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 effects.
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(Drug information on morphine), and fentanyl(Drug information on 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.