Conversion ratios for opioid switching: a pragmatic study.

Background: The final conversion ratios among opioids used for successful switching are unknown. The aim of this study was to determine the initial and final conversion ratios used for a successful opioid switching in cancer patients, and eventual associated factors.

Methods: Ninety-five patients who were successfully switched were evaluated.

An analysis of the experiences of bereaved relatives and health care providers following palliative sedation: a study protocol for a qualitative international multicenter case study.

Background: Patients at the end-of-life may experience refractory symptoms of which pain, delirium, vomiting and dyspnea are the most frequent. Palliative sedation can be considered a last resort option to alleviate one or more refractory symptoms. There are only a limited number of (qualitative) studies exploring the experiences of relatives of sedated patients and their health care professionals (HCPs).

Cancer Pain Treatment Strategies in Patients with Cancer.

Management of cancer pain is challenging. Despite the poor evidence, opioid therapy still remains the cornerstone for the management of cancer-related pain. Opioids should be given according to the clinical presentation in the different stages of disease.

Rapid Titration With Intravenous Oxycodone for Severe Cancer Pain and Oral Conversion Ratio.

Context: to assess a dose titration with intravenous oxycodone to achieve rapid pain relief of cancer pain of severe intensity. The second objective was to provide a conversion ratio with the oral route.

Methods: Cancer patients admitted for severe pain were prospectively assessed.

The Paradigm Shift from End of Life to Pre-Emptive Palliative Care in Patients with Cancer.

In most countries, health care providers have circumscribed palliative care in a network represented by home care and hospice care [...

A peripheral opioid antagonist for treating urinary retention induced by opioids: A case report.

Background: Urinary retention is a poorly studied opioid-related adverse effect. There is a paucity of data regarding the treatment of such disturbance in patients with advanced cancer receiving opioids.

Actual Case: A young man, without comorbidities, was receiving 30 mg/day of oxycodone for abdominal pain due to pancreatic cancer, unsuccessfully.

Opioid Rotation and Conversion Ratios Used by Palliative Care Professionals: An International Survey.

The opioid rotation ratios (ORRs) and conversion ratios (CRs) used worldwide among palliative care (PC) professionals to perform opioid rotations (ORs) and route conversions may have a wide variation. We surveyed PC professionals on opioid ratios used through email to the Multinational Association of Supportive Care in Cancer's PC study group and Twitter and Facebook posts between September and November 2020. We received 370 responses from respondents from 53 countries: 276 (76%) were physicians, 46 (13%) advanced practice providers, 39 (11%) pharmacists, and 9 respondents did not report their profession.

Commentary: Interpreting Data of Celiac Plexus Block in Patients with Pancreatic Pain: Timing, Patients, Survival.

Although celiac plexus block (CPB) is a well known technique that has been performed for years, only in the last 30 years controlled studies, demonstrated its efficacy and safety. A historical pathway of literature regarding CPB and a critical analysis may help understand some points which remain still controversial, for a better interpretation of data.

Maddalena Opioid Switching Score in patients with cancer pain.

Evaluation of opioid switching (OS) for cancer pain has not been properly assessed. The aim of this study was to assess an integrated score (Maddalena Opioid Switching Score) as a simple and repeatable tool to evaluate the outcomes of OS, facilitating the interpretation and comparison of studies, and information exchange among researchers. The integrated score took into account pain intensity, intensity of opioid-related symptoms, and cognitive function by using an author's formula.

Constipation in Cancer Patients - an Update of Clinical Evidence.

Constipation is one of the most frequent problems in cancer patients, and its etiology is multifactorial. It leads to decreased quality of life and impedes optimal pain treatment. Despite the high prevalence, constipation is frequently underdiagnosed mainly because of lack of validated diagnostic criteria or widely accepted definition of constipation in cancer patients.

Methadone as First-line Opioid for the Management of Cancer Pain.

Aim: The aim of this study was to assess the efficacy and adverse effects of methadone when used as first-line therapy in patients that are either receiving low doses of opioids or none.

Methods: Patients with advanced cancer were prospectively assessed. Opioid-naive patients (L-group) were started with methadone at 6 mg/day.

Systemic therapy for pre-treated malignant mesothelioma: A systematic review, meta-analysis and network meta-analysis of randomised controlled trials.

Background: Randomised controlled trials (RCTs) with systemic therapies for patients with pre-treated mesothelioma have reported equivocal efficacy results and generated a degree of clinical uncertainty about the choice of active treatment in this poor prognosis malignancy.

Methods: To compare the effectiveness and safety and weigh the benefit of different systemic treatments in patients with pre-treated mesothelioma by systematic review, meta-analysis and network meta-analysis of RCTs. Full-text articles and abstracts were searched on PubMed, EMBASE, Cochrane Library and oncology conferences proceedings from 2005 through November 2021 for phase 2 and 3 RCTs.

High-flow nasal OXYGEN therapy.

Objective: To report data of the use of high-flow nasal therapy (HFNT) in the palliative care setting.

Methods: Five hypoxaemic patients were treated by HFNT in a 1-year period in a palliative care setting, either in the last days of life or as part of an intensive treatment for a reversible cause of hypoxic dyspnoea.

Results: Four patients had a similar clinical pattern.

When the game is hard, more complex weapons are needed.

Objectives: The aim of this paper is to illustrate how to manage a very difficult pain condition.

Methods: This is a clinical note of a complex approach using multiple analgesic regimens to effectively afford challenging pain situations.

Results: A man underwent an opioid dose titration, followed by dose stabilisation for some months.

Pattern and characteristics of patients admitted to a hospice connected with an acute palliative care unit in a comprehensive cancer center.

Purpose: Information about inpatient hospice activity is limited. No data exist about the pattern and the characteristics of advanced cancer patients admitted to a hospice connected to an acute supportive/palliative care unit (ASPCU).

Methods: Data of hospice admissions were retrieved from the database where all data were prospectively collected.

Immunotherapeutic Advances for NSCLC.

Immunotherapy with antibodies against PD-1 or PD-L1, either alone or in combination with chemotherapy, has revolutionized treatment paradigms of non-small cell lung cancer (NSCLC) patients without oncogenic driver alterations. These agents, namely immune checkpoint inhibitors (ICIs), have also widely demonstrated a remarkable efficacy in locally advanced as well as in early-stage NSCLC. Assessment of tumor PD-L1 expression by immunohistochemistry has entered into routine clinical practice to select patients for immunotherapy, even though its predictive role has long been debated.

Out-of-pocket costs in gastrointestinal cancer patients: Lack of a perfectly framed problem contributing to financial toxicity.

Fighting cancer is an economically expensive challenge for both health care payers, and the patients and their families and the median costs for cancer care are rapidly increasing in the last decade. Although both direct and indirect costs of medical assistance have been a frequent source of distress and contention, however analysis of the non-medical expenses incurred directly by cancer patients has not received adequate attention. Developing a deeper understanding of so-called "out-of-pocket" costs may be necessary.

The use of complementary alternative medicines in advanced cancer patients followed at home.

Objectives: To assess the use of complementary alternative medicines (CAM) in advanced cancer patients followed at home.

Methods: A consecutive sample of advanced cancer patients admitted to a home palliative care program was invited to participate in the study in a period of two months. Demographic characteristics, religious belief, education level, diagnosis, and socio-economic condition were recorded.

The Role of Religiosity in Symptom Expression of Advanced Cancer Patients.

Aim: The aim of this study was to assess the religious pattern and its impact on symptom expression in patients with advanced cancer.

Methods: A consecutive sample of advanced cancer patients screened at admission to palliative care. Standard epidemiological data were recorded.