Oncology Ny
-
Only a few studies have assessed the economic outcomes of palliative therapy. The major areas of interest include hospice care, the process and structure of care, symptom management, and palliative chemotherapy compared to best supportive care. Compared with nonhospice care, hospice care saves at best 3% of total care costs. ⋯ Current data suggest that changes in palliative care cost can only come from dramatic changes in how we provide care. One model is coordinated, expert, high-volume care that can prevent end-of-life hospitalization, with early use of advance directives. Preliminary data from our program support the hypothesis that costs may be reduced by 40% to 70%.
-
Adjuvant chemotherapy is an integral component of the multidisciplinary curative treatment of primary breast cancers. The experience of the last 3 decades indicates that anthracycline-containing regimens provide the most effective cytotoxic treatment for this purpose. The development of the taxanes over the past 10 years represents substantial progress, and taxane-containing regimens are widely used for the treatment of metastatic breast cancer. ⋯ The docetaxel (Taxotere)-containing regimens were developedfollowing one of three important strategies: (1) the sequential administration of docetaxel to existing, commonly used combinations; (2) the simultaneous addition of docetaxel to an existing regimen; and (3) the substitution of docetaxelfor one of the drugs included in standard combinations. These three approaches are under intense investigation by large multicenter, multinational clinical trials. The results of these phase III, prospective, randomized trials will establish the contribution of docetaxel to the curative treatment of breast cancer and will determine the optimal method of incorporating this drug into standard adjuvant therapy.
-
As active participants in the care of patients with acquired immunodeficiency syndrome (AIDS), oncologists need to be aware of the many facets of pain management in this population. This two-part article, which will conclude in the July 2002 issue, describes the prevalence and types of pain syndromes encountered in patients with AIDS, and reviews the psychological and functional impact of pain as well as the barriers to adequate pain treatment in this group and others with human immunodeficiency virus (HIV)-related disease. Finally, principles of pain management, with particular emphasis on controlling pain in HIV-infected patients with a history of substance abuse, are outlined.
-
Dyspnea is defined as a sensation of difficult or uncomfortable breathing. The symptom is highly prevalent among cancer patients with and without direct lung involvement. The gold standard of assessment is based on patient self-report. ⋯ Opioids are the first-line therapy for relief of dyspnea symptoms. When prescribed appropriately, respiratory depression is not a significant concern. In the rare cases in which opioids are unable to control dyspnea, sedation is an effective, ethical, and legal option.