Symptom prevalence and severity in palliative cancer medicine.

OBJECTIVES: To establish symptom prevalence and associated distress in a large cohort of UK patients with cancer referred to a palliative care team. METHODS: This is a secondary analysis of two large data sets of patients with advanced cancer. Each patient had completed the Memorial Symptom Assessment Scale-Short Form to assess 32 symptoms and related distress. Data frequencies were conducted in Excel. RESULTS: 1507 patients were recruited. The most common symptoms were lack of energy (89%), pain (83%), feeling drowsy (77%) and dry mouth (70%). 67% of patients had psychological symptoms, with 31% of all patients having significant psychological distress. CONCLUSIONS: Symptom burden is significant in palliative patients with cancer. Structured symptom assessment with access to relevant supportive services is recommended.

Alcohol and drug use disorders in patients with cancer and caregivers: effects on caregiver burden.

BACKGROUND: The estimated prevalence of alcohol use disorders in patients with advanced cancer is reported as 4%-38%. There are limited data regarding alcohol and drug use disorders in caregivers of patients with cancer and the effects on other issues. AIM: To establish the prevalence of alcohol and drug use disorders in a large cohort of patients with advanced cancer and their caregivers.To evaluate the relationship between alcohol and drug use disorders and patient symptoms and caregiver burden. DESIGN: The patient with cancer and caregiver completed the Alcohol Use Disorders Identification Tool, CAGE questionnaire and Drug Abuse Screening Test. The patient completed the Memorial Symptom Assessment Scale-Short Form, and the caregiver completed the Zarit Burden Questionnaire.Statistical analysis compared cases and non-cases of alcohol and drug use disorders with symptom and burden score. SETTING/PARTICIPANTS: Patients with cancer, and their caregivers, were recruited from 11 UK sites, 6 hospices and 5 hospitals. RESULTS: Five hundred and seven patients and their caregivers were recruited. Twenty-seven patients (5%) and 44 caregivers (9%) screened positively for alcohol use disorders on the Alcohol Use Disorders Identification Tool. Thirty patients (6%), and 16 caregivers (3%), screened positively for drug abuse problems on the Drug Abuse Screening Test.There was a significantly higher carer burden score in caregivers screening positively for alcohol and drug abuse problems. CONCLUSIONS: The prevalence of alcohol use disorders in patients with cancer and caregivers was lower than reported in previous studies. Caregiver burden scores were significantly higher in carers screening positively for alcohol and drug use disorders. TRIAL REGISTRATION NUMBER: Trial registered National Institute for Health Research Clinical Research Network Portfolio (CPMS ID 30723) IRAS ID 198753.

Breakthrough cancer pain (BTcP) management: a review of international and national guidelines.

OBJECTIVE: Breakthrough cancer pain (BTcP) is common and has a significant impact on the quality of life of patients with cancer. This review compares current national/international BTcP guidelines in order to identify disparities and priorities for further research. METHODS: Relevant guidelines were identified using searches of PubMed, the National Guideline Clearinghouse, the internet (commercial search engines), and correspondence with key opinion leaders and relevant pharmaceutical companies. Identified guidelines were compared, using the Association for Palliative Medicine of Great Britain and Ireland recommendations as the 'reference' guideline. RESULTS: Ten specific BTcP guidelines were identified/reviewed, as well as major international generic cancer pain guidelines. In general, there was good agreement between the specific BTcP guidelines, although there remain some differences in terms of definition, diagnostic criteria and treatment of BTcP. Disparities between the different BTcP guidelines invariably reflect personal opinion rather than research evidence. Generic cancer pain guidelines continue to support the use of oral opioids as rescue medication, while specific BTcP guidelines invariably endorse the use of transmucosal opioids as rescue medication. CONCLUSION: Current guidelines agree on many aspects of the management of BTcP. However, the evidence to support current guidelines remains low grade, and so more research is needed in this area of care. Moreover, there needs to be an international consensus on the definition and diagnosis criteria of BTcP.

The Influence of Low Salivary Flow Rates on the Absorption of a Sublingual Fentanyl Citrate Formulation for Breakthrough Cancer Pain.

CONTEXT: Salivary gland hypofunction may affect the absorption of drugs through the oral mucosa, which in turn may affect their clinical efficacy (e.g., onset of action). OBJECTIVES: The aim of this study was to assess the pharmacokinetics of a sublingual fentanyl orally disintegrating tablet (Abstral, Prostrakan Inc.) in a group of cancer patients with salivary gland hypofunction. METHODS: Nine cancer patients with salivary gland hypofunction underwent a series of three pharmacokinetic studies with the sublingual fentanyl orally disintegrating tablet. In the first phase, the patients received no pretreatment; in the second phase, the patients were allowed to moisten the oral cavity before dosing; in the third phase, the patients were given pilocarpine hydrochloride (saliva stimulant) before dosing. Fentanyl concentrations were measured using a method of high-performance liquid chromatography with validated tandem mass spectrometric detection. RESULTS: The Tmax was longer, the Cmax was lower, the AUC0-30 lower, and the AUClast lower in the phase involving no pretreatment; the Tmax/Cmax/AUC0-30/AUClast were similar in the phase involving moistening of the oral cavity and the phase involving giving pilocarpine hydrochloride. CONCLUSION: The pharmacokinetics of the sublingual fentanyl orally disintegrating tablet appear to be negatively affected by the presence of salivary gland hypofunction, although the moistening of the oral cavity before dosing results in a pharmacokinetic profile similar to that seen with the giving of pilocarpine hydrochloride.