERIA: No previous use of methylphenidate or current use of other antidepressants. EVALUATION: Depression and response to treatment were determined by asking the patient: "are you depressed?" Patients were assessed at baseline and at days 3, 5, and 7. TREATMENT: Starting dose was 5 mg at 8:00 a.m. and 12:00 noon. The dose was titrated for lack of response on any of the assessment days. RESPONSE CRITERIA: A negative response to the question: "are you depressed?" RESULTS: Some 41 patients were enrolled and 30 (15 men, 15 women) completed the study. Median age was 68 years (range: 30-90). Methylphenidate was stopped for six patients because of side effects and five were not evaluable; 21 responded to 10 mg/day on day 3; the other nine responded to 20 mg/day on day 5, 29 maintained their positive response through day 7. Anorexia, fatigue, concentration, and sedation also improved in some. All who completed the study had tolerable side effects, none of which caused treatment to stop. CONCLUSIONS: Methylphenidate is effective for depression in advanced cancer A starting dose of 10 mg in divided doses is effective in most patients. Dose escalation may be needed. Improvement occurs within three days. Close monitoring of side effects is recommended.
Subject(s)
Central Nervous System Stimulants/therapeutic use , Depression/drug therapy , Depression/etiology , Methylphenidate/therapeutic use , Neoplasms/complications , Adult , Aged , Aged, 80 and over , Anorexia/chemically induced , Attention/drug effects , Central Nervous System Stimulants/pharmacology , Depression/diagnosis , Drug Administration Schedule , Drug Monitoring , Fatigue/chemically induced , Female , Humans , Male , Methylphenidate/pharmacology , Middle Aged , Psychiatric Status Rating Scales , Sleep Stages/drug effects , Treatment OutcomeABSTRACT
This article discusses the use of a medication kit at home for terminal symptoms. This innovation has been in place for more than two years at the Hospice of the Cleveland Clinic. There is no previously published information on this innovation in the literature.
Subject(s)
Drug Therapy/methods , Emergencies , Home Care Services, Hospital-Based/organization & administration , Terminal Care/methods , Analgesics, Opioid/therapeutic use , Anti-Anxiety Agents/therapeutic use , Antiemetics/therapeutic use , Atropine/therapeutic use , Chlorpromazine/therapeutic use , Diazepam/therapeutic use , Humans , Morphine/therapeutic use , Muscarinic Antagonists/therapeutic use , Ohio , Palliative CareABSTRACT
For any palliative medicine inpatient unit to be economically viable, certain management metrics need to be followed. Palliative medicine can provide both a compassionate and economical service within the current acute inpatient hospital environment. In this article, we will review the administrative and financial factors we have identified that influence the business of acute palliative medicine.
Subject(s)
Financial Management, Hospital/organization & administration , Hospice Care/organization & administration , Hospital Units/organization & administration , Palliative Care/organization & administration , Commerce , Diagnosis-Related Groups/economics , Direct Service Costs/statistics & numerical data , Hospital Costs/statistics & numerical data , Hospitals, Teaching , Humans , Length of Stay/economics , Ohio , Patient Care Planning/organization & administration , Patient Discharge , Personnel Staffing and Scheduling/economicsABSTRACT
While much attention has been devoted to cytotoxic drugs and radiation therapy in the pregnant cancer patient, the drugs used for management of symptoms and complications related to cancer during pregnancy have been overlooked. There is substantial overlap between the symptoms of cancer and cancer management and the symptoms related to pregnancy. The mainstay of symptom management is drug therapy and the potential for a drug to be embryotoxic or teratogenic depends on when it is given. In general, drugs not proven safe in pregnancy should be withheld, especially during the first trimester. The few drugs that have been proven to be teratogenic are alcohol, thalidomide, the folic acid antagonists (which includes methotrexate), diethylstilbestrol, and the vitamin A isomers, but there is a good deal of uncertainty about many other therapeutic agents. Placental transport of drugs from mother to fetus must be taken into consideration from the fifth week of gestation to parturition. Although the first trimester is the time of most organ development in the fetus, the brain continues to develop throughout pregnancy and may be damaged later in pregnancy, resulting in diminished intelligence or behavioral problems. This review will focus on the treatment of the most common symptoms of cancer in a pregnant patient and the potential for fetal damage.
Subject(s)
Palliative Care , Pharmaceutical Preparations , Pregnancy Complications, Neoplastic , Drug-Related Side Effects and Adverse Reactions , Female , Humans , Pregnancy , Pregnancy Complications, Neoplastic/physiopathology , United States , United States Food and Drug AdministrationABSTRACT
Communication between physician, patient, and family becomes intense and fraught with problems in the setting of advanced disease. Protocols for end-of-life communication have been developed by various authors, but they have focused primarily on delivery of "bad news" in an individual encounter. This article addresses the need for ongoing conversation throughout the progression from life-prolonging treatment to hospice care. A case study illustrates the utility of this approach.
Subject(s)
Communication , Palliative Care , Physician-Patient Relations , Humans , Physician's Role , Psychology , Terminally IllABSTRACT
There has been growing interest in the United States in postgraduate training in palliative medicine. In order for this to proceed in an organized fashion, educational standards need to be developed. We must define what our knowledge base is and what we require of a specialty-trained individual. This article reports the development of the first fellowship program in the United States, with the goal of encouraging further discussion and ultimately obtaining specialty recognition.
Subject(s)
Education, Medical, Graduate , Fellowships and Scholarships , Palliative Care , Program Development , Eligibility Determination , Goals , Humans , Research , United StatesABSTRACT
Complications due to cancer and its treatment are common and increase in incidence and severity as the disease progresses. Central nervous system complications affect 15% to 20% of patients, and up to 75% have bone metastases at some point during the disease process. Endocrine abnormalities include hypercalcemia, adrenal insufficiency, and inappropriate antidiuretic syndrome. Hematologic disorders, malignant effusions, and gastrointestinal (GI) problems may cause significant morbidity.
Subject(s)
Neoplasms/complications , Neoplasms/therapy , Palliative Care , Disease Progression , Endocrine System Diseases/etiology , Endocrine System Diseases/therapy , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/therapy , Hematologic Diseases/etiology , Hematologic Diseases/therapy , Humans , Muscular Diseases/etiology , Muscular Diseases/therapy , Nervous System Diseases/etiology , Nervous System Diseases/therapy , Vascular Diseases/etiology , Vascular Diseases/therapyABSTRACT
Cough is a common symptom in advanced cancer. Hydrocodone is the antitussive of choice in our palliative medicine inpatient unit. We reviewed the pharmacy records for the use of hydrocodone for all cancer admissions to our unit from May 1996 to December 1998. Median treatment duration with hydrocodone was three days (range 1-18). Median maximum daily dose was 15 mg (range 5-100), and median total dose during the hospital stay was 32 mg (range 5-455). Lung cancer as a primary cancer site was strongly related to the use of hydrocodone. The highest median duration of treatment (five days) was for esophageal cancer and the highest median maximum daily dose (35 mg) and total dose (75 mg) were for treating kidney cancer. This retrospective review provides information regarding the use of hydrocodone on the palliative medicine unit of the Cleveland Clinic Foundation. Controlled trials are needed to evaluate the efficacy and safety of hydrocodone for cough in advanced cancer.
Subject(s)
Antitussive Agents/administration & dosage , Cough/drug therapy , Hydrocodone/administration & dosage , Neoplasms/complications , Aged , Cough/etiology , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Dyspnea is a common and devastating symptom of life-threatening disease. Approximately 90% of non-small cell lung cancer patients experience moderate to severe dyspnea by death. Currently, the pathology is ill-defined and measurement of this subjective symptom is imprecise. The treatment is directed at the underlying cause when appropriate. When specific therapies no longer exist, palliative interventions are necessary. This article outlines the current state of knowledge and standards of care for palliative interventions in dyspnea. These include nonpharmacologic interventions, oxygen supplementation, and medications. Further research is needed to clarify the role of each and to develop better pathophysiologic understanding.
