The management of inoperable gastrointestinal obstruction in terminal cancer patients.
The aim of the study was to assess vomit and pain control in terminal cancer patients with inoperable gastrointestinal obstruction, using a pharmacologic symptomatic treatment which prevents recourse to nasogastric tube placement and intravenous hydration, in hospital and home care settings. Twenty-two symptomatic patients, who were judged as inoperable, were treated with a pharmacologic association of morphine hydrochloride and scopolamine butylbromide as analgesics and haloperidol as an antiemetic. The drugs were administered by continuous subcutaneous infusion via a syringe driver or intravenously only when a central venous catheter had been inserted previously. Daily recordings included assessment of pain, number of vomiting episodes, dry mouth, drowsiness, and thirst sensation. Data were examined before starting the treatment (T0), 2 days after (T2) and 2 days before death (T-2). They showed that there was a significant decrease in the pain score (p less than 0.001) on T2 and a further decrease on T-2 (p less than 0.05). Vomiting was controlled in all patients, with the exception of three patients with upper abdomen obstruction who required nasogastric tube placement. Dry mouth showed an upward trend throughout the observation period (p less than 0.05) but was successfully treated by administering liquids by mouth or ice-cubes to suck. Drowsiness too presented an upward trend from T0 to T-2 (p less than 0.001). Only one patient out of 16 who reported to be thirsty required intravenous hydration. We believe that in terminal cancer patients, vomit and pain resulting from inoperable intestinal obstruction, with the exception of obstruction of the upper abdomen, can be controlled through administration of analgesic and antiemetic drugs, in the hospital and at home, without recourse to nasogastric tube placement or intravenous hydration.
Division of Pain Therapy and Palliative Care National Cancer Institute, Milan, Italy.
V
V
Ventafridda
C
C
Ripamonti
A
A
Caraceni
E
E
Spoldi
L
L
Messina
F
F
De Conno
D000008:Abdominal Neoplasms / Q000150:complications*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002086:Butylscopolammonium Bromide / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage / Q000627:therapeutic use; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D013727:Terminal Care / Q000379:methods; D014839:Vomiting / Q000188:drug therapy* / Q000209:etiology; D014987:Xerostomia / Q000188:drug therapy* / Q000209:etiology
D002086:Butylscopolammonium Bromide; D009020:Morphine; D006220:Haloperidol