Oncology Ny
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This article addresses the practical application of palliative care (PC) in the outpatient oncology setting. While information on this topic is scarce, data published by a few outpatient practices provide the basis for potential models of integrated care. In general, the perceived impact of integrating PC into standard oncology practice is positive for patients, providers, oncology practices, and the healthcare system as a whole. As the benefits of integrating PC into oncology practice continue to be realized, more data will become available.
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The majority of patients with advanced malignancy die with a predictable disease trajectory. Increasing use of chemotherapy and radiotherapy near the end of life has not changed that trajectory. For adults with advanced solid tumors, the period from becoming symptomatic to death of the patient is 4 to 6 weeks. ⋯ The data are now in; hospice care is the best standard of care for cancer patients, it is not an alternative to standard care. Payers for high-quality cancer care will expect referral with an interval of care--generally on the order of 4 to 6 weeks of enrollment--as a measure of quality cancer care given by the oncologist. In this article, prognostic data are summarized and a suggested approach for discussing hospice enrollment with patients is presented.
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Sarcoma metastasizes to the lungs in 20% to 40% of patients and in most cases does not involve any other organ. Systemic chemotherapy is of unproven benefit for stage IV sarcoma. Retrospective studies have shown 5-year survival rates of 21% to 38% with wedge resection of metastatic pulmonary nodules, and up to 30% to 40% of patients survive an additional 5 years with repeated metastasectomy. In this article, we provide an extensive review of patient selection criteria and surgical approaches, as well as of controversies regarding resection for metastatic sarcoma.
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Comparative Study
No survival advantage for mastectomy vs breast conservation therapy.