Hematology/oncology clinics of North America
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Hematol. Oncol. Clin. North Am. · Jun 2002
ReviewClinical support for families in the palliative care phase of hematologic or oncologic illness.
This article focuses on families' needs for support and care when the patient is receiving palliative care. Health care professionals providing care to patients with hematologic or oncologic illnesses are coming to understand that care for the family must begin at the time of patient's diagnosis and treatment. Families who do not receive adequate information and support in the early phases of the patient's treatment have greater needs, less trust and confidence in the health care system, and cope more poorly in the later stages than families who have been informed and supported throughout the course of the illness. This article documents the needs of families in the palliative phase of a patient's hematologic or oncologic illness and provides empirically based recommendations for assessment and care of the family unit.
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Managing delirium is of major importance in end-of-life care and frequently gives rise to controversies and to clinical and ethical dilemmas. These problems arise from a number of causes, including the sometimes-poor recognition or misdiagnosis of delirium despite its frequent occurrence. Delirium generates major symptomatic of distress for the patient, consequent stress for the patient's family, the potential to misinterpret delirium symptomatology, and behavioral management challenges for health care professionals. ⋯ Future research might focus on phenomenology, the development of low-burden instruments for assessment, communication strategies, and the family education regarding the manifestations of delirium. Further research is needed among patients with advanced cancer to establish a predictive model for reversibility that recognizes both baseline vulnerability factors and superimposed precipitating factors. Evidence-based guidelines should be developed to assist physicians in more appropriate use of sedation in the symptomatic management of delirium.
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When considered with other parameters, prognostic factors of survival in far advanced cancer patients are necessary to enable the doctor, the patient, and his or her relative to choose the most suitable clinical management and care setting. Original studies and literature reviews, albeit with methodologic difficulties, have identified the most important prognostic factors as being: CPS, KPS, signs and symptoms relating to nutritional status (i.e., weight loss, anorexia, dysphagia, xerostomia), other symptoms (dyspnea, cognitive failure) and some simple biologic parameters (serum albumin level, number of white blood cells and lymphocyte ratio). Some authors have weighed the different impact of the most important prognostic factors and have integrated them into prognostic scores for clinical use. Despite the usefulness of these instruments, however, the communication of a poor prognosis is one of the most difficult moments to face in the relationship between doctor and patient.
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Hematol. Oncol. Clin. North Am. · Jun 2002
ReviewFever and sweats in the patient with advanced cancer.
Fever and sweats are common complications of cancer and its treatment. This article reviews potential causes and pathophysiologic mechanisms of fever and sweat. Management recommendations, consisting of primary interventions directed at contributing causes and pathophysiologic mechanisms, and non-specific palliative measures are discussed. Optimal management is contingent on the physician's integration of medical expertise with patient-derived goals of care.
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Hematol. Oncol. Clin. North Am. · Aug 2001
ReviewPediatric hematology-oncology outreach for developing countries.
Health care in some developing countries is now at a level that makes programs for care of children with cancer feasible. Examples of successful international programs in this field include twinning programs, nongovernmental assistance organizations, such as the National Children's Cancer Society, and committees of professional organizations, such as the International Society of Pediatric Oncology (SIOP). ⋯ Jude Children's Research Hospital includes training programs within the hospital, partner sites in 13 countries, a school for Latin American nurses, a distance learning website, and telecommunications programs, which are described in detail. Future programs should be designed to maximize and evaluate impact, report accomplishments and failures, and avoid duplication.