Klinická onkologie : casopis Ceské a Slovenské onkologické spolecnosti
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Chronic lymphocytic leukemia is a disease of older patients, most of them suffering from significant comorbidities or functional limitations (so -called 'slow- go' patients). Unfortunately, clinical trials in chronic lymphocytic leukemia have until recently focused mainly on the subgroup of younger patients in good overall condition ('go- go' patients). Clinico- biological parameters, such as performance status, calculated creatinine clearance, the number and severity of comorbidities along with individual clinical assessment can help guide decisions relating to the objectives and ultimately the intensity of treatment. ⋯ Both drugs radically changed the approach to the treatment of relapsed/ refractory chronic lymphocytic leukemia; relatively mild toxicity also predetermines their use in elderly/ comorbid patients. Other treatment options for relapsed/ refractory chronic lymphocytic leukemia in this subgroup include alemtuzumab, ofatumumab, high-dose glucocorticoids + anti-CD20 antibodies, or bendamustine + rituximab regimen. This review summarizes current data regarding the treatment of elderly and comorbid patients with chronic lymphocytic leukemia.
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Pain is one of the most important and most frequent symptoms of malignancy. Its intensity and prevalence is growing with disease status. ⋯ Right pain management is always multidimensional and pain should be assessed at each contact. In review article we would like to bring some alerts of pain context in complexity of cancer and we would like to stress some forms of acute pain management.
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Patients with advanced cancer experience a significant number of physical symptoms and psychological distress, which worsen their quality of life (QOL). Palliative care is oriented to prevent and relieve suffering and promote QOL of patients with advanced cancer. In oncology, the role of palliative care is traditionally perceived to be the treatment after the antineoplastic therapy is finished. ⋯ Early palliative care has been shown to provide benefits in QOL, mood, symptoms, health care utilization and survival. In this review, we summarize published data about benefits and difficulties of early palliative care. We also discuss the model of general and specialized palliative care integrated into oncological practice, their differences and consequences.
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The appraisal and the right diagnostics of all needs and problems of patients, including the spiritual needs, are unavoidable for increase of the quality of the all-embracing nursing care. In the case of satisfying of the needs of the patients, it is important to have view the person as a unity of thebody and the soul. Identification and satisfying of the spiritual needs are not uncomplicated; moreover, spirituality does not have a target--ed and clear definition. ⋯ The target of summarizing study was to define the term of spirituality, to describe a lot of measurement devices these are suitable for the evaluation of human spiritual needs. For methodology for acquiring of the results of research works that are concerned with the questions of spiritual needs in case of the incurable patients, the following databases were used (2005-2013): EBSCO, Bibliographia Medica Čechoslovaca, Google Scholar, Solen - www.solen.cz, Profese on-line as the source of the data. The choice of studies were as follows the systematic overview, the summarizing essay, the qualitative and quantitative study.
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Chemotherapy combinations with monoclonal antibodies are now the basis for treatment of chronic lymphocytic leukemia. Rituximab, the most widely used anti-CD20 antibody in routine clinical practice, led not only to improvement of progression-free survival, but also to improvement of overall survival in previously untreated patients with good performance status in combination with fludarabine and cyclophosphamide. ⋯ Alemtuzumab and ofatumumab improved treatment results in refractory chronic lymphocytic leukemia. Targeted therapy with combination chemotherapy and monoclonal antibody in patients with chronic lymphocytic leukemia represents a significant advance in the treatment of this disease.