Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
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Support Care Cancer · Oct 2002
Comparative Study Clinical TrialEfficacy and tolerance of a scalp-cooling system for prevention of hair loss and the experience of breast cancer patients treated by adjuvant chemotherapy.
The applicability and efficacy of a scalp cooling system were studied in 105 breast cancer patients receiving four cycles of adjuvant chemotherapy with mitoxantrone + cyclophosphamide (NC chemotherapy). Women accepting the scalp-cooling system were compared for alopecia both against those who refused and against a "reference" group of 109 patients similarly treated but without being offered a scalp-cooling system. Hair loss in the 105 study patients was evaluated by nurses using World Health Organization (WHO) criteria at each cycle of chemotherapy. ⋯ Tolerance was generally good and no scalp metastasis was observed among the 77 accepting patients followed up. This study demonstrates that scalp cooling was an effective method of protection against hair loss caused by NC chemotherapy. Its routine use as part of adjuvant chemotherapy, especially in cancers with low prevalences of scalp metastasis, should be seriously considered.
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Delirium is a frequent complication of advanced cancer. It is characterized by cognitive deficits and behavioral disturbance, and therefore can potentially result in severe symptom distress and impeded communication between patient and family and between patient and medical staff. The reversibility of delirium depends on its underlying causes. ⋯ This review examines the latter association in the light of recent studies. It also provides an outline of relevant pathophysiology and clinical assessment, a decision-making framework and a practical approach to the techniques of assisting hydration. This will hopefully help physicians and families in weighing up the merits of assisted hydration in an individual context and help them to achieve a consensus on the role of hydration that is consistent with the goals of care.
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Support Care Cancer · Jul 2002
Outcome and cost implications of cardiopulmonary resuscitation in the medical intensive care unit of a comprehensive cancer center.
Intensive care unit (ICU) resources are frequently utilized in the supportive care of hospitalized patients with cancer. Patients with cancer reportedly have poor outcomes from cardiopulmonary resuscitation (CPR). The goal of this study was to evaluate the effectiveness and patient care costs of CPR applied to patients already receiving life support in an ICU. ⋯ The application of CPR to cancer patients receiving life support is costly and typically does not lead to long-term survival. Cancer patients requiring admission to an ICU should receive full supportive care short of resuscitation. Providing assurances that care will remain appropriate, aggressive, and in accordance with the patient's and family's wishes can optimize compassionate care while avoiding futile life-sustaining interventions.
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Support Care Cancer · Jul 2002
Isometric strength measurement for muscle weakness in cancer patients: reproducibility of isometric muscle strength measurements with a hand-held pull-gauge dynamometer in cancer patients.
Our aim was to determine several indexes of reproducibility for strength measurements with a hand-held pull-gauge dynamometer (MFB50K) in cancer patients. Two independent testers performed repeated measurements of maximal isometric elbow and knee strength. The measurements were gathered in a convenience sample of 40 patients (27 men, age 20-72 years) with various types and stages of cancer. ⋯ The Pearson product moment correlation and the ICC suggested good reproducibility. However, the more informative indices of reproducibility, i.e. the SEM and the SDD, showed relatively large measurement error between the testers. Therefore, the current use of the MFB50K for the measurement of muscle strength is not supported in cancer patients.
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Support Care Cancer · May 2002
ReviewSpirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer.
Existential and spiritual issues are at the frontier of new clinical and research focus in palliative and supportive care of cancer patients. As concepts of adequate supportive care expand beyond a focus on pain and physical symptom control, existential and spiritual issues such as meaning, hope and spirituality in general have received increased attention from supportive care clinicians and clinical researchers. ⋯ These two constructs of spirituality are reviewed in terms of their role in supportive care. Finally, a review of existing psychotherapeutic interventions for spiritual suffering are reviewed and a novel meaning-centered group psychotherapy for advanced cancer patients is described.