Abstract Context Haloperidol is used commonly for the control of nausea and vomiting (N/V) in palliative care patients, but there is very little evidence to support its use. Objectives To assess the ...efficacy of haloperidol as an antiemetic in patients with cancer and N/V not related to cancer treatment. Methods Patients with an N/V score of at least 1 on a 4-point scale were prescribed either oral or subcutaneous haloperidol. N/V and toxicity were assessed daily for the duration of the study (maximum five days) by both the patient and an observer (health professional). Results At Day 2, 33 of 42 (79%) treated patients were assessable for response. Eight (24%; 95% confidence interval CI: 10%–39%) patients had complete control of N/V and 12 (36%; 95% CI: 20%–53%) had partial control, giving an overall response rate of 61% (95% CI: 44%–77%). At Day 5, 23 patients were assessable for response. The overall response rate was 17 of 23 (74%; 95% CI: 56%–92%). If all patients are included in the response analysis, the overall response rates at Days 2 and 5 were 47% and 40%, respectively. Conclusion Haloperidol has some efficacy in the treatment of N/V in this patient group. The results from this uncontrolled study provide pilot data from which to plan future controlled trials of antiemetics in the palliative care population.
Purpose
Little is known about the pharmacokinetics (PKs) of oxycodone in patients with advanced cancer. There is considerable reluctance to subject these patients to non-essential tests including ...repeated venipuncture that has been necessary in PK studies to date. We investigated the possibility of using saliva sampling as a simple non-invasive test to investigate opioid PKs.
Methods
Patients with malignant disease receiving oral sustained release (SR) oxycodone at any dose were asked to provide saliva samples at the same time as blood samples. Samples were not taken within 6 h of a dose of immediate release oxycodone. Plasma and saliva oxycodone and metabolite concentrations were measured using HPLC coupled with tandem mass spectrometric detection.
Results
One hundred and thirty-nine paired plasma/saliva samples were collected from 43 cancer patients who had been taking SR oxycodone for more than 5 days at doses ranging from 10 to 600 mg/day (median 40 mg/day). Plasma concentrations of oxycodone and noroxycodone ranged from 1.0 to 256.0 and 0.9–269.4 μg/L, respectively. Salivary concentrations of oxycodone (range 0.93–3,620, mean 336 μg/L) were much higher than plasma concentrations (mean 38.2 μg/L). There was a poor correlation between concentrations of both oxycodone and noroxycodone in plasma and saliva over a range of times following dosing (
r
2
= 0.4641 and 0.3891, respectively). No correlation was shown between salivary pH and oxycodone or noroxycodone concentrations. The majority of patients questioned chose saliva sampling over plasma sampling as the preferred method.
Conclusion
High levels of both oxycodone and its major metabolite are present in saliva, but this does not provide a valid substitute for plasma when monitoring oxycodone levels for PK studies or therapeutic monitoring.
The evidence to date regarding memory processes in children with autism spectrum disorders (ASD) remains equivocal. Although children with these neurodevelopmental disorders have been shown to ...display exceptional memories for fact-based information, they seem to be less able to attach meaning or context to their memories. Thus, this study investigated the specific role of source memory in autism. Children with ASD were compared to a chronological and mental age-matched comparison group of typically developing children. Although children with autism performed similarly to controls on a fact recognition measure, their performance on a source memory task was significantly lower. The findings indicated, however, that the nature of source memory confusion in children with autism does not appear to reflect a generalized deficit in attaching context to memories but rather is dependent on the specific to-be-remembered information that, in this study, involves social aspects of context.
In advanced cancer, the prevalence of fatigue is high and can be related to treatment or disease. Methylphenidate hydrochloride (MPH) is a central nervous system stimulant that has been used to ...palliate fatigue. There is no standard dose for MPH when used for this indication; recommended doses range from 5–20 + mg/d.
To identify a dose to test formally in a subsequent n-of-1 trial of fatigue, we recruited patients with advanced cancer and a fatigue score of 4 or more on a 10-point scale. Following a 3-day baseline assessment, each patient titrated MPH at doses ranging from 5 mg/d to 15 mg twice daily at 3-day intervals. In a daily diary, patients recorded measures of fatigue, depression, toxicity, and symptom control.
Ten patients provided consent, 9 completed 8 days and 5 received maximum dose at day 15. Three patients were unwilling to increase the dose to maximum levels as they were satisfied with the response at a lower dose. Across all patients, there was a pattern of rapidly improving fatigue and depression scores to day 9 (5 mg twice daily), with minimal improvement thereafter.
The results indicate a dose of 5 mg twice daily for the definitive study. There was little correlation between performance status and maximum tolerated dose. No patient withdrew because of toxicity.
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