Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
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Support Care Cancer · Jan 2003
Clinical estimation of survival and impact of other prognostic factors on terminally ill cancer patients in Oman.
A prospective study was carried out in the only tertiary oncology department in Oman to analyse the pattern of various prognostic factors in terminally ill cancer patients and their impact on these patients. Between September 1999 and February 2001, terminally ill cancer patients with solid tumours who fulfilled the eligibility criteria were included. All of them were coded Do Not Resuscitate (DNR). ⋯ Multiple regression analysis showed that PS and oedema were the only independent predictors of survival. Clinical prediction of survival was correlated with observed survival. Patient's PS, presence of peripheral oedema and clinical estimate of survival are good predictors of survival in terminally ill cancer patients.
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In recent years the necessity of measuring quality of life in childhood cancer survivors has been stressed. This paper gives an overview of the results of studies into the quality of life (QL) of young adult survivors of childhood cancer and suggest areas for future research. The review located 30 empirical studies published up to 2001. ⋯ Although the literature yields some inconsistent findings, a number of clear trends can be identified: (a) most survivors reported being in good health, with the exception of some bone tumour survivors; (b) most survivors function well psychologically; (c) survivors of CNS tumours and survivors of acute lymphoblastic leukaemia (ALL) are at risk for educational deficits; (d) job discrimination, difficulties in obtaining work and problems in obtaining health and life insurance were reported; (e) survivors have lower rates of marriage and parenthood; (f) survivors worry about their reproductive capacity and/or about future health problems their children might experience as a result of their cancer history. There is a need for methodological studies that measure QL among survivors of childhood cancer more precisely by taking into account the effects of the severity of the cancer and the long-term impact of different treatments. Additional data are needed to help us understand the needs of survivors and to identify those subgroups of survivors who are at greatest risk for the adverse sequelae of the disease and its treatment.
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Support Care Cancer · Nov 2002
Discussion of the do-not-resuscitate order: a pilot study of perceptions of patients with refractory cancer.
Do not resuscitate (DNR) discussions are difficult for physicians and patients alike, resulting in DNR orders being written shortly before death. To understand the patients' point of view, interviews about the perception of DNR discussions were conducted as a pilot study. ⋯ The least favorably rated scenarios were delivery of recommendation by physician with whom patient had had no prior contact (1.8); presence of unknown medical personnel with physician (2.0); refusal of physician to answer questions (2.1); and agreement between physician and patient to discuss only positive aspects of patient's case (2.1). This study supports the importance to the patient of a supportive relationship with the attending physician who is both attuned to the need for comprehensive palliative care and is honest about the prognosis.
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Many medical professionals are still confused when facing the reduction of food or fluid intake in terminal cancer patients. The aim of this study was to assess the frequency and causes of the inability of eating or drinking in terminal cancer patients and to investigate the use of artificial nutrition and hydration (ANH); the frequency, type, and the extent to which staff found ANH to be ethically justified. Three hundred forty-four consecutive patients with terminal cancer admitted to a palliative care unit in Taiwan were recruited. ⋯ We have found it easier to reduce artificial hydratation than artificial nutrition, which corresponds to local cultural practice. Whether or not ANH was used did not influence survival in this study. Thus, the goals of care for terminal cancer patients should be refocused on the promotion of quality of life and preparation for death, rather than in simply making every effort to improve the status of hydratation and nutrition.
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Support Care Cancer · Nov 2002
Case ReportsLong-term rectal administration of high-dose sustained-release morphine tablets.
Two proprietary sustained-release morphine tablets for oral administration are available in the USA, and the authors have found that rectal administration of these provide excellent analgesia although their use by this route is not approved by the United States Food and Drug Administration. An illustrative case in a 72-year-old patient with prostate cancer is reported.