Carleen Brenneis

Use of the subcutaneous route for the administration of narcotics in patients with cancer pain

From February 1985 until January 1987, 108 consecutive patients with pain due to advanced cancer requiring parenteral narcotics were treated with a subcutaneous infusion of morphine (62 patients) or hydromorphone (46 patients). Mean maximal daily dose of morphine and hydromorphone was 305 mg (range, 80–3000 mg) and 310 mg (range, 40–4024 mg), respectively. The infusion was maintained for a mean of 31 ± 16 days (range, 2–156). Seventy patients were treated with a portable pump. Of these patients, 33 (45%) were discharge home for a mean of 29 ± 20 days. Eighty‐six of one hundred eight (86/108, 80%) patients experienced adequate pain control (less than two extra doses of analgesics per day). The duration of the site of the infusion was 7 days (range, 2–31). The mean daily increase in those was 2.4 ± 1.6% of the initial dose (only 15% of patients needed an increase more than or equal to 5% per day). Systemic toxicity consisted of respiratory depression in two patients, severe sedation in six, and confusion in three; all patients improved upon reduction of the daily dose of narcotics. Local toxicity consisted in infection in two patients, bleeding in one, and chemical irritation in six. Cost analysis shows that subcutaneous infusion reduced costs by either allowing home discharges, or replacing intravenous infusion. The authors conclude that this method is safe and effective in patients admitted and at home, and should be considered the first choice when parenteral analgesia is required.

Use of methylphenidate as an adjuvant to narcotic analgesics in patients with advanced cancer

Abstract Between October 1984 and July 1987, 50 patients were treated with methylphenidate (MP) for narcotic-induced sedation. All patients had pain due to advanced cancer and were receiving a mean daily equivalent dose of morphine of 165 ± 30 mg/day. Methylphenidate was started at a dose of 15 mg/day. Two patients (4%) had acute toxicity (hallucinations and paranoid-aggressive reaction, respectively) and required discontinuation of the drug. Forty-four of the 48 (91 %) remaining cases reported improvement after 48 hr of treatment and continued on MP for 39 ± 20 days. No other patient needed to discontinue MP because of toxicity. The mean maximal daily dose of MP and narcotics was 42 ± 6 mg and 237 ± 62 mg, respectively. The main reason for discontinuation of MP was a decrease in the dose of narcotics (18 cases); 12 patients continued to take MP until time of death. We conclude that: (1) MP can be administered to carefully selected advanced cancer patients with good tolerance; (2) toxicity occurs very early in the treatment, and late toxicity is infrequent; (3) significant tolerance develops to MP over the period of a month.

Association between asthenia and nutritional status, lean body mass, anemia, psychological status, and tumor mass in patients with advanced breast cancer

Sixty-four consecutive patients with advanced breast cancer were included in a study designed to determine the prevalence of asthenia and its association with other clinical features. The Asthenia Score (AS, the average of four tests designed by our group to assess asthenia) was 59 +/- 9 for patients versus 88 +/- 7 for a group of 68 normal controls (p less than 0.001). Twenty-six patients (41%) scored below the tenth percentile of normal controls and were considered asthenics. AS was correlated with depression and the general severity index of the SCL-90 R test. No association was found between AS and nutritional status, lean body mass, tumor mass, anemia, or type of treatment. We conclude that asthenia is a frequent symptom in patients with advanced breast cancer, which, in our series, showed independent correlations only with psychological distress.

Influence of the pain and symptom control team (PSCT) on the patterns of treatment of pain and other symptoms in a cancer center

To assess the influence of a pain and symptom control team on the pattern of prescription of pharmacologic and nonpharmacologic treatments for cancer pain, we reviewed the charts of 100 consecutive patients admitted to the Cross Cancer Institute during 1987 and 100 patients admitted during 1984. The average daily dose of parenteral morphine per patient was 44 +/- 26 mg in 1987 versus 34 +/- 38 mg in 1984 (p less than 0.05). In 1987 and 1984, only 31 and 22% of the analgesics were ordered around the clock respectively (P:NS). Approximately half of the patients in 1987 and 1984 were prescribed antiemetics and two-thirds of the patients were prescribed laxatives. Parenteral narcotics were prescribed subcutaneously in 0/52 cases in 1984 versus 21/63 cases in 1987 (33%, p less than 0.01). The pattern of prescription of narcotics by residents changed significantly during the last four weeks of rotation as compared to the first four weeks. We conclude that there have been some changes in the modality of treatment of pain that are probably due to changes in the pattern of prescription by the residents and continued improvement in assessment of pain by nurses. However, in several areas of treatment the impact of a pain and symptom control team remains minimal.

Changing pattern in the treatment of pain and other symptoms in advanced cancer patients.

Abstract We reviewed the charts of 100 consecutive patients admitted to the Cross Cancer Institute during 1980 and of 100 patients admitted during 1984 in order to assess changes in the pattern of prescription of pharmacologic and non-pharmacologic treatments for cancer pain. The average daily dose of parenteral morphine per patient was 23–31mg in 1980, v 34–38 mg in 1984 (P

Metoclopramide Infusion with a Disposable Portable Pump

Excerpt To the editor: Chronic nausea and anorexia are frequent symptoms in patients with advanced cancer (1, 2). In patients who have no mechanical obstruction of the gastrointestinal tract or who...

Continuous subcutaneous (SC) infusion of metoclopramide (MCP) using a plastic disposable infusor for the treatment of chemotherapy-induced emesis

Abstract This study evaluated the antiemetic effect of a subcutaneous infusion of metoclopramide (MCP) in 24 patients receiving chemotherapy. All patients had received at least one course of chemotherapy and had described their emesis as severe before being admitted to the study. During their first course in this study all patients received chemotherapy plus intravenous antiemetics (MCP 20 to 70 mg plus dexamethasone 10 mg, both 15 minutes before and one hour after treatment) and oral MCP (10 mg) or dimenhydrinate (50 mg) every four hours for the next 24 hours. During their second course, patients received the same type and dose of chemotherapy and intravenous antiemetics plus a subcutaneous infusion of MCP (240 and 120 mg in patients receiving chemotherapy including and excluding cisplatin, respectively). MCP was administered using a portable disposable infusor. The number of vomiting episodes and intensity of nausea were 13 ± 9 and 5.4 ± 1, respectively, during the first course ν 5 ± 7 (P