Curr Oncol
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Canadian data describing inpatient palliative care unit (PCU) utilization are scarce. In the present study, we performed a quality assessment of a 24-bed short-term PCU with a 3-months-or-less life expectancy policy in a tertiary care setting. ⋯ Many patients requiring PCU services are admitted within a few days of referral, especially patients with the least available support: those at home. However, half of the non-admitted patients die while waiting-a potential area for improvement. The los for admitted patients complied with the 3-month "expected lifespan" PCU policy. Results are significant, because ensuring quality of life for palliative care patients includes timely PCU access and sufficient los to address end-of-life needs.
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Systematic symptom reporting by patients and the use of questionnaires such as the Edmonton Symptom Assessment System (ESAS) have potential to improve clinical encounters and patient satisfaction. We review findings from published studies of the ESAS to guide use of the system and to focus research. ⋯ The ESAS is reliable, but it has restricted validity, and its use requires a sound clinical process to help interpret scores and to give them an appropriate level of attention. Research priorities are to further develop the ESAS for assessing a greater number of important physical symptoms (and to target "physical symptom distress"), and to develop a similar instrument for emotional symptoms.
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Symptom clusters (scs) are a dynamic construct. They consist of at least 2 or 3 interrelated symptoms that may be a significant predictor of patient morbidity. In a previous study, we identified 2 scs in patients with bone metastases: An activity-related interference cluster, psychology-related interference cluster. These scs may be clinically important in the pain and symptom management of patients with metastatic bone pain. It is therefore important to validate the reported scs to determine if they hold true across similar patient populations. ⋯ The scs in our two studies were not identical for patients receiving palliative rt for symptomatic bone metastases. Another sc validation study should be conducted with a larger sample before a conclusion is drawn about the existence of an unstable phenomenon in sc research.
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An estimated 20%-40% of cancer patients will develop brain metastases. Whole-brain radiotherapy (WBRT) is the standard treatment for patients with brain metastases. Although WBRT can reduce neurologic symptoms, the median survival following WBRT is between 3 and 6 months. Given this limited survival, it is important to consider quality of life (QOL) when treating patients with brain metastases. However, few studies have focused on QOL and improvement in patient-rated symptoms as primary outcomes. ⋯ To date, fourteen trials in brain metastases that have included an evaluation of the study population's QOL have been published. Although some studies showed that certain parameters of QOL deteriorate after WBRT, other studies showed that QOL in patients with better prognosis is improved after WBRT. Because a standard, validated QOL instrument has not been used for this patient population, a comparison of findings concerning QOL between the studies is difficult. The present review emphasizes the need to include QOL measures in future WBRT clinical trials for brain metastases.
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Individuals have increasingly sought complementary therapies to enhance health and well-being during cancer, although little evidence of their effect is available. ⋯ Over the course of the Iyengar Yoga for Cancer program, participants reported an improvement in overall well-being. The program was also found to present participants with a holistic approach to care and to provide tools to effectively manage the demands of living with cancer and its treatment.