Current opinion in supportive and palliative care
-
Curr Opin Support Palliat Care · Mar 2009
ReviewImpact and management of breakthrough pain in cancer.
To outline the impact of breakthrough pain, the evidence for the current management and new treatment options that are becoming available. ⋯ Breakthrough is a common heterogeneous pain state that can have a devastating impact on both patients and carers. Despite the growing literature on breakthrough pain, there are still many aspects yet to be addressed including an urgent need to standardize terminology, for carefully designed epidemiological studies and for well designed controlled trials comparing the different treatment options.
-
Curr Opin Support Palliat Care · Dec 2008
ReviewAssessing alterations in taste and their impact on cancer care.
As the discipline of supportive and palliative cancer care grows, there is increasing acknowledgement of taste and smell alterations (TSAs) as barriers to nutrient intake and detriments to the food-related quality of life and well being of the population. The focus of this brief review is to summarize the recent advances regarding the cause and nature of TSAs and patients' perceptions of TSAs and to identify promising approaches for the alleviation of TSAs. ⋯ A variety of approaches to the assessment of TSAs continue to generate a description of the development, duration and recovery of distorted chemosensory perception in cancer patients. Attention to individual variation in the nature and severity of TSAs as well as nutritional support and focus on flavorful foods can enhance patients' well being and food-related quality of life.
-
Cognitive failure is known to be common in patients with advanced illness and can lead to significant distress for the persons affected and their environment. To get an insight on the most recent advances concerning cognitive failure at the end of life, a literature review has been performed focusing on the syndrome in general palliative care as well as on palliative care in patients with dementia. ⋯ An overall improvement in professional care independent of the place of care for patients with cognitive impairment and dementia is still claimed by professionals and primary caretakers. In addition to further research, the lack of palliative care expertise can possibly be resolved by more specific, supportive and educational initiatives.
-
Curr Opin Support Palliat Care · Sep 2008
ReviewManagement of dyspnea in advanced motor neuron diseases.
Patients with amyotrophic lateral sclerosis or motor neuron disease (ALS/MND) invariably develop respiratory muscle weakness and most die from pulmonary complications. Little evidence is available that identifies optimal management approaches for caring for the dying patient. This review discusses the state of the art on dyspnea in advanced ALS/MND and its treatment. ⋯ In ALS/MND, loss of function relentlessly progresses, and subsequent death occurs mostly in a predictable manner. Therefore, the end of life care is heavily influenced by the type and quality of care provided from the earliest stages. Most patients with ALS/MND develop dyspnea, agitation, anxiety and air hunger in the final phase. Noninvasive positive pressure ventilation has become the standard of care for patients with ALS/MND and advanced respiratory insufficiency. A multidisciplinary approach is strongly recommended.
-
Curr Opin Support Palliat Care · Jun 2008
ReviewOxygen for relief of dyspnea: what is the evidence?
Refractory dyspnea is a common and distressing symptom complicating respiratory illness, including chronic obstructive pulmonary disease, and life-limiting illnesses in general, including cancer. Oxygen is often prescribed for relief of dyspnea and several consensus guidelines support this practice. The goal of this review is to outline the evidence for the use of oxygen for relief of dyspnea, with specific attention to situations in which oxygen is not already funded through long-term oxygen treatment guidelines (i.e., when PaO2 is >/=55 mmHg; also known as palliative oxygen). ⋯ The data highlighted in this review support the belief that certain individuals benefit from the use of palliative oxygen but continue to suggest that definitive randomized trials are required to fully establish the benefit of palliative oxygen and to delineate characteristics predictive of benefit.