Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines.

In recent years, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain have undergone substantial revisions focusing on the appropriate and safe prescription of opioid analgesics, optimization of nonopioid analgesics and adjuvant medications, and integration of nonpharmacologic methods of cancer pain management. This selection highlights some of these changes, covering topics on management of adult cancer pain including pharmacologic interventions, nonpharmacologic interventions, and treatment of specific cancer pain syndromes. The complete version of the NCCN Guidelines for Adult Cancer Pain addresses additional aspects of this topic, including pathophysiologic classification of cancer pain syndromes, comprehensive pain assessment, management of pain crisis, ongoing care for cancer pain, pain in cancer survivors, and specialty consultations.

/pdf/adult-cancer-pain-version-3-2019-nccn-clinical-practice-2iceu8iq3c.pdf

Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology.

This chapter discusses different aspects of cancer. Many of the attitudes toward cancer today are similar to the popular prejudices that were held about infections before the germ theory was worked out and before the causes of different infections were understood. One of the popular misconceptions about cancer is that it is a single disease. In fact, cancer is a group of many different disorders affecting the different parts of the body, and cancer of one part is quite different from cancer of another part. It is a common belief that cancer is always incurable, but in truth, 70%–90% of patients can be completely cured of certain types of cancers. It is also believed that cancer can be transmitted by coming in contact with a cancer patient and that it is caused by dirty living, by knocks or blows, or by tinned foods. Doctors have recognized that lung cancer is associated with cigarette smoking even though they have not completely worked out the combination of chemicals that causes this effect.

What is Cancer

Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines.

Summary Background Pain is a common non-motor symptom of Parkinson's disease. We investigated the analgesic efficacy of prolonged-release oxycodone–naloxone (OXN PR) in patients with Parkinson's disease and chronic, severe pain. Methods We did this phase 2 study in 47 secondary care centres in the Czech Republic, Germany, Hungary, Poland, Romania, Spain, and the UK. We enrolled patients with Hoehn and Yahr Stage II–IV Parkinson's disease, at least one type of severe pain, and an average 24-h pain score of at least 6 (assessed on an 11-point rating scale from 0=no pain to 10=pain as bad as you can imagine). Participants were randomly assigned (1:1) with a validated automated system (block size four) to either oral OXN PR or placebo for 16 weeks (starting dose oxycodone 5 mg, naloxone 2·5 mg, twice daily). Patients and investigators were masked to treatment assignment. The primary endpoint was average 24-h pain score at 16 weeks in the full analysis population. This study is registered with EudraCT (2011-002901-31) and ClinicalTrials.gov (NCT01439100). Findings We enrolled 202 patients; 93 were assigned to OXN PR and 109 to placebo; the full analysis population consisted of 88 patients versus 106 patients. Least squares mean average 24-h pain score at 16 weeks in the full analysis population was 5·0 (95% CI 4·5 to 5·5) in the OXN PR group versus 5·6 (5·1 to 6·0) in the placebo group (difference −0·6, 95% CI −1·3 to 0·0; p=0·058). Similar proportions of patients in each group had adverse events (60/92 [65%] vs 76/109 [70%]), treatment-related adverse events (52/92 [57%] vs 62/109 [57%]), and serious adverse events (5/92 [5%] vs 7/109 [6%]). Treatment-related nausea was more common in the OXN PR group than in the placebo group (16/92 [17%] vs 10/109 [9%]), as was treatment-related constipation (16/92 [17%] vs 6/109 [6%]). Interpretation The primary endpoint, based on the full analysis population at week 16, was not significant. Nonetheless, the results of this study highlight the potential efficacy of OXN PR for patients with Parkinson's disease-related pain and might warrant further research on OXN PR in this setting. Funding Mundipharma Research.

/pdf/prolonged-release-oxycodone-naloxone-for-treatment-of-severe-l0hkjetk6d.pdf

Prolonged-release oxycodone–naloxone for treatment of severe pain in patients with Parkinson's disease (PANDA): a double-blind, randomised, placebo-controlled trial

Aim
To evaluate the long-term safety and efficacy of prolonged-release oxycodone/naloxone (OXN PR) and its impact on quality of life (QoL), in patients with moderate-to-severe cancer pain.

/pdf/long-term-safety-and-efficacy-of-oxycodone-naloxone-wm8osyqwtn.pdf

Long-term safety and efficacy of oxycodone/naloxone prolonged-release tablets in patients with moderate-to-severe chronic cancer pain

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Long-term safety and efficacy of oxycodone/naloxone prolonged-release tablets in patients with moderate-to-severe chronic cancer pain