Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
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Support Care Cancer · Mar 2015
Observational StudyCare trajectories and survival after discharge from specialized inpatient palliative care--results from an observational follow-up study.
Little is known about the patients' individual care trajectories after discharge or transfer from inpatient palliative care units (PCU) to other care settings. This study aims to survey the further care trajectory and overall survival from the time of discharge of patients in a palliative care situation. Patient groups from either the PCU or the palliative care mobile support team (PCMT) are compared in order to analyze the demographic data, discharge settings, frequency of changes of care settings, overall survival from the time of discharge and place of death. ⋯ The results show a high percentage of stable care trajectories at the end of life with few or no changes of care setting. To achieve this, well-considered discharge planning and an adequately chosen network of care providers are necessary.
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Support Care Cancer · Mar 2015
Observational StudyUse of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?
Cancer pain is complex, and despite the introduction of the WHO cancer pain ladder, few studies have looked at the prevalence of adjuvant medication use in an inpatient palliative medicine unit. In this study, we evaluate the use of adjuvant pain medications in patients admitted to an inpatient palliative care unit and whether their use affects pain scores or opiate dosing. ⋯ Adjuvant agents are used in over 80 % of those treated for cancer pain.
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Support Care Cancer · Mar 2015
Case ReportsInhaled medicinal cannabis and the immunocompromised patient.
Medicinal cannabis is an invaluable adjunct therapy for pain relief, nausea, anorexia, and mood modification in cancer patients and is available as cookies or cakes, as sublingual drops, as a vaporized mist, or for smoking. However, as with every herb, various microorganisms are carried on its leaves and flowers which when inhaled could expose the user, in particular immunocompromised patients, to the risk of opportunistic lung infections, primarily from inhaled molds. ⋯ We describe the results of culturing the cannabis herb, three methods of sterilization, and the measured loss of a main cannabinoid compound activity. Systematic sterilization of medicinal cannabis can eliminate the risk of fatal opportunistic infections associated with cannabis among patients at risk.
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Support Care Cancer · Mar 2015
Attitudes of oncologists towards palliative care and the Edmonton Symptom Assessment System (ESAS) at an Ontario cancer center in Canada.
Cancer Care Ontario promotes the Edmonton Symptom Assessment System (ESAS) for standardized systematic screening and assessment of symptoms across cancer centers in Ontario, Canada. Attitudes of medical oncologists (MOs), radiation oncologists (ROs), and general practitioners in oncology (GPOs) toward palliative care, and the ESAS were surveyed in Ottawa. ⋯ MOs and GPOs appear more positive than ROs toward regular use of ESAS. There is discordance between what is perceived to be a useful beneficial instrument versus actual use of the instrument in daily practice. The reasons for this gap need to be better understood in future studies.
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Support Care Cancer · Feb 2015
Changes in medication profile among patients with advanced cancer admitted to an acute palliative care unit.
The decision-making process for medication use in the last weeks of life is complex because of patient frailty and poor prognosis. Limited literature is available on medication use in the palliative care setting, particularly in acute palliative care units (APCUs). We examined the changes in medication profile among hospitalized patients with advanced cancer before their palliative care inpatient consultation team referral, after palliative care consultation, at the time of APCU admission, and at APCU discharge or death. ⋯ Palliative care involvement was associated with an increase in symptom control medications and decrease in medications for comorbid conditions over time.