The effectiveness and adverse effects profile of "burst" ketamine in refractory cancer pain: The VCOG PM 1-00 study.
This multi-centre study of adjuvant "burst" ketamine in palliative care in-patients documents its effectiveness, duration of pain relief, and adverse effects (AE) profile. Patients received a three-to-five day continuous subcutaneous infusion (CSCI) of ketamine escalated from 100 to 300 to 500 mg/24 hours if required. When the effective or maximum tolerated dose was attained, the infusion was continued for three days and each patient assessed as a responder or non-responder using strict criteria. The response rate was 22/44 (50 percent), with 4 (9 percent) becoming pain-free. Pain relief lasting two or more weeks was documented in 50 percent of responders. AEs were documented daily using the National Cancer Institute (NCI) Common Toxicity Criteria 0-4 scales. There were 11 grade 3 and 4 neurological AEs. However, no responders elected to cease treatment early due to neurological AEs. We concluded that this protocol in the controlled environment of an in-patient PC unit is relatively safe and simple with reasonable effectiveness.
Supportive and Palliative Care Unit, Southern Health and Monash University, and McCulloch House PCU, Monash Medical Centre, Locked Bag 29, Clayton South, Victoria 3169, Australia. kate.jackson@southernhealth.org.au
Kate
K
Jackson
Michael
M
Ashby
Deb
D
Howell
Jennifer
J
Petersen
David
D
Brumley
Phillip
P
Good
Maria
M
Pisasale
Simon
S
Wein
Roger
R
Woodruff
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D055104:Infusions, Subcutaneous; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010147:Pain Measurement; D010148:Intractable Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D012449:Safety; D016896:Treatment Outcome; D014739:Victoria
D000700:Analgesics; D007649:Ketamine