Journal of pain and symptom management
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J Pain Symptom Manage · Feb 2014
Review Meta AnalysisA meta-analysis of randomized trials: immediate stent placement vs. surgical bypass in the palliative management of malignant biliary obstruction.
Many patients with unresectable pancreatic and peripancreatic cancer require treatment for malignant biliary obstruction. ⋯ Nearly all patients with unresectable pancreatic cancer benefit from some procedure to manage biliary obstruction. Patients with low surgical risk benefit more from surgery because the risk of recurrence and subsequent hospital utilization are lower than after stent placement.
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J Pain Symptom Manage · Jan 2014
Review Meta AnalysisPrevalence of symptoms in older cancer patients receiving palliative care: a systematic review and meta-analysis.
Symptom control is an essential part of palliative care and important to achieve optimal quality of life. Studies showed that patients with all types of advanced cancer suffer from diverse and often severe symptoms. Research focusing on older persons is scarce because this group is often excluded from studies. Consequently, it is unclear which symptoms older palliative care patients with cancer experience and what is the prevalence of these symptoms. To date, no systematic review has been performed on the prevalence of symptoms in older cancer patients receiving palliative care. ⋯ There is a high degree of uncertainty about the reported symptom prevalence because of small sample sizes, high heterogeneity among studies, and the extent of instrument validation. Research based on rigorous methods is needed to allow more conclusive results.
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J Pain Symptom Manage · Jan 2014
Review Meta AnalysisPrevalence of breakthrough cancer pain: a systematic review and a pooled analysis of published literature.
Despite the large body of literature on breakthrough cancer pain (BTcP), an accurate estimate of BTcP prevalence is still not available. ⋯ In the context of a large between-studies heterogeneity, more than one in two patients with cancer pain also experiences BTcP, with some variability according to clinical and organizational variables.
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J Pain Symptom Manage · Dec 2013
Review Meta AnalysisFentanyl for the relief of refractory breathlessness: a systematic review.
Fentanyl is a potent opioid that has been proven to provide effective treatment for breakthrough cancer pain. Although opioids are the only drug group with evidence for the symptomatic treatment of breathlessness, evidence about the efficacy of fentanyl for the relief of breathlessness is unknown. ⋯ Descriptive studies yielded promising results for the use of fentanyl for the relief of breathlessness; however, efficacy trials are lacking. Fully powered RCTs are warranted to determine the efficacy of fentanyl for breathlessness relief, but these require pilot studies to evaluate effective size, study procedures, and outcome measures.
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J Pain Symptom Manage · Dec 2013
Review Meta AnalysisAdvising patients on the use of non-herbal nutritional supplements during cancer therapy: a need for doctor-patient communication.
Many cancer patients are using non-herbal nutritional supplements (NHNS), often without informing their oncologists. ⋯ There is a need to develop an open and nonjudgmental dialogue between oncologists and cancer patients, addressing the needs of the patient while dealing with issues related to the efficacy and safety of these products. Referral of patients to an integrative medicine consultant may help achieve these goals, providing both parties with the option of reaching an informed and respectful decision about treatment.