Hematology/oncology clinics of North America
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Declining physical, emotional, and social function as a result of anorexia and cachexia are considerable contributors to discomfort for cancer patients and their families, and they impair the patient's ability to express optimal physical and psychosocial potential as long as possible. This decline no longer has to be accepted as an indispensable sequel to advanced cancer, just as pain is no longer considered to be unavoidable. A routine screening for anorexia and cachexia and associated symptoms is necessary, as is a careful, comprehensive assessment, because the condition is not always obvious. ⋯ Specialist palliative care services can be helpful to provide, hand-in-hand with the disease specialists [172], assessment and management of psychophysical symptoms and sociospiritual needs of patients during the course of the illness and at the end of life [173]. Research efforts aim to better characterize subgroups of patients suffering from secondary causes of anorexia and cachexia and to elucidate the mechanisms involved in the primary anorexia and cachexia syndrome. Increasingly individualized treatments are expected with combination treatments that involve different mechanisms including nutrition.
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Hematol. Oncol. Clin. North Am. · Jun 2002
ReviewCancer patients in pain: considerations for assessing the whole person.
Pain is a subjective perception that is influenced by psychosocial and behavioral factors and physical pathology. In cancer, the source of the pain may be the disease itself, the treatment, or co-occurring pain syndromes. Often, cancer is a progressive disease, and pain may be marked by exacerbations, additional treatment, and remissions. ⋯ In some circumstances, such as when patients are unwilling or unable to report on their pain, it is useful to gather information from caretakers. At a minimum, the severity, location, and pattern of pain and patients' functional activity and mood should be assessed. Timely, appropriate, and thorough assessment and treatment of cancer patients experiencing pain should reduce their suffering and improve the quality of their lives.
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Hematol. Oncol. Clin. North Am. · Jun 2002
ReviewInsights from cancer patient communication research.
Good communication skills are essential for all aspects of patient care in a palliative setting. A considerable body of evidence has accrued in the general oncology literature concerning doctor-patient and doctor-doctor communication. Many of the models and methods explored in the oncology setting may be applied usefully to palliative care; however palliative care is unique in some aspects and has its own particular challenges. Further evidence is needed to guide palliative care and other health care professionals in communicating effectively and sensitively with palliative care patients while holding a balance between telling the truth and maintaining hope.
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Although most patients with cancer pain can attain a favorable balance between analgesia and side effects with a conventional approach to opioid therapy, a substantial minority cannot. For these patients, an important subgroup of whom have neuropathic pain, alternative therapeutic strategies are needed. With a detailed assessment, clinicians should be able to choose among the large and diverse group of options available and implement an approach, or combination of approaches, that have a high probability of improving analgesic outcomes.
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Dyspnea, like pain, is a subjective experience that incorporates physical elements and affective components. Management of breathlessness in patients with cancer requires expertise that includes an understanding and assessment of the multidimensional components of the symptom, knowledge of the pathophysiologic mechanisms and clinical syndromes that are common in cancer, and familiarity with the indications and limitations of the available therapeutic approaches. Relief of breathlessness should be the goal of treatment at all stages of cancer. Good control of dyspnea will improve the patient's quality of life.