Dr. Pietras on Palliative Care for Patients With Ovarian Cancer

Christopher J. Pietras, MD, director, Palliative Care, assistant clinical professor, University of California, Los Angeles (UCLA) School of Medicine, discusses palliative care for patients with ovarian cancer.

Though there are no large randomized trials, there are smaller studies that suggest that ketamine may be beneficial when used appropriately for patients with very difficult to control pain symptoms who are already on very high doses of opioids and non-opioid adjuvant medicines like gabapentin (Neurontin) for pain. Ketamine can significantly improve pain scores in up to half of patients, says Pietras, though physicians still need to do larger studies and prospective trials to confirm if these data are correct or not.

Pietras says that ketamine should only be used in a select group of patients who have uncontrollable pain—despite highly escalated opioids and other medications—and in patients who do not have traits that would make them more likely to have side effects. This includes patients who might feel confused and those who have anxiety, as those are the most common side effects with ketamine. Pietras notes that it is also important not to increase the dose too high too quickly because hallucinations are often seen at high doses.