Purpose: Since sustained cough causes great distress to cancer patients, it is important to palliate this symptom. Here, we report a case of intractable cough that could not be controlled by morphine but was successfully managed using continuous infusion of lidocaine for 1 year. Case: A female patient suffered from breast cancer in her fifties. Its lung metastasis invaded endobronchial space, causing frequent and sustained coughing. Further, coughing was often induced by her body motion, hampering the patient's quality of life. Morphine hydrochloride up to a dose of 480mg/day was ineffective in alleviating this symptom. Therefore, we started lidocaine administration via continuous infusion at a dose of 480mg/day. From the day administered, both frequency and duration of her coughing bouts were markedly reduced. Although its dose was increased to 960mg/day because of aggravated coughing in the course of her disease, the symptom was successively managed for 1 year with no side effects. Conclusion: Continuous and long-term infusion of lidocaine could be an alternative treatment for morphine-ineffective intractable cough. Palliat Care Res 2008;3(1):305-307

Purpose: Nausea is a common distressing symptom experienced by advanced cancer patients. This study compared the clinical efficacy of haloperidol to hydroxyzine hydrochloride in combination with haloperidol in the management of nausea induced by continuous infusion of opioids. Methods: This retrospective study comprised 50 advanced cancer patients using continuous infusion of opioids who had been administered either haloperidol alone (haloperidol group) or hydroxyzine hydrochloride with haloperidol (hydroxyzine hydrochloride group); their nausea and characteristics were assessed using multivariate analysis. Results: After the continuous infusion of opioids, nausea occurred in 34% patients in the haloperidol group and 10% patients in the hydroxyzine hydrochloride group. No significant differences were observed in patient characteristics, except for the number of the patients using infusion of opioids. By multivariate analysis, nausea before using continuous infusion of opioids, ileus, and haloperidol without hydroxyzine hydrochloride were extracted as the risk factors of nausea. In both the groups, nausea occurred only in the patients using morphine; nausea occurred in 32.5% patients in the haloperidol group and in 4.5% patients in the hydroxyzine hydrochloride group. Conclusion: Hydroxyzine hydrochloride in combination with haloperidol was observed to be more effective than haloperidol alone in the management of nausea induced by continuous infusion of opioids.

Insomnia in advanced cancer patients has a highly negative impact on the patients, their families and caregivers. Insomnia is principally managed by pharmacological therapy； however, most advanced cancer patients are unable to receive oral medications. This prospective audit study investigated the efficacy of single—dose subcutaneous administration of flunitrazepam for treating insomnia in patients with advanced cancer. Sleep evaluation was conducted using the St. Mary’s Hospital Sleep Questionnaire. The primary endpoint was the quality of sleep； the secondary endpoints comprised other subscales of total sleep time, sleep latency and adverse effects. We enrolled 30 patients. The average dose of flunitrazepam dose was 0.9(0.1)mg. The good response rate for the quality of sleep was 90％. The total sleep time and sleep latency were 7.5(3.2)h and 31(9.1)min, respectively. Two patients were newly diagnosed with delirium during the study. The mean respiratory rate decreased(15/min before treatment to 14/min after treatment, P＝0.01) without any critical events. Single—dose subcutaneous administration of flunitrazepam may be potentially efficacious and simple in treating insomnia in advanced cancer patients.