|
Advertisement |
|
|
||
 |
|
|||||
|
|||||
|
 |
||||||
|
||||||
|
||||||
|
Journal of Clinical Oncology, Vol 26, No 25 (September 1), 2008: pp. 4226 © 2008 American Society of Clinical Oncology. DOI: 10.1200/JCO.2008.18.5454
In ReplyInstitute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Campus, Petah-Tiqva; and the Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
Department of Hemato-Oncology, Davidoff Center Rabin Medical Center, Beilinson Campus, Petah-Tiqva; and the Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
Infectious Disease Unit, Rabin Medical Center, Beilinson Campus, Petah-Tiqva; and the Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
Department of Medicine E, Rabin Medical Center, Beilinson Campus, Petah-Tiqva; and the Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel We appreciate the interest of Pinna et al in our systematic review and believe some issues should be further clarified. Pinna et al asked whether chloropromazine has a role in alleviation of cancer-related dyspnea based on an open-label study1 that examined the effect of chloropromazine on restlessness and dyspnea in terminally ill cancer patients. Our systematic review2 included only randomized controlled trials that assessed cancer related dyspnea. Observational studies can serve as a prompt for randomized controlled trials, but they constitute weak evidence. We think it is hardly appropriate to prescribe a phenothiazine for shortness of breath in patients with cancer based on a single observational study. Pinna et al referred to the presence of comorbidity other than cancer that can also cause dyspnea. In the original included studies, patients with cancer with other comorbidities were not always excluded. We think that in pragmatic trials such exclusion would be inappropriate. In some of the studies, patients with certain comorbidities were primarily excluded, and those details are mentioned in our review (Tables 1 and 3). As for the role of benzodiazepines, we agree with Pinna et al that benzodiazepines should be further assessed in randomized controlled trials and state in our review that the fact that only midazolam has been examined in a single trial "is rather surprising given that benzodiazepines are widely used in clinical practice without considerable evidence." Pinna et al pointed the aspect of different dosages of oral opioids, as reflected also in the clinical practice. We agree with this remark and included the trial of Allard et al3 in our review (Tables 1 and 2). We emphasize again the importance of conducting randomized controlled trials on alleviation of dyspnea in patients with cancer, either to further establish the commonly used agents or to test other agents for this indication. Given the paucity of effective interventions, and the potential for harm (even at the end of life) of interventions that are used, there is a clear ethical justification for such trials and we congratulate Pinna et al's group for performing a randomized trial in this issue. AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest. REFERENCES 1. McIver B, Walsh D, Nelson K: The use of chlorpromazine for symptom control in dying cancer patients. J Pain Symptom Manage 9:341-345, 1994[CrossRef][Medline] 2. Ben-Aharon I, Gafter-Gvili A, Paul M, et al: Interventions for alleviating cancer-related dyspnea: A systematic review. J Clin Oncol 26:2396-2404, 2008 3. Allard P, Lamontagne C, Bernard P, et al: How effective are supplementary doses of opioids for dyspnea in terminally ill cancer patients? A randomized continuous sequential clinical trial. J Pain Symptom Manage 17:256-265, 1999[CrossRef][Medline]
Related Correspondence
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||
|
|||||||||||
|
|
Copyright © 2008 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
|
