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Conrad Notes
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PHARMACOTHERAPY OF COMMON SYMPTOMS IN CANCER PATIENTS

R. K. Portenoy, MD, Memorial Sloan Kettering Cancer Center (MSKCC), New York City, recommends aggressive treatment of physical and psychological symptoms of cancer patients. A recent MSKCC survey of 240 outpatients (cancer of breast, colon, prostate, ovary) showed a mean of 9.5 symptoms per patient. Leading complaints included fatigue or lack of energy (75%), worry (71%), feeling sad (66%), pain (63%), and nervousness (62%). Optimal symptomatic therapy helps to correct the functional impairment of cancer. This therapy improves the patient's quality of life and aids in coping with the disease.

Moderate-Severe Pain Current guidelines favor using opioid analgesics such as morphine, hydromorphone, oxycodone, levorphanol, methadone and fentanyl. The oral route is preferred. Because many cancer patients have difficulty swallowing, the subcutaneous or transdermal routes are commonly used. Optimal pain control often requires opioid rotation or sequential opioid trials due to patient variability in the response to drugs. A patient's dose needs to be individualized to produce a favorable balance between analgesia and side effects.
Anorexia and Cachexia Both conditions are extremely common in cancer patients and are often accompanied by fatigue. Long-term adverse drug reactions limit the use of corticosteroids to far-advanced cancer patients. Portenoy suggests alternate medications such as megestrol, anabolic steroids, and cannabinoids to achieve improved appetite and weight gain.
Managing Delirium Many cancer patients have signs of reduced awareness, attention, and perception requiring treatment. Haloperidol is useful in managing delirium, confirming the favorable results reported by Breitbart in AIDS patients (Am J Psychiatry 153:231,1996). According to Portenoy, psychostimulants also help reverse cognitive impairment and opioid-induced sedation.

For professional correspondence, please contact Dr. Portenoy at: portenor@mskmail.mskcc.org

Eugene A. Conrad

Presented at Third World Congress of Psycho-Oncology 5 Oct 1996
CONRAD NOTES, © October 1996 All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078 / posted 9-Dec-1996

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