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Biomedical subjects

E Bruera

Publications and source records attributed to E Bruera.

At least 217 records · Page 12Linked to original sources
PubMed1994

Anorexia and cachexia in advanced cancer patients.

Cachexia is a frequent and devastating complication of advanced cancer. Current understanding of the pathophysiology of this syndrome implicates tumour induced metabolic changes and immune responses. Clinical manifestation include anorexia, chronic nausea, asthenia and change in body image. Aggressive nutritional intervention has not been shown to be of benefit. Patients and families should be counselled about the goals of nutritional intake. In selected cases, enteral nutrition may be appropriate. Pharmacological management should first be directed at correcting nausea. Agents of potential usefulness in the treatment of anorexia include corticosteroids, megestrol acetate, cyproheptadine, hydrazine sulphate and dronabinol. Future research should further address pathophysiology, symptomatic and metabolic effects of interventions and interactions with other syndromes of terminal cancer.

Adrenal Cortex Hormones↗
PubMed1993

Effects of oxygen on dyspnoea in hypoxaemic terminal-cancer patients.

Dyspnoea is a frequent and devastating symptom of advanced cancer. The purpose of this prospective, double-blind, crossover trial was to assess the effects of supplemental oxygen on the intensity of dyspnoea. 14 patients with hypoxaemic dyspnoea due to advanced cancer were randomised to receive either oxygen or air; the gases were delivered at 5 L/min by mask. After 5 min of stable oxygen saturation (pulse oximetry), patients were crossed over to receive the other treatment. The crossover was repeated twice. Dyspnoea was assessed with a visual analogue scale (O = no dyspnoea, 100 = worst dyspnoea). Mean difference in dyspnoea visual analogue scale between air and oxygen treatment was 20.5 (95% confidence interval 13.5 to 27.6). 12 patients consistently preferred oxygen to air; similarly, the investigator consistently chose oxygen for the same 12 patients. In a global rating questionnaire, patients reported little or no benefit during the air phase compared with moderate to much benefit during the oxygen phase. We conclude that oxygen is beneficial to patients with hypoxia and dyspnoea at rest.

Aged↗
PubMed1993

Is the pharmacological treatment of cancer cachexia possible?

Cancer cachexia is highly prevalent in patients with advanced cancer. Its main clinical manifestation is profound anorexia. Progestational drugs have shown meaningful effects on appetite, food intake, and nutritional status in patients with advanced cancer and AIDS, and could be useful in managing anorexia. Corticosteroids also seem to produce increased appetite, but these effects are short-lived. Cyproheptadine, hydrazine sulfate, and cannabinoids also are being studied in the management of cancer-induced anorexia, but their role has not yet been clearly established. Future research should evaluate how the different drugs affect specific symptoms associated with cachexia.

Adrenal Cortex Hormones↗
PubMed1993

Palliative care in Latin America.

During the last 5 yr, a number of palliative care programs have been developed in Latin America. All these programs benefit from the strong personal motivation of leaders who commit a considerable amount of their own time and resources to the success of their programs. Financial problems, the lack of adequate knowledge of pain control and other palliative care issues, difficulties in communication and obstacles related to local legislation are common to all programs, although each group has dealt with these problems in different ways. International programs have helped in the development of many of the local leading groups. Improved communication between different local groups, national governments, and international WHO Collaborating Centers will, hopefully, further promote the development of palliative care in Latin America in years to come.

Delivery of Health Care↗
PubMed1993

Use of the Edmonton Injector for parenteral opioid management of cancer pain: a study of 100 consecutive patients.

In this retrospective study, we reviewed the patterns of use of the Edmonton Injector (EI) in 100 consecutive cancer patients. Seventy-eight patients used the EI for an average of 23 +/- 27 days. The main reasons for starting the EI were nausea (37 patients) and severe pain (31 patients). The median opioid dose equivalent to parenteral morphine (MEDD) was 264 +/- 443 mg/day. The mean duration of the subcutaneous injection site was 6.5 +/- 9.2 days. The most frequent reasons for change were accidental needle pulling (59%) and erythema (12%). Only two patients developed local infection (1% of 196 sites). The average cost of treatment was $1.65 Canadian per patient per day. No mechanical problems or refusals to start or continue treatment were detected. We conclude that the EI is a safe and simple device that allows for cost-effective parenteral administration of opioids for cancer pain.

Aged↗
PubMed1993

Local tolerance to subcutaneous infusions of high concentrations of hydromorphone: a prospective study.

In a prospective open study, 24 patients with cancer pain receiving parenteral opioids were administered highly concentrated solutions of hydromorphone in order to assess the local tolerance to the subcutaneous infusion. Patients received a mean concentration of hydromorphone of 30 +/- 15 mg/mL at a mean rate of infusion of 0.3 +/- 0.25 mL/hr. Of 22 evaluable patients, 17 (77%) had a site duration of more than 7 days with their first subcutaneous site (mean concentration of 34 +/- 8 mg/mL of hydromorphone). Four of the five remaining patients (80%) had site duration of more than 7 days with their second subcutaneous site. Only one patient (5%) did not reach a 7-day duration after three consecutive site changes. Out of 7 subcutaneous sites that presented signs of toxicity before 7 days of infusion, the main problem was erythema in three cases, swelling in two cases, and bleeding in two cases. All sites improved spontaneously and did not require any medical treatment. No correlation was found between the concentration or rate of infusion of hydromorphone and the duration of the subcutaneous site. The duration of the site was significantly correlated with weight, tricep skinfold, subscapular skinfold, and age of the patients. Our findings suggest that hydromorphone can be safely administered in concentrations that are much higher than those commercially available. The availability of highly concentrated formulations of different opioids for parenteral use will make home management simpler and cheaper.

Administration, Cutaneous↗
PubMed1993

Placebo-blinded study of morphine sulfate sustained-release tablets and immediate-release morphine sulfate solution in outpatients with chronic pain due to advanced cancer.

PURPOSE: This study was conducted to compare the relative analgesic efficacy and safety of an every-4-hour immediate-release oral morphine (IRM) solution with that of an every-12-hour sustained-release oral morphine (SRM) formulation. PATIENTS AND METHODS: This was a double-blind, placebo-blinded, crossover study in 34 adult male and female outpatients with pain due to advanced cancer. Baseline data were collected on day 1. On days 2 and 3, randomly assigned patients received either placebo plus IRM (Roxanol; Roxane Laboratories, Inc, Columbus, OH; 20 mg/mL) at 2, 6, and 10 am, and 2, 6, and 10 pm, or alternatively SRM (Oramorph SR; Roxane Laboratories, Inc; 30 mg) at 10 AM and 10 PM. Patients were then crossed over to the alternate treatment for days 4 through 6. Pain relief was measured using a conventional 100-mm visual analog scale (VAS) and by recording the incidence of breakthrough pain. Information on side effects was obtained from VAS scores for sedation, nausea, anxiety, and depression; by directly questioning the patient as to mental confusion, bowel movements, and laxative use; and from Karnofsky performance status scores. VAS data were analyzed using a linear statistical model. Breakthrough pain data were analyzed using analysis of variance (ANOVA). RESULTS: There were no statistically significant differences between IRM and SRM treatments with respect to VAS pain scores, side effect scores, or incidence of breakthrough pain data. Karnofsky performance scores remained stable for all patients throughout the study. CONCLUSION: It was concluded that every-12-hour administration of SRM and every-4-hour administration of IRM provide similar analgesic effectiveness and side effect profiles in the treatment of chronic pain in cancer patients.

Chemistry, Pharmaceutical↗
PubMed1993

A perspective on the management of delirium in terminally ill patients on a palliative care unit.

This article outlines the approach to the management of delirium developed by the staff of the palliative care unit at the Edmonton General Hospital. Delirium occurs commonly in the terminally ill and is associated with a poor prognosis. Management requires a clear understanding of what delirium is, how to assess it, investigations for reversible causes, and the medical treatments that are most useful. If not well managed, delirium can be a very distressing symptom for the patient and family as well as having a very destructive impact on the functioning of a palliative care unit.

Antipsychotic Agents↗
PubMed1992

The assessment of pain intensity in patients with cognitive failure: a preliminary report.

We reviewed our experience with 14 consecutive patients with cancer pain who developed severe cognitive failure that reverted either spontaneously or after specific treatment. In 3 patients who developed a nonagitated cognitive failure episode (CFE), there was no difference in the pain intensity measured by the patient before and after the episode and that measured by the nurse during the episode. In 11 patients who developed an agitated CFE, pain intensity assessed by a nurse during the CFE was significantly higher than the patient's assessment, both before and after the CFE. Patients who developed agitated CFE received a mean of 5 +/- 2 extra doses of narcotics per day, versus a mean of 2.17 +/- 1.6 doses in the average patient in our unit (P less than 0.01). Upon complete recovery, none of the 14 patients recalled having had any discomfort during the CFE. Problematic conflict between staff and family was detected in 4 of 11 cases of agitated CFE (36%), versus an expected 13 of 260 cases (5%, P less than 0.01). We conclude that (a) patients who recover from a severe CFE have no memory of pain; (b) medical and nursing staff are likely to overestimate the level of pain of patients with agitated CFE; and (c) agitated CFE in patients with cancer pain is a major source of distress for the patients' families and staff.

Cognition Disorders↗
PubMed1992

Cognitive failure in patients with terminal cancer: a prospective study.

In a prospective open study, 61 consecutive patients with terminal cancer admitted to the hospital underwent cognitive assessment using the Mini-Mental State Questionnaire three times a week between admission and discharge or death. Mini-Mental State Questionnaire score upon admission was 28 +/- 1.5 in patients who were discharged (N = 14), and 25 +/- 3 in patients who died in the hospital (N = 47, P less than 0.01). The forty-seven patients who died in the hospital presented a total of 66 episodes of cognitive failure (CF) that were defined as a score of less than 24 or a drop of greater than 30% in the score on the Mini-Mental State Questionnaire. Of these 47 patients, 39 (83%) presented CF an average of 16 days before death. Upon detection of CF, a complete medical examination, laboratory evaluation, computerized tomography of the brain if indicated by abnormal findings on medical examination, and a complete medication review were performed. The cause of CF could not be established in 37 (56%) cases. Drugs, sepsis, and brain metastasis were the most frequently detected causes and were present in 6, 4, and 4 cases, respectively. In addition, 22 episodes (33%) of CF improved (10 episodes spontaneously and 12 episodes as a result of treatment). Our findings suggest that CF is extremely prevalent during the last weeks of life and, consequently, informed consent for therapeutic or research procedures or resuscitation may be impossible to obtain reliably at that stage.

Aged↗
PubMed1992

The use of urinary catheters in terminally ill cancer patients.

Recent reports have commented on the need to improve our knowledge and management of urinary problems in terminally ill patients. We conducted a prospective study in 61 consecutive patients admitted to our palliative care unit (PCU), who were assessed for urinary problems, use of urinary catheters, and management of problems associated with the catheters. A total of 74% (45 of 61) of the patients required a catheter before death, with 23 (38%) being admitted to the PCU with a catheter, and 22 patients (36%) requiring a catheter during admission to PCU. We present our findings regarding the duration of catheter use, indications for catheters, type of catheters used, and complications of catheters. The data collected suggest that, although urinary problems and catheter use are common in terminal illness, if strict guidelines are followed there is no demonstrable mortality, and morbidity associated with catheter use is outweighed by patient benefit.

Aged↗