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Improving Palliative Care for Cancer
terms cancer and pain produces 147 hits. Inspection of the result finds a total of 42 that relate to basic or clinical research that might have relevance to clinical cancer pain. Of these studies, 9 are descriptive (including correlational and behavioral studies), 19 deal with trials of interventions, and 14 are basic science studies.
CURRENTLY FUNDED CLINICAL TRIALS
Combination Chemotherapy in Treating Pain in Patients with Hormone-Refractory Metastatic Prostate Cancer
Phase III Randomized Study of Mitoxantrone and Prednisone with or Without Clodronate in Patients with Hormone Refractory Metastatic Prostate Cancer and Pain
Flecainide in Treating Patients with Chronic Neuropathic Pain
Pain Control in Patients with Recurrent or Metastatic Breast or Prostate Cancer
Morphine for the Treatment of Pain in Patients with Breast Cancer
Treatment of Prostate Cancer with Docetaxel Alone and in Combination with Thalidomide Treating Patients With Stage IV Prostate Cancer
Effect of Androgen Suppression on Bone Loss in Patients With or Without Bone Metastases
Combination Chemotherapy in Treating Pain in Patients with Hormone Refractory Metastatic Prostate Cancer
Anorexia and Cachexia
Cancer patients often experience a profound loss of appetite (anorexia), especially in the last weeks of life, as well as a deterioration and wasting of body tissue (cachexia). There is clear evidence that cancer patients have undergone metabolic changes in their physiological responses to food. The metabolic changes with cachexia seem to be mediated by a variety of molecules in the body (including proinflammatory cytokines, neuroendocrine hormones, neurotransmitters, eicosanoids, and tumor-related substances) (produced by the tumor itself and by the body in response to the tumor; Barber et al., 2000). Cachexia is the immediate cause of nearly one-third of cancer deaths (Argiles and Lopez-Soriano, 1999).
Pharmacologic agents commonly used to treat cachexia include corticosteroids and progestational drugs (Gagnon and Bruera, 1998). Eight randomized, double-blind, placebo-controlled studies have confirmed that progestational drugs can increase appetite, food intake, and energy level. Additionally, in many patients, these drugs increase weight, and may also have an effect on nausea and vomiting (Body, 1999). Drugs that lessen the process of skeletal muscle protein catabolism that occurs in cachexia pa