Acta oncologica
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Randomized Controlled Trial Clinical Trial
Treatment of breast-cancer-related lymphedema with or without manual lymphatic drainage--a randomized study.
A prospective randomized study was carried out to investigate whether the addition of manual lymphatic drainage (MLD) to the standard therapy could improve treatment outcome in women with lymphedema of the ipsilateral arm after breast cancer treatment. Forty-two patients were randomly assigned to receive standard therapy or standard therapy plus MLD 8 times in 2 weeks and training in self-massage. ⋯ The patients were followed-up for a total of 12 months. The study showed that both groups obtained a significant reduction in edema and that MLD did not contribute significantly to reduce edema volume.
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The dynamics surrounding the patient and family facing a death as the 'unit of care' is discussed. Aspects of communication, openness within the family, especially concerning children and teenagers, and factors that enable a family to function under the stress of a loved one's terminal illness are explored. The use of a genogram in palliative care to help to piece together the family dynamics and available support is fundamental to the care for the whole family.
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Clinical Trial
High dose etretinate and interferon-alpha--a phase I study in squamous cell carcinomas and transitional cell carcinomas.
Simultaneous exposure to retinoids and interferons can result in enhanced antiproliferative and differentiating effects on malignant lesions. We studied the toxicity and the potential efficacy of an association of high dose etretinate and Interferon-alpha (IFN-alpha) in squamous cell carcinomas of the lung, head and neck, the esophagus, cervix and the penis, as well as in transitional carcinomas of the bladder. The treatment consisted of etretinate (Tigason) 4 mg/kg/d on 2, 3, 4 and finally 5 consecutive days every other week and IFN-alpha (Roferon) 6 Mio IU sc. q.d. for 5 days every week. ⋯ Toxicity was mild otherwise, mostly at grades 1 and 2 level, causing fatigue, skin peeling and erythema, mucositis and cheilitis; 3 PR (partial response) and 8 SD (stable disease) were recorded. Of the responders, one patient had become resistant to cisplatin-based chemotherapy and the other two had at no time ever received systemic therapy. We conclude that the association of high doses of etretinate and IFN-alpha has moderate activity in squamous cell carcinomas, is well tolerated, and that IFN-alpha plays a role in the improved tolerance of the retinoid.