BMJ supportive & palliative care
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BMJ Support Palliat Care · Nov 2019
ReviewPatients' spirituality perspectives at the end of life: a qualitative evidence synthesis.
Understanding patient perceptions of their spiritual needs when approaching the end of life is essential to support the delivery of patient-centred care. ⋯ CRD42019122062.
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Pain control is an essential component of high-quality palliative care. Unfortunately, many low-income and middle-income countries lack an appropriate infrastructure to provide palliative care and suffer from a severe lack of access to opioid analgesics to alleviate pain from various conditions such as cancer. ⋯ Although Mexico has made significant improvements in pain control and palliative care, much needs to be done. Expansion of drug availability, improvement of palliative care training, and constant oversight of regulations and guidelines will help to strengthen Mexico's palliative care services.
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BMJ Support Palliat Care · Sep 2019
Age, cancer site and gender associations with symptoms and problems in specialised palliative care: a large, nationwide, register-based study.
Patients referred to specialised palliative care are troubled by symptoms/problems, but more knowledge is needed on the level and frequency of symptoms/problems. It is also uncertain how gender, age and cancer diagnosis, respectively, are associated with symptoms/problems. ⋯ At the start of specialised palliative care, patients with cancer experience severe levels of symptoms, poor physical function and poor quality of life. Age, gender and diagnosis were significantly associated with most symptoms/problems, but the strength and direction of the associations differed across symptoms/problems.
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Sleep is often disturbed in patients with advanced cancer. There is limited knowledge about sleep in patients with cancer treated with strong opioids. This study examines sleep quality in patients with advanced cancer who are treated with a WHO Step III opioid for pain. ⋯ The majority (78%) of these patients with cancer treated with Step III opioids experienced poor sleep quality. Pain intensity, emotional function, constipation, financial difficulties and KPS predicted poor PSQI global scores. The clinical implication is that healthcare personnel should routinely assess and treat sleep disturbance in patients with advanced cancer disease.
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BMJ Support Palliat Care · Sep 2019
Case ReportsIntravenous methadone in a patient with advanced cancer.
A patient receiving maintenance treatment with methadone (MTM) was treated with parenteral methadone for intense pain crises in cancer of the tongue with severe mucositis and dysphagia. Authors like Manfredi et al describe good results in the use of methadone as an analgesic in patients with MTM. The difficulties which arise with parenteral use derive from the drug itself and from those to whom the treatment is administered: serious side effects like malignant arrhythmias and respiratory depression and the complex nature of these patients, addicted to opiates with a terminal illness and pain which is difficult to treat. It should be administered by experts in palliative care in a healthcare unit where it can be successfully monitored.