Breakthrough cancer pain: review and calls to action to improve its management.

In this paper, we review the current state of breakthrough cancer pain (BTcP) management. BTcP is a heterogeneous condition and a global problem for cancer patients. It is often managed suboptimally, which results in a negative outcome for patients, healthcare providers, and healthcare systems. Several barriers to the appropriate management of BTcP have been identified. These include, among others, an incomplete definition of BTcP, poor training of healthcare providers and patients alike, a lack of a multidisciplinary approach and the absence of specific protocols and tools. We provide some actions to help physicians and patients improve their approach to BTcP, including specific training, the design of easy-to-use tools for BTcP identification and assessment (such as checklists and pocket-sized cards), individualized treatment, and the use of multidisciplinary teams.

SEOM clinical guidelines for the treatment of early breast cancer

The incidence is increasing due to mammographic screening and an ageing population. In some countries the mortality rate has decreased especially in middleaged and younger groups because of improved treatment and possibly earlier detection. However, breast cancer is still the leading cause of cancer-related death in European women. The purpose of this work was to elaborate a Spanish Society of Medical Oncology guideline on pharmacologic interventions for early breast cancer (BC). We have compiled the latest advances in the management of this pathology either in the adjuvant and neoadjuvant setting, cytostatic and hormonal treatment, so that in a simple way could be useful to oncologist, residents and other related specialties (AU)

SEOM clinical guidelines for the treatment of metastatic breast cancer

Patients with metastatic breast cancer have a wide number of treatment options, including medical, surgical, and supportive care measures. Treatment decisions are based in predictive and prognostic factors and the informed choice of the patients. SEOM has elaborated these guidelines with evidence-based recommendations for the diagnostic work-up, treatment (chemotherapy, endocrine therapy and targeted therapies) and supportive care for the management of these patient (AU)

EOM clinical guidelines for the adjuvant treatment of colorectal cancer

Colorectal cancer is the third most common malignant neoplasm and the second cause of death by cancer in western countries. In this manuscript, the clinical guidelines of the Spanish Society of Medical Oncology (SEOM) for diagnosis and adjuvant treatment of colon cancer and rectal cancer are reported (AU)

SEOM clinical guidelines for the treatment of advanced colorectal cancer

Colorectal cancer is the first cause of cancer diagnosis in Spain. Over half of the patients are diagnosed with or will eventually develop distant metastasis. The current manuscript aims to provide synthetic practical guidelines for the therapeutic approaches in advanced disease. Available systemic therapeutic options, and integration and sequencing of chemotherapy with surgical procedures are discussed. Extent of disease, treatment objective, tumor kras mutation status, as well as patient's functional and comorbid conditions shall be considered to properly design the most adequate therapeutic strategy (AU)

SEOM clinical guidelines for the treatment of non-small-cell lung cancer: an updated edition

The purpose of this article is to provide updated recommendations for the diagnosis and treatment of patients non-small-cell lung cancer (NSCLC). The staging system for lung cancer has recently been revised by the International Association for Study of Lung Cancer and patients with NSCLC shall now be staged according to the UICC system 7th edition. Recommendations for treatment were based on treatment strategies that improve overall survival. In functionally fit patients with stage I-II disease surgical resection is recommended. Four cycles of adjuvant cisplatin-based chemotherapy is recommended in patients with pathologic stage II-III. For patients with stage IIIA and non-bulky mediastinal lymph node survival was significantly improved with induction chemotherapy plus surgical resection. Patients with unresectable or bulky stage IIIA and those with stage IIIB, should be treated with platinum-based chemotherapy and thoracic radiotherapy. For patients with metastatic disease and performance status of 0 or 1, a platinum-based two-drug combination of cytotoxic drugs is recommended. Nonplatinum cytotoxic doublets are acceptable for patients with contraindications to platinum therapy. For elderly patients and those with performance status of 2, a single cytotoxic drug is sufficient. Stop first-line cytotoxic chemotherapy at disease progression or after four cycles in patients who are not responding to treatment. Stop two-drug cytotoxic chemotherapy at six cycles even in patients who are responding to therapy. The first-line use of gefitinib may be recommended for patients with known epidermal growth factor receptor (EGFR) mutation; for negative or unknown EGFR mutation status, cytotoxic chemotherapy is preferred. Bevacizumab is recommended with platinum-based chemotherapy, except for patients with certain clinical characteristics. Maintenance therapy with pemetrexed or erlotinib increases survival in patients who did not progress after 4 cycles of a platinum based chemotherapy. Docetaxel, erlotinib, gefitinib, or pemetrexed is recommended as second-line therapy. Erlotinib is recommended as third-line therapy for patients who have not received prior erlotinib or gefitinib. Data are insufficient to recommend the routine third-line use of cytotoxic drugs (AU)

SEOM clinical guidelines for the treatment of head and neck cancer

Head and neck cancer constitutes the fifth highest cause of cancer in Spain. It is a neoplasm with a high possibility of cure if it is diagnosed in early stages, but unfortunately two thirds of the patients are diagnosed at an advanced loco-regional stage (stage III and IV, without metastasis). The multidisciplinary team, bringing together all professionals who specialize in the diagnosis and treatment of these tumors make the decision to establish the best sequence of individualized diagnosis, staging and treatment for each patient. This guide gives recommendations for diagnosis, staging and treatment for squamous cell carcinoma of the head and neck. In order to simplify the amount of information about any subsite of the head and neck area, the treatment recommendations are summarized as local disease, locally advance resectable and unresectable stages, function-preserving laryngeal treatment and recurrent and metastatic disease (AU)

SEOM clinical guidelines for the treatment of nasopharyngeal carcinoma

Nasopharyngeal carcinoma is an unusual tumour in Spain. It has differences in epidemiology, histology, clinical behaviour, treatment and prognosis from those of other head and neck neoplasms, which justifies separate analysis. It is a neoplasm with a high possibility of cure with a combined treatment if even it is diagnosed in an advanced locoregional stage (stage III or IV, without metastasis). The multidisciplinary team, bringing together all professionals who specialize in the diagnosis and treatment of these tumors make the decision to establish the best sequence of individualized diagnosis, staging and treatment for each patient. This guide gives recommendations for diagnosis, staging and treatment for nasopharyngeal carcinoma. The treatment recommendations are summarized as local disease, locally advance and recurrent and metastatic disease (AU)

SEOM clinical guidelines for the treatment of Hodgkin's lymphoma

Hodgkin's lymphoma is a malignant disease with an incidence of 2.2 cases/100,000. The main goals of staging are to measure the extent of disease and associated prognostic factors. Distinct recommendations were produced for initial work-up, first-line therapy of early and advanced stage disease and treatment of relapsed or resistant patients (AU)

SEOM clinical guidelines for the treatment of follicular non-Hodgkin's lymphoma

Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin's lymphoma (NHL) in the Western world. FL constitutes the most frequent indolent lymphoma, well characterized by its clinical presentation related to nodal involvement and its morphologic and biologic features. It is often managed as an incurable disease. However, several active therapeutic approaches from the "wait and watch" strategy to the allogeneic transplantation are available for management of patients with FL and clearly have changed the natural history of this disease, achieving a long-term disease-free survival. Therapeutic decision is mostly conditioned by patient's characteristics, stage, histological grade, tumor burden, and risk-predicting factors. This article try to summarizes the diagnosis and treatment of this heterogeneous group of patients (AU)

SEOM clinical guidelines for the treatment of diffuse large B-cell lymphoma

Diffuse large B-cell non-Hodgkin's lymphoma (LDCGB) is one of the best examples of chemotherapy curable malignant diseases. This "Oncoguía SEOM" summarizes the basic directions of staging and recommended treatment options. The staging study should be thorough and includes clinical, laboratory, diagnostic imaging and nuclear medicine. Treatment depends on patient characteristics and comorbidity and on disease extension and prognostic factors. In localized cases, chemoimmunotherapy (CHOP-R) of short duration, followed by involved-field irradiation is the preferred option. In advanced stages, the association of CHOP-like chemotherapy and Rituximab has been a major breakthrough in terms of cure rate. It is important do not forget the supportive treatment in these patients (AU)

SEOM clinical guidelines for the treatment of antiemetic prophylaxis in cancer patients receiving chemotherapy

Chemotherapy-induced emesis is one of the most frequent side effects that affect the quality of life of cancer patients undergoing chemotherapy. In recent years, clinical research has allowed us to increase our therapeutic arsenal with new drugs that have increased efficiency in the control of nausea and vomiting associated with chemo. This guide provides and update of the earlier published by our society and represents the continued commitment of SEOM to move forward and improve in the supportive care of cancer patients (AU)

SEOM clinical guidelines for the treatment of small-cell lung cancer

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Dramatic complete response in patient with lung adenocarcinoma

The poor prognosis of non-small-cell lung cancer (NSCLC) is changing thanks to the constant development of new treatments and the introduction of target therapies, even in stage IV disease. This patient had bone metastases when he was diagnosed. Maintenance treatment, a much discussed topic nowadays, achieved a dramatic complete response (AU)

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El uso de fentanilo transdérmico por una unidad de atención domiciliaria en pacientes oncológicos en el final de la vida / Use of transdermic fentanyl by a department of home medical care of terminal oncologic patients

• Propósito: Se ha realizado un estudio observacional y retrospectivo para evaluar el modo de utilizacióny los efectos secundarios de fentanilo transdérmico (FTTS) en pacientes oncológicos en situación terminal.• Material y métodos: Se han evaluado estadísticamente pacientes incluidos en un programa de AtenciónDomiciliaria que recibieron tratamiento con FTTS.• Resultados: 112 pacientes (p) recibieron tratamiento con FTTS. Mediana de edad de 71.5 años (29-88).102p presentaban dolor y 10 disnea. Tipo de dolor: visceral 55% p, óseo 25% p, neuropático 12.5%, muscular5% p y otro 2.5% p. EVA inicial: media 5.9. La analgesia previa a la utilización de fentanilo fue: 31% p AINES,32.2% p tramadol, 5.6% p codeína y 31% p morfina. La dosis mediana inicial de fentanilo fue 50mgr/hora(25-300). La dosis mediana final fue 75 mgr/hora (25-400). EVA final media: 3,3. La mediana de la duracióndel tratamiento fue de 44 días (1-372). 35 p (31%) presentaron náuseas G2-3, somnolencia 5 p, agitacióny/o delirio 13 p. 81 p (72%) precisaron laxantes. En 10 p fue necesario rotar a otro opioide: 4 p por toxicidad y6 p por mal control del dolor.• Conclusiones: El FTTS es un analgésico bien tolerado en pacientes terminales y proporciona una analgesiaadecuada (91%), a un bajo coste en cuanto a yatrogenia intolerable (4%), tanto con paso previo conopioides como directamente desde primer escalón analgésico OMS

• Purpose: An observational and retrospective study was performed in order to evaluate the activity andtoxicity of transdermal fentanyl in patients with advanced cancer.• Material and methods: 112 patients treated by a home palliative care unit were studied. Thecharacteristics of patients, analgesic treatments, and opioid rotation were analysed from the beginning offentanyl administration to the death.• Results: The mean age of the patients (p) was 71.5 years (range, 29-88). The indication for opioidadministration was pain in 102 and dyspnea in 10 patients. The type of pain was visceral in 56 p (55%), bonyin 25 p (25%), neuropatic in 13 p (12.8%), muscular in 5 p (5%), and others in 3 p (2.1%). The baseline meanvalue of the pain analogical visual scale (AVS) was 5.9. The analgesics administered before fentanyl was givenwere tramadol (32.2%), NSAIDs (31%), morphine (31%) and codeine (5.6%). The median initial dose offentanyl was 50 µg (range, 25-300). The final mean dose at the time of death was 75 µg (25-400). The finalmean AVS was 3.3. The median treatment duration was 44 days (range, 1 to 372). It caused G2-3 nausea in 35p (31%), somnolence in 13 p, and agitation in 5 p; 81 patients received laxatives. Opioid rotation withmorphine was necessary in 10 p because of toxicity, and in 6 p because uncontrolled pain.• Conclusions: Transdermal fentanyl is a well tolerated analgesic in patients with advanced cancer,providing a good analgesia in up to 91% of the patients previously treated with opioids, as well as of thepatients proceeding directly from the first or second step of the WHO ladder