Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Dec 2013
ReviewStatus of palliative care in Latin America: looking through the Latin America Atlas of Palliative Care.
Several studies have been published reporting the status of palliative care in different countries of Latin America, but no studies have been published on the status of the discipline across the whole region. This article provides a summary of the current situation as reported in the Atlas of Palliative Care recently completed by the Latin American Association for Palliative Care. The aim of this project was to collect information on the degree of palliative care development, help create a network, and influence the progress of palliative care across Latin America. ⋯ The information in this review gives a broad notion of the current status of palliative care in Latin America. The Atlas is expected to help the progress of palliative care and serve as a driver of the field in Latin America and other regions.
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Patients with brain tumours show a high symptom burden, and symptoms are difficult to treat and prone to be overlooked. This review of publications dealing with advanced stages of brain tumours tries to assess the knowledge gained in the past 2 years and to develop an outlook for further investigations. ⋯ Data suggest that patients with primary or metastatic brain tumours often have a high symptom burden and unmet needs for palliative care, and symptoms are hard to diagnose; patients suffer often and early from cognitive impairment but are rarely appropriately prepared concerning end-of-life wishes. This reflects on their caregivers' burden as well. For symptomatic treatment of common symptoms such as fatigue, depression and cognitive impairment, methylphenidate has established an important role. For assessment of these symptoms, a shortened questionnaire Quality of Life Questionnaire-15-Palliative shows potential. Cancer-directed therapy in advanced stages of brain tumours has to be weighed critically. To assess adequate strategies to help patients and caregivers with the challenges of brain tumour-specific symptoms, randomized intervention studies are necessary. The same accounts for cancer-directed treatment in relation to quality of life in advanced stages of brain tumours.
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Curr Opin Support Palliat Care · Dec 2013
ReviewA systematic review of the influence of opioids on advanced cancer patient survival.
Many health professionals still believe that opioids shorten the lifespan of patients. This situation implies that the ethical doctrine of double effect is often invoked to justify their use in extreme circumstances. The objective of this study is to revise the evidence existing in the recently published literature regarding the effect on patient survival of opioid used to control disease symptoms. ⋯ The studies revised have not shown that the use of opioids for symptom control in advanced disease stages or in the last days of life has any effect on patient survival. Similarly, survival was not influenced by either the use of higher or lower doses of opioids, or by the practice of administering a double dose at night.
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Curr Opin Support Palliat Care · Jun 2013
ReviewManagement of neuropathic pain in children with cancer.
Many children with cancer suffer from neuropathic pain. However, there are no published pediatric randomized controlled trials (RCTs), nor agreed upon pediatric treatment recommendations. Pediatric neuropathic pain in patients with malignancies is often underassessed and undertreated with ineffective therapies. ⋯ A combination of integrative, rehabilitative, and supportive therapies with pharmacotherapy, including first line medications such as NSAIDs, opioids, low-dose tricyclics, and gabapentinoids, appear to be successful treatment strategies. There is a dearth of evidence regarding the management of neuropathic pain in children with cancer; studies, especially RCTs, are desperately needed.