Patient with disseminated renal cell cancer with severe bone and neuropathic pain syndrome and social problems - a case report

A 72-years-old woman diagnosed with renal cell carcinoma and metastases to pelvic bones that caused severe bone and neuropathic pain was depicted. Apart from difficulties in pain management social problems connected with the care for a patient’s spouse who also needed palliative care due to disseminated prostate cancer and died during the care for the patient were discussed. This patient’s case indicates the need for holistic approach to patients in palliative care with the provision of effective symptomatic treatment along with comprehensive psychosocial and spiritual support.A 72-years-old woman diagnosed with renal cell carcinoma and metastases to pelvic bones that caused severe bone and neuropathic pain was depicted. Apart from difficulties in pain management social problems connected with the care for a patient’s spouse who also needed palliative care due to disseminated prostate cancer and died during the care for the patient were discussed. This patient’s case indicates the need for holistic approach to patients in palliative care with the provision of effective symptomatic treatment along with comprehensive psychosocial and spiritual support

The role of naldemedine in the treatment of patients with opioid-induced constipation

Opioid-induced bowel dysfunction (OIBD) and opioid-induced constipation (OIC) significantly decrease patients’ quality of life (QoL), lead to complications and opioid non-compliance resulting in pain exacerbation. Traditional laxatives are first-line preventive and therapeutic measures, although they display limited efficacy and several adverse effects (AE). Non-pharmacology measures, prokinetics, opioid switch, all have little evidence and do not target OIBD and OIC pathophysiology both associated with activation of predominantly μ-opioid receptors mostly peripherally in the gastrointestinal (GI) tract. A combination of prolonged-release (PR) oxycodone with PR naloxone in one tablet with a ratio of 2:1 is available, although limitations include maximal daily dose of 160 mg/80 mg, respectively, and normal liver function. Peripherally acting μ-opioid receptor antagonists (PAMORA) block opioid receptors in the GI tract without compromising analgesia as they do not cross the blood–brain barrier. Currently three drugs are available: methylnaltrexone, naloxegol and naldemedine. Naldemedine has proven efficacy superior to placebo in the treatment of OIC in both cancer and non-cancer patients while improving patient-reported constipation symptoms and patients’ QoL. It is well tolerated with mostly mild to moderate intensity GI adverse effects such as abdominal, pain, nausea, and diarrhea, without compromising analgesia. Naldemedine dosing is convenient as it is administered once daily by an oral route. Moreover, naldemedine may be safely used in patients with renal failure and mild to moderate hepatic impairment. Effective prevention and treatment of OIC is of paramount importance in patients receiving long-term opioid therapy. Palliat Med Pract 2019; 13, 3: 113–12

Role of intranasal fentanyl in breakthrough pain management in cancer patients

Fentanyl is a strong opioid analgesic, which is commonly used in the form of a transdermal patch for the treatment of chronic cancer pain. An intranasal route of fentanyl administration is a novel treatment for breakthrough cancer pain (BTCP). The prevalence, assessment, and management of BTCP is outlined in this paper, and basic pharmacodynamic and pharmacokinetic properties, dosing guidelines, and clinical experience with the use of intranasal fentanyl in this indication are discussed. Intranasal fentanyl is an attractive and convenient mode of BTCP treatment in opioid-tolerant patients due to its quick onset and short duration of action, noninvasive administration route, high bioavailability, and avoidance of a hepatic first-pass effect. Until now, few clinical trials have been conducted with intranasal fentanyl, but all have confirmed its usefulness and acceptability in BTCP treatment. Intranasal fentanyl may be used in opioid-tolerant patients without nasal pathologies. The dose should be titrated in each patient regardless of the regular opioid dose administered. Future studies should compare intranasal fentanyl with other fentanyl formulations used for BTCP management, and with analgesia, adverse effects, and quality of life taken into consideration

New challenges in palliative care in Poland during the COVID-19 pandemic

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Interdisciplinary approach in a patient diagnosed with prostate cancer and spine metastases

Prostate cancer is one of the malignant tumours in which treatment of bone metastases is a significant clinical problem. In this article 66-year-old patient diagnosed with prostate cancer and multiple metastases to all parts of the spine with accompanying neuropathic pain of severe intensity, which disabled self-moving of a patient is presented. The patient was not qualified for surgery during neurosurgeon consultation. During palliative care provision for the patient by an interdisciplinary team of Home Hospice composed pharmacology treatment of pain was introduced using oxycodone/naloxone, ketoprofen and adjuvant analgesics: zoledronate acid with calcium and vitamin D supplementation, pregabalin and dexamethasone. Stability of the spine was provided through high trunk orthosis in order to minimize the risk of spine damage associated with rehabilitation. A significant decrease in pain, constipation and anxiety intensity was achieved with an improvement of overall performance status and quality of life, which enabled a further anticancer treatment and palliative radiotherapy. The submitted case indicates on a necessity of palliative care provided by the interdisciplinary team for patients diagnosed with prostate cancer and dissemination to bones and severe pain intensity, which significantly increases a chance for obtaining satisfactory analgesia, improvement in the quality of life and a possibility of continuing anticancer and symptomatic treatment.Palliat Med Pract 2018; 12, 4: 207–213Do nowotworów, w przebiegu których leczenie przerzutów do kości stanowi istotny problem kliniczny, należy rak gruczołu krokowego. W artykule przedstawiono opis 66–letniego chorego, z rozpoznaniem raka gruczołu krokowego i mnogimi przerzutami do wszystkich odcinków kręgosłupa i towarzyszącym bólem neuropatycznym o silnym natężeniu, który uniemożliwiał samodzielne poruszanie się pacjenta. W wyniku konsultacji neurochirurgicznej chorego nie zakwalifikowano do leczenia operacyjnego. W trakcie sprawowania nad chorym opieki paliatywnej przez interdyscyplinarny zespół Hospicjum Domowego wdrożono złożone farmakologiczne leczenie przeciwbólowe z zastosowaniem oksykodonu/naloksonu, ketoprofenu i adjuwantów analgetycznych: kwasu zoledronowego z suplementacją wapnia i witaminy D, pregabaliny i deksametazonu. Zapewniono stabilizację kręgosłupa przy pomocy wysokiej ortezy tułowia, celem minimalizacji ryzyka związanego z uszkodzeniem kręgosłupa podczas rehabilitacji. Uzyskano skuteczne zmniejszenie natężenia bólu, zaparcia stolca i lęku, poprawę ogólnej sprawności i jakości życia, umożliwiającą podjęcie dalszego leczenia przyczynowego i zastosowania paliatywnej radioterapii. Przedstawiony opis przypadku wskazuje na konieczność objęcia chorych z rozpoznaniem nowotworu gruczołu krokowego z rozsiewem do kości i nasilonym bólem opieką paliatywną przez interdyscyplinarny zespół, co w znaczący sposób zwiększa szansę na uzyskanie zadowalającej analgezji, poprawy jakości życia i możliwości kontynuacji leczenia przeciwnowotworowego i objawowego