Orphan symptoms in advanced cancer patients followed at home

Abstract

Orphan symptoms are rarely assessed, particularly at home. The aim of this multicenter prospective study was to assess the prevalence of these symptoms and eventual factors possibly associated in advanced cancer patients at admission of a home care program. A prospective study was performed at three home care programs in Italy. Patients' data were collected, including age, sex, diagnosis, and Karnofsky status. Possible contributing factors were analyzed; preexisting neurological diseases, cerebral metastases, hyperthermia, diabetes, a state of dehydration clinically evident and/or oliguria, possible biochemical parameters when available, data regarding recent chemotherapy, opioids and doses, use of neuroleptics, benzodiazepine or anticonvulsants, corticosteroids, anti-inflammatory, and antibiotics were collected.

Incidence of Acute Suppurative Sialadenitis in End-Stage Cancer Patients: A Retrospective Observational Study

“…In end-stage cancer patients with a prognosis of approximately one month, the incidence of sialadenitis was found to be 2.9%. A past study reported the following incidences of rare symptoms in home care patients with advanced cancer: 0.3% for myoclonus, 5% for diaphoresis, 2% for tenesmus, 4% for pruritus, and 4% for hiccups, 3 which are comparable with that of sialadenitis in the present study. Although sialadenitis is a rare complication compared with major physical symptoms such as pain and breathing problems, its onset is often accompanied by increasing physical suffering as shown in the present study, in which pain was experienced by 86% of the patients and fever by 62%.…”

Palliative Sedation in Patients with Cancer

“…The debates about the characteristics and how to define palliative sedation are reflected in the wideranging prevalence of the practice observed in the literature (1%-88%), [8][9][10]13 which can be attributed to a number of factors: • Different health care settings Higher prevalence in inpatient acute tertiary palliative care units compared with home-care hospice programs 33,34 • Different case mixes in similar settings…”

“…14,15 In home-care hospice programs, palliative sedation may be a feasible option. Mercadante et al 37 reported that 13.2% of patients with cancer were sedated in their homes.…”

“…Some studies advocate use of neuroleptics for delirium (eg, haloperidol). [35][36][37] Haloperidol has less sedating power than midazolam, so it is typically used to attenuate delirium; thus, it is not the most appropriate choice of drug for achieving continuous sedation. Other drugs used for palliative sedation have included levomepromazine, chlorpromazine (especially when profound sedation is needed for acute agitated delirium), propofol, ketamine, and dronabinol.…”

Research in Palliative Care: My Past, My Present, My Future

“…Although the symptoms examined have a low prevalence in advanced cancer patients admitted to home care, the distress for patients may be high and deserve further analyses. Given the low prevalence of these symptoms, large studies are needed to find possible associated factors [25,26]. The future home care research agenda includes the prevalence of breakthrough dyspnea, the prevalence of oral symptoms and sleep disturbances at home, of which data are in existent.…”