Abstract
Introduction
Sialorrhea is a distressing symptom accompanying oral cancer and many heterogeneous cancer-related conditions (chemotherapy-induced nausea, bowel subocclusion, pharmacologic side effects), but its incidence is low in cancer patients. Conversely, it is frequent in patients with neurological damage, and some therapeutic options have been attempted such as botulinum toxins, anticholinergic agents, and surgical procedures.
Case report
We report the case of an 80-year-old woman with peritoneal carcinomatosis and bowel subocclusion, suffering from distressing nausea and sialorrhea that rapidly improved using transdermal scopolamine. No relevant side effects occurred during the treatment, and the reduction of the abnormal salivation allowed the recovery of oral feeding.
Conclusions
Anticholinergic drugs are classified as secondary options in the treatment of sialorrhea of patients with Parkinson’s disease or cerebral palsy, owing to the relevant side effects occurring during prolonged treatments. However, they could be useful in cancer patients with bowel subocclusion, as the reduction of gastrointestinal secretions and intestinal motility (frequent side effects of anticholinergic drugs) could be effective in controlling nausea, vomiting, and abdominal pain. Moreover, the transdermal or sublingual route of administration can be of some interest, avoiding other more invasive parenteral approaches.
References
Bachrach SJ, Walter RS, Trzcinski K (1998) Use of glycopyrrolate and other anticholinergic medications for sialorrhea in children with cerebral palsy. Clin Pediatr (Phila) 37(8):485–490
Bennett M, Lucas V, Brennan M et al (2002) Using anti-muscarinic drugs in the management of death rattle: evidence-based guidelines for palliative care. Palliat Med 16(5):369–374
De Conno F, Sbanotto A, Ripamonti C, Ventafridda V (2004) Mouth care. In: Doyle D, Hanks G, Cherny N, Calman K (eds) Oxford textbook of palliative medicine, 3rd edn. Oxford University Press, New York, pp 673–687
Friedman A, Potulska A (2001) Botulinum toxin for treatment of parkinsonian sialorrhea. Neurol Neurochir Pol 35(Suppl 3):23–27
Hockstein NG, Samadi DS, Gendron K, Handler SD (2004) Sialorrhea: a management challenge. Am Fam Phys 69(11):2628–2634
Hyson HC, Johnson AM, Jog MS (2002) Sublingual atropine for sialorrhea secondary to parkinsonism: a pilot study. Mov Disord 17(6):1318–1320
Mercadante S, Ripamonti C, Casuccio A, Zecca E, Groff L (2000) Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction. Support Care Cancer 8(3):188–191
Ondo WG, Hunter C, Moore W (2004) A double-blind placebo-controlled trial of botulinum toxin B for sialorrhea in Parkinson’s disease. Neurology 62(1):37–40
Potter J, Hami F, Bryan T, Quigley C (2003) Symptoms in 400 patients referred to palliative care services: prevalence and patterns. Palliat Med 17(4):310–314
Ripamonti C, Mercadante S, Groff L et al (2000) Role of octreotide, scopolamine butylbromide and hydration in symptom control of patients with inoperable bowel obstruction and nasogastric tubes: a prospective randomized trial. J Pain Symptom Manage 19(1):23–34
Ripamonti C, Twycross R, Baines M et al (2001) Clinical practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer 9:223–233
Santamaria LB, Fodale V, Mandolfino T et al (1991) Transdermal scopolamine reduces nausea, vomiting and sialorrhea in the postoperative period in teeth and mouth surgery. Minerva Anestesiol 57(9):686–687
Savarese R, Diamond M, Elovic E, Millis SR (2004) Intraparotid injection of botulinum toxin A as a treatment to control sialorrhea in children with cerebral palsy. Am J Phys Med Rehabil 83(4):304–311
Serrano-Duenas M (2003) Sialorrhea in patients with Parkinson. A six year prospective study. Rev Neurol 37(7):623–626
Shorthose K, Andrew ND (2003) Symptom prevalence in palliative care. Palliat Med 17(8):723–724
Stern Y, Feinmesser R, Collins M, Shott SR, Cotton RT (2002) Bilateral submandibular gland excision with parotid duct ligation for treatment of sialorrhea in children: long-term results. Arch Otolaryngol Head Neck Surg 128(7):801–803
Suskind DL, Tilton A (2002) Clinical study of botulinum—a toxin in the treatment of sialorrhea in children with cerebral palsy. Laryngoscope 112(1):73–81
Tranmer JE, Heyland D, Dudgeon D, Groll D, Squires-Graham M et al (2003) Measuring the symptom experience of seriously ill cancer and non cancer hospitalized patients near the end of life with memorial symptom assessment scale. J Pain Symptom Manage 25:420–429
Tscheng DZ (2003) Sialorrhea-therapeutic drug options. Ann Pharmacother 36(11):1785–1790
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tassinari, D., Poggi, B., Fantini, M. et al. Treating sialorrhea with transdermal scopolamine. Exploiting a side effect to treat an uncommon symptom in cancer patients. Support Care Cancer 13, 559–561 (2005). https://doi.org/10.1007/s00520-005-0826-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-005-0826-3