Journal of the National Comprehensive Cancer Network : JNCCN
-
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.
-
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".
-
J Natl Compr Canc Netw · Jul 2003
Assessment of pain caused by invasive procedures in cancer patients.
Invasive procedures are commonly required in the diagnosis and management of cancer in adults. However, little is known regarding the prevalence and severity of procedure-related pain in this patient population. This prospective study was conducted to determine the frequency and types of invasive procedures performed in a large comprehensive cancer center, the intensity of pain associated with these procedures, the types of periprocedural analgesics administered, and how these patients would like their procedural pain to be managed in the future. ⋯ There was no statistical relationship between patients' pain ratings and their satisfaction with the pain control they received during the procedures. This study represents the largest descriptive study of procedural pain in adult cancer patients. As more than 50% of these patients experienced moderate to severe pain during procedures, further studies are needed to improve the control of procedure-related pain in patients with cancer.