Palliative care in Edmonton.

The Palliative Care Program at the Edmonton General Hospital, Edmonton, Canada provides a comprehensive multidisciplinary service to terminally ill patients in the area. The political, clinical, educational, and research developments impacting on this program are described.

Methylphenidate for the management of somatization in terminal cancer patients.

We report a case that illustrates methylphenidate's (MP) usefulness in the management of psychological distress and associated somatization in the palliative-care setting. A 60-year-old man affected by terminal cancer of the prostate had been complaining of increasing physical pain, without any evidence of significant disease progression, opioid toxicity, or previous history of drug addiction. Because of patient's denial, the team had been unsuccessful in identifying any potential emotional factors affecting his physical suffering.

Basics of pressure-flow studies.

Pressure-flow studies of voiding contain information about urethral resistance or obstruction and about the detrusor contraction or contractility. A fundamental problem, discussed in this paper, is how to disentangle these two. A second, more difficult, problem is how to evaluate them in a simple, clinically useful way.

Comparison of the efficacy, safety, and pharmacokinetics of controlled release and immediate release metoclopramide for the management of chronic nausea in patients with advanced cancer.

Background: The short elimination half-life of metoclopramide necessitates frequent administration for optimal relief of nausea. This study compares a newly developed controlled release preparation of metoclopramide (CRM) and immediate release metoclopramide (IRM) with respect to efficacy, safety, and pharmacokinetics in patients with chronic nausea associated with advanced cancer.

Methods: Thirty-four patients with advanced cancer with nausea lasting more than 1 month and with no evidence of involvement of the gastrointestinal tract, peptic ulcer or gastritis, brain metastases, or metabolic abnormalities were randomized, in a double-blind cross-over study, to receive 40 mg of CRM every 12 hours or 20 mg of IRM every 6 hours for 3 days.

The assessment of constipation in terminal cancer patients admitted to a palliative care unit: a retrospective review.

Constipation is a frequent and distressing complication in patients with advanced cancer. However, very few studies have reviewed the assessment and management of these patients. The purpose of this study was to review the documentation and assessment and diagnosis of constipation in patients admitted to a Palliative Care Unit, and the correlation between those findings and radiological evidence of stool in the colon.

Corticosteroids as adjuvant analgesics.

Corticosteroids have multiple effects as adjuvant drugs in pain management. Their pharmacologic characteristics will be described. Studies documenting the efficacy of corticosteroids for different pain syndromes and other cancer-related symptoms will be reviewed.

New developments in the assessment of pain in cancer patients.

Pain occurs in more than 80% of cancer patients before death. During recent years major progress has taken place in our techniques for the adequate assessment of cancer pain. Major prognostic factors associated with the pain syndrome have been recognized.

Psychostimulants as adjuvant analgesics.

Psychostimulants have multiple roles in the adjuvant treatment of pain. This article reviews the pharmacology of different agents in this class. Studies will be discussed that demonstrate the efficacy of these drugs in potentiating opioid analgesia, counteracting opioid-induced sedation and cognitive impairment, allowing dose escalation in difficult pain syndromes, and alleviating symptoms of depression.

Proximal muscle weakness in a patient with hepatocellular carcinoma.

Asthenia and generalized weakness are common in cancer patients. There are multiple causes for these symptoms. We describe a case of rapid onset of proximal muscle weakness in a patient with hepatocellular carcinoma.

The use of hypodermoclysis for rehydration in terminally ill cancer patients.

The need to treat dehydration in terminally ill patients to minimize symptom distress remains a controversial issue. Hypodermoclysis (HDC) is a simple technique for rehydration that offers many advantages over the intravenous route. In this prospective open study of 100 consecutive patients who died on a palliative care unit, we recorded our indications for, and use of, HDC.

Cerebral aetiology of urinary urge incontinence in elderly people.

We have examined 73 elderly incontinent patients (mean age 79 years) and 27 continent subjects (mean age 78 years) of similar cognitive status. Among the incontinent patients, 20 were shown objectively to have urge incontinence with normal bladder filling sensation, 14 had objectively demonstrated urge incontinence with reduced bladder sensation, and 39 had other types of incontinence. We compared cognitive function (by Mini-mental State Examination: MMSE) and regional brain perfusion (by SPECT scanning) in these four groups.

A prospective comparison study between a butterfly needle and a Teflon cannula for subcutaneous narcotic administration.

To evaluate the hypothesis that subcutaneous sites initiated with the Teflon cannula would have longer durations and be more comfortable for the patient than the butterfly needle, we performed a prospective randomized crossover trial to compare the 25-gauge butterfly needle to a Teflon cannula with a 26-gauge introducer needle and a 24-gauge cannula. The analysis of 20 patients showed that duration of the subcutaneous site was significantly longer with the Teflon cannula. Both patients and nurses preferred the Teflon cannula because it did not need to be changed as frequently.

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.

Long-term changes in urodynamic studies of voiding in the elderly.

Urodynamic studies were conducted in 80 incontinent elderly patients (27 men and 53 women; mean age, 77 years) and repeated 2-4 weeks later after patients had been subject to interventions. Interpretable voiding studies were performed in 84% of sessions. Interpretable initial and repeat studies were performed in 74% of patients.

Ethical issues in palliative care research.

During the last 10 years interest in palliative care research has grown. This interest has brought about an awareness of the unique ethical issues related to research in this special population. Issues related to the vulnerability of patients and families, consent protocols, unstable mental status, and the invasiveness of assessments have been discussed.

Symptom control in terminally ill patients with malignant bowel obstruction (MBO).

The inadequacy of prolonged conservative management with nasogastric suction and intravenous fluids for terminally ill patients with bowel obstruction has long been recognized. Using previous reports and our experience on the Palliative Care Unit at the Edmonton General Hospital, we have developed a basic approach to bowel obstruction management. In a review of 100 consecutive patients who died on our Palliative Care Unit, 15 required medical management for bowel obstruction.

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.