Hypomagnesemia as a possible explanation behind episodes of severe pain in cancer patients receiving palliative care.

Within an oncology setting, certain chemotherapy drugs, such as cisplatin, may lead to magnesium loss causing nephropathy. Neurological and cardiovascular symptoms caused by hypomagnesaemia are well known. The relationship between serious hypomagnesemia and severe pain is not well documented but nevertheless, when faced with unexplained episodes of pain which do not respond to powerful analgesics, it is important to review blood magnesium levels. We present two cases of opioid-refractory pain attacks. Patients received drugs which have been linked to hypomagnesemia. In both cases, endovenous magnesium replacement led to a drastic improvement in pain management.

A new palliative care consultation team at the oncology department of a university hospital: an assessment of initial efficiency and effectiveness.

PURPOSE: Palliative care consultation teams (PCCT) in acute hospitals have increased in number over recent years. To assess whether these teams are both efficient in their role within a palliative care centre and effective in the care that is provided for patients, we reviewed the initial activity of a new PCCT at the Oncology Department of Clínica Universidad de Navarra, a European Society for Medical Oncology-designated centre of integrated oncology and palliative care. METHODS: All patients evaluated by the PCCT over the first 3 years of its activity were included. Data about diagnosis, demographic characteristics, survival and initial symptom burden were evaluated using the Edmonton Symptom Assessment System (ESAS); whenever possible, a follow-up ESAS for inpatients was collected within 1 week from the electronic charts and analysed retrospectively. RESULTS: The PCCT evaluated 611 cancer patients within the initial 3 years of the service commencing. On the first visit, 392 patients (64%) completed the ESAS evaluation. Of those that completed the ESAS, 43% were outpatients, 52% had gastrointestinal tumours, and 16% died within a month. The evaluated patients had an average of six uncontrolled symptoms (≥4/10). The most common moderate to severe symptoms were fatigue (80%), anorexia (67%) and depression (62%); 70% of patients presented with pain (14% with severe pain). Of the 225 inpatients evaluated, 110 (49%) completed the follow-up ESAS within 1 week. A statistically significant decrease was observed for pain, nausea, depression, anxiety and somnolence as well as in the number of uncontrolled symptoms and in the symptom distress score. The patient's perception of his/her general well-being was better as meassured with the specific question of ESAS. CONCLUSION: From the initial stages, the PCCT was both efficient in its role within the palliative care centre and effective in the care that was provided for patients. A significant number of patients were evaluated, many of them with severe symptoms and/or at the end of life. Inpatients receiving care from the PCCT experienced an improvement in symptom control within just a few days.