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Introduction: Intractable and persistent cough is experienced by more than a third of patients with advanced cancer, with a significant negative impact on quality of life. Pharmacological treatment has been of little help in some patients. Limited evidence suggests novel agents such as paroxetine may reduce cough severity. This retrospective study aimed to assess effectiveness and tolerability of paroxetine for the treatment of intractable cough in patients with cancer. Methods: Single-centre medical record review of paroxetine use in patients with advanced malignancy and cough treated at an Australia tertiary referral cancer centre between 1 October 2012 and 1 October 2017. Data relating to cough type and severity, response and adverse events were extracted from medical records. Cough type was described as non-productive dry cough, productive chesty cough or cough exhibiting both non-productive and productive features (mixed cough). Results: Overall, 24/34 patients (71%) experienced a major or moderate reduction in their cough severity after treatment with paroxetine. Nearly half (47%) described a major improvement and a quarter (24%) moderate improvement. Of the 34 patients, nearly half had a lung primary cancer (16/34, 47%) and nearly all (17/18) of those without lung cancer had lung metastases from another primary cancer. Patients with dry cough reported greater benefit from paroxetine. Of the 56% (19/34) of patients with non-productive dry cough, 80% (15/19) reported an improvement in symptoms post paroxetine. The remaining 15 patients, 44% of the group, presented with either a productive chesty cough (9/34, 27%) or mixed cough (6/34, 18%). Of these patients, 60% (9/15) reported an improvement in symptoms. Two thirds of patients were commenced on paroxetine 10 mg (22/34, 65%), with the remainder starting at 20 mg (14/34, 35%). Conclusion: Paroxetine may be an effective, novel, off-label treatment for intractable and persistent cough in patients with advanced cancer. [ABSTRACT FROM AUTHOR]

Background: Intravenous lidocaine is effective in treating pain. Limited studies have assessed the effectiveness and safety of subcutaneous lidocaine infusions. Methods: We conducted a retrospective review of patients with cancer who received subcutaneous lidocaine infusions for pain. Patient characteristics, pain scores and opioid doses before and after lidocaine, and details of infusions were recorded. We identified three time periods of interest. T0 is defined as the 24-hour period immediately before commencing lidocaine treatment. T1 is defined as the 24-hour period before lidocaine was ceased. T2 is defined as the first 24-hour period after lidocaine was ceased. In addition, the overall impression of the effectiveness of lidocaine was subjectively evaluated by the authors. Results: Twenty patients (13M;7F) received lidocaine. Two patients received it twice, totaling 22 episodes. The median lidocaine dose was 0.67 mg/kg/h with the median duration being 5.5 days. The median worst pain score at T0 and T1 was 8.5 and 5.5, respectively. The difference in the mean pain scores was 3.2 95% CI (2.1, 4.4; p < 0.001). In 15/22 episodes (68%), patients experienced a decrease in pain scores of more than 2. The median morphine oral equivalent (MOE) daily doses at T0, T1, and T2 were 425, 362.5, and 275 mg, respectively. The difference in the mean MOE between T0 and T1 was −126 (95% CI [−281, 28]; p = 0.13). The difference in the mean MOE between T0 and T2 was −207 (95% CI [−370, −44]; p = 0.025). Lidocaine was subjectively deemed effective in 10/22 episodes (45%). There were no documented adverse events attributed to lidocaine. Univariate analyses did not identify any subgroups likely to benefit from lidocaine. Conclusion: Subcutaneous lidocaine infusions may be used safely in cancer pain management and is effective in some patients. [ABSTRACT FROM AUTHOR]

Background: Increasing demand for palliative care unit (PCU) admissions has led to a stronger focus on discharge planning. This has resulted in shorter inpatient length of stays (LOS), and stable patients not requiring specialist palliative care services being referred for placement in residential aged care facilities (RACFs). The process of placement is time-consuming and can be distressing to patients and families, so RACF placement should only be proposed in patients whose prognosis is relatively good (i.e., weeks to months). Objective: Our aim was to identify the outcomes of palliative care inpatients referred for residential aged care placement. Methods: A retrospective chart audit was conducted. The patients' outcomes (discharge or death and survival time) were recorded and analyzed using SPSS statistical software. Subjects were 100 consecutive inpatients from a 30-bed PCU who had been referred for RACF placement. Results: Of the 100 patients referred for RACF placement 73 of 100 (73%) patients had a malignant diagnosis, whereas 27 (27%) had a noncancer diagnosis. Thirty-eight (38%) patients died before discharge, including 33 of 73 (45%) patients with cancer and 5 of 27 (13%) patients with nonmalignant conditions. In particular, 12 of 17 (71%) patients with metastatic non-small cell lung (NCSLC) cancer died before or soon after discharge. Conclusion: Over one-third of all patients died before discharge to an RACF could take place. The rate of death before discharge was higher among patients who had cancer. Patients suffering from NCSLC need to be more carefully selected for placement as only one-third of these patients survived to discharge. [ABSTRACT FROM AUTHOR]