Journal of the National Comprehensive Cancer Network : JNCCN
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J Natl Compr Canc Netw · Sep 2004
ReviewEarly-stage NSCLC: the role of radiotherapy and systemic therapy.
Although surgical resection offers the best opportunity for cure in early-stage non-small cell lung cancer, long-term survival remains less than 50% for all but clinical stage IA disease. Nearly 80% of relapses occur in distant sites. Thus, investigators have turned to chemotherapy or radiotherapy to prevent relapse and extend survival. ⋯ Retrospective series, as well as randomized trials, show consistent benefit, but these trials suffer from small numbers of patients. More recently, phase II trials have confirmed the feasibility of this strategy in patients with stage IB-IIIA disease, with nearly all patients completing induction chemotherapy and no apparent increase in operative mortality. Ongoing trials continue to assess the role of preoperative and postoperative chemotherapy or radiotherapy in early stage non-small cell lung cancer.
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Opioid-induced bowel dysfunction is a major complication in oncology practice and must be approached aggressively. Every patient starting opioids should be thoroughly instructed in the management of this side effect. Prevention is the key and use of agents such as senna and a stool softener with the initiation of therapy is mandatory, with rapid titration if the initial dose is not effective. ⋯ Other agents then can be added as necessary. Fecal impaction must always be considered and it should be recognized that it may lead to other symptoms such as increased pain, urinary difficulties, or nausea and vomiting. In summary, the words of Dame Cicely Saunders, founder of the hospice movement, must be kept in mind: "Remember the bowels".
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J Natl Compr Canc Netw · Jul 2003
Practice GuidelineDistress management. Clinical practice guidelines.
The evaluation and treatment model expressed in the NCCN Distress Management Guidelines recommends that each new patient be rapidly assessed in the office or clinic waiting room for evidence of distress using a brief screening tool (the Distress Thermometer and Problem List) presented in Figure 1 (see page 369). A score of 5 or greater on the thermometer should trigger further evaluation and referral to a psychosocial service. The choice of which service should be determined by the problem areas specified on the Problem List. ⋯ Presently, the quality of the psychological care patients receive is not routinely monitored. Accrediting bodies have not directly examined the quality of psychosocial care, nor have they established minimal performance standards for its delivery. The panel believes that psychosocial care should and will eventually be on our institution's report cards.