The journal of supportive oncology
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Review Meta Analysis
Measuring quality of life in patients with melanoma: development of the FACT-melanoma subscale.
A systematic review of the literature on quality of life (QOL) in melanoma patients suggested an overwhelming need for a disease-specific subscale. A melanoma subscale for the Functional Assessment of Cancer Therapy (FACT-Melanoma) was developed to meet this need. This instrument was developed in three stages. ⋯ After final revisions were made, the FACT-Melanoma tool included 24 items encompassing three QOL domains: 20 items relate to physical well-being, 3 to emotional well-being,and 1 to social well-being. The face and content validity of the FACT-Melanoma assessment tool has been confirmed in melanoma patients and by professionals. Formal validation and reliability testing of the questionnaire is being determined in a prospective cohort of melanoma patients.
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Many investigations have focused on an optimal dosing schedule for paclitaxel since its regulatory approval. Paclitaxel is generally administered at a dose of 175 mg/m2 IV over 3 hours or 135-175 mg/m2 IV over 24 hours, every 3 weeks. The purpose of this study was to simplify the administration of paclitaxel to make it suitable and practical in the outpatient setting. ⋯ Paclitaxel always was administered before other chemotherapeutic agents. Hypersensitivity reactions were recorded in 4 patients (7.7%) and were not influenced by age, gender, disease, dose schedule, or number of cycles of therapy; no serious hypersensitivity reactions were observed. The present study supports the efficacy and safety of a short premedication schedule; with further study, this schedule might become a standard premedication protocol prior to paclitaxel administration.
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Review Comparative Study
Managing pain in patients with aberrant drug-taking behaviors.
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The most common cancers, such as those affecting the breast, prostate, and lung have a strong predilection to metastasize to bone. Bone metastasis frequently results in pain, pathologic fractures, hypercalcemia, and spinal cord compression. Pain can have a devastating effect on the quality of life in advanced cancer patients and is a serious complication of cancer. ⋯ New insights into the mechanisms that induce cancer pain now are coming from animal models. Chemicals derived from tumor cells, inflammatory cells, and cells derived from bone appear to be involved simultaneously in driving this frequently difficult-to-control pain state. Understanding the mechanisms involved in the pathophysiology of bone cancer pain will improve both our ability to provide mechanism-based therapies and the quality of life of cancer patients.
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Many patients in the terminal phase of their illness experience reduced oral intake before death, due to causes related to their cancer or its treatment. When oral intake is not adequate, dehydration and malnutrition are the obvious results. But these terminally ill patients present a challenge to healthcare providers: to rehydrate these patients or not and, if so, how? Adequate hydration levels are much lower in terminal patients with cancer than in normal adults. ⋯ In doubtful cases, a short trial of hydration may be appropriate. If hydration is considered, there are a number of methods to consider based on the needs of the patient, including intravenous administration, hypodermoclysis, and proctoclysis. The subcutaneous route is an excellent alternative due to its simplicity, low cost, and feasibility in the home setting.