NEW YORK-An implanted epidural catheter can be a safe and effective
means of providing analgesia in the home setting for patients
with advanced cancer, Memorial Sloan-Kettering Cancer Center researchers
found in a retrospective review.
Angela Racolin, RN, and her colleagues in the Anesthesiology Pain
Management Group examined the charts of 40 cancer patients referred
for management of inadequate analgesia or intolerable opioid side
These patients lived an average of 2.3 months after catheter implantation,
with 85% dying at home, the majority with satisfactory pain relief
provided by the epidural till the end.
"Most patients do deteriorate as their disease progresses,
requiring multiple dosage changes," Ms. Racolin said in an
interview, "but we can usually do that with the home care
agencies over the telephone, so patients can remain in their homes."
In her poster presentation, Ms. Racolin said that in this series
of patients, there were no serious complications associated with
the epidural catheters or with the medications used-hydromorphone
(Dilaudid), morphine, and fentanyl (Sublimaze).
One catheter had to be removed due to infection 7 months after
insertion, and one catheter became dislodged 6 weeks after implantation.
Cost analysis showed an average charge of $200 to $600/day, depending
on the choice of analgesic drug and home care company. In these
patients, with a life expectancy of 2.3 months, the total cost
per patient of epidural drug delivery with home nursing care ranged
from $21,000 to $42,000.