Russell K. Portenoy, MD | Authors

Commentary (Cruciani/Portenoy)-Opioid Rotation in Cancer Patients: Pros and Cons

April 01, 2005

Opioid rotation is now consideredstandard practice in themanagement of cancer pain.The rationale for the approach hasbeen well summarized by Estfan andcolleagues. Rotation should be viewedas one strategy among many to dealwith patients who demonstrate relativelypoor responsiveness to an opioid.[1] Application of well acceptedclinical guidelines for opioid administration,beginning with those originallypromulgated by the WorldHealth Organization,[1] emphasizethe need to individualize the opioiddose through a process of gradualdose titration, irrespective of the specificdrug. Most cancer patients attainan adequate balance betweenanalgesia and side effects, at leastinitially. Some, however, experiencetreatment-limiting toxicity, the sinequa non of “poor responsiveness.”This response reflects an outcome thatis related to a specific drug, route ofadministration, set of patient-relatedvariables, and time.

Treatment of Dyspnea in Cancer Patients

June 01, 2002

Dyspnea is an extremely common symptom among cancer patients.[1] Like pain, it is inherently subjective and is best defined as the perception of difficulty in breathing, or an uncomfortable awareness of breathing. Although it may be associated with one or more physiologic disturbances (such as hypercapnia, hypoxia, obstructive or restrictive patterns on pulmonary function tests, or various abnormalities on chest imaging studies), it is not strongly associated with any specific abnormality and may occur in the absence of any. Patient self-report is the gold standard for assessment and may range from mild breathlessness on exertion to a terrifying sense of suffocation.

Changing Perspectives on Palliative Care

April 01, 2002

In their article, Drs. Choi and Billings address a number of strategic areas in palliative care. These topics include the definition and scope of the evolving field, the complexities involved in the use of modalities that carry burden or risk (such as artificial nutrition and bowel decompression), and the underappreciated importance of communication skills and a capacity for ethical reasoning.

Management of Fatigue in the Cancer Patient

March 01, 2002

Fatigue is one of the most common symptoms experienced by patients with cancer and other progressive diseases. Although reported to be a major obstacle to maintaining normal daily activities and quality of life, remarkably few studies of this syndrome have been conducted.

Neuropathic Cancer Pain: The Role of Adjuvant Analgesics

November 01, 2001

Neuropathic pain may be defined as pain related to abnormal somatosensory processing in either the peripheral or central nervous system. This pathophysiologic label is typically applied when the painful symptom is associated

Sedation in the Imminently Dying Patient

April 01, 2000

It is a propitious time for the publication of Dr. Wein’s thoughtful paper on sedation in the imminently dying. Although this intervention has been accepted by most palliative care specialists for many years, it seems to be unfamiliar to many oncologists. The numerous surveys[1-7] and published guidelines[8] that have informed discussions of the technique have not appeared in the oncology literature and probably have been read by few of the front-line clinicians who care for dying cancer patients. Like the broader model of palliative care of which it is part, sedation in the imminently dying must be “mainstreamed”-ie, understood in all its complexity by clinicians whose patients may benefit most from its skillful application.

A 38-Year-Old Man With Pancreatic Cancer

May 01, 1999

Michael H. Levy, MD: This 38-year-old white male first came to his physician in January of 1993 complaining of epigastric and low back pain. In March of 1993, he was diagnosed with pancreatic cancer that was metastatic to his

Managing Pain in Patients With Advanced Cancer: The Role of Neuraxial Infusion

May 01, 1999

As a result of a burgeoning science and an intensive educational campaign that began more than a decade ago, oncologists

A 15-Year-Old Boy With Primitive Neurectodermal Tumor

May 01, 1999

Dr. Peter Staats presented the case of a 15-year-old, 40-kg boy with a primitive neurectodermal tumor located in

Managing Cancer Pain Poorly Responsive to Systemic Opioid Therapy

May 01, 1999

Large surveys of populations with cancer pain indicate that as many as 90% of patients can attain adequate relief of pain using optimal, systemic, opioid-based pharmacotherapy. Skilled clinicians should be able to achieve