Gan to kagaku ryoho. Cancer & chemotherapy
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Gan To Kagaku Ryoho · Dec 2009
[The outpatient palliative care conference for the home palliative care shift (the second report)--the conference was used to look back on the case where the patient's QOL was kept and improved].
The patient was a 30-year-old woman with right tongue cancer and SCC (T4N2bM0). After it had relapsed, the outpatient palliative care conference intervened. The purpose of intervention was as follows: pain control, nutrition management, home recuperation support, and relief of a spiritual pain. ⋯ By offering necessary home care supports, the patient and family fully demonstrated their potentials what they could do to recuperate and resulted in a long home stay. It was thought that our relationship with the patient and family appeared to have enhanced their self-resistance feelings against the disease. Consequently, we contributed the improvement of QOL.
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From July 1 in 2003 through December 31 in 2008, 150 terminal lung cancer patients were provided home hospice care by us and died at home, whereas the following clinical characteristics along with the practical care we provided were examined by comparing with 432 non-lung cancer patients who died at home during that period. The frequency of home death (lung cancer/control group, 96.8/96.2%) and the duration of caring at home (48.7/54.6 days) did not show a significant difference. Significant differences were observed in suffering of breathing (62.7/31.5%), use of the opioids (96.0/ 87.5%), slow releasing oral morphine (32.7/18.1%), morphine suppository (73.3/56.5%), morphine injected subcutaneously (37.3/25.7%), slow releasing oral oxycodone (61.3/37.3%), and fentanyl (20.0/46.1%). These findings led us to conclude: (1) the main symptom, in case of the terminal lung cancer patients, was to control a difficulty in breathing, (2) the appropriate opioids were morphine and oxycodone in palliation of respiratory difficulties, (3) fentanyl was inappropriate for palliation of respiratory difficulties.
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Pain relief is a quite important subject for maintaining the home medical care of patients with terminal cancer. Therefore, the opioid rotation should be made in conjunction with an individual medical condition, which is of growing importance in a proper pain management. ⋯ The most important thing in the opioid rotation at home is to perform a rotation before exacerbation of pain becomes apparent. For this purpose, morphine hydrochloride injection is thought to be the best dosage form because it has advantages of: (1) quickness in varying the amount, (2) immediate rescue efficacy, and (3) usefulness in case of ingestion.
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Gan To Kagaku Ryoho · Nov 2009
Case Reports[A case of mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer after radical operation for lung cancer].
We herein report a case of thoracic esophageal cancer operated on by mediastinoscope-assisted transhiatal esophagectomy after a right upper lobectomy for primary lung cancer. A 70-year-old male with non-small-cell lung cancer (T4N2M0, cStage III B) underwent chemo-radiation therapy followed by an upper lobectomy of the right lung with mediastinal lymph node dissection. The lung cancer histologically showed complete remission (CR), and no recurrence has been shown. ⋯ He was alive for 11 months after the operation for esophageal cancer, although a local recurrence was observed. There are still many problems remained of the treatment for esophageal cancer patients who had previously undergone a radical operation for lung cancer. However, mediastinoscope-assisted transhiatal esophagectomy may become a procedure for surgical approach if it seems to be difficult to approach the esophageal cancer by thoracotomy again.
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Gan To Kagaku Ryoho · Nov 2009
Case Reports[A case of retroperitoneal dedifferentiated liposarcoma successfully treated with IFM and CDDP].
A 53-year-old man was evaluated for a chief complaint of abdominal bloating. Physical examination revealed an abdominal distention and ascites, and CT showed multiple large retroperitoneal masses. The patient was diagnosed with retroperitoneal liposarcoma. ⋯ A partial response (PR) against peritoneal dissemination was achieved. However, hepatic metastases increased, and the patient died 6 months after surgery. This case suggests that IFM+CDDP may be useful in dedifferentiated liposarcoma.