Objective To evaluate the efficacy and safety of Chinese herb compared with an analgesic drug in the treatment of cancer pain. Methods We electronically searched CBM (1990 to 2008), CNKI (1990 to 2008), VIP (1990 to 2008), The Cochrane Library (Issue 3, 2008), and MEDLINE (1990 to 2008). Relevant journals and conference proceedings were also handsearched. The quality of the included trials was assessed according to the criteria recommended by the Cochrane Handbook for systematic reviews of interventions and meta-analyses were performed for homogeneous studies using the Cochrane collaboration’s review manager 4.2.2 software. Results Five randomized controlled trails (RCTs), all published in Chinese, involving 590 participants, were included. The quality of all RCTs was graded C (low). Meta-analyses were not performed due to heterogeneity. Instead, descriptive analyses were conducted. The results showed that as for the total effective rate in pain-relieving, Zhentongsan (RR=1.11, 95%CI 1.00 to 1.24, P=0.05) and Xiaozhengzhitong paste (RR=1.35, 95%CI 1.02 to 1.78, P=0.04) were more effective than Indometacin, with significant differences. There were no significant differences between Duyiwei capsule and Indometacin, and so were between Huajianbadumo as well as Shebingzhitong paste and Tramado. In terms of early potency, there were significant differences between Zhentongsan (SMD= –?9.87, 95%CI –10.84 to –8.89, Plt;0.000 01) as well as Xiaozhengzhitong paste (SMD= –8.74, 95%CI –10.164 to –7.32, Plt;0.000?01) and Indometacin, and so were between Shebingzhitong paste and Tramadol (SMD= –2.24, 95%CI –3.00 to –1.49, Plt;0.000?01). There were no significant differences between Huajianbadumo and Tramodo. With regard to the durative effect on pain-relieving, there were significant differences between Xiaozhengzhitong paste and Indometacin (WMD=4.78, 95%CI 2.99 to 6.57, Plt;0.00001), but not between Shebingzhitong paste and Tramadol. Conclusion Because of low quality of the existing studies, the current evidence is insufficient to define the efficacy and safety of compound Chinese herb, and further large-scale and high-quality RCTs are needed.
ObjectiveTo explore the role of clinical pharmacists in caring for one patient with breast cancer complicated with multiple metastases. MethodsClinical pharmacists monitored the entire treatment process of a patient with breast cancer complicated with multiple metastases. Blood glucose level was recorded, and the pharmacists evaluated the patient's pain, gave appropriate doses of cancer pain drugs, and responded positively to the hand-foot syndrome (HFS) induced by chemotherapeutic drugs. ResultsWith the participation of the pharmacists, clinicians adjusted the medication. Ideal control of cancer pain and blood glucose was achieved with successful chemotherapy, and HFS fully recovered. ConclusionPharmaceutical care by clinical pharmacists can assist clinicians to ensure the safety and effectiveness of drug use.
ObjectiveTo systematically review the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain. MethodsDatabases such as The Cochrane Library (Issue 1, 2014), PubMed, Web of Science, CNKI, VIP, CBM and WanFang Data were searched for randomized controlled trials (RCTs) on the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain up to January 2014. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.1.0 software. ResultsA total of 35 RCTs involved 3 406 patients were included. The results of meta-analysis showed that, there was no significant difference in effectiveness between transdermal fentanyl and oral morphine for moderate/severe cancer pain (OR=1.00, 95%CI 0.80 to 1.27, P=0.99). Compared with oral morphine, transdermal fentanyl was better in lowering the incidences of constipation, nausea and vomiting, lethargy and urinary retention; but transdermal fentanyl increased the incidences of skin rashes and itch (P < 0.05). ConclusionTransdermal fentanyl is as effective as oral morphine in the treatment of moderate/severe cancer pain, and transdermal fentanyl causes less side effects. Due to poor quality of the included studies, the above conclusion should be verified by further conducting more high quality RCTs.