To evaluate the efficacy of palonosetron in the clinical practice setting

Patients were given premedication with 0.25 mg palonosetron on day one of each chemotherapy cycle. All patients were prescribed standard antiemetics as recommended in Multinational Association of Supportive Care in Cancer (MASCC) and American Society of Clinical Oncology (ASCO) guidelines. Patients completed questionnaires to document satisfaction with control of nausea and emesis in the acute and delayed phases.

• The study consisted of 135 participants.
• Age of patients was not provided.
• The majority of patients were female (67%).
• Patients had a variety of cancer diagnoses, with the most frequently being breast, lung, and ovarian; 67% of patients had metastatic disease.
• The majority of patients were receiving cisplatin, carboplatin, anthracyclines, 5-floururacil, or cyclophosphamide.
• One-fifth of patients reported anticipatory nausea, and 19% of patients were chemotherapy naïve.
• Patients were receiving either moderately or highly emetogenic treatments.

The study was conducted in multiple outpatient settings in Austria.

All patients were in active treatment.

This was a prospective trial.

• Patients reported their satisfaction with antiemetic control on a four-point Likert-type scale.
• Complete response (CR) was defined a lack of emesis and no rescue medications used on days 1–5 of chemotherapy.

• The overall CR rate was 68%, with 87% on day 1, and 72% on days 2–5.
• Response rates were highest in males (82%), those age 50 or older (70%–73%), and those who were chemotherapy naïve (73%) (p < 0.05).
• Subgroup analysis showed that the CR rate also was lower in patients who received highly emetogenic therapy.
• Nausea was highest on days 2 and 3. Palonsetron side effects including vertigo and dyspepsia were reported by 1.5% of patients.

Palonosetron was found to be effective for prevention of chemotherapy-induced nausea and vomiting (CINV) and to provide a significant contribution to the antiemetic armamentarium.

• An appropriate control group was not included.
• Actual measurement of nausea was not provided.
• Method of measurement of emesis episodes or use of rescue medications was not described.

Findings support the effectiveness of palonosetron in management of CINV. Effectiveness in managing nausea, rather than just emesis, is not clear.

To evaluate the safety and efficacy of human intestinal trefoil factor (rh/TF) oral spray for the treatment and prevention of chemotherapy-induced oral mucositis.

Patients who had at least grade 2 oral mucositis after the first course of chemotherapy were randomized to receive placebo spray, low-dose rh/TF (10 mg/ml) spray, or high-dose rh/TF (80 mg/ml) spray. Patients had to fully recover from the mucositis prior to study entry. Patients were instructed to administer three puffs to the oral mucosa eight times daily for 14 days, beginning on the first day of the second chemotherapy cycle. Patients were to refrain from oral intake for 15 minutes after dosing.

• The sample consisted of 99 participants.
• Mean patient age was 58.7 years (SD = 9.1 years) in the placebo group, 62.1 years (SD = 8.9 years) in the low-dose group, and 56 years (SD = 7.9 years) in the high-dose group.
• The sample was composed of 58.6% females and 41.4% males.
• All patients had colon cancer and were receiving chemotherapy based on fluorouracil (5-FU). Of all participants, 85% had had prior radiotherapy; 97% had had leucovorin also.

• Multisite
• Outpatient setting
• Russia

Randomized double-blind placebo-controlled trial

World Health Organization grading system for oral mucositis

• Of all participants, 48.5% developed recurrent oral mucositis.
• Treatment with low-dose rh/TF and high-dose rf/TF, respectively, produced an 81.2% and a 75.1% reduction in WHO grade 2 or higher mucositis (p < 0.002). The proportion of patients with grade 0 mucositis was 60% in the low-dose group, 69.7% in the high-dose group, and 33.3% in the placebo group.
• Patient self-assessment reported higher frequency of mouth and throat soreness with placebo (p < 0.05) between days 6 and 11.
• Analgesic use was infrequent and not significantly different among groups.
• The safety profile of rh/TF was similar to that of placebo.

Topical administration of rh/TF was safe and effective in ameliorating symptoms of chemotherapy-induced oral mucositis.

• The sample had a small sample size, with fewer than 100 participants.
• The study was of limited duration, lasting through only one additional course of chemotherapy with 5-FU. Efficacy in the longer term and in other patient populations, with other chemotherapeutic regimens, is unknown.

The study suggests that rh/TF is a promising approach for the prevention and management of oral mucositis. Its ease of use and safety profile makes rh/TF a practical treatment. Authors did not discuss cost, which may be a consideration. Further study in other patient groups is warranted.

To summarize the evidence around the use of radiotherapy, standard-dose chemotherapy, and high-dose chemotherapy with or without total body irradiation plus hematopoietic stem cell transplantation (HSCT) for the management of mucositis

• Databases searched were the Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO).
• Evidence was evaluated based on the American Society of Clinical Oncology (ASCO) Levels of Evidence (I-V) and Grades of Recommendation (A-D). Statements without grading were considered justified standard clinical practice by the expert authors and the European Society for Medical Oncology (ESMO) faculty.

• Institutions should develop oral care protocols based on clinical practice and interdisciplinary involvement. Staff and patient education are essential. Basic oral care should include saline mouth rinses 4–6 times per day and use of a soft toothbrush replaced on a regular basis. 
• Patient-controlled analgesic (PCA) with morphine is recommended for the treatment of pain in patients with oral mucositis undergoing HSCT.
• Regular oral pain assessment and topical anesthetics can provide short-term pain relief. 
• Chlorhexidine rinses are not recommended to treat established mucositis but may be an option to enhance treatment of oral infection.
• Benzydamine oral rinse is recommended for prevention of mucositis in patients with head and neck cancer receiving radiotherapy.
• For prevention of mucositis in patients receiving standard-dose chemotherapy,
  • Oral cryotherapy for 30 minutes is recommended in patients receiving fluorouracil (5-FU).
  • Keratinocyte growth factor-1 (palifermin) 40 mcg/kg per day for three days may be useful in patients receiving bolus 5-FU plus leucovorin.
• For prevention of mucositis in patients receiving high-dose chemotherapy with or without total body irradiation plus HSCT, the following are recommended.
  • Palifermin 60 mcg/kg per day for three days prior to transplant and three days post-transplant
  • Cryotherapy in high-dose melphalan
  • Low-level laser therapy (LLLT) before HSCT

The primary author was the principal investigator on the National Institutes of Health (NIH) R13 Conference Grant that provided partial support for the symposium “Oral Complications of Emerging Cancer Therapies,” 14-15 April 2009, Bethesda, MD, USA. Production of a Journal of the National Cancer Institute (JNCI) Monograph for conference publications was supported by an unrestricted educational grant form Biovirum, which owned palifermin at the time of the publication. Peterson also is a member of the Scientific Advisory Board and a paid consultant for the GI Co., Inc, which is responsible for the development of recombinant intestinal trefoil factor, for which the phase II study is cited in the references.

The mucositis guidelines reported contain few changes from the previous two versions of the ESMO Clinical Practice Guidelines. With the 2009 MASCC/ISCO Mucositis Study Group in June 2009, it was decided that no new guidelines were warranted based on the current published literature. Progress has been made in the understanding of molecular basis of mucositis. Evidence-based, cancer-specific identification of risk factors and management of mucositis depend on clinical research so that approval of new drugs and devices will be possible.

• Glutamine (Saforis, MGI Pharma) was administered at 2.5 g per 5 ml, three times per day, for a total daily dose of 7.5 g. Treatment began on the first day of chemotherapy and continued for 14 days after the last dose in patients who did not develop oral mucositis or until 5 days after resolution of oral mucositis. Glutamine was orally swished for 30 seconds, then swallowed.
• Oral hygiene consisted of gently brushing teeth twice per day, 30 minutes or more after each study drug treatment, with a soft toothbrush and fluoride toothpaste. Daily flossing and alcohol-free fluoride rinse was recommended.
• All patients were treated with 200 mg oral acyclovir twice per day.

• Patients were eligible for the study if they
  • Were age 18 or older.
  • Had European Cooperative Oncology Group (ECOG) scores of 2 or less.
  • Had histopathologically confirmed breast cancer to be treated with anthracycline-based chemotherapy.
  • Experienced World Health Organization (WHO) grade 2 or higher mucositis during the first cycle of chemotherapy.
  • Were scheduled to receive at least two more cycles without dose reduction.
• In cycle 1, 163 patients received glutamine and 163 received placebo.
• In cycle 2, 150 patients received glutamine and 155 received placebo.

The study was conducted in Russia.

This was a randomized, double-blind, placebo-controlled, crossover, phase III trial.

• Oral mucositis was measured with regard to incidence, severity, ability to eat solid food, and pain.
• The WHO scale and Oral Mucositis Assessment Scale (OMAS) were used.

• Some nausea was reported.
• In treatment cycle 1, incidence of WHO grade 2 or higher was 38.7% in the treatment group and 49.7% in the placebo group (p = 0.026).
• Incidence of grade 3 or higher was 1.2% in the treatment group versus 6.7% in the control group (p = 0.005).
• Ability to eat solid food was 97.5% in the treatment group versus 91.9% in the control group (p = 0.039).
• No differences were observed in oral pain intensity or difficulty swallowing.
• In treatment cycle 2, incidence of WHO grade 2 or higher oral mucositis among patients in the placebo group was significantly lower than cycle 1 (31.9 versus 49.7; p = 0.0269); this was considered to be a carryover effect.

Glutamine is easy to use, has a favorable safety profile, and is low in cost. The total daily dose was within the range of dietary glutamine consumed by an adult on a high-protein diet (about 8 g per day). This treatment should be tested in higher intensity chemotherapy regimens.

To summarize the oral and gastrointestinal mucositis guidelines developed by the Mucositis Study Group of Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO) for patients receiving high-dose chemotherapy, standard-dose chemotherapy, radiation therapy, and combination chemotherapy/radiation therapy

The resource type is guidelines. The process of development was not explained.

Patients were undergoing the active treatment phase of care.

This study has clinical applicability for the following.

• High-dose (HD) head and neck radiation
• Hematopoietic stem cell transplant (HSCT)
• Standard multicycle chemotherapy
   

This report contains few changes compared to previous versions published in 2008 and 2010. The oral mucositis (OM) guidelines are as follows.

• Basic oral care and good clinical practice
  • ​Multidisciplinary development and evaluation of oral care protocols that include frequent use of nonmedicated oral rinses (e.g., saline mouth rinses 4–6 times per day) is recommended. Patient and staff education in the use of such protocols is recommended.
  • Alcohol-based mouth rinses should be avoided.
  • Interdisciplinary development of systemic oral care protocols is suggested. The protocol should include the use of a soft toothbrush that is replaced on a regular basis.
  • Patient-controlled analgesia with morphine is recommended as the treatment of choice for OM pain in patients undergoing HSCT. Regular oral pain assessment using validated instruments for self-reporting is essential.
  • All patients should be screened for nutritional risk, and early enteral nutrition should be started if patients cannot swallow.
  • Topical anesthesia can provide short-term pain relief for OM on an empiric basis.
• ​Prevention of OM associated with radiotherapy (RT)
  • ​Use of midline radiation blocks and three-dimensional RT to reduce mucosal injury is recommended.
  • Benzydamine oral rinse for prevention of radiation-induced mucositis in patients with head and neck cancer receiving moderate-dose RT is recommended. (This is not available in the United States.) 
  • Chlorhexidine is not recommended for patients with head and neck cancer.
  • Antimicrobial lozenges are not recommended
• ​Prevention of OM for patients receiving standard-dose (SD) chemotherapy
  • ​Oral cryotherapy recommended for prevention of OM in patients receiving bolus 5-FU and reduction of OM with bolus edatrexate.
  • Including granulocyte-colony stimulating factor (G-CSF) in Taxotere^®, Adriamycin, cyclophosphamide (TAC) breast cancer regimens has been associated with significant reduction in toxicities, including OM.
  • IV acyclovir and its analogs are not recommended to prevent OM in SD chemotherapy. However, antivirals may be indicated to treat viral infections that may coexist with OM.
  • IV palifermin in solid tumors needs additional research.
• Prevention of OM in patients receiving HD chemotherapy with or without total body irradiation (TBI) plus HSCT
  • Palifermin is recommended.
  • Oral cryotherapy is recommended with HD melphalan.
  • Topical pentoxifylline is not recommended.
  • Granulocyte macrophage-colony stimulating factor (GM-CSF) mouthwashes are not suggested.
  • Low-level laser therapy (LLLT) is suggested to reduce OM and pain associated with OM, if available.
• Treatment of OM associated with RT
  • Oral sucralfate is not recommended.
• Treatment of OM with SD chemotherapy
  • Chlorhexidine oral rinses are not recommended.
  • Approved devices for OM, including Gelclair^®, Caphasol^TM, and Biotene^®, have a limited research evidence base but are safe and may offer some benefit for some patients.

Other recommendations are listed in the article for gastrointestinal mucositis prevention and treatment.

• Few changes were made from previously published guidelines.
• Revisions to these guidelines are expected in the next 2–5 years because of newer technology, better understanding of the clinical impact of OM, molecular pathobiology, and emerging targeted cancer therapy.
• Oncology nurses should recommend evidence-based management for prevention and treatment of OM because some therapies may be expensive and have not been proven effective. For example, “magic mouthwash” continues to be prescribed without evidence to support its use.    
• Consistent oral care with bland rinses continues to be recommended, is easy to use, and is inexpensive.

To evaluate the impact of antifungal prophylaxis in patients with hematologic cancers

Retrospective analysis of medical records was used to compare invasive fungal infection outcomes among patients who received prophylactic posaconazole and a historical cohort treated prior to the implementation of standard prophylaxis. Prophylaxis was used in high-risk patients.

• N = 200 (100 historical controls)
• MEAN AGE = 51 years
• AGE RANGE = 18–77 years
• MALES: 50%        
• FEMALES: 50%
• KEY DISEASE CHARACTERISTICS: Patients had acute myeloid leukemia or myelodysplastic syndromes or received hematopoietic cell transplantation 

• SITE: Single site 
• SETTING TYPE: Multiple settings 
• LOCATION: Germany

• PHASE OF CARE: Active antitumor treatment

• Retrospective, descriptive with historical control comparison

• Aspergillus testing
• Weekly stool samples and mouth swabs
• European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria for possible, probable, or proven invasive fungal disease (IFD)

Mean duration of posaconazole prophylaxis was 21.7 days. Comparisons showed that 43% of controls had no IFD, compared to 72% of those with prophylaxis. Possible IFD was seen in 43% of controls and 24% of those on posaconazole.  Probable IFD was 7% in controls, compared to 4% of those getting prophylaxis. No cases of IFD were proven among patients receiving prophylaxis, compared to 7% of controls with proven IFD. Forty-one percent of those on prophylaxis required antifungal therapy, compared to 91% of controls.

Findings showed that routine posaconazole prophylaxis in high-risk patients was associated with substantial reduction in the incidence of IFD and treatment with antifungal therapy.

• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Other limitations/explanation: The definition of high-risk used for the intervention was not specifically described.

Findings support the routine use of antifungal prophylaxis in high-risk patients with cancer.

To document the characteristics of do-not-intubate (DNI) patients on high-flow nasal cannula (HFNC)—Optiflow™—including underlying disease, HFNC FiO2/flows, breathing frequency, oxygen saturation (pre and post HFNC), escalation to noninvasive ventilation (NIV), and hospital mortality for participants

Based on chart review, HFNC therapy was usually started at previous FiO2 and at a flow of 35 L per minute, with flow titrated as tolerated to 45–50 L per minute. FiO2 was ultimately titrated to maintain SaO2 greater than 90%, or according to specific clinical orders. Average changes in oxygen saturation and breathing frequency before and after HFNC were compared. Arterial blood gases were available for all participants at baseline but with variable availability after HFNC. Data were analyzed using closest values prior to HFNC and about one hour after starting HFNC (participants served as their own control).

• N = 50   
• MEAN AGE = 73 years
• AGE RANGE = 27–96 years
• MALES: 50%, FEMALES: 50% 
• CURRENT TREATMENT: Not applicable
• KEY DISEASE CHARACTERISTICS: Participant diagnoses include pulmonary fibrosis (PF) (n = 15), pneumonia (n = 15), chronic obstructive pulmonary disease (COPD) (n = 12), cancer (n = 7), hematologic malignancy (n = 7), congestive heart failure (CHF) (n = 3), pulmonary embolism (n = 2), sepsis (n = 2), alveolar hemorrhage (n = 1), and myocardial infarction (n = 1).
• OTHER KEY SAMPLE CHARACTERISTICS: Subjects were included if they had do-not-resusitate (DNR)/DNI status, clinical evidence of respiratory distress (e.g., dyspnea, tachypnea), hypoxemia, and mild or compensated hypercapnia (PaCO2 less than or equal to 65; pH greater than 7.28). Participants were excluded if they were on comfort care or if no indication for progress to NIV was evident.

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Medical or medical-surgical intensive care unit (ICU) of two hospitals of the Mayo Clinic in Rochester, MN

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Palliative care 

• Retrospective study

• PaO2
• SaO2
• PaCO2
• pH
• FiO2
• Breaths per minute

• Hospital mortality for participants was 60% (30 out of 50) ranging from 33.3% in COPD and CHF patients to 73.3% in patients with PF.
• Breathing frequency decreased from 30.6 to 24.7 breaths per minute on HFNC (p < 0.001).
• Mean oxygen saturation improved from 89.1% to 94.7% (p <  0.001).
• Nine out of 50 (18%) participants escalated to NIV, and 41 of 50 participants (82%) were maintained on HFNC until improvement or withdrawal of support. Of the nine patients who escalated to NIV, six (67%) died versus death in 24 of 41 (58%) who did not receive NIV (p = 0.72). Of the nine participants who escalated to NIV, the six had PF, two had COPD, and one had sepsis.
• Median duration of use of HFNC was 30 hours (mean = 41.9 hours, range = 2–144 hours).
• HFNC was well-tolerated with no documented nasal bleeding or facial skin breakdown.

HFNC reduced hypoxemic respiratory failure in patients with DNI, as well as the need for NIV. HFNC is, therefore, an effective, tolerable, and safe alternative to noninvasive intubation for patients with DNI with hypoxemic respiratory failure.

• Small sample (< 100)
• Risk of bias (no random assignment)
• Retrospective analysis of data was from a single institution. The mixture of diagnoses allowed for only small samples for generalization. Participants with severe acidosis and hypercapnia were excluded. The timing of baseline arterial blood gases varied prior to ICU admission or transfer and was relative to HFNC initiation. Participants all were managed in the ICU, so no comparison of management on the ward was available. Sample was notably very ill as evidenced by overall hospital mortality and may, therefore, have some influence on the generizability of the data.

HFNC has the ability to generate a low level of positive airway pressure with the mouth closed and sufficiently provides oxygenation for patients with hypoxemic respiratory failure.

STUDY PURPOSE: To evaluate the effectiveness of exercise interventions compared with usual care on physical fitness, fatigue, and quality of life in patients treated with hematopoietic stem cell transplantation (HSCT)

TYPE OF STUDY: Meta-analysis and systematic review

• FINAL NUMBER STUDIES INCLUDED = 9
• TOTAL PATIENTS INCLUDED IN REVIEW = 472
• SAMPLE RANGE ACROSS STUDIES: 19-105
• KEY SAMPLE CHARACTERISTICS: All had HSCT. Mean ages ranged from 29.1-55 years.

PHASE OF CARE: Active antitumor treatment

Six studies showed a positive effect on cardiorespiratory fitness (effect size [ES] = 0.53, 95% confidence interval [CI] [0.13, 0.94]) compared to usual care. Positive effects were seen in muscle strength. Five studies showed positive effects on quality of life (QOL) in global QOL (ES = 0.41, p = 0.0005), cognitive functioning (ES = 0.36, 95% CI [0.13, 0.59], p = 0.002) from the European Organization of Research on Treatment and Cancer (EORTC) self-report instrument. Compared to usual care, exercise had a moderate and significant positive effect on fatigue (ES = 0.53, 95% CI [0.27, 0.79], p < 0.0001).

Exercise interventions were shown to have a positive effect on cardiorespiratory fitness and fatigue, and might show some benefit in terms of several aspects of health-related quality of life for patients undergoing HSCT.

• Limited number of studies included
• Mostly low quality/high risk of bias studies
• Low sample sizes
• Single-item scale data were used for outcome measurement in areas of cognitive function and quality of life, and in two of those related to fatigue.
• High variability in the content, timing, and duration of interventions

This review adds to the body of evidence showing the effectiveness of exercise interventions for fatigue among various types of patients with cancer. Exercise may also have an impact on various aspects of health-related quality of life; however, the evidence in this area is weak, and additional research is needed to determine efficacy in this area.

To evaluate the efficacy of cocculine (a complex homeopathic medicine) in the control of chemotherapy-induced nausea and vomiting (CINV) in patients with nonmetastatic breast cancer who are undergoing standard chemotherapy regimens

Participants were randomized to receive standard antiemetic treatment plus either a complex homeopathic remedy (cocculine) and or the matching placebo in addition to standard antiemetic prophylactic (8 mg ondansetron [or 3 mg granisetron] and 80 mg methylpredinosolone twice daily). Cocculine is a registered remedy in France for the treatment of nausea and travel sickness. It contains four homeopathic components: Cocculus indicus, tabacum, nux vomica, and petroleum.

Patients were stratified by participating center and type of chemotherapy regimen. Study treatments (cocculine and placebo) were given as two tablets on the evening before chemotherapy; two tablets three times on day 1, and two tablets on the morning and evening of day 2.

Nausea and vomiting were monitored for five days by completing the Functional Living Index-Emesis (FLIE) on day 6. The study regimen was repeated in cycles 2 and 3, and symptoms were monitored until cycle 6.

• The study consisted of 431 patients.
• The median age was 52.8 years with a range of 20–74 years.
• All of the patients were female.
• Patients were chemotherapy-naïve with non-metastatic breast cancer and scheduled to receive six adjuvant cycles of chemotherapy including at least three initial cycles of 500 mg/m 95-fluoruracil, 50 mg/m adriamycin, and 500 mg/m cyclophosphamide (FAC 50); 500 mg/m 5-fluoruracil, 100 mg/m epirubicin, and 500 mg/m cyclophosphamide (FEC 100), or 75 mg/m docetaxel, 50 mg/m adriamycine, and 500 mg/m cyclophosphamide (TAC).
• To be included patients must have had no previous malignancies (except those in complete remission for more than five years), no contraindications to corticoids or 5-HT₃ receptor antagonists, and no prior treatment with cocculine or other antiemetics within the previous 15 days. Patients had to be able to be followed up with by phone.
• Patients were excluded from the study if they were pregnant or lactating.

The study was conducted at multiple outpatient sites in France.

All patients were in active antitumor treatment.

This was a randomized, multi-centered, double-blind, longitudinal, placebo-controlled, phase III trial.

• Patients measured nausea and vomiting by using the Functional Living Index for Emesis (FLIE) with five days recall (on day six for the first three cycles).
• A patient self-evaluation (EVA) daily diary was used to record nausea occurrence and intensity and the number of vomiting episodes on days 1–5.
• Investigators recorded adverse events using the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 3.0 (NCI-CTC AE V3.0). They also measured treatment compliance by intake of study drugs and counting returned drug boxes.

No difference was found between the two arms.

Adding a complex homeopathic medicine (cocculine) to standard antiemetic prophylaxis does not improve the control of CINV in patients just diagnosed with breast cancer.

• A risk of bias exists because of the sample characteristics.
• The investigators did not measure or control for history of alcohol consumption, nausea and vomiting during pregnancy, or anxiety level about nausea and vomiting before randomization.
• Because the study began on the first cycle of chemotherapy, the investigators had no chance to determine prior CINV experience or anticipatory nausea and vomiting.

Nurses should advise patients who use any complementary interventions that some can be ineffective and costly.

To provide practical guidance regarding the use of transdermal buprenorphine to treat cancer pain, particularly in those who need high-dose treatment to achieve pain control

• Of 122 articles retrieved, 22 were reviewed and made available to panel members before the November 2007 panel conference. Panel members contributed case reports for review. Authors provide points of discussion regarding several cases.
• Database searched was PubMed.
• Search keywords were buprenorphine, transdermal buprenorphine, neuropathic pain, and cancer pain.
• Attendance at the panel conference was funded by Grünenthal GmbH, the license holder of branded transdermal buprenorphine. The company paid the meeting chair's and primary author's honoraria. The primary author is a member of that company’s advisory board. Peer reviewers received honoraria from the parent organization of the company. The report states that the views expressed in the consensus statement are those of the expert panel and not necessarily those of the meeting sponsor.

The report provides information regarding the pharmacology and safety profile of transdermal buprenorphine. In addition, authors present some information, from studies and case reports, regarding efficacy. Authors provide no comprehensive review of search result or appraisal method. They do not detail the panel’s process.

• In identifying the benefits of transdermal buprenorphine in managing cancer pain, the panel concluded that the treatment
  • Is reliable and predictably efficacious.
  • Has antihyperalgesic potential.
  • Is effective, in low doses, at treating neuropathic pain. (Authors note effectiveness of transdermal buprenorphine compared to morphine.)
  • Has a favorable safety profile.
  • Presents a low risk of respiratory depression.
  • Is easy to use and convenient, involving a twice-weekly dosing schema.  
• The consensus was that transdermal buprenorphine
  • Is valuable in the treatment of cancer pain.
  • Is usable in combination with other opioids. (Authors note that no problems involving combination were reported.)
  • Offers advantages over other opioids in regard to treating neuropathic pain and mixed pain. 
• Authors identified the need for more research to determine best dosages and dose ceilings.

• The search was limited, as was the information the panel reviewed.
• Recommendations were created by consensus rather than based on standard appraisal of available evidence.
• A company that produces transdermal buprenorphine supported the work of the consensus group.

Expert opinion suggests that, for the treatment of cancer pain, transdermal buprenorphine is a useful alternative or adjunct to other medication.