Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
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A major goal of palliative medicine is to control symptoms that interfere with quality of life. Identification of symptoms that occur together (cluster) may aid in symptom management, resulting in greater therapeutic benefit to the patient. An analysis of 25 symptoms from 922 patients with advanced cancer was undertaken to determine if symptom clusters could be identified. ⋯ Seven clusters were identified: (1) fatigue: anorexia-cachexia; (2) neuropsychological; (3) upper gastrointestinal; (4) nausea and vomiting; (5) aerodigestive; (6) debility; (7) pain. Recognition of symptom clusters should help understand symptom pathophysiology and target therapies that perhaps can be used to relieve multiple symptoms in that cluster. This could result in improved quality of life for patients with advanced cancer and perhaps reduce polypharmacy, lessen drug side effects, and have pharmacoeconomic benefits.
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Cancer patients often experience multiple symptoms, many of which have been reported to correlate with each other. The goals of this study were to understand which cancer-related symptoms cluster together and to test the conceptual meanings of the revealed symptom clusters. ⋯ This study identified three underlying symptom clusters and verified their conceptual meaning in cancer patients. Knowing these symptom clusters may help healthcare professionals understand plausible mechanisms for the aggregation of symptoms.
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A questionnaire study was carried out among attendants at a community cancer center to determine the subjects' preferences and understanding of the meaning of do-not-resuscitate (DNR). Only 34% correctly understood the meaning of DNR, and 66% thought that DNR was administered only to prolong life without realizing that a DNR decision would result in not being resuscitated even if the cause of the sudden death was potentially reversible. We then determined the subjects' preferences if they had developed a treatment complication needing resuscitation and be put on the ventilator machine temporarily. ⋯ The adjusted odds for the correct understanding of DNR were less for respondents who preferred resuscitation. The adjusted odds ratio (AOR) was 0.58 (CI: 0.35-0.93) (p=0.02) after adjusting for age and 0.53 (CI: 0.32-0.86) (p=0.01) after adjusting for both age and treatment group. These results suggest that physicians should be open to the possibility that patients may not always understand what DNR means, and they may be placed on DNR by mistake.