Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
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Support Care Cancer · Jan 1996
Invasive mold infections in cancer patients: 5 years' experience with Aspergillus, Mucor, Fusarium and Acremonium infections.
Twenty systemic mold infections due to hyphic fungi (molds) arising within the last 5 years in a 60-bed cancer department are analyzed. The most frequent risk factors were plants in ward (75%), prior therapy with broad spectrum antibiotics (70%), catheter insertion (70%), acute leukemia (65%) and neutropenia (60%). ⋯ Of 20 patients, 8 (40%) were cured or improved after antifungal therapy with amphotericin B, ambisome and/or itraconazole; 8/20 (40%) died of fungal infection and 4/20 (20%) of underlying disease with fungal infection. Even though the diagnosis was made and antifungal therapy started before death in 15/ 20 (75%), invasive mold infection had a 60% overall mortality in patients with malignant disease.
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Support Care Cancer · Jan 1996
Comparative StudyCost analysis of long-term feeding by percutaneous endoscopic gastrostomy in cancer patients in an Italian health district.
The aim of this study was to evaluate prospectively the cost of long-term feeding by percutaneous endoscopic gastrostomy (PEG). Cost analysis was carried out in 34 head and neck cancer patients, followed from the time of PEG placement to the death or the end of the study. Three main items were considered: (a) PEG placement (on an inpatient basis), subdivided into five subitems: the Freka FK-07 gastrostomy kit, materials and anaesthetic drugs used, antibiotics and antisecretory drugs, gastroscope amortization expenses and staff; (b) nutrition, considering the costs of enteral-feeding products, nutrition container and flexible tube connecting the container to the PEG; (c) patient care, dividing the patients into three groups: outpatients, home-care patients and outpatients shifting to home care during the follow-up. ⋯ Two wound infections, treated with antibiotics, occurred during the follow-up. The mean daily costs of placement, nutrition and patient care were (Italian Iiras) L 2500, 24 510 and 1880 respectively (Deutschemarks: DM 2.08, 20.42 and 1.56), for a total mean daily cost of L 28,890 (DM 24.06), slightly higher than that of feeding via a nasogastric tube (L 27,340; DM 22.78). On the basis of the improved quality of life, as well as from the economic point of view, PEG can be considered the procedure of choice for enteral feeding of cancer patients, provided that a reasonably long survival can be expected.
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Many factors can modify nutritional status in cancer patients, including cachexia, nausea and vomiting, decreased caloric intake or oncologic treatments capable of determining malabsorption. Cachexia is a complex disease characterized not only by a poor intake of nutrients or starvation, but also by metabolic derangement. Nausea and vomiting may limit the nutrient intake and are most often the consequences of oncologic treatments or opioid chronic therapy. ⋯ The benefits of parenteral nutrition are not often demonstrable in patients with bowel obstruction. Different ethical aspects are presented. Flexibility in attempting to meet the nutrition needs of each patient is probably the most useful guide.
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Support Care Cancer · Sep 1995
Randomized Controlled Trial Multicenter Study Clinical TrialDexamethasone improves the efficacy of granisetron in the first 24 h following high-dose cisplatin chemotherapy.
The object of the study was to determine whether dexamethasone improved the efficacy of the serotonin receptor (5-HT3) antagonist granisetron in controlling acute (within 24 h) emesis in cancer patients receiving high-dose cisplatin chemotherapy and to ascertain whether continuation of granisetron after 24 h reduces the occurrence of delayed emesis. This randomised, double-blind, multicentre, three-arm study was conducted at 21 medical centres. A group of 292 nausea- and emesis-free patients with cancer, who had never had chemotherapy and were scheduled to receive at least 50 mg/m2 cisplatin, were given 3 mg granisetron i.v. in a 15-min infusion with or without 10 mg dexamethasone i.v. completed 5 min prior to high-dose cisplatin and 1 mg granisetron p.o. at +6 h and +12 h. ⋯ At the end of the 24-h period, the patients who received dexamethasone had a significantly higher complete protection rate from emesis (64% compared to 39%) than those who received no steroid. Similarly, the dexamethasone-treated group had a significantly higher complete plus partial (0-2 emetic episodes) protection rate (84% compared to 64%). This study shows that dexamethasone markedly enhances the antiemetic efficacy of granisetron for acute-onset emesis in high-dose cisplatin chemotherapy.
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Mortality from septic shock is considerable despite the advantages of cardiovascular support and antibiotic therapy. This article reviews current therapy of septic shock including immunotherapy and further possibilities of septic shock treatment. The role of cytokines, their inhibitors and antibodies to endotoxin is mentioned. Although these treatments hold much promise for the future, careful evaluation of both the benefits and complications of therapy is needed before widespread clinical use can be recommended.